Determinants of rural practice: positive interaction between rural background and rural undergraduate training.

OBJECTIVE: To determine the role of rural background and years of rural clinical school training on subsequent rural clinical practice. DESIGN, SETTING AND PARTICIPANTS: Retrospective cohort study of University of Queensland (UQ) medical graduates who graduated during the period 2002-2011 (contacted via internet, telephone and mail, using information obtained from UQ, the Australian Health Practitioner Regulation Agency, and telephone directory and internet searches) who completed an online or hard copy questionnaire during the period December 2012 to October 2013. MAIN OUTCOME MEASURE: Current clinical practice in a rural location. RESULTS: Of 1572 graduates to whom the questionnaire was sent, 754 (48.0%) completed the questionnaire. Of the respondents, 236 (31.3%) had a rural background and 276 (36.6%) had attended the University of Queensland Rural Clinical School (UQRCS). Clinical practice location was rural for 18.8% (90/478) of UQ metropolitan clinical school attendees and 41.7% (115/276) of UQRCS attendees (P < 0.001). In the multivariate model with main effects, independent predictors of rural practice were (OR [95% CI]): UQRCS attendance for 1 year (1.84 [1.21-2.82]) or 2 years (2.71 [1.65-4.45]), rural background (2.30 [1.57-3.36]), partner with rural background (3.08 [1.96-4.84]), being single (1.98 [1.28-3.06]) and having a bonded scholarship (2.34 [1.37-3.98]). In the model with interaction between UQRCS attendance and rural background, independent predictors of rural practice were rural background and UQRCS attendance for 1 year (4.44 [2.38-8.29]) or 2 years (7.09 [3.57-14.10]), partner with rural background (3.14 [1.99-4.96]), being single (2.02 [1.30-3.12]) and bonded scholarship (2.27 [1.32-3.90]). The effects of rural background and UQRCS attendance were duration dependent. CONCLUSIONS: This study strengthens evidence that, after adjusting for multiple confounders, a number of exposures are independent predictors of rural medical practice. The strong positive interaction between rural background and rural clinical school exposure, and the duration-dependent relationships, could help inform policy changes aimed at enhancing the efficacy of Australia's rural clinical school program.

A decade of Australian Rural Clinical School graduates--where are they and why?

INTRODUCTION: The Australian Rural Clinical School (RCS) initiative has been addressing the rural medical workforce shortage at the medical education level for over a decade. A major expectation of this initiative is that it will improve rural medical workforce recruitment and subsequent retention through a rurally based undergraduate clinical training experience. The longitudinal nature of these workforce initiatives means that definitive evidence of its impact on the shortage of rural doctors is yet to be provided; however, to date cross-sectional studies are accumulating a measure of efficacy for these initiatives by monitoring early career factors such as internship location choice and speciality choice of RCS graduates. This article reports on a study in one RCS that is monitoring the impact of rural undergraduate clinical training on trends in workforce participation patterns of its graduates as long as 9 years in the workforce. Career location and speciality choice are reported as well as perspectives on early career intentions and the reality of making career and life decisions as a doctor in the medical workforce. METHODS: A longitudinal mixed methods sequential explanatory design employed a quantitative data collection phase followed by a qualitative phase with the merging of data sources during the interpretation and analysis. In 2007 a database was established that maintained the contact details of all former graduates since 2002. Every 2 years graduates are invited to participate in a survey and provide an update on the influences on their current career intentions/decisions. The qualitative sample was recruited through a survey question asking for interest in participating in an interview. RESULTS: The whole-sample survey results showed that out of a 64% (N = 115) response rate, 40% of respondents were currently working in non-urban locations. The majority (

Coping with increasing numbers of medical students in rural clinical schools: options and opportunities.

The critical shortage of the rural medical workforce in Australia continues. There is pressure on medical schools to produce not only more doctors, but to supply them in geographical areas of need. The latest policy to tackle these problems will increase medical student numbers while the supply of clinical teachers and patients for teaching remains static. This challenges the traditional apprenticeship model for learning medicine. Coupled with this is the requirement of medical schools to provide compulsory rural clinical placements for all students. The success of rural clinical schools and University Departments of Rural Health (UDRH) is increasingly apparent, but they must find new strategies to maintain a quality clinical experience and exposure to rural lifestyle for all medical students. The dilemma is providing this quality rural experience to all medical students in the immediate future. We suggest approaches to meet this challenge at a policy, organisational, student and teaching level.

Evaluation of an ultrasound program (intermediate obstetric and emergency medicine) for Australian rural and remote doctors.

INTRODUCTION: This paper describes the evaluation of an intermediate obstetric ultrasound and emergency medicine ultrasound education workshop for rural and remote Australian doctors, which was developed in response to an educational needs assessment that showed an unmet need in this area. The workshop was held in four Australian states. The participants were 61 rural and remote doctors. METHODS: Data from pre- and post-workshop knowledge tests and general workshop evaluation were analysed. RESULTS: Sixty-one doctors attended an ultrasound workshop and self-reported increases in knowledge, confidence and expertise in ultrasound. The mean pretest score for 56 doctors who completed both the pre- and post-workshop knowledge tests was 31.6 and the post-test score mean was 33.3 out of a possible score of 44, which demonstrated a statistically significant increase in knowledge (P = 0.003). DISCUSSION AND IMPLICATIONS FOR PRACTICE: The evaluation of the workshop demonstrated that it was an effective way of increasing knowledge and confidence in intermediate obstetric ultrasound and emergency medicine ultrasound. The workshop was popular and received very positive feedback from the attendees.