1
|
Cortie CH, Garne D, Parker-Newlyn L, Ivers RG, Mullan J, Mansfield KJ, Bonney A. A comparison of rural and regional work locations and speciality choices between graduates from the University of Wollongong and all Australian medical schools using the Medical Schools Outcomes Database. Aust J Rural Health 2024; 32:152-161. [PMID: 38084505 DOI: 10.1111/ajr.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/02/2023] [Accepted: 11/24/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION The shortfall in medical workers in rural and remote Australia has led to health discrepancies in these regions. The University of Wollongong's medical program was designed to encourage graduates to work in these regions to address this shortfall. OBJECTIVE To compare rural and regional locations of work and choices of speciality between University of Wollongong's graduates and graduates from all Australian universities. DESIGN We conducted a longitudinal analysis on data available from the Medical Schools Outcome database, with graduate exit surveys linked to registrations of location and speciality. Rural and remote locations were identified as MM2-7 regions using the Modified Monash Model. In total, 716 graduates from the University of Wollongong and 26 915 graduates from all Australian medical schools completed the MSOD exit survey in 2010-2021 and registered with the Australian Health Practitioner Regulation Agency in 2022. The main outcome was the relative likelihood (relative risk) of cohorts working in rural and regional areas and of cohorts choosing general practice as their speciality. FINDINGS University of Wollongong's medical graduates were 1.51 times or 51% more likely to work in regional or rural areas (RR 1.51, 95% CI 1.34 to 1.71, p < 0.0001). Respondents who were 10 or more years post graduation were 1.57 times or 57% more likely to specialise in general practice than all other Australian medical graduates (RR 1.57 95% CI: 1.40 to 1.79, p < 0.0001). DISCUSSION The University of Wollongong's medical school is producing graduates to meet Australia's rural health workforce needs. This may be due to a higher intake of rural students, and a higher percentage of students taking rural placements. CONCLUSIONS Rural health workforce needs can be addressed through rural-focussed education strategies.
Collapse
Affiliation(s)
- Colin H Cortie
- Graduate School of Medicine, University of Wollongong, West Nowra, New South Wales, Australia
| | - David Garne
- Graduate School of Medicine, University of Wollongong, West Nowra, New South Wales, Australia
| | - Lyndal Parker-Newlyn
- Graduate School of Medicine, University of Wollongong, West Nowra, New South Wales, Australia
| | - Rowena G Ivers
- Graduate School of Medicine, University of Wollongong, West Nowra, New South Wales, Australia
| | - Judy Mullan
- Graduate School of Medicine, University of Wollongong, West Nowra, New South Wales, Australia
| | - Kylie J Mansfield
- Graduate School of Medicine, University of Wollongong, West Nowra, New South Wales, Australia
| | - Andrew Bonney
- Graduate School of Medicine, University of Wollongong, West Nowra, New South Wales, Australia
| |
Collapse
|
2
|
Cortie CH, Garne D, Parker-Newlyn L, Ivers RG, Mullan J, Mansfield KJ, Bonney A. An automated protocol for assessing career rurality outcomes of Australian health professionals using retrospective data. Aust J Rural Health 2023; 31:1252-1260. [PMID: 37859332 DOI: 10.1111/ajr.13053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/28/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Addressing the imbalance of the health workforce between metropolitan and rural areas requires a clear understanding of trends in choices of work location of health care staff. OBJECTIVE Here, we provide an automated and highly reproducible protocol to examine the location of health care workers over multiple years using medical graduates as a case study. DESIGN Data linkage cohort study. The study cohort examined was University of Wollongong Medical graduates from 2010 to 2021 who were registered to practice in Australia. The main outcome measure was graduate location of practice in Modified Monash regsions MM1 or MM2-7 across multiple postgraduate years. This protocol used R Markdown. FINDINGS An automated and reproducible protocol was used to analyse choices of work location for the University of Wollongong's medical graduates. Over 90% of graduates were registered with AHPRA. Around 25%-30% of graduates were found to work in MM2-7 regions across their careers, exceeding the national average. DISCUSSION The protocol presented allows for a fast and reproducible analysis of work location by region for health care workers. This will allow comparisons of outcomes between universities or health professions.
Collapse
Affiliation(s)
- Colin H Cortie
- Graduate School of Medicine, University of Wollongong, Australia, Wollongong, New South Wales, Australia
| | - David Garne
- Graduate School of Medicine, University of Wollongong, Australia, Wollongong, New South Wales, Australia
| | - Lyndal Parker-Newlyn
- Graduate School of Medicine, University of Wollongong, Australia, Wollongong, New South Wales, Australia
| | - Rowena G Ivers
- Graduate School of Medicine, University of Wollongong, Australia, Wollongong, New South Wales, Australia
| | - Judy Mullan
- Graduate School of Medicine, University of Wollongong, Australia, Wollongong, New South Wales, Australia
| | - Kylie J Mansfield
- Graduate School of Medicine, University of Wollongong, Australia, Wollongong, New South Wales, Australia
| | - Andrew Bonney
- Graduate School of Medicine, University of Wollongong, Australia, Wollongong, New South Wales, Australia
| |
Collapse
|
3
|
Beks H, Walsh S, Alston L, Jones M, Smith T, Maybery D, Sutton K, Versace VL. Approaches Used to Describe, Measure, and Analyze Place of Practice in Dentistry, Medical, Nursing, and Allied Health Rural Graduate Workforce Research in Australia: A Systematic Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031438. [PMID: 35162455 PMCID: PMC8834932 DOI: 10.3390/ijerph19031438] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 01/06/2023]
Abstract
Redressing the maldistribution of the health workforce in regional, rural, and remote geographical areas is a global issue and crucial to improving the accessibility of primary health care and specialist services. Geographical classification systems are important as they provide an objective and quantifiable measure of access and can have direct policy relevance, yet they are not always consistently applied in rural health research. It is unclear how research focusing on the graduate health workforce in Australia has described, measured, and analyzed place of practice. To examine approaches used, this review systematically scopes Australian rural studies focusing on dentistry, medicine, nursing, and allied health graduates that have included place of practice as an outcome measure. The Joanna Brigg’s Institute Scoping Review Methodology was used to guide the review. Database searches retrieved 1130 unique citations, which were screened, resulting in 62 studies for inclusion. Included studies were observational, with most focusing on the practice locations of medical graduates and predicators of rural practice. Variations in the use of geographical classification approaches to define rurality were identified and included the use of systems that no longer have policy relevance, as well as adaptations of existing systems that make future comparisons between studies challenging. It is recommended that research examining the geographical distribution of the rural health workforce use uniform definitions of rurality that are aligned with current government policy.
Collapse
Affiliation(s)
- Hannah Beks
- School of Medicine, Deakin University, Geelong 3220, Australia; (H.B.); (L.A.)
| | - Sandra Walsh
- Department of Rural Health, University of South Australia, Whyalla 5608, Australia; (S.W.); (M.J.)
| | - Laura Alston
- School of Medicine, Deakin University, Geelong 3220, Australia; (H.B.); (L.A.)
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla 5608, Australia; (S.W.); (M.J.)
| | - Tony Smith
- Department of Rural Health, University of Newcastle, Taree 2430, Australia;
| | - Darryl Maybery
- Department of Rural Health & Indigenous Health, Monash University, Warragul 3820, Australia; (D.M.); (K.S.)
| | - Keith Sutton
- Department of Rural Health & Indigenous Health, Monash University, Warragul 3820, Australia; (D.M.); (K.S.)
| | - Vincent L Versace
- School of Medicine, Deakin University, Geelong 3220, Australia; (H.B.); (L.A.)
- Correspondence: ; Tel.: +613-5563-3513
| |
Collapse
|
4
|
Playford D, Ngo H, Puddey I. Intention mutability and translation of rural intention into actual rural medical practice. MEDICAL EDUCATION 2021; 55:496-504. [PMID: 33141924 DOI: 10.1111/medu.14404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Rural intention and experience during medical school have been related to subsequent rural work. However, their relative contributions and the timing of their effects are not known. These data are critical to effective educational interventions able to improve rural medical workforce numbers, an international priority. METHODS Participants were graduates of an Australian MBBS degree between 2006 and 2016, who completed both entry and exit surveys approved by the Medical Deans of Australia, including workplace intention data. Rural/urban workplace intention changes from entry to exit were analysed using multinomial logistic regression. Binary logistic regression was used to assess actual rural versus urban work, obtained from a public practitioner registration website. RESULTS Of 547 eligible undergraduates, 169 completed a year-long rural clinical school (RCS). A subset of 93 of the 547 graduates practiced rurally, of whom 42 had completed RCS. Both rural background and RCS predicted rural practice intention; both were also significantly related to actual rural work. Enduring rural intention was associated with nearly sevenfold odds of actually practicing rurally, compared with an enduring urban intention. Those who changed practice intention from entry to exit were more likely to practice in the region of their exit intention. Of special note: Rural Clinical School of Western Australia (RCSWA) exposure particularly affects urban origin students such that the odds of changing from an urban to a rural orientation immediately after their rural experience were more than fourfold higher than those not so participating. DISCUSSION Both intention and RCSWA experience are associated with subsequent rural work. The impacts of RCSWA were able to be localised after the rural educational experience. Amongst those with mutable intention, exit intention was that most strongly related to actual work, suggesting this as the most reliable point to select for further rural training.
Collapse
Affiliation(s)
- Denese Playford
- Rural Clinical School of Western Australia, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Hanh Ngo
- Rural Clinical School of Western Australia, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Ian Puddey
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| |
Collapse
|
5
|
Gupta S, Ngo H, Burkitt T, Puddey I, Playford D. Survival analysis of Rural Clinical School of Western Australia graduates: the long-term work of building a long-term rural medical workforce. BMC Health Serv Res 2019; 19:998. [PMID: 31878913 PMCID: PMC7050761 DOI: 10.1186/s12913-019-4816-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 12/09/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Deficits in the rural medical workforce is an international issue. In Australia, The Rural Clinical School intervention is effective for initial recruitment of rural doctors. However, the extent of survival is not yet established. This paper summarises rural survival over a 10-year period. METHODS Rural Clinical School graduates of Western Australia were surveyed annually, 2006-2015, and post Graduate Years (PGY) 3-12 included. Survival was described as "tours of service", where a tour was either a period of ≥1 year, or a period of ≥2 weeks, working rurally. A tour ended with a rural work gap of ≥52 weeks. Considering each exit from urban as an event, semi-parametric repeated measures survival models were fitted. RESULTS Of 468 graduates, using the ≥2 weeks definition, 239 PGY3-12 graduates spent at least one tour rurally (average 61.1, CI 52.5-69.7 weeks), and a total length of 14,607 weeks. Based on the tour definition of ≥1 year, 120 graduates completed at least one tour (average 1.89, 1.69-2.10 years), and a total of 227 years' rural work. For both definitions, the number of tours increased from one to four by PGY10/11, giving 17,786 total weeks (342 years) across all PGYs for the ≥2 weeks tour definition, and 256 years total for ≥1 year. Significantly more graduates exited from urban work for the 2007-09 middle cohort compared with 2010-11 (HR 1.876, p = 0.022), but no significant difference between 2002 and 06 and 2010-11. Rural origin, age and gender were not statistically significant. CONCLUSIONS PGY3-12 RCS graduates contributed substantially to the rural workforce: 51% did so by short rotations, while 26% contributed whole years of service. There was an apparent peak in entry and survival for the middle cohort and decline thereafter, likely attributable to lack of advanced/specialist vocational training. These data indicate a real commitment to rural practice by RCS graduates, and the need for rural vocational training as a key element of a successful rural survival strategy.
Collapse
Affiliation(s)
- Surabhi Gupta
- Rural Clinical School of WA, School of Medicine, UWA, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Hanh Ngo
- Rural Clinical School of WA, School of Medicine, UWA, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Tessa Burkitt
- Rural Clinical School of WA, School of Medicine, UWA, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Ian Puddey
- Rural Clinical School of WA, School of Medicine, UWA, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Denese Playford
- Rural Clinical School of WA, School of Medicine, UWA, 35 Stirling Highway, Crawley, WA 6009 Australia
| |
Collapse
|
6
|
Playford D, Ngo H, Atkinson D, Puddey IB. Graduate doctors' rural work increases over time. MEDICAL TEACHER 2019; 41:1073-1080. [PMID: 31177927 DOI: 10.1080/0142159x.2019.1621278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background: The contribution of rural clinical school (RCS) and rural origin to developing a long-term rural medical workforce was examined. Methods: Longitudinal cohort study, after undergraduate location in either rural or urban setting, for all medical graduates 2004-2010, identified in the Australian Health Practitioner Regulation Agency, in the following groups: Urban origin/no RCS; Rural origin/no RCS; Urban origin/RCS; and Rural origin/RCS. Results: Proportions of all graduates working rurally increased from 2013 to 2018, including amongst urban origin/nonRCS graduates. Rural origin/RCS participants worked rurally at the highest rates across all time points, with an endpoint of 47%, and an odds ratio of 9.70 (5.41, 17.40) relative to the urban reference group. They had a cumulative duration of rural practice over 5 times higher than the urban reference group. RCS graduates were more likely to be working in remote areas than nonRCS graduates. Conclusion: All graduates' contribution to rural and remote workforce is dynamic and increasing. Both RCS participation and rural student recruitment make synergistic and increasing contributions to rural work. RCS effects workforce distribution to more remote areas. Single cross-sectional studies do not capture this dynamic growth in the rural workforce.
Collapse
Affiliation(s)
- Denese Playford
- The Rural Clinical School of Western Australia, The School of Medicine, The Faculty of Health and Medical Sciences, The University of Western Australia , Crawley , WA , USA
| | - Hanh Ngo
- The Rural Clinical School of Western Australia, The School of Medicine, The Faculty of Health and Medical Sciences, The University of Western Australia , Crawley , WA , USA
| | - David Atkinson
- The Rural Clinical School of Western Australia, The School of Medicine, The Faculty of Health and Medical Sciences, The University of Western Australia , Crawley , WA , USA
| | - Ian B Puddey
- School of Medicine and Pharmacology, The School of Medicine, The Faculty of Health and Medical Sciences, The University of Western Australia , Crawley , WA , USA
| |
Collapse
|
7
|
O'Sullivan B, McGrail M, Major L, Woodfield M, Holmes C. Rural work outcomes of medical students participating in a contracted Extended Rural Cohort (ERC) program by course-entry preference. MEDICAL TEACHER 2019; 41:703-710. [PMID: 30907206 DOI: 10.1080/0142159x.2019.1569755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This paper evaluates rural work location outcomes of an Extended Rural Cohort (ERC) program in medical school. Students nominate a preference and are contracted to the program at entry to the medical course, involving 2-3 years continuous rural training. Data included 2412 graduates from a large university medical school cohort study. Regression modeling compared 2017 work location of ERC participants, by their level of preference for the ERC and students who had other (similar or shorter duration) rural training with a metropolitan-only trained group. Students who entered medicine with ERC as their first preference commonly had rural background (95.5%) compared with second or lower preferences (61.5% and 40.4%, respectively). Multivariate regression modeling identified ERC participants were more likely to work rurally (OR: 2.69-3.27, compared with metropolitan-trained), though higher odds were associated with lower preference for ERC. However, non-ERC students undertaking a similar duration rural training by opting for this "year by year" after course entry, had the strongest odds of rural work (OR: 4.62, 95%CI: 3.00-7.13) and work in smaller rural towns (RRR: 4.08, 95%CI: 2.36-7.06). The ERC attracts rural background students and increases rural work outcomes. However, students choosing a rural training path of equivalent duration after course entry may be more effective and improve rural workforce distribution.
Collapse
Affiliation(s)
| | - Matthew McGrail
- b Rural Clinical School , University of Queensland , Rockhampton , Australia
| | - Laura Major
- c School of Rural Health , Monash University , Clayton , Australia
| | - Mark Woodfield
- c School of Rural Health , Monash University , Clayton , Australia
| | - Christian Holmes
- a School of Rural Health , Monash University , Bendigo , Australia
| |
Collapse
|
8
|
Playford DE, Burkitt T, Atkinson D. Social network analysis of rural medical networks after medical school immersion in a rural clinical school. BMC Health Serv Res 2019; 19:305. [PMID: 31088454 PMCID: PMC6515657 DOI: 10.1186/s12913-019-4132-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/29/2019] [Indexed: 11/26/2022] Open
Abstract
Background The impact of new medical graduates on the social dimensions of the rural medical workforce is yet to be examined. Social Network Analysis (SNA) is able to visualize and measure these dimensions. We apply this method to examine the workforce characteristics of graduates from a representative Australian Rural Clinical School. Methods Participants were medical graduates of the Rural Clinical School of Western Australia (RCSWA) from the 2001–2014 cohorts, identified as being in rural work in 2017 by the Australian Health Practitioner Regulation Agency. SNA was used to examine the relationships between site of origin and of work destination. Data were entered into UCInet 6 as tied pairs, and visualized using Netdraw. UCINet statistics relating to node centrality were obtained from the node editor. Results SNA measures showed that the 124 of 709 graduates in rural practice were distributed around Australia, and that their practice was strongly focused on the North, with a clear centre in the remote Western Australian town of Broome. Women were strongly recruited, and were widely distributed. Conclusions RCSWA appears to be a “weak tie” according to SNA theory: the School attracts graduates to rural nodes where they had only passing prior contact. The multiple activities that comprise the social capital of the most attractive, remote, node demonstrate the clear workforce effects of being a “bridge, broker and boundary spanner” in SNA terms, and add new understanding about recruiting to the rural workforce.
Collapse
Affiliation(s)
- Denese E Playford
- The Rural Clinical School of Western Australia, RCSWA, M706, The School of Medicine, The University of Western Australia, Crawley, WA, 6009, Australia. .,The University of Notre Dame Australia, Fremantle Campus, Western Australia, Australia, 32 Mouat St, Fremantle, WA, 6160, Australia.
| | - Tessa Burkitt
- The Rural Clinical School of Western Australia, RCSWA, M706, The School of Medicine, The University of Western Australia, Crawley, WA, 6009, Australia.,The University of Notre Dame Australia, Fremantle Campus, Western Australia, Australia, 32 Mouat St, Fremantle, WA, 6160, Australia
| | - David Atkinson
- The Rural Clinical School of Western Australia, RCSWA, M706, The School of Medicine, The University of Western Australia, Crawley, WA, 6009, Australia.,The University of Notre Dame Australia, Fremantle Campus, Western Australia, Australia, 32 Mouat St, Fremantle, WA, 6160, Australia
| |
Collapse
|
9
|
Johnson G, Byun R, Foster K, Wright FAC, Blinkhorn A. A longitudinal workforce analysis of a Rural Clinical Placement Program for final year dental students. Aust Dent J 2019; 64:181-192. [DOI: 10.1111/adj.12691] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2019] [Indexed: 11/30/2022]
Affiliation(s)
- G Johnson
- Sydney Institute for Women, Children and Their Families Sydney New South Wales Australia
- Sydney Medical School University of Sydney Sydney New South Wales Australia
| | - R Byun
- Centre for Oral Health Strategy Ministry of Health Sydney New South Wales Australia
| | - K Foster
- Northern Clinical School University of Sydney Sydney New South Wales Australia
- Office for Global Health Sydney Medical School Sydney New South Wales Australia
| | - FAC Wright
- Centre for Education and Research on Ageing Concord Clinical School University of Sydney Sydney New South Wales Australia
| | - A Blinkhorn
- Population Oral Health University of Sydney Sydney New South Wales Australia
| |
Collapse
|
10
|
Burkitt T, Playford D. Responses to post-graduation surveys do not accurately reflect the workforce. MEDICAL TEACHER 2017; 39:898-899. [PMID: 28506138 DOI: 10.1080/0142159x.2017.1324143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Tessa Burkitt
- a The Rural Clinical School of Western Australia , UWA , M706 35 Stirling Highway , Crawley , WA , 6009 , Australia
| | - Denese Playford
- a The Rural Clinical School of Western Australia , UWA , M706 35 Stirling Highway , Crawley , WA , 6009 , Australia
| |
Collapse
|
11
|
Playford DE, Nicholson A, Riley GJ, Puddey IB. Longitudinal rural clerkships: increased likelihood of more remote rural medical practice following graduation. BMC MEDICAL EDUCATION 2015; 15:55. [PMID: 25879715 PMCID: PMC4372318 DOI: 10.1186/s12909-015-0332-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 02/27/2015] [Indexed: 05/16/2023]
Abstract
BACKGROUND Extended rural clerkships clearly increase the likelihood of rural practice post-graduation. What has not been determined is whether such rural interventions increase the likelihood of graduates practicing in more remote, versus inner regional, locations. METHODS The Australian Health Practitioner Regulation Agency database was used to identify the current workplace of every graduate of the Medical School of Western Australia, 1980 to 2011. There were 324 graduates working in a primary practice location defined by the Australian Standard Geographical Classification as inner regional to very remote. They were divided into 3 groups - 200 graduates who entered medical school before commencement of the Rural Clinical School of Western Australia (RCSWA), 63 who entered after the RCSWA had started, but not participated in RCSWA, and 61 who participated in the RCSWA. The RCSWA offers a longitudinal rural clinical clerkship throughout level 5 of the MBBS course. RESULTS The two groups not participating in the RCSWA had 45.5% and 52.4% of subjects in outer regional/very remote locations, respectively. In comparison, 78.7% of those who had participated in the RCSWA were currently practicing in outer regional/very remote locations. When the 3 groups were compared, the significant predictors of working in a more remote practice compared to working in an inner regional area were being female (OR 1.75 95% CI 1.13, 2.72, P = 0.013) and participating in the RCSWA (OR 4.42, 95% CI 2.26, 8.67, P < 0.001). In multivariate logistic regression that corrected for gender and remoteness of rural address before entry to medical school, participation in the RCSWA still predicted a more than 4-fold increase in the odds of practicing in a more remote area (OR 4.11, 95% CI 2.04, 8.30, P < 0.001). CONCLUSION Extended rural clinical clerkship during an undergraduate MBBS course is related to a much greater likelihood of practicing in more remote, under-serviced rural locations.
Collapse
Affiliation(s)
- Denese E Playford
- School of Primary, Aboriginal and Rural Health Care, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Asha Nicholson
- School of Primary, Aboriginal and Rural Health Care, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Geoffrey J Riley
- School of Primary, Aboriginal and Rural Health Care, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Ian B Puddey
- Faculty Office, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| |
Collapse
|
12
|
Playford DE, Evans SF, Atkinson DN, Auret KA, Riley GJ. Impact of the Rural Clinical School of Western Australia on work location of medical graduates. Med J Aust 2014; 200:104-7. [PMID: 24484114 DOI: 10.5694/mja13.11082] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 11/26/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether completing a year of the Rural Clinical School of Western Australia (RCSWA) program is associated with entering the rural medical workforce. DESIGN AND SETTING Cohort study of graduates from the University of Western Australia who completed Year 5 of medical school between 2002 and 2009, comparing work location (identified from the Australian Health Practitioner Regulation Agency database in March-June 2013) between those who participated in the RCSWA (RCSWA graduates) and those who did not (controls). MAIN OUTCOME MEASURE Rural or urban work location of graduates. RESULTS Of 1116 eligible graduates, 1017 (91.1%) could be traced and were included in the study. Of 258 RCSWA graduates, 42 (16.3%) were working rurally compared with 36 of 759 controls (4.7%). Of 195 RCSWA graduates from urban backgrounds, 29 (14.9%) were working rurally compared with 26 of 691 urban-background controls (3.8%). Of 63 rural-background RCSWA graduates, 13 (20.6%) were working rurally, compared with 10 of 68 rural-background controls (14.7%). Using logistic regression, RCSWA participation had a strong relationship with working rurally (rural-background RCSWA graduates: odds ratio [OR], 7.5; 95% CI, 3.5-15.8; urban-background RCSWA graduates: OR, 5.1; 95% CI, 2.9-9.1). Rural background without RCSWA participation (OR, 4.2; 95% CI, 1.8-9.2) and older age (age in 2012, 30-39 years: OR, 2.2; 95% CI, 1.3-3.7 v ≥ 40 years: OR, 6.6; 95% CI, 2.8-15.0) were also significant factors for working rurally. CONCLUSIONS Participation in the RCSWA is strongly associated with greater likelihood of working rurally. Graduates from urban backgrounds who participated in the RCSWA were much more likely to work in rural areas than those who did not. These data substantiate the RCSWA as an effective rural workforce strategy.
Collapse
Affiliation(s)
- Denese E Playford
- Rural Clinical School of Western Australia, University of Western Australia, Perth, WA, Australia.
| | - Sharon F Evans
- Rural Clinical School of Western Australia, University of Western Australia, Perth, WA, Australia
| | - David N Atkinson
- Rural Clinical School of Western Australia, University of Western Australia, Broome, WA, Australia
| | - Kirsten A Auret
- Rural Clinical School of Western Australia, University of Western Australia, Albany, WA, Australia
| | - Geoffrey J Riley
- Rural Clinical School of Western Australia, University of Western Australia, Albany, WA, Australia
| |
Collapse
|