The Murray-Darling Medical Schools Network Research Collaboration: protocol for a longitudinal, multi-university program of work to explore the effect of rurally based medical school programs in the Murray-Darling region.

INTRODUCTION: There is now strong evidence to support the positive impact of place-based medical education on the recruitment and retention of the rural health workforce in Australia. Much of this work, however, has been undertaken in the context of 'extended rural clinical placement' - students undertaking part of their medical degree in a rural location. Until recently, there were only a few places in Australia in which students could undertake the entirety of their medical degree in a rural area. With the introduction of the Murray-Darling Medical Schools Network (MDMSN) initiative, this dynamic is changing. The MDMSN is part of the Stronger Rural Health Strategy and builds on the Australian Government's existing Rural Health Multidisciplinary Training Program to establish a network of rurally based medical programs in the Murray-Darling region. The MDMSN offers a unique opportunity to explore the effect of complete rural immersion during medical school on subsequent rural practice. This article describes the establishment of a research collaboration intended to ensure the harmonisation of research data collection from the outset of the MDMSN program. METHODS: The MDMSN research collaboration is a longitudinal, multi-university program of work to explore the effect of rurally based medical school programs in the Murray-Darling region. Initially it has been agreed that administrative student data will be collected from existing university datasets to help characterise this novel student cohort. Each university will then distribute an entry survey to all first-year MDMSN students. The survey will collect demographic information as well as information regarding rural background, preferences and future practice intention. Questions have been aligned with and adapted from the Medical Schools Outcomes Database survey, the Australian Bureau of Statistics, and from the literature. This information will be combined with graduate information from the Australian Health Practitioner Regulation Agency. RESULTS: The MDMSN research collaboration will work toward the co-design of research projects, to facilitate and progress multi-site research addressing nationally relevant research questions. Early research efforts are focused on our ability to better understand the new cohort of students embarking on rurally based medical education, their practice intentions and realisation. Subsequent work of the collaboration may lead to deeper understanding of the rural student experience, any effect of 'place', changes in student professional identity over time, and their relationship to subsequent rural practice. CONCLUSION: The MDMSN research collaboration is a proactive initiative that brings together data and experience from five new rurally based medical programs, and answers calls for multi-institution and longitudinal studies. It is uniquely placed to capture the impact of the MDMSN program, including the effect of complete rural immersion on the future practice location of these graduates. Ultimately, the combined research efforts of the MDMSN research collaboration will add knowledge to address the known rural workforce maldistribution, particularly how to attract and retain medical workforce.

Increasing the availability of health workers in rural sub-Saharan Africa: a scoping review of rural pipeline programmes.

INTRODUCTION: Rural pipeline approach has recently gain prominent recognition in improving the availability of health workers in hard-to-reach areas such as rural and poor regions. Understanding implications for its successful implementation is important to guide health policy and decision-makers in Sub-Saharan Africa. This review aims to synthesize the evidence on rural pipeline implementation and impacts in sub-Saharan Africa. METHODS: We conducted a scoping review using Joanna Briggs Institute guidebook. We searched in PubMed and Google scholar databases and the grey literature. We conducted a thematic analysis to assess the studies. Data were reported following the PRISMA extension for Scoping reviews guidelines. RESULTS: Of the 443 references identified through database searching, 22 met the inclusion criteria. Rural pipeline pillars that generated impacts included ensuring that more rural students are selected into programmes; developing a curriculum oriented towards rural health and rural exposure during training; curriculum oriented to rural health delivery; and ensuring retention of health workers in rural areas through educational and professional support. These impacts varied from one pillar to another and included: increased in number of rural health practitioners; reduction in communication barriers between healthcare providers and community members; changes in household economic and social circumstances especially for students from poor family; improvement of health services quality; improved health education and promotion within rural communities; and motivation of community members to enrol their children in school. However, implementation of rural pipeline resulted in some unintended impacts such as perceived workload increased by trainee's supervisors; increased job absenteeism among senior health providers; patients' discomfort of being attended by students; perceived poor quality care provided by students which influenced health facilities attendance. Facilitating factors of rural pipeline implementation included: availability of learning infrastructures in rural areas; ensuring students' accommodation and safety; setting no age restriction for students applying for rural medical schools; and appropriate academic capacity-building programmes for medical students. Implementation challenges included poor preparation of rural health training schools' candidates; tuition fees payment; limited access to rural health facilities for students training; inadequate living and working conditions; and perceived discrimination of rural health workers. CONCLUSION: This review advocates for combined implementation of rural pipeline pillars, taking into account the specificity of country context. Policy and decision-makers in sub-Saharan Africa should extend rural training programmes to involve nurses, midwives and other allied health professionals. Decision-makers in sub-Saharan Africa should also commit more for improving rural living and working environments to facilitate the implementation of rural health workforce development programmes.

The Healthcare Travelling Roadshow: a qualitative study of a rural community engagement initiative in Canada.

INTRODUCTION: Youth from rural communities face significant challenges in the pursuit of healthcare training. Healthcare trainees with a rural background are more likely than those without to practice rurally as healthcare professionals. The Healthcare Travelling Roadshow (HCTRS) is an initiative in Canada that provides rural youth with exposure to healthcare careers, while providing healthcare students with exposure to rural opportunities, and an interprofessional education experience. To the authors' knowledge, this is the first description of an initiative for rural university-high school healthcare career outreach that involves near-peer teaching, highly interactive sessions, and an interprofessional focus. METHODS: Ten HCTRSs took place throughout northern rural and remote British Columbia between 2010 and 2017. Questionnaires were delivered to youth in a pilot research project in 2010. Healthcare students and community members completed questionnaires for ongoing program evaluation from 2010 to 2017. Quantitative elements were graded on a five-point Likert scale. Qualitative elements were analyzed thematically. RESULTS: Participants indicated that the program was very successful (4.71, 95% confidence interval (CI) 4.63-4.79), would likely encourage healthcare students to consider rural practice (4.12, 95%CI 3.98-4.26), and that it inspired local youth to consider careers in health care much or very much (4.45, 95%CI 4.35-4.55). Qualitative analysis led to description of four themes: (1) sincerity and interactivity sparking enthusiasm, (2) learning through rural exposure and community engagement, (3) healthcare student personal growth and (4) interprofessional collaboration and development. Open-ended feedback identified successes outside of the primary goals and illustrated how this program could act in a multi-faceted way to promote healthcare recruitment and retention. Constructive comments emphasized the importance of taking a balanced approach to planning the HCTRS, ensuring the goals of the HCTRS are best met, while meeting the needs of the host communities as much as possible. CONCLUSIONS: The HCTRS is an interdisciplinary experience that successfully engages rural youth, healthcare students, and community stakeholders. Participants consistently indicated that it encouraged rural youth towards healthcare careers and healthcare students towards rural practice. Success of the program requires meaningful engagement with multiple academic and community stakeholders.

Could adoption of the rural pipeline concept redress Australian optometry workforce issues?

People living in rural and remote areas have poorer ocular health outcomes compared with those living in metropolitan areas. Reasons for this are multiple and complex but access to care is consistently reported as a defining factor. The geographic maldistribution of eye-care professionals is a major obstacle for regional, rural and remote Australians seeking care. Research from the medical profession suggests adopting the 'rural pipeline' concept to address the issue of maldistribution. This approach appears to have had some success in medicine, and involves recruiting students from a rural background, exposing students to rural practice through placements and offering graduates incentives and support to practice rurally. Lessons could be learnt from the medical field as there is a dearth of literature describing the utilisation of the rural pipeline in allied health. However, given the differences between professions it cannot be assumed factors and results will be the same. A greater understanding is required to determine whether optometry is a profession which may benefit from the rural pipeline concept.

Expectations of rural community-based medical education: a case study from Thailand.

INTRODUCTION: Thailand has recognised and sought to remedy rural medical workforce shortages. The Collaborative Project to Increase Production of Rural Doctors (CPIRD) has improved rural workforce recruitment through publicly funding medical school places for students with rural backgrounds. However, challenges in rural retention continue. CPIRD is seeking to develop a Thai rural community-based medical education (RCBME) program in the southern region of Thailand to improve preparation for rural practice and rural medical retention rates. Prospective stakeholder consultations will allow the understanding of expectations and concerns of stakeholders required for successful RCBME implementation. This study aims to explore stakeholders' expectations of the Southern Thai RCBME initiative. METHODS: A qualitative case study comprised a purposive sample of students, clinical educators, policymakers, rural health professionals and local community stakeholders, all likely to be involved in a new RCBME program in Songkhla Province, Thailand. Individual semi-structured interviews were audiotaped, transcribed in Thai and coded using Worley's symbiosis framework. Following this, text and quotes used in the initial analysis were translated into English, discussed and reanalysed for emergent themes across the framework. RESULTS: A total of 21 participants contributed RCBME stakeholder perspectives. They demonstrated expectations and concerns in each of the relationship axes of the symbiosis model including the clinical, institutional, social and personal axes. Three major themes emerged from the data that integrated stakeholder perspectives on the implication of RCBME in Thailand. These themes were a dramatic shift in Thai medical education paradigm, seeing rural practice as a future career, and collaboration to improve education and health in rural services. CONCLUSION: This study comprehensively describes Thai stakeholder expectations of RCBME and demonstrates that, although some principles of RCBME are universal, context does influence the expectations and capacity of stakeholders to contribute to RCBME. Prospective formal stakeholder engagement is recommended to ensure successful implementation of new educational innovations.

The 'rural pipeline' and retention of rural health professionals in Europe's northern peripheries.

The major advance in informing rural workforce policy internationally over the past 25 years has been the recognition of the importance of the 'rural pipeline'. The rural pipeline suggests that people with 'rural origin' (who spent some childhood years in rural areas) and/or 'rural exposure' (who do part of their professional training in rural areas) are more likely to select rural work locations. What is not known is whether the rural pipeline also increases the length of time professionals spend in rural practice throughout their careers. This paper analyses data from a survey of rural health professionals in six countries in the northern periphery of Europe in 2013 to examine the relationship between rural origin and rural exposure and the intention to remain in the current rural job or to preference rural jobs in future. Results are compared between countries, between different types of rural areas (based on accessibility to urban centres), different occupations and workers at different stages of their careers. The research concludes that overall the pipeline does impact on retention, and that both rural origin and rural exposure make a contribution. However, the relationship is not strong in all contexts, and health workforce policy should recognise that retention may in some cases be improved by recruiting beyond the pipeline.