Call to expand teaching opportunities in rural family medicine

Are Australian rural clinical school students' career choices influenced by perceived opinions of primary care? Evidence from the national Federation of Rural Australian Medical Educators survey

OBJECTIVE

To investigate whether perceived opinions of primary care are associated with student career preferences after graduation among a rural clinical school cohort and whether the preferred location of practice moderates these relationships.

DESIGN

Cross-sectional study using data from the national Federation of Rural Australian Medical Educators survey.

PARTICIPANTS/SETTING

Medical students across 18 Australian universities who completed a clinical year in a rural setting in 2019.

MAIN OUTCOME MEASURE(S)

Career preference in primary care after graduation.

RESULTS

The survey was completed by 624 students (response rate = 69.9%). A preference for primary care was reported by 35.5% (95% CI: 29.4-42.0) of students and was more likely among those age 30+ years, with a rural background, or preferring to practise rurally after graduation. Students reported that primary care was more commonly respected by medical academics (66.8%) than peers (24.0%) or junior/hospital doctors (24.0%). In adjusted analysis, none of the perceived opinions were associated with student career preferences. However, among students aiming to work in small rural locations, a career in primary care was associated with more frequent reports that peers had poor opinions of primary care (P = .004).

CONCLUSION

Rural clinical school students perceive negative opinions of primary care, particularly among peers and junior/hospital doctors. Students aiming to work in small towns after graduation are more likely to report negative opinions among their peers, suggesting they may be more attuned to negative attitudes. This points to the need for a community of practice of like-minded peers and clinicians to preserve the career interest of these students.

Co-designing community-focused rural placements for collaborative practice

AIMS AND CONTEXT

As a University Department of Rural Health, we have identified recurrent areas of service need among vulnerable rural populations, specifically the need for allied health. Concurrently, we have also identified missed opportunities for deliberate collaborative practice in rural clinical placements. This paper provides a commentary on our work in progress as we work to leverage available opportunities to provide both service from and education for health profession students on rural clinical placements.

APPROACH

We developed a transdisciplinary placement model, informed by practice theory, which encompasses pre-placement preparation, student support, host sites and clinicians, and a structured evaluation strategy. This model aims to facilitate service provision alongside of student learning about community and collaborative practice. In particular, the co-design of the model is expected to facilitate student's sense of social accountability and reduce stigma in working with vulnerable population groups.

CONCLUSION

This paper highlights the need for greater alignment between rural health education and practice, describes a placement model that is working towards this and showcases how this has been enacted in a remote community in New South Wales. More cross-sector discussion and evaluation is needed to determine the implications of adopting this model more widely if service and learning opportunities are to be equally achieved, and to determine the ways in which training and service provision can be aligned with community need, as recommended in the recent Rural Health Commissioner Report.