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McGrail M, Woolley T, Pinidiyapathirage J, Paton K, Smith D, Brumpton K, Teague PA. Exploring recent trends (2014-21) in preferencing and accepting Queensland medical internships in rural hospitals. BMC Health Serv Res 2024; 24:236. [PMID: 38395849 PMCID: PMC10885368 DOI: 10.1186/s12913-024-10683-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Medical internship is a key transition point in medical training from student to independent (junior) doctor. The national Regional Training Hubs (RTH) policy began across Australia in late 2017, which aims to build medical training pathways for junior doctors within a rural region and guide students, interns and trainees towards these. This study aims to explore preferencing and acceptance trends for rural medical internship positions in Queensland. Moreover, it focuses on internship preference and acceptance outcomes prior to and following the establishment of RTHs, and their association with key covariates such as rural training immersions offered by medical schools. METHODS Data from all applicants to Queensland Health intern positions between 2014-2021 were available, notably their preference order and location of accepted internship position, classified as rural or metropolitan. Matched data from Queensland's medical schools were added for rural training time and other key demographics. Analyses explored the statistical associations between these factors and preferencing or accepting rural internships, comparing pre-RTH and post-RTH cohorts. RESULTS Domestic Queensland-trained graduates first preferencing rural intern positions increased significantly (pre-RTH 21.1% vs post-RTH 24.0%, p = 0.017), reinforced by a non-significant increase in rural acceptances (27.3% vs 29.7%, p = 0.070). Rural interns were more likely to have previously spent ≥ 11-weeks training in rural locations within medical school, be rurally based in the year applying for internship, or enrolled in the rural generalist pathway. CONCLUSIONS The introduction of the RTH was associated with a moderate increase of graduates both preferencing and accepting a rural internship, though a richer understanding of the dominant reasons for and against this remain less clear. An expansion of graduates who undertook longer periods of undergraduate rural training in the same period did not diminish the proportion choosing a rural internship, suggesting there remains an appetite for these opportunities. Overall, domestic graduates are identified as a reliable source of intern recruitment and retention to rural hospitals across Queensland, with entry to the rural generalist pathway and extended rural placement experiences enhancing uptake of rural practice.
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Affiliation(s)
- Matthew McGrail
- The University of Queensland, Rural Clinical School, Rockhampton, QLD, 4700, Australia.
| | - Torres Woolley
- James Cook University, College of Medicine & Dentistry, Townsville, QLD, 4811, Australia
| | - Janani Pinidiyapathirage
- Griffith University, School of Medicine and Dentistry, Southport, QLD, 4222, Australia
- Rural Medical Education Australia, Toowoomba, QLD, 4350, Australia
| | - Kath Paton
- James Cook University, College of Medicine & Dentistry, Townsville, QLD, 4811, Australia
| | - Deborah Smith
- James Cook University, College of Medicine & Dentistry, Townsville, QLD, 4811, Australia
| | - Kay Brumpton
- Griffith University, School of Medicine and Dentistry, Southport, QLD, 4222, Australia
- Rural Medical Education Australia, Toowoomba, QLD, 4350, Australia
| | - Peta-Ann Teague
- James Cook University, College of Medicine & Dentistry, Townsville, QLD, 4811, Australia
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Carrigan B, Bass L, Pinidiyapathirage J, Walters S, Woodall H, Brumpton K. Connectivity is the key to longer rural placement: Retaining students on rural longitudinal integrated clerkships. Med Teach 2024; 46:225-231. [PMID: 37557884 DOI: 10.1080/0142159x.2023.2243025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE Recruitment and retention of medical practitioners to rural practice is an ongoing global issue. Rural longitudinal integrated clerkships (LIC) are an innovative solution to this problem, which are known to increase rural workforce. Crucially this association increases with time on rural placement. This study examines factors that promote retention in a Rural LIC. METHODS A two-phased, sequential design qualitative study in a cohort of students enrolled in a rural LIC at Griffith University, Queensland, Australia. Phase I consisted of an open-ended questionnaire and phase II follow-up focus groups from the same cohort. Data was transcribed and analysed using an iterative, six-step thematic analysis process to identify salient themes. RESULTS Twenty-four students were invited to participate, of which eight respond in phase I and thirteen participated in phase II. Participants described retention being driven by connectivity within three broad themes: current practice, future practice (immediate internship and career intention), and social networks. Participant proposals to increase connectivity were also suggested including peer-led solutions and short rotations in metropolitan hospitals. CONCLUSION Connectivity is key to retention on rural longitudinal integrated clerkships. Programs which enhance connectivity with current practice, future practice, and social networks will increase retention on rural medical programs.
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Affiliation(s)
- Brendan Carrigan
- Rural Medical Education Australia, Toowoomba, Australia
- School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Lucy Bass
- School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Janani Pinidiyapathirage
- Rural Medical Education Australia, Toowoomba, Australia
- School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Sherrilyn Walters
- Rural Medical Education Australia, Toowoomba, Australia
- School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Hannah Woodall
- Rural Medical Education Australia, Toowoomba, Australia
- School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Kay Brumpton
- Rural Medical Education Australia, Toowoomba, Australia
- School of Medicine and Dentistry, Griffith University, Southport, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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McGrail MR, Doyle Z, Fuller L, Gupta TS, Shires L, Walters L. The pathway to more rural doctors: the role of universities. Med J Aust 2023; 219 Suppl 3:S8-S13. [PMID: 37544002 DOI: 10.5694/mja2.52021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 08/08/2023]
Affiliation(s)
| | - Zelda Doyle
- Lithgow Clinical School, University of Notre Dame Australia, Lithgow, NSW
| | - Lara Fuller
- School of Medicine, Deakin University, Geelong, VIC
| | - Tarun Sen Gupta
- College of Medicine and Dentistry, James Cook University, Townsville, QLD
| | - Lizzi Shires
- Rural Clinical School, University of Tasmania, Burnie, TAS
| | - Lucie Walters
- Adelaide Rural Clinical School, University of Adelaide, Mount Gambier, SA
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Connell CJW, Salkeld AJ, Wells C, Verstappen AC, Poole P, Wilkinson TJ, Bagg W. Sample representativeness and influence of attrition on longitudinal data collected as part of a national medical career tracking project. BMC Med Educ 2023; 23:532. [PMID: 37491266 PMCID: PMC10369717 DOI: 10.1186/s12909-023-04472-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 06/23/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND The Medical Schools Outcomes Database and Longitudinal Tracking Project (MSOD) in New Zealand is one example of a national survey-based resource of medical student experiences and career outcomes. Longitudinal studies of medical students are valuable for evaluating the outcomes of medical programs against workforce objectives. As a prospective longitudinal multiple-cohort study, survey response rates at each collection point of MSOD vary. This paper assesses the effects of participant non-response rates on MSOD data. METHODS Demographic variables of MSOD respondents between 2012 and 2018 were compared to the distribution of the demographic variables in the population of all NZ medical graduates to ascertain whether respondent samples at multiple survey collection points were representative of the population. Analysis using logistic regression assessed the impact of participant non-response on variables at collection points throughout MSOD. RESULTS 2874 out of a total population of 2939 domestic medical students graduating between 2012 and 2018 responded to MSOD surveys. Entry and exit surveys achieved response rates around 80% and were broadly representative of the total population on demographic variables. Post-graduation survey response rates were around 50% of the total population of graduates and underrepresented graduates from the University of Auckland. Between the entry and exit and the exit and postgraduation year three samples, there was a significant impact of non-response on ascribed variables, including age at graduation, university, gender and ethnic identity. Between the exit and postgraduation year one sample, non-response significantly impacted ascribed and non-ascribed variables, including future practice intentions. CONCLUSION Samples collected from MSOD at entry and exit are representative, and findings from cross-sectional studies using these datasets are likely generalisable to the wider population of NZ medical graduates. Samples collected one and three years post-graduation are less representative. Researchers should be aware of this bias when utilizing these data. When using MSOD data in a longitudinal manner, e.g. comparing the change in career intentions from one collection point to the next, researchers should appropriately control for bias due to non-response between collection points. This study highlights the value of longitudinal career-tracking studies for answering questions relevant to medical education and workforce development.
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Affiliation(s)
- Charlotte J W Connell
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | | | - Cameron Wells
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Antonia C Verstappen
- The Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Phillippa Poole
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Tim J Wilkinson
- Otago Medical School, University of Otago, Christchurch, New Zealand
| | - Warwick Bagg
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Brütting C, Herget S, Bauch F, Nafziger M, Klingenberg A, Deutsch T, Frese T. Factors promoting willingness to practice medicine in rural regions and awareness of rural regions in the university's catchment area - cross-sectional survey among medical students in central Germany. GMS J Med Educ 2023; 40:Doc52. [PMID: 37560039 PMCID: PMC10407585 DOI: 10.3205/zma001634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/13/2023] [Accepted: 04/06/2023] [Indexed: 08/11/2023]
Abstract
Aim Many universities offer rural medical internships for medical students. The present survey was designed to show how rural medical work is perceived by students, whether these perceptions are associated with origin and previous experience, and how well medical students know rural regions in the vicinity of their university. In addition, students were asked how to support and inspire medical students to later work in a rural region. Methods This cross-sectional study was based on an anonymous online survey of medical students at the Universities of Halle-Wittenberg and Leipzig. The evaluations included descriptive statistics, statistical group comparisons, and qualitative content analysis of free text answers. Results A total of 882 students took part in the survey. Students who had grown up in a rural region or had lived there for a longer time (71.7% of the respondents) rated the work-life balance better (p<0.01) and the patient variety in the countryside slightly higher (p<0.05) than their fellow students from the big city. Students who had worked in a rural practice or hospital before (62.2%) rated patient diversity (p<0.001) and work variety (p<0.001), as well as workload (p<0.01), slightly higher in rural areas than students with no prior experience. On average, the specified rural model regions were still unknown to more than 60% of the students. The suggestions for attracting medical students to later work as rural physicians included financial incentives and, above all, better information about life as a rural physician and the rural regions. Conclusion Thus, the medical faculties of the universities as well as the counties threatened by medical undersupply should further expand the transfer of knowledge and experience regarding rural physician life for the students.
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Affiliation(s)
- Christine Brütting
- University of Halle-Wittenberg, Faculty of Medicine, Institute for General Medicine, Halle (Saale), Germany
| | - Sabine Herget
- University of Leipzig, Faculty of Medicine, Department of General Practice, Leipzig, Germany
| | - Felix Bauch
- University of Halle-Wittenberg, Faculty of Medicine, Institute for General Medicine, Halle (Saale), Germany
| | - Melanie Nafziger
- University of Halle-Wittenberg, Faculty of Medicine, Institute for General Medicine, Halle (Saale), Germany
| | - Anja Klingenberg
- aQua Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany
| | - Tobias Deutsch
- University of Leipzig, Faculty of Medicine, Department of General Practice, Leipzig, Germany
| | - Thomas Frese
- University of Halle-Wittenberg, Faculty of Medicine, Institute for General Medicine, Halle (Saale), Germany
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Young L, Anderson E, Gurney T, McArthur L, McGrail M, O'Sullivan B, Hollins A. A comparative evaluation of quality and depth of learning by trainee doctors in regional, rural, and remote locations. BMC Med Educ 2023; 23:215. [PMID: 37020284 PMCID: PMC10077336 DOI: 10.1186/s12909-023-04175-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND An equitable supply and distribution of medical practitioners for all the population is an important issue, especially in Australia where 28% of the population live in rural and remote areas. Research identified that training in rural/remote locations is a predictor for the uptake of rural practice, but training must provide comparable learning and clinical experiences, irrespective of location. Evidence shows GPs in rural and remote areas are more likely to be engaged in complex care. However, the quality of GP registrar education has not been systematically evaluated. This timely study evaluates GP registrar learning and clinical training experiences in regional, rural, and remote locations in Australia using assessment items and independent evaluation. METHODS The research team retrospectively analysed GP trainee formative clinical assessment reports compiled by experienced medical educators during real-time patient consultations. Written reports were assessed using Bloom's taxonomy classified into low and high cognitive level thinking. Regional, rural, and remotely located trainees were compared using Pearson chi-squared test and Fisher's exact test (for 2 × 2 comparisons) to calculate associations between categorical proportions of learning setting and 'complexity'. RESULTS 1650 reports (57% regional, 15% rural and 29% remote) were analysed, revealing a statistically significant association between learner setting and complexity of clinical reasoning. Remote trainees were required to use a high level of clinical reasoning in managing a higher proportion of their patient visits. Remotely trained GPs managed significantly more cases with high clinical complexity and saw a higher proportion of chronic and complex cases and fewer simple cases. CONCLUSIONS This retrospective study showed GP trainees in all locations experienced comparable learning experiences and depth of training. However, learning in rural and remote locations had equal or more opportunities for seeing higher complexity patients and the necessity to apply greater levels of clinical reasoning to manage each case. This evidence supports learning in rural and remote locations is of a similar standard of learning as for regional trainees and in several areas required a superior level of thinking. Training needs to seriously consider utilising rural and remote clinical placements as exceptional locations for developing and honing medical expertise.
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Affiliation(s)
- Louise Young
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Emily Anderson
- College of Medicine and Dentistry, James Cook University, Queensland, Australia.
| | - Tiana Gurney
- Rural Clinical School, The University of Queensland, Queensland, Australia
| | - Lawrie McArthur
- General Practice Training, James Cook University, Queensland, Australia
| | - Matthew McGrail
- Rural Clinical School, The University of Queensland, Queensland, Australia
| | - Belinda O'Sullivan
- Rural Clinical School, The University of Queensland, Queensland, Australia
| | - Aaron Hollins
- General Practice Training, James Cook University, Queensland, Australia
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McGrail MR, Nasir BF, Chater AB, Sangelaji B, Kondalsamy-Chennakesavan S. The value of extended short-term medical training placements in smaller rural and remote locations on future work location: a cohort study. BMJ Open 2023; 13:e068704. [PMID: 36707116 PMCID: PMC9884882 DOI: 10.1136/bmjopen-2022-068704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To investigate the effects of extended short-term medical training placements in small rural and remote communities on postgraduate work location. DESIGN AND SETTING Cohort study of medical graduates of The University of Queensland, Australia. PARTICIPANTS Graduating medical students from 2012 to 2021 who undertook a minimum of 6 weeks training in a small rural or remote location. Some participants additionally undertook either or both an extended short-term (12-week) placement in a small rural or remote location and a long-term (1 or 2 years) placement in a large regional centre. PRIMARY OUTCOME MEASURE Work location was collected from the Australian Health Practitioner Regulation Agency in 2022, classified as either rural, regional or metropolitan and measured in association with rural placement type(s). RESULTS From 2806 eligible graduates, those participating in extended small rural placements (n=106, 3.8%) were associated with practising rurally or regionally postgraduation (42.5% vs 19.9%; OR: 2.2, 95% CI: 1.1 to 4.6), for both those of rural origin (50% vs 30%; OR: 4.9, 95% CI: 2.6 to 9.2) or metropolitan origin (36% vs 17%; OR: 2.8, 95% CI: 1.7 to 4.8). Those undertaking both an extended small rural placement and 2 years regional training were most likely to be practising in a rural or regional location (61% vs 16%; OR: 8.6, 95% CI: 4.5 to 16.3). Extended small rural placements were associated with practising in smaller rural or remote locations in later years (15% vs 6%, OR: 2.7, 95% CI: 1.3 to 5.3). CONCLUSION This work location outcome evidence supports investment in rural medical training that is both located in smaller rural and remote settings and enables extended exposure with rural generalists. The evaluated 12-week programme positively related to rural workforce outcomes when applied alone. Outcomes greatly strengthened when the 12-week programme was combined with a 2-year regional centre training programme, compared with either alone. These effects were independent of rural origin.
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Affiliation(s)
- Matthew R McGrail
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Rockhampton, Queensland, Australia
| | - Bushra F Nasir
- Rural Clinical School, The University of Queensland Faculty of Medicine, Toowoomba, Queensland, Australia
- Mayne Academy of Rural and Remote Medicine, The University of Queensland Faculty of Medicine, Theodore, Queensland, Australia
| | - Alan Bruce Chater
- Mayne Academy of Rural and Remote Medicine, The University of Queensland Faculty of Medicine, Theodore, Queensland, Australia
| | - Bahram Sangelaji
- Mayne Academy of Rural and Remote Medicine, The University of Queensland Faculty of Medicine, Theodore, Queensland, Australia
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Noya F, Carr S, Freeman K, Thompson S, Clifford R, Playford D. Strategies to Facilitate Improved Recruitment, Development, and Retention of the Rural and Remote Medical Workforce: A Scoping Review. Int J Health Policy Manag 2022; 11:2022-2037. [PMID: 34973053 PMCID: PMC9808272 DOI: 10.34172/ijhpm.2021.160] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 11/14/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Medical workforce shortages in rural and remote areas are a global issue. High-income countries (HICs) and low- and middle-income countries (LMICs) seek to implement strategies to address this problem, regardless of local challenges and contexts. This study distilled strategies with positive outcomes and success from international peer-reviewed literature regarding recruitment, retention, and rural and remote medical workforce development in HICs and LMICs. METHODS The Arksey and O'Malley scoping review framework was utilised. Articles were retrieved from electronic databases Medline, Embase, Global Health, CINAHL Plus, and PubMed from 2010-2020. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guideline was used to ensure rigour in reporting the methodology in the interim, and PRISMA extension for scoping review (PRISMA-ScR) was used as a guide to report the findings. The success of strategies was examined against the following outcomes: for recruitment - rural and remote practice location; for development - personal and professional development; and for retention - continuity in rural and remote practice and low turnover rates. RESULTS Sixty-one studies were included according to the restriction criteria. Most studies (n=53; 87%) were undertaken in HICs, with only eight studies from LMICs. This scoping review found implementation strategies classified as Educational, Financial, and Multidimensional were successful for recruitment, retention, and development of the rural and remote medical workforce. CONCLUSION This scoping review shows that effective strategies to recruit and retain rural and remote medical workforce are feasible worldwide despite differences in socio-economic factors. While adjustment and adaptation to match the strategies to the local context are required, the country's commitment to act to improve the rural medical workforce shortage is most critical.
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Affiliation(s)
- Farah Noya
- Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, WA, Australia
| | - Sandra Carr
- Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, WA, Australia
| | - Kirsty Freeman
- Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, WA, Australia
- Duke National University Singapore Medical School, Singapore, Singapore
| | - Sandra Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, WA, Australia
| | - Rhonda Clifford
- School of Allied Health, University of Western Australia, Perth, WA, Australia
| | - Denese Playford
- The Rural Clinical School of WA, School of Medicine, The University of Western Australia, Perth, WA, Australia
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Connell CJW, Bagg W, Jo E, Poole P. Effects of a regional-rural immersion program in Northland, New Zealand, on returning to work in that region. Aust J Rural Health 2022; 30:666-675. [PMID: 35567770 PMCID: PMC9790617 DOI: 10.1111/ajr.12876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 03/22/2022] [Accepted: 04/06/2022] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION It is well established that rural workforce outcomes are more likely among medical graduates who spend time training in non-urban areas; however, fewer studies have assessed whether graduates are more likely to return to the specific area where they undertook rural training. OBJECTIVE This study aimed to determine whether graduates who had undertaken a regional-rural immersion program in Northland, NZ, were more likely to have returned to work in Northland as of mid-2021, relative to peers who did not participate. DESIGN This prospective cohort study used longitudinal tracking survey responses, medical school administrative data and workforce outcome information. A multinomial model, accounting for other covariates, was built to determine the association between graduates practising in Northland (population ⟨ 100 000), which encompasses both rural (population ⟨ 25 000) and regional (25 000 ⟩ population ⟨ 100 000) areas, and having participated in a Northland-based immersion program during medical school. The study population was University of Auckland domestic medical students graduating between 2009 and 2018, inclusive. Immersion program participants who responded to longitudinal career tracking surveys were included in the study sample. FINDINGS The final sample size was 1320 students (80% of population of interest). Graduates who undertook the Northland immersion program (n = 169) were more likely than non-participants (n = 1151) to be working in Northland as of 2020-2021 (relative risk: 3.2). DISCUSSION AND CONCLUSION Regional-rural immersion programs might preferentially build workforces in that specific region; however, further research is required to understand whether these findings are generalizable, and the main reasons for this effect.
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Affiliation(s)
| | - Warwick Bagg
- Department of Medicine, School of MedicineThe University of AucklandAucklandNew Zealand
| | - Emmanuel Jo
- Department of Medicine, School of MedicineThe University of AucklandAucklandNew Zealand,Analytics and Intelligence SectionHealth Workforce, Ministry of HealthWellingtonNew Zealand
| | - Phillippa Poole
- Department of Medicine, School of MedicineThe University of AucklandAucklandNew Zealand
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11
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Russell DJ, Wilkinson E, Petterson S, Chen C, Bazemore A. Family Medicine Residencies: How Rural Training Exposure in GME Is Associated With Subsequent Rural Practice. J Grad Med Educ 2022; 14:441-450. [PMID: 35991106 PMCID: PMC9380633 DOI: 10.4300/jgme-d-21-01143.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/16/2022] [Accepted: 06/01/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Rural US populations face a chronic shortage of physicians and an increasing gap in life expectancy compared to urban US populations, creating a need to understand how to increase residency graduates' desire to practice in such areas. OBJECTIVE This study quantifies associations between the amount of rural training during family medicine (FM) residencies and subsequent rural work. METHODS American Medical Association (AMA) Masterfile, AMA graduate medical education (GME) supplement, American Board of Family Medicine certification, Accreditation Council for Graduate Medical Education (ACGME), and Centers for Medicare and Medicaid Services hospital costs data were merged and analyzed. Multiple logistic regression measured associations between rural training and rural or urban practice in 2018 by all 12 162 clinically active physicians who completed a US FM residency accredited by the ACGME between 2008 and 2012. Analyses adjusted for key potential confounders (age, sex, program size, region, and medical school location and type) and clustering by resident program. RESULTS Most (91%, 11 011 of 12 162) residents had no rural training. A minority (14%, 1721 of 12 162) practiced in a rural location in 2018. Residents with no rural training comprised 80% (1373 of 1721) of those in rural practice in 2018. Spending more than half of residency training months in rural areas was associated with substantially increased odds of rural practice (OR 5.3-6.3). Only 4% (424 of 12 162) of residents spent more than half their training in rural locations, and only 5% (26 of 436) of FM training programs had residents training mostly in rural settings or community-based clinics. CONCLUSIONS There is a linear gradient between increasing levels of rural exposure in FM GME and subsequent rural work.
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Affiliation(s)
- Deborah J. Russell
- Deborah J. Russell, MBBS, MClinEpid, PhD, is Senior Research Fellow, Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia
| | - Elizabeth Wilkinson
- Elizabeth Wilkinson, BA, is former Junior Analyst, Robert Graham Center for Policy Studies in Family Medicine and Primary Care
| | - Stephen Petterson
- Stephen Petterson, PhD, is Affiliate Faculty, The George Washington University Milken Institute School of Public Health
| | - Candice Chen
- Candice Chen, MD, MPH, is Associate Professor, The George Washington University Milken Institute School of Public Health
| | - Andrew Bazemore
- Andrew Bazemore, MD, MPH, is Senior Vice President of Research and Policy, American Board of Family Medicine, and Co-Director, Center for Professionalism and Value in Health Care
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12
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Purea P, Brumpton K, Kumar K, Pinidiyapathirage J. Exploring the learning environment afforded by an Aboriginal Community Controlled Health service in a rural longitudinal integrated clerkship. Educ Prim Care 2022; 33:214-220. [PMID: 35343387 DOI: 10.1080/14739879.2022.2054371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/04/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Despite the extensive literature regarding longitudinal integrated clerkships (LICs), there is very little evidence about this model in non-traditional settings, such as Aboriginal Community Controlled Health Organisations (ACCHOs). This study explored the key elements of the learning experience in a rural LIC programme, within an ACCHO from the perspective of multiple stakeholders including medical students, the general practice supervisory team, Aboriginal health workers (AHWs) and cultural mentors. METHODS The study was conducted using a qualitative case-study design. Participants included Year 3 medical students and the health care team (general practitioners, practice nurse, AHWs, and a practice manager in the role of cultural mentor) from an ACCHO in regional Queensland. Data was collected through semi-structured interviews and analysed using inductive thematic analysis. RESULTS Three key features were identified within the learning experience of students undertaking an LIC in the ACCHO setting. This study showed it was a safe context for learners to learn about 'culturally safe practice', 'putting relationships at the centre', and to 'try new things', reinforcing ACCHO as an invaluable site for learning. CONCLUSION The extended clinical placement in an ACCHO setting afforded an increase in the number of opportunities to develop students' cultural safety, communication skills and relationships with patients and the supervisory team, including AHWs and cultural mentors.
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Affiliation(s)
- Paul Purea
- Rural Medical Education Australia, Toowoomba, QLD, Australia
| | - Kay Brumpton
- Rural Medical Education Australia, Toowoomba, QLD, Australia
- School of Medicine and Dentistry, Griffith University Gold Coast Campus, QLD, Australia
| | - Koshila Kumar
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Janani Pinidiyapathirage
- Rural Medical Education Australia, Toowoomba, QLD, Australia
- School of Medicine and Dentistry, Griffith University Gold Coast Campus, QLD, Australia
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13
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Seal AN, Playford D, McGrail MR, Fuller L, Allen PL, Burrows JM, Wright JR, Bain-Donohue S, Garne D, Major LG, Luscombe GM. Influence of rural clinical school experience and rural origin on practising in rural communities five and eight years after graduation. Med J Aust 2022; 216:572-577. [PMID: 35365852 PMCID: PMC9322683 DOI: 10.5694/mja2.51476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/04/2022] [Indexed: 12/04/2022]
Abstract
Objective To examine associations between extended medical graduates’ rural clinical school (RCS) experience and geographic origins with practising in rural communities five and eight years after graduation. Design, participants Cohort study of 2011 domestic medical graduates from ten Australian medical schools with rural clinical or regional medical schools. Main outcome measures Practice location types eight years after graduation (2019/2020) as recorded by the Australian Health Practitioner Regulation Agency, classified as rural or metropolitan according to the 2015 Modified Monash Model; changes in practice location type between postgraduate years 5 (2016/2017) and 8 (2019/2020). Results Data were available for 1321 graduates from ten universities; 696 were women (52.7%), 259 had rural backgrounds (19.6%), and 413 had extended RCS experience (31.3%). Eight years after graduation, rural origin graduates with extended RCS experience were more likely than metropolitan origin graduates without this experience to practise in regional (relative risk [RR], 3.6; 95% CI, 1.8–7.1) or rural communities (RR, 4.8; 95% CI, 3.1–7.5). Concordance of location type five and eight years after graduation was 92.6% for metropolitan practice (84 of 1136 graduates had moved to regional/rural practice, 7.4%), 26% for regional practice (56 of 95 had moved to metropolitan practice, 59%), and 73% for rural practice (20 of 100 had moved to metropolitan practice, 20%). Metropolitan origin graduates with extended RCS experience were more likely than those without it to remain in rural practice (RR, 2.0; 95% CI, 1.3–2.9) or to move to rural practice (RR, 1.9; 95% CI, 1.2–3.1). Conclusion The distribution of graduates by practice location type was similar five and eight years after graduation. Recruitment to and retention in rural practice were higher among graduates with extended RCS experience. Our findings reinforce the importance of longitudinal rural and regional training pathways, and the role of RCSs, regional training hubs, and the rural generalist training program in coordinating these initiatives.
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Affiliation(s)
- Alexa N Seal
- Rural Clinical School, School of Medicine Sydney, the University of Notre Dame Australia, Wagga Wagga, NSW
| | - Denese Playford
- Rural Clinical School of Western Australia, University of Western Australia, Perth, WA
| | | | - Lara Fuller
- Rural Community Clinical School, Deakin University, Colac, VIC
| | - Penny L Allen
- Rural Clinical School, University of Tasmania, Burnie, TAS
| | - Julie M Burrows
- Rural Clinical School, University of Newcastle, Tamworth, NSW
| | - Julian R Wright
- Rural Clinical School, University of Melbourne, Melbourne, VIC
| | | | - David Garne
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW
| | - Laura G Major
- School of Rural Health, Monash University, Melbourne, VIC
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14
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Farrugia L, Smith T, Depczynski J. Factors influencing medical radiation science graduates' early career principal place of practice: a retrospective cohort study. J Med Radiat Sci 2022; 69:182-190. [PMID: 34802192 PMCID: PMC9163475 DOI: 10.1002/jmrs.559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION While studies have investigated influences on graduate practice locations of other health professionals, especially medicine, none have investigated practice locations of medical radiation science (MRS) graduates. This study aimed to explore factors influencing the registered principal place of practice (PPP) of diagnostic radiography, radiation therapy and nuclear medicine graduates from the University of Newcastle (UON), Australia, in their second post-graduate year. METHODS Data were extracted from the UON enrolment and clinical placement databases and linked to Australian Health Practitioners Regulation Agency (Ahpra) registration data for PPP location in 2019 for 187 graduates who completed their studies in 2017. Explanatory variables included age at enrolment, gender, MRS discipline, location of origin, socio-economic index for location of origin, and locations and duration of undergraduate professional placements. Descriptive statistics, tests of association and logistic regression compared rural and non-rural origin, and professional placement locations with Ahpra PPP. RESULTS Factors related to non-metropolitan PPP were location of origin (P = 0.002), number (P = 0.002) and duration (P = 0.007) of rural placements, and MRS discipline (P = 0.033). Controlling for other variables, location of origin and MRS discipline remained significant. Graduates of rural origin had up to 3.54 (95%CI = 1.51-8.28) times the odds of a rural PPP. Diagnostic radiography graduates had up to 5.46 (95%CI = 1.55-19.20) times the odds of nuclear medicine of a rural PPP. CONCLUSION To help reduce the gap between rural and metropolitan medical radiation service availability, there is a need for targeted recruitment of rural origin students. Further investigation of the effect of rural undergraduate MRS placements is justified.
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Affiliation(s)
- Lauren Farrugia
- Medical Radiation ScienceUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Tony Smith
- Department of Rural HealthUniversity of NewcastleTareeNew South WalesAustralia
| | - Julie Depczynski
- Department of Rural HealthUniversity of NewcastleMoreeNew South WalesAustralia
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15
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Elma A, Nasser M, Yang L, Chang I, Bakker D, Grierson L. Medical education interventions influencing physician distribution into underserved communities: a scoping review. Hum Resour Health 2022; 20:31. [PMID: 35392954 PMCID: PMC8991572 DOI: 10.1186/s12960-022-00726-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/24/2022] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVE Physician maldistribution is a global problem that hinders patients' abilities to access healthcare services. Medical education presents an opportunity to influence physicians towards meeting the healthcare needs of underserved communities when establishing their practice. Understanding the impact of educational interventions designed to offset physician maldistribution is crucial to informing health human resource strategies aimed at ensuring that the disposition of the physician workforce best serves the diverse needs of all patients and communities. METHODS A scoping review was conducted using a six-stage framework to help map current evidence on educational interventions designed to influence physicians' decisions or intention to establish practice in underserved areas. A search strategy was developed and used to conduct database searches. Data were synthesized according to the types of interventions and the location in the medical education professional development trajectory, that influence physician intention or decision for rural and underserved practice locations. RESULTS There were 130 articles included in the review, categorized according to four categories: preferential admissions criteria, undergraduate training in underserved areas, postgraduate training in underserved areas, and financial incentives. A fifth category was constructed to reflect initiatives comprised of various combinations of these four interventions. Most studies demonstrated a positive impact on practice location, suggesting that selecting students from underserved or rural areas, requiring them to attend rural campuses, and/or participate in rural clerkships or rotations are influential in distributing physicians in underserved or rural locations. However, these studies may be confounded by various factors including rural origin, pre-existing interest in rural practice, and lifestyle. Articles also had various limitations including self-selection bias, and a lack of standard definition for underservedness. CONCLUSIONS Various educational interventions can influence physician practice location: preferential admissions criteria, rural experiences during undergraduate and postgraduate medical training, and financial incentives. Educators and policymakers should consider the social identity, preferences, and motivations of aspiring physicians as they have considerable impact on the effectiveness of education initiatives designed to influence physician distribution in underserved locations.
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Affiliation(s)
- Asiana Elma
- Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Center, McMaster University, 100 Main St. W., Hamilton, ON, L8P 1H6, Canada
| | - Muhammadhasan Nasser
- Bachelor of Health Sciences Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Laurie Yang
- Bachelor of Health Sciences Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Irene Chang
- Bachelor of Health Sciences Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Dorothy Bakker
- Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Center, McMaster University, 100 Main St. W., Hamilton, ON, L8P 1H6, Canada
- McMaster Community and Rural Education Program, McMaster University, Hamilton, Canada
| | - Lawrence Grierson
- Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Center, McMaster University, 100 Main St. W., Hamilton, ON, L8P 1H6, Canada.
- McMaster Community and Rural Education Program, McMaster University, Hamilton, Canada.
- McMaster Education Research, Innovation and Theory, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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16
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Jessup B, Hoang H, Podubinski T, Obamiro K, Bourke L, Hellwege B, Jatrana S, Heaney S, Farthing A, Sheepway L, Rasiah R. 'I can't go, I can't afford it': Financial concern amongst health students undertaking rural and remote placements during COVID-19. Aust J Rural Health 2022; 30:238-251. [PMID: 35229400 PMCID: PMC9111257 DOI: 10.1111/ajr.12855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/06/2022] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION As the coronavirus pandemic unfolded during 2020, widespread financial uncertainty emerged amongst university students across the globe. What is not yet clear is how Australian health students were financially impacted during the initial stages of the pandemic and whether this influenced their ability to undertake planned rural or remote placements. OBJECTIVE To examine (a) financial concern amongst health students during COVID-19, (b) the financial implications of changes to planned rural or remote placements and (c) the impact of these factors on students' ability to undertake placements during the pandemic. DESIGN Mixed-methods design involving an online survey (n = 1210) and semi-structured interviews (n = 29). Nursing, medical and allied health students with a planned University Department of Rural Health-facilitated rural or remote placement between February and October 2020 were invited to participate. FINDINGS 54.6% of surveyed students reported financial concern during COVID-19. Financial concern correlated with both changes in financial position and employment, with 36.6% of students reporting a reduction in income and 43.1% of students reporting a reduction in, or cessation of regular employment. Placement changes yielded a range of financial implications. Cancelled placements saved some students travel and accommodation costs, but left others out of pocket if these expenses were prepaid. Placements that went ahead often incurred increased accommodation costs due to limited availability. Financial concern and/or financial implications of placement changes ultimately prevented some students from undertaking their rural or remote placement as planned. DISCUSSION Many nursing, allied health and medical students expressed financial concern during COVID-19, associated with a loss of regular employment and income. Placement changes also presented unforeseen financial burden for students. These factors ultimately prevented some students from undertaking their planned rural or remote placement. CONCLUSION Universities need to consider how best to align financially burdensome placements with the personal circumstances of students during periods of economic uncertainty.
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Affiliation(s)
- Belinda Jessup
- Centre for Rural HealthThe University of TasmaniaLauncestonTasmaniaAustralia
| | - Ha Hoang
- Centre for Rural HealthThe University of TasmaniaLauncestonTasmaniaAustralia
| | - Tegan Podubinski
- Department of Rural HealthThe University of MelbourneSheppartonVictoriaAustralia
| | - Kehinde Obamiro
- Centre for Rural HealthThe University of TasmaniaLauncestonTasmaniaAustralia
| | - Lisa Bourke
- Department of Rural HealthThe University of MelbourneSheppartonVictoriaAustralia
| | - Barbara Hellwege
- Department of Rural HealthThe University of MelbourneSheppartonVictoriaAustralia
| | - Santosh Jatrana
- JCU Murtupini Centre for Rural and Remote HealthJames Cook UniversityMount IsaQueenslandAustralia
| | - Susan Heaney
- The University of Newcastle Department of Rural HealthThe University of NewcastlePort MacquarieNew South WalesAustralia
| | - Annie Farthing
- Centre for Remote HealthFlinders UniversityAlice SpringsNorthern TerritoryAustralia
| | - Lyndal Sheepway
- La Trobe Rural Health SchoolLa Trobe UniversityWodongaVictoriaAustralia
| | - Rohan Rasiah
- Western Australian Centre for Rural HealthThe University of Western AustraliaKarrathaWestern AustraliaAustralia
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Beattie J, Binder MJ, Fuller L. Rural longitudinal integrated clerkships and medical workforce outcomes: a scoping review protocol. BMJ Open 2022; 12:e058717. [PMID: 35236734 PMCID: PMC8896063 DOI: 10.1136/bmjopen-2021-058717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The shortage of doctors in rural locations is an international problem, contributing to limited access to healthcare and a health disparity between rural and metropolitan populations. To encourage additional doctors to work in rural locations, more doctors than ever are being trained in rural settings. One rural clerkship model that is gaining recognition for fostering rural careers is the Longitudinal Integrated Clerkship. Longitudinal Integrated Clerkship programmes vary in terms of settings and durations, but at their core have the fundamental commonality of continuity, with students learning the curriculum in an integrated manner. The scoping review will synthesise the literature pertaining to medical workforce outcomes of rural Longitudinal Integrated Clerkship programmes, to uncover areas that require further research and establish elements of medical education programme design that positively influence rural workforce outcomes. METHODS AND ANALYSIS The review will follow Arksey and O'Malley's six step scoping review framework. MEDLINE, CINAHL complete (EBSCOhost), Scopus, Embase (Elsevier) and ISI Web of Science databases will be searched along with Google, Google Scholar, ProQuest and WHO library database. Single design studies examining the geographic work locations and/or medical specialty of rural Longitudinal Integrated Clerkship graduates will be included. Data from quantitative and mixed-methods studies will be included. Only studies written in English will be included. There will be no date range restriction imposed on the reviewed studies. Two reviewers will independently screen and critically appraise the articles to determine if they meet the inclusion criteria. Data from eligible studies will be extracted for synthesis. ETHICS AND DISSEMINATION Scoping reviews do not require ethics approval. Results will be submitted to a peer-reviewed journal and may be presented at relevant conferences. The findings will also be shared within the Longitudinal Integrated Clerkship community of medical educators.
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Affiliation(s)
- Jessica Beattie
- Rural Community Clinical School, Deakin University, Warrnambool, Victoria, Australia
| | - Marley J Binder
- Deakin Rural Health, Deakin University, Geelong, Victoria, Australia
| | - Lara Fuller
- Rural Community Clinical School, Deakin University, Colac, Victoria, Australia
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18
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Hippolyte-Blake D, Dreschler A, Rose A, Rae P, Archer J, Garrod TJ. A qualitative study of the incentives and barriers that influence preferences for rural placements during surgical training in Australia. ANZ J Surg 2022; 92:341-345. [PMID: 35112443 DOI: 10.1111/ans.17523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Rural exposure of long durations during clinical training is positively associated with rural career uptake and is a central strategy to addressing the geographical maldistribution of Australia's surgical workforce. However, the incentives and barriers to trainees undergoing surgical training preferencing repeated rural placements in Australia are not well understood. This qualitative study explores the incentives and barriers that influence preference for rural placements during surgical training in Australia. METHODS This qualitative study employed online semi-structured in-depth interviews. Participants were recruited using an online survey, and interviews were conducted between October 2020 and November 2020. Transcripts were transcribed and de-identified, and thematically analysed. RESULTS Twenty-nine semi-structured interviews were conducted with trainees and 12 Fellows. Twenty-five participants identified as male, and four identified as female. Four main incentives identified were: (1) broad scope of learning opportunities, (2) quality of supervision, (3) positive work environment and (4) lifestyle. Seven barriers identified were: (1) inadequate preparation for placement, (2) limited case mix to support learning outcomes, (3) lack of formally structured learning opportunities, (4) workload and safe hours concerns, (5) lack of peer support, (6) childcare and educational needs and (7) partner career development. CONCLUSION The strategy of encouraging trainees to undertake rural placements to address the maldistribution of the surgical workforce should include initiatives that support learning outcomes across their training levels. In addition, improving trainees' ability to prepare adequately for placements may also improve the number and duration of rural placements trainees undertake during their training.
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Affiliation(s)
- Dinah Hippolyte-Blake
- Education Portfolio, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Alison Dreschler
- Fellowships Portfolio, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Andrew Rose
- Training Services Portfolio, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Peter Rae
- Education Portfolio, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Julian Archer
- Education Portfolio, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Tamsin J Garrod
- Education Portfolio, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
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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. Int J Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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20
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Okyere E, Ward P, Marfoh K, Mwanri L. What do Health Workers say About Rural Practice? Glob Qual Nurs Res 2021; 8:23333936211054812. [PMID: 34869792 PMCID: PMC8637704 DOI: 10.1177/23333936211054812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022] Open
Abstract
Adequately staffed rural health services improve healthcare delivery and health outcomes,
yet this is lacking in rural Ghana. We used a descriptive qualitative design to understand
the contextual issues that affect rural practice, in the Upper East Region, Ghana.
Sixty-eight in-depth interviews were conducted with healthcare workers and analysed
thematically. Four themes were identified: types of postings to rural settings, healthcare
workers’ perceptions of their rural postings, perceived enablers and motivators for rural
practice, and perceived challenges and barriers to rural practice. While adequate
supervision and family proximity are needed to improve the feelings of loneliness,
isolation and neglect in rural areas, challenges and barriers such as inadequate security,
unstable electricity supply, language barrier, lack of equipment and transport/ambulance
have been identified to have negative influence on healthcare workers. The findings
highlight the need for healthcare managers to improve fairness and transparency in the
posting and reshuffling processes of healthcare workers.
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Affiliation(s)
- Eunice Okyere
- College of Medicine, Nursing and Health
Sciences, Fiji National University, Suva, Fiji Islands
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
- Eunice Okyere, Department of Public Health, College
of Medicine, Nursing and Health Sciences, Fiji National University, Princess Road,
Tamavua, Suva, Fiji Islands.
| | - Paul Ward
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
| | - Kissinger Marfoh
- Department of Public Health, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
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21
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Bingham A, O'Sullivan B, Couch D, Cresser S, McGrail M, Major L. How rural immersion training influences rural work orientation of medical students: Theory building through realist evaluation. Med Teach 2021; 43:1398-1405. [PMID: 34280328 DOI: 10.1080/0142159x.2021.1948520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM To develop theory about how contexts and mechanisms interact to contribute to openness to future rural practice by medical students undertaking immersive rural training. METHODS A realist evaluation based on RAMESES II protocol. We interviewed 23 students exploring Contexts (C) which were external (place-based) and internal (the student's characteristics), Mechanisms (M) (that drive a response) and Outcomes (O) (openness to rural work). RESULTS 'Openness to rural work' related to: a desire to live rurally, work in rural medicine, or consider this as a possibility. This was triggered by responses to experience in rural places of an aspirational, intellectual and emotional nature (mechanisms). Students most affected were those with a strong motivation to help others and who value teamwork. Students with clearly envisaged career paths suited to metropolitan areas, or those retaining/prioritising strong social and community ties in metropolitan areas were less likely to commit to future rural work. CONCLUSION Our theory indicates multi-level stimuli activates openness. Implications are that rural immersion programs could select students with an orientation towards teamwork, without pre-set professional ideation, and with a strong commitment to helping others. Experiencing rural immersion will trigger aspirational, intellectual and emotional responses leading to rural work openness for such students.
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Affiliation(s)
- Amie Bingham
- School of Rural Health, Monash University, Clayton, Australia
| | | | - Danielle Couch
- School of Rural Health, Monash University, Bendigo, Australia
| | | | - Matthew McGrail
- Rural Clinical School, University of Queensland, Rockhampton, Australia
| | - Laura Major
- School of Rural Health, Monash University, Clayton, Australia
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McGrail MR, O’Sullivan BG. Increasing doctors working in specific rural regions through selection from and training in the same region: national evidence from Australia. Hum Resour Health 2021; 19:132. [PMID: 34715868 PMCID: PMC8555311 DOI: 10.1186/s12960-021-00678-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/15/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND 'Grow your own' strategies are considered important for developing rural workforce capacity. They involve selecting health students from specific rural regions and training them for extended periods in the same regions, to improve local retention. However, most research about these strategies is limited to single institution studies that lack granularity as to whether the specific regions of origin, training and work are related. This national study aims to explore whether doctors working in specific rural regions also entered medicine from that region and/or trained in the same region, compared with those without these connections to the region. A secondary aim is to explore these associations with duration of rural training. METHODS Utilising a cross-sectional survey of Australian doctors in 2017 (n = 6627), rural region of work was defined as the doctor's main work location geocoded to one of 42 rural regions. This was matched to both (1) Rural region of undergraduate training (< 12 weeks, 3-12 months, > 1 university year) and (2) Rural region of childhood origin (6+ years), to test association with returning to work in communities of the same rural region. RESULTS Multinomial logistic regression, which adjusted for specialty, career stage and gender, showed those with > 1 year (RRR 5.2, 4.0-6.9) and 3-12 month rural training (RRR 1.4, 1.1-1.9) were more likely to work in the same rural region compared with < 12 week rural training. Those selected from a specific region and having > 1-year rural training there related to 17.4 times increased chance of working in the same rural region compared with < 12 week rural training and metropolitan origin. CONCLUSION This study provides the first national-scale empirical evidence supporting that 'grow your own' may be a key workforce capacity building strategy. It supports underserviced rural areas selecting and training more doctors, which may be preferable over policies that select from or train doctors in 'any' rural location. Longer training in the same region enhances these outcomes. Reorienting medical training to selecting and training in specific rural regions where doctors are needed is likely to be an efficient means to correcting healthcare access inequalities.
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Affiliation(s)
- Matthew R. McGrail
- The University of Queensland Rural Clinical School, 78 on Canning St, Rockhampton, QLD 4700 Australia
| | - Belinda G. O’Sullivan
- The University of Queensland, Rural Clinical School, Locked Bag 9009, Toowoomba, QLD DC 4350 Australia
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John J, Brown ME. The impact of longitudinal integrated clerkships on patient care: a qualitative systematic review. Educ Prim Care 2021; 33:137-147. [PMID: 34702143 DOI: 10.1080/14739879.2021.1980438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Longitudinal Integrated Clerkships (LIC) are a relatively novel type of clinical placement model within medical education, particularly within the UK. The research on LICs primarily focuses on the impact of the model on students, tutors, communities, and organisations. The impact of LICs on patients has not yet been adequately synthesised. This systematic review aims to fill this gap by examining empirical evidence regarding the impact of LICs on patient care using quality-of-care measures, namely, health process measures and outcome measures. METHODS A systematic search was conducted in MEDLINE, PsycINFO, Academic Search Premier, Education Research Complete, CINAHL Complete, ERIC, Web of Science, and Scopus. Two reviewers independently conducted the screening process for study selection. Results across studies were analysed and summarised by thematic analysis. RESULTS The reviewers screened 1632 records. Seven studies met the inclusion criteria following a full-text review, from which four themes were created. Three themes describe health process measures, including: 1) Advocacy within healthcare system, 2) Provision of supplementary and personalised care, and 3) Providing companionship with care. One theme described a health outcome measure: Therapeutic Alliance. CONCLUSION Current evidence demonstrates an overall beneficial impact of LICs on patient health processes and outcome measures. However, the available evidence is weak and limited. Further research is required to illuminate the true impact of LICs on patient health.
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Affiliation(s)
- Jomcy John
- School of Medicine, Cardiff University, Cardiff, UK.,Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Megan El Brown
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK.,Medical Education Innovation and Research Centre, Imperial College London, London, UK
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Noya F, Carr S, Thompson S, Clifford R, Playford D. Factors associated with the rural and remote practice of medical workforce in Maluku Islands of Indonesia: a cross-sectional study. Hum Resour Health 2021; 19:126. [PMID: 34627282 PMCID: PMC8502290 DOI: 10.1186/s12960-021-00667-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Many factors contribute to engagement in rural and remote (RR) medical practice, but little is known about the factors associated with rural and remote medical practice in such remote locations as the Maluku Province of Indonesia. This study describes factors associated with actual RR practice, preferred RR practice, and intention to remain practice in Maluku Province. METHODS An online survey of work-related experience and intentions for future rural work was administered to 410 doctors working in the Maluku province of Indonesia. Participant characteristics were described using descriptive statistics, associations between the independent variables with the location of the workforce, intention to remain practice in Maluku, preference for future RR practice in Maluku were analysed using Chi-square tests and logistic regression. RESULTS A total of 324 responses (79% response rate) were recorded, comprising 70% females and 30% Pattimura University graduates of doctors employed in Maluku. Doctors working in RR areas were more likely to be a GP (OR 3.49, CI 1.03-11.8), have a monthly salary of more than IDR 6 million (OR 11.5, CI 4.24-31.1), and have no additional practice (OR 2.78, CI 1.34-5.78). Doctors intended to stay practice in Maluku were more likely to be born in Maluku (OR 7.77, CI 3.42-17.7) and have graduated from Pattimura University (OR 3.06, CI 1.09-8.54), and less likely to be a temporary employee (OR 0.24, CI 0.10-0.57). Doctors who prefer future RR practice in Maluku were more likely to experience rural living (OR 2.05 CI 1.05-3.99), have a positive indication of the impact of community exposure during medical schools on their current practice (OR 2.08, CI 1.06-4.09), currently practising in RR Maluku (OR 8.23, CI 3.27-20.8); and less likely to have bigger take-home pay (OR 0.30, CI 0.13-0.70). CONCLUSION This study indicates that special attention should be given to recruiting doctors with a rural background and ongoing support through attractive opportunities to build a sustainable RR workforce. Since a regional medical school helps supply doctors to the RR areas in its region, a sustained collaboration between medical schools and local government implementing relevant strategies are needed to widen participation and improve the recruitment and retention of RR doctors.
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Affiliation(s)
- Farah Noya
- Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, Australia
- Medical Education Unit, Faculty of Medicine, Pattimura University, Ambon, Indonesia
- Health Professions Education Building, The University of Western Australia, Crawley Avenue (off Mounts Bay Road-next to CAR PARK 25), Nedlands, WA 6009 Australia
| | - Sandra Carr
- Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, Australia
| | - Rhonda Clifford
- School of Allied Health, University of Western Australia, Perth, Australia
| | - Denese Playford
- The Rural Clinical School of WA, School of Medicine, The University of Western Australia, Perth, Australia
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Ostini R, McGrail MR, Kondalsamy-Chennakesavan S, Hill P, O'Sullivan B, Selvey LA, Eley DS, Adegbija O, Boyle FM, Dettrick Z, Jennaway M, Strasser S. Building a sustainable rural physician workforce. Med J Aust 2021; 215 Suppl 1:S5-S33. [PMID: 34218436 DOI: 10.5694/mja2.51122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 11/17/2022]
Abstract
CHAPTER 1: CHARACTERISING AUSTRALIA'S RURAL SPECIALIST PHYSICIAN WORKFORCE: THE PROFESSIONAL PROFILE AND PROFESSIONAL SATISFACTION OF JUNIOR DOCTORS AND CONSULTANTS: Objective: To assess differences in the demographic characteristics, professional profile and professional satisfaction of rural and metropolitan junior physicians and physician consultants in Australia. DESIGN, SETTING AND PARTICIPANTS Cross-sectional, population level national survey of the Medicine in Australia: Balancing Employment and Life longitudinal cohort study (collected 2008-2016). Participants were specialist physicians from four career stage groups: pre-registrars (physician intent); registrars; new consultants (< 5 years since Fellowship); and consultants. MAIN OUTCOME MEASURES Level of professional satisfaction across various job aspects, such as hours worked, working conditions, support networks and educational opportunities, comparing rural and metropolitan based physicians. RESULTS Participants included 1587 pre-registrars (15% rural), 1745 physician registrars (9% rural), 421 new consultants (20% rural) and 1143 consultants (13% rural). Rural physicians of all career stages demonstrated equivalent professional satisfaction across most job aspects, compared with metropolitan physician counterparts. Some examples of differences in satisfaction included rural pre-registrars being less likely to agree they had good access to support and supervision from qualified consultants (odds ratio [OR], 0.6; 95% CI, 0.3-0.9) and rural consultants being more likely to agree they had a poorer professional support network (OR, 1.9; 95% CI, 1.2-2.9). In terms of demographics, relatively more rural physicians had a rural background or were trained overseas. Although most junior physicians were women, female consultants were less likely to be working in a rural location (OR, 0.6; 95% CI, 0.4-0.8). CONCLUSION Junior physicians in metropolitan or rural settings have a similar professional experience, which is important in attracting future trainees. Increased opportunities for rural training should be prioritised, along with addressing concerns about the professional isolation and poorer support network of those in rural areas, not only among junior doctors but also consultants. Finally, making rural practice more attractive to female junior physicians could greatly improve the consultant physician distribution. CHAPTER 2: GENERAL PHYSICIANS AND PAEDIATRICIANS IN RURAL AUSTRALIA: THE SOCIAL CONSTRUCTION OF PROFESSIONAL IDENTITY: Objective: To explore the construction of professional identity among general physicians and paediatricians working in non-metropolitan areas. DESIGN, SETTING AND PARTICIPANTS In-depth qualitative interviews were conducted with general physicians and paediatricians, plus informants from specialist colleges, government agencies and academia who were involved in policy and programs for the training and recruitment of specialists in rural locations across three states and two territories. This research is part of the Training Pathways and Professional Support for Building a Rural Physician Workforce Study, 2018-19. MAIN OUTCOME MEASURES Individual and collective descriptors of professional identity. RESULTS We interviewed 36 key informants. Professional identity for general physicians and paediatricians working in regional, rural and remote Australia is grounded in the breadth of their training, but qualified by location - geographic location, population served or specific location, where social and cultural context specifically shapes practice. General physicians and paediatricians were deeply engaged with their local community and its economic vulnerability, and they described the population size and dynamics of local economies as determinants of viable practice. They often complemented their practice with formal or informal training in areas of special interest, but balanced their practice against subspecialist availability, also dependent on demographics. While valuing their professional roles, they showed limited inclination for industrial organisation. CONCLUSION Despite limited consensus on identity descriptors, rural general physicians and paediatricians highly value generalism and their rural engagement. The structural and geographic bias that preferences urban areas will need to be addressed to further develop coordinated strategies for advanced training in rural contexts, for which collective identity is integral. CHAPTER 3: SUSTAINABLE RURAL PHYSICIAN TRAINING: LEADERSHIP IN A FRAGILE ENVIRONMENT: Objectives: To understand Royal Australasian College of Physicians (RACP) training contexts, including supervisor and trainee perspectives, and to identify contributors to the sustainability of training sites, including training quality. DESIGN, SETTING AND PARTICIPANTS A cross-sectional mixed-methods design was used. A national sample of RACP trainees and Fellows completed online surveys. Survey respondents who indicated willingness to participate in interviews were purposively recruited to cover perspectives from a range of geographic, demographic and training context parameters. MAIN OUTCOME MEASURES Fellows' and trainees' work and life satisfaction, and their experiences of supervision and training, respectively, by geographic location. RESULTS Fellows and trainees reported high levels of satisfaction, with one exception - inner regional Fellows reported lower satisfaction regarding opportunities to use their abilities. Not having a good support network was associated with lower satisfaction. Our qualitative findings indicate that a culture of undermining rural practice is prevalent and that good leadership at all levels is important to reduce negative impacts on supervisor and trainee availability, site accreditation and viability. Trainees described challenges in navigating training pathways, ensuring career development, and having the flexibility to meet family needs. The small number of Fellows in some sites poses challenges for supervisors and trainees and results in a blurring of roles; accreditation is an obstacle to provision of training at rural sites; and the overlap between service and training roles can be difficult for supervisors. CONCLUSION Our qualitative findings emphasise the distinctive nature of regional specialist training, which can make it a fragile environment. Leadership at all levels is critical to sustaining accreditation and support for supervisors and trainees. CHAPTER 4: PRINCIPLES TO GUIDE TRAINING AND PROFESSIONAL SUPPORT FOR A SUSTAINABLE RURAL SPECIALIST PHYSICIAN WORKFORCE: Objective: To draw on research conducted in the Building a Rural Physician Workforce project, the first national study on rural specialist physicians, to define a set of principles applicable to guiding training and professional support action. DESIGN We used elements of the Delphi approach for systematic data collection and codesign, and applied a hybrid participatory action planning approach to achieve consensus on a set of principles. RESULTS Eight interconnected foundational principles built around rural regions and rural people were identified: FP1, grow your own "connected to" place; FP2, select trainees invested in rural practice; FP3, ground training in community need; FP4, rural immersion - not exposure; FP5, optimise and invest in general medicine; FP6, include service and academic learning components; FP7, join up the steps in rural training; and FP8, plan sustainable specialist roles. CONCLUSION These eight principles can guide training and professional support to build a sustainable rural physician workforce. Application of the principles, and coordinated action by stakeholders and the responsible organisations, are needed at national, state and local levels to achieve a sustainable rural physician workforce.
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Banerjee S, Jones C, Wright J, Grosvenor W, Hebditch M, Hughes L, Feeney Y, Farina N, Mackrell S, Nilforooshan R, Fox C, Bremner S, Daley S. A comparative study of the effect of the Time for Dementia programme on medical students. Int J Geriatr Psychiatry 2021; 36:1011-1019. [PMID: 33686788 PMCID: PMC9291285 DOI: 10.1002/gps.5532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/04/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Traditional healthcare education typically focuses on short block clinical placements based on acute care, investigations and technical aspects of diagnosis and treatment. It may therefore fail to build the understanding, compassion and person-centred empathy needed to help those with long-term conditions, like dementia. Time for Dementia was developed to address this. METHOD Parallel group comparison of two cohorts of UK medical students from universities, one participating in Time for Dementia (intervention group) and one not (control group). In Time for Dementia students visit a person with dementia and their family in pairs for 2 hours three times a year for 2 years, the control group received their normal curriculum. RESULTS In an adjusted multilevel model (intervention group n = 274, control n = 112), there was strong evidence supporting improvements for Time for Dementia participants in: total Approaches to Dementia Questionnaire score (coefficient: 2.19, p = 0.003) and its person-centredness subscale (1.32, p = 0.006) and weaker evidence in its hopefulness subscale (0.78, p = 0.070). There was also strong evidence of improvement in the Dementia Knowledge Questionnaire (1.63, p < 0.001) and Dementia Attitudes Scale (total score: 6.55, p < 0.001; social comfort subscale: 4.15, p < 0.001; dementia knowledge subscale: 3.38, p = 0.001) scores. No differences were observed on the Alzheimer's Disease Knowledge Scale, the Medical Condition Regard Scale or the Jefferson Scale of Empathy. DISCUSSION Time for Dementia may help improve the attitudes of medical students towards dementia promoting a person-centred approach and increasing social comfort. Such patient-focused programmes may be a useful complement to traditional medical education.
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Affiliation(s)
- Sube Banerjee
- Faculty of HealthUniversity of PlymouthPlymouthUK,Centre for Dementia StudiesBrighton and Sussex Medical SchoolUniversity of SussexBrightonUK
| | - Christopher Jones
- Centre for Dementia StudiesBrighton and Sussex Medical SchoolUniversity of SussexBrightonUK
| | - Juliet Wright
- Centre for Dementia StudiesBrighton and Sussex Medical SchoolUniversity of SussexBrightonUK
| | | | - Molly Hebditch
- Centre for Dementia StudiesBrighton and Sussex Medical SchoolUniversity of SussexBrightonUK,School of Health SciencesUniversity of SurreyGuildfordUK
| | - Leila Hughes
- Centre for Dementia StudiesBrighton and Sussex Medical SchoolUniversity of SussexBrightonUK
| | - Yvonne Feeney
- Centre for Dementia StudiesBrighton and Sussex Medical SchoolUniversity of SussexBrightonUK
| | - Nicolas Farina
- Centre for Dementia StudiesBrighton and Sussex Medical SchoolUniversity of SussexBrightonUK
| | | | | | - Chris Fox
- Norwich Medical SchoolUniversity of East AngliaNorfolkUK
| | - Stephen Bremner
- Centre for Dementia StudiesBrighton and Sussex Medical SchoolUniversity of SussexBrightonUK
| | - Stephanie Daley
- Centre for Dementia StudiesBrighton and Sussex Medical SchoolUniversity of SussexBrightonUK
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O'Sullivan B, Gurney T, McGrail M. Selection, training and employment to encourage early-career doctors to pursue a rural postgraduate training pathway. Aust J Rural Health 2021; 29:267-271. [PMID: 33982850 DOI: 10.1111/ajr.12744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Belinda O'Sullivan
- Faculty of Medicine, Rural Clinical School, The University of Queensland, Toowoomba, QLD, Australia
| | - Tiana Gurney
- Faculty of Medicine, Rural Clinical School, The University of Queensland, Toowoomba, QLD, Australia
| | - Matthew McGrail
- Faculty of Medicine, Rural Clinical School, The University of Queensland, Rockhampton, QLD, Australia
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Putri LP, Russell DJ, O'Sullivan BG, Kippen R. Factors Associated With Working in Remote Indonesia: A National Cross-Sectional Study of Early-Career Doctors. Front Med (Lausanne) 2021; 8:594695. [PMID: 34055819 PMCID: PMC8155628 DOI: 10.3389/fmed.2021.594695] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 03/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Doctor shortages in remote areas of Indonesia are amongst challenges to provide equitable healthcare access. Understanding factors associated with doctors' work location is essential to overcome geographic maldistribution. Focused analyses of doctors' early-career years can provide evidence to strengthen home-grown remote workforce development. Method: This is a cross-sectional study of early-career (post-internship years 1–5) Indonesian doctors, involving an online self-administered survey on demographic characteristics, and; locations of upbringing, medical clerkship (placement during medical school), internship, and current work. Multivariate logistic regression was used to test factors associated with current work in remote districts. Results: Of 3,176 doctors actively working as clinicians, 8.9% were practicing in remote districts. Compared with their non-remote counterparts, doctors working in remote districts were more likely to be male (OR 1.5,CI 1.1–2.1) or unmarried (OR 1.9,CI 1.3–3.0), have spent more than half of their childhood in a remote district (OR 19.9,CI 12.3–32.3), have completed a remote clerkship (OR 2.2,CI 1.1–4.4) or internship (OR 2.0,CI 1.3–3.0), currently participate in rural incentive programs (OR 18.6,CI 12.8–26.8) or have previously participated in these (OR 2.0,CI 1.3–3.0), be a government employee (OR 3.2,CI 2.1–4.9), or have worked rurally or remotely post-internship but prior to current position (OR 1.9,CI 1.2–3.0). Conclusion: Our results indicate that building the Indonesian medical workforce in remote regions could be facilitated by investing in strategies to select medical students with a remote background, delivering more remote clerkships during the medical course, deploying more doctors in remote internships and providing financial incentives. Additional considerations include expanding government employment opportunities in rural areas to achieve a more equitable geographic distribution of doctors in Indonesia.
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Affiliation(s)
- Likke Prawidya Putri
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,School of Rural Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Bendigo, VIC, Australia
| | - Deborah Jane Russell
- School of Rural Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Bendigo, VIC, Australia.,Menzies School of Health Research, Alice Springs, NT, Australia
| | - Belinda Gabrielle O'Sullivan
- School of Rural Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Bendigo, VIC, Australia.,Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia
| | - Rebecca Kippen
- School of Rural Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Bendigo, VIC, Australia
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Thomas JM, Butler S, Battye K, Sefton C, Smith J, Skinner I, Springer S, Callander E. Rural placements during undergraduate training promote future rural work by nurses, midwives and allied health professionals. Aust J Rural Health 2021; 29:253-258. [PMID: 33982846 DOI: 10.1111/ajr.12728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/17/2021] [Accepted: 01/28/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | | | | | - Janie Smith
- Bond University/Dr Janie Smith Consulting, Varsity Lakes, QLD, Australia
| | | | - Shannon Springer
- Bond University/Springer Health Consultants, Varsity Lakes, QLD, Australia
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Fuller L, Beattie J, Versace V. Graduate rural work outcomes of the first 8 years of a medical school: What can we learn about student selection and clinical school training pathways? Aust J Rural Health 2021; 29:181-190. [PMID: 33982843 DOI: 10.1111/ajr.12742] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the student characteristics and clinical school training pathways that are associated with postgraduate rural practice. DESIGN A cross-sectional observational study. SETTING Deakin University's School of Medicine, encompassing 3 rural and 2 metropolitan clinical schools, including a rural longitudinal integrated clerkship (LIC) year. PARTICIPANTS A total of 948 School of Medicine medical graduates (2011-2018) who had an Australian Health Practitioners Regulation Agency registered work location in Australia (September 2019). MAIN OUTCOME MEASURE(S) Graduates' work locations were linked with admission and clinical school training data and analysed for significant associations. RESULTS Graduates completing a rural LIC year and a regional rural clinical school year were 7 times more likely to be working rurally than metropolitan trainees. A small number of rural background (RB) students completed a rural LIC and rural clinical school year, 66.7% of whom were practising rurally. Further associations with rural practice were attending a rural clinical school for 2 years or a rural LIC for 1 year, student having a RB, rurally bonded course placement and being an international student. CONCLUSION The significant influence of a rural LIC year on graduate rural work location is noteworthy, especially when undertaken by students from a RB in combination with a second regional rural clinical school year. These findings support the strategic alignment of rural student selection with rural clinical school training pathways to achieve the greatest impact on rural graduate workforce outcomes.
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Affiliation(s)
- Lara Fuller
- School of Medicine, Deakin University, Geelong, Vic., Australia
| | - Jessica Beattie
- School of Medicine, Deakin University, Warrnambool, Vic., Australia
| | - Vincent Versace
- Deakin Rural Health, Deakin University, Warrnambool, Vic., Australia
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Raftery D, Isaac V, Walters L. Factors associated with medical students' interest in remote and very remote practice in Australia: A national study. Aust J Rural Health 2021; 29:34-40. [PMID: 33556203 PMCID: PMC7986186 DOI: 10.1111/ajr.12694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 11/12/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the factors that are associated with medical student interest in remote and very remote practice in Australia. Design Aggregated data of an annual cross‐sectional survey from 2013 to 2017. Setting Australia. Participants Medical students from 17 medical schools, at the point of finishing one year of clinical training in a rural or remote location in Australia. Main outcome measures Intention for working in a remote or very remote location as a doctor. Results Responses were analysed from 3328 medical students. From this cohort, 37.6%, 54.0% and 7.0% of students reported future career intent in capital or major cities; regional Australia; and remote or very remote Australia respectively. Multivariable analysis indicated students interested in remote and very remote practice compared to those interested in regional practice were more likely to be from a rural background, have prior generalist intentions, felt as though their rural clinical school (RCS) experience increased interest in remote and very remote practice, and had higher rural practice self‐efficacy. Odds ratios were larger for these factors when students interested in remote or very remote practice were compared with students interested in practicing in capital or major cities. Conclusions Rural background, prior generalist intentions, rural practice self‐efficacy and the overall influence of the RCS experience are associated with interest in remote and very remote practice.
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Affiliation(s)
- Dylan Raftery
- Flinders University School of Medicine, Bedford Park, SA, Australia
| | - Vivian Isaac
- Flinders Rural Health South Australia, Flinders University, Renmark, SA, Australia
| | - Lucie Walters
- Adelaide Rural Clinical School, University of Adelaide, Mount Gambier, SA, Australia
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O'Sullivan B, Chater B, Bingham A, Wynn-Jones J, Couper I, Hegazy NN, Kumar R, Lawson H, Martinez-Bianchi V, Randenikumara S, Rourke J, Strasser S, Worley P. A Checklist for Implementing Rural Pathways to Train, Develop and Support Health Workers in Low and Middle-Income Countries. Front Med (Lausanne) 2020; 7:594728. [PMID: 33330559 PMCID: PMC7729061 DOI: 10.3389/fmed.2020.594728] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/30/2020] [Indexed: 12/11/2022] Open
Abstract
Background: There is an urgent need to scale up global action on rural workforce development. This World Health Organization-sponsored research aimed to develop a Rural Pathways Checklist. Its purpose was to guide the practical implementation of rural workforce training, development, and support strategies in low and middle-income countries (LMICs). It was intended for any LMICs, stakeholder, health worker, context, or health problem. Method: Multi-methods involved: (1) focus group concept testing; (2) a policy analysis; (3) a scoping review of LMIC literature; (4) consultation with a global Expert Reference Group and; (5) field-testing over an 18-month period. Results: The Checklist included eight actions for implementing rural pathways in LMICs: establishing community needs; policies and partners; exploring existing workers and scope; selecting health workers; education and training; working conditions for recruitment and retention; accreditation and recognition of workers; professional support/up-skilling and; monitoring and evaluation. For each action, a summary of LMICs-specific evidence and prompts was developed to stimulate reflection and learning. To support implementation, rural pathways exemplars from different WHO regions were also compiled. Field-testing showed the Checklist is fit for purpose to guide holistic planning and benchmarking of rural pathways, irrespective of LMICs, stakeholder, or health worker type. Conclusion: The Rural Pathways Checklist provides an agreed global conceptual framework for the practical implementation of "grow your own" strategies in LMICs. It can be applied to scale-up activity for rural workforce training and development in LMICs, where health workers are most limited and health needs are greatest.
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Affiliation(s)
- Belinda O'Sullivan
- Faculty of Medicine, Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia
| | - Bruce Chater
- Faculty of Medicine, Rural Clinical School, University of Queensland, Theodore, QLD, Australia
| | - Amie Bingham
- Faculty of Medicine, Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia
| | - John Wynn-Jones
- Keele Medical School, Keele University, Keele, United Kingdom
| | - Ian Couper
- Ukwanda Center for Rural Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Nagwa Nashat Hegazy
- Medical Education and Human Resources Center, Faculty of Medicine, Menoufia University, Shibin el Kom, Egypt
| | - Raman Kumar
- Family Medicine Practitioner, DOC24 Family Practice Clinic, Ghaziabad, India
| | - Henry Lawson
- Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | | | - James Rourke
- Center for Rural Health Studies, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Sarah Strasser
- Faculty of Medicine, Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia
| | - Paul Worley
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Stupart D, Beattie J, Lawson M, Watters D, Fuller L. Medical Students Can Learn Surgery Effectively in a Rural Longitudinal Integrated Clerkship. J Surg Educ 2020; 77:1407-1413. [PMID: 32451311 DOI: 10.1016/j.jsurg.2020.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/11/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND At Deakin University School of Medicine, compulsory formal teaching in Surgery occurs in year 3. This may occur as part of a rural longitudinal integrated clerkship (LIC), or in a traditional teaching hospital block rotation (BR). The purpose of this study was to compare these groups' exposure to surgical common conditions and their academic outcomes. METHODS Part I: This was a survey of students' encounters with patients with common surgical conditions between 2016 and 2018. Self-reported data were collected describing the nature of the encounters and their clinical settings. Part II: All third year Surgery MCQ and OSCE results from 2011 to 2017 were analyzed. Students were deidentified and grouped according to whether they were in the LIC or BR programme. RESULTS Part I: Thirty-eight third year students (20 LIC, 18 BR) submitted data for a total of 188 clinical encounters. Both groups encountered all nominated common surgical conditions, but the settings in which this occurred were different. BR students saw most patients as hospital inpatients whereas LIC student encounters were distributed across multiple clinical sites. Part II: A total of 942 (121 [26%] LIC and 821 [74%] BR) students' assessment results were analyzed. The groups performed similarly in the MCQ (p = 0.21) and OSCE (p = 0.16) examinations. CONCLUSIONS Students who were taught surgery in a LIC program performed similarly to on their final exams to their peers in traditional clerkships, with self-reported student data indicating both groups encountered a similar range of conditions.
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Affiliation(s)
- Douglas Stupart
- Department of Surgery, Deakin University, Geelong, Australia.
| | - Jessica Beattie
- Rural Community Clinical School, Deakin University, Geelong, Australia
| | - Mary Lawson
- School of Medicine, Deakin University, Geelong, Australia
| | - David Watters
- Department of Surgery, Deakin University, Geelong, Australia
| | - Lara Fuller
- Rural Community Clinical School, Deakin University, Geelong, Australia
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McGrail MR, O'Sullivan BG, Russell DJ, Rahman M. Exploring preference for, and uptake of, rural medical internships, a key issue for supporting rural training pathways. BMC Health Serv Res 2020; 20:930. [PMID: 33032604 PMCID: PMC7543036 DOI: 10.1186/s12913-020-05779-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/30/2020] [Indexed: 11/12/2022] Open
Abstract
Background Improved medical care access for rural populations continues to be a major concern. There remains little published evidence about postgraduate rural pathways of junior doctors, which may have strong implications for a long-term skilled rural workforce. This exploratory study describes and compares preferences for, and uptake of, rural internships by new domestic and international graduates of Victorian medical schools during a period of rural internship position expansion. Methods We used administrative data of all new Victorian medical graduates’ location preference and accepted location of internship positions for 2013–16. Associations between preferred internship location and accepted internship position were explored including by rurality and year. Moreover, data were stratified between ‘domestic graduates’ (Australian and New Zealand citizens or permanent residents) and ‘international graduates’ (temporary residents who graduated from an Australian university). Results Across 2013–16, there were 4562 applicants who filled 3130 internship positions (46% oversubscribed). Domestic graduates filled most (69.7%, 457/656) rural internship positions, but significantly less than metropolitan positions (92.2%, p < 0.001). Only 20.1% (551/2737) included a rural location in their top five preferences, less than for international graduates (34.4%, p < 0.001). A greater proportion of rural compared with metropolitan interns accepted a position not in their top five preferences (36.1% versus 7.4%, p < 0.001). The proportion nominating a rural location in their preference list increased across 2013–2016. Conclusions The preferences for, and uptake of, rural internship positions by domestic graduates is sub-optimal for growing a rural workforce from local graduates. Current actions that have increased the number of rural positions are unlikely to be sufficient as a stand-alone intervention, thus regional areas must rely on international graduates. Strategies are needed to increase the attractiveness of rural internships for domestic students so that more graduates from rural undergraduate medical training are retained rurally. Further research could explore whether the uptake of rural internships is facilitated by aligning these positions with protected opportunities to continue vocational training in regionally-based or metropolitan fellowships. Increased understanding is needed of the factors impacting work location decisions of junior doctors, particularly those with some rural career intent.
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Affiliation(s)
- Matthew R McGrail
- Rural Clinical School, The University of Queensland, Cnr Cambridge & Canning Street, Rockhampton, Queensland, 4700, Australia.
| | - Belinda G O'Sullivan
- School of Rural Health, Monash University, PO BOX 666, Bendigo, Victoria, 3550, Australia.,Rural Clinical School, The University of Queensland, 152 West St, South Toowoomba, Queensland, 4350, Australia
| | - Deborah J Russell
- Menzies School of Health Research, PO BOX 4066, Alice Springs, Northern Territory, 0870, Australia
| | - Muntasirur Rahman
- Rural Clinical School, The University of Queensland, 152 West St, South Toowoomba, Queensland, 4350, Australia
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Paynter JA, O'Sullivan BG. Preferences and pathways of the next generation of rural doctors. Aust J Rural Health 2020; 28:309-310. [DOI: 10.1111/ajr.12629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/06/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jessica A. Paynter
- Australia Medical Students’ Association of Rural Health Barton ACT Australia
- School of Rural Health ‐ Bendigo Monash University Bendigo Vic. Australia
| | - Belinda G. O'Sullivan
- School of Rural Health ‐ Bendigo Monash University Bendigo Vic. Australia
- The University of Queensland Rural Clinical School Toowoomba QLD Australia
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Wu H, Pei L, Li S, Jiang C. Medical career expectations of academically talented high school students: a nationwide cross-sectional study in China. BMC Med Educ 2020; 20:166. [PMID: 32448157 PMCID: PMC7247248 DOI: 10.1186/s12909-020-02083-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 05/17/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND Academically talented high school students (ATHSSs), an exceptional cohort, are not well studied for their career expectations, especially for those with medical career expectation (MCE). Nowadays, the public perception of the medical profession is changing in China. The purpose of this study was to answer questions about 'is medicine attractive for ATHSSs and 'what factors affect medical career expectations (MCE) for ATHSSs' in China. METHODS A total of 16,479 representative ATHSSs in senior three completed a questionnaire and four different academic tests. Frequency statistics showed the proportion of ATHSSs with MCE. Unpaired t-tests were performed to find out the differences in demographics, family background, and academic performance between students with and without MCE. The logit models analysis were applied to explore the potential factors that affected the MCE of this exceptional group of students. RESULTS ATHSSs with MCE accounted for 20.6% (ranking 7/18) of the respondents. They were more likely to be female, came from relatively poorer families, lived in a rural area, and performed significantly worse in all academic tests except for mathematics, compared with those without MCE. In addition, the results revealed that gender (β = - 0.436, p < 0.01), region of hometown (β = - 103, p < 0.1), mother's years of schooling (β = - 0.019, p < 0.05), and father's occupational status (β = - 0.005, p < 0.01) contributed significantly to the MCE of academically talented students. Better performance in mathematics affected the MCE of ATHSSs taking the liberal arts and science tests differently. CONCLUSIONS We found the medical career is becoming unattractive to academically talented students and the medical career may be losing their aura in China. Students who have medical career expectations are likely to be females and to have a weak family background.
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Affiliation(s)
- Hongbin Wu
- Institute of Medical Education/National center for Health Professions Education Development, Peking University, Beijing, China
| | - Leisi Pei
- Faculty of Education, The University of Hong Kong, Hong Kong SAR, China
| | - Shan Li
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Cheng Jiang
- Peking University, Graduate School of Education, No.5 Yiheyuan Road, Haidian District, Beijing, 100871, China.
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O'Sullivan BG, McGrail MR. Effective dimensions of rural undergraduate training and the value of training policies for encouraging rural work. Med Educ 2020; 54:364-374. [PMID: 32227376 DOI: 10.1111/medu.14069] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 05/05/2023]
Abstract
CONTEXT The implementation of rural undergraduate medical education can be improved by collecting national evidence about the aspects of these programmes that work well and the value of investing in national policies. OBJECTIVES This study aimed to explore how different durations, degree of remoteness and number of rural undergraduate medical training placements relate to working rurally, and to investigate differences after the introduction of formal national training policies that fund short- and long-term rural training experiences for medical students. METHODS A cohort of 6510 Australian-trained doctors who completed the Medicine in Australia: Balancing Employment and Life survey recalled their participation in rural undergraduate medical training. Responses were categorised by duration, remoteness as defined by the Modified Monash Model levels 3-4 and 4-7 compared with 1, and total number of placements. Multivariate regression was used to test associations with working rurally in 2017, and differences between cohorts of students who graduated pre- and post-2000, of which the latter were exposed to formal national training policies. RESULTS Any rural undergraduate training was associated with working rurally (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.3-1.9) with incrementally stronger associations for longer duration (>1 year: OR 3.0, 95% CI 2.3-4.0), greater remoteness (OR 1.8, 95% CI 1.5-2.1) and three placements (OR 2.4, 95% CI 1.9-3.0) compared with none. Rural background (OR 2.6, 95% CI 2.3-3.0) and general practice (OR 2.6, 95% CI 2.2-2.9) were independently associated with working rurally; being female was negatively associated with rural work (OR 0.7, 95% CI 0.6-0.8). The cohort of doctors who trained in a period when national rural training policies had been implemented included more graduates with a rural background and experience of undergraduate rural training but returned equivalent proportions of rural doctors to pre-policy cohorts, and included proportionally more women and fewer general practitioners. CONCLUSIONS Rural undergraduate training should focus on multiple dimensions of duration, remoteness and number of rural undergraduate training experiences to grow the rural medical workforce. Formal national rural training policies may be an important part of the broader system for rural workforce development, but they rely on the uptake of general practice and the participation of female doctors in rural medicine.
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Affiliation(s)
- Belinda G O'Sullivan
- Rural Clinical School, University of Queensland, Toowoomba DC, Queensland, Australia
| | - Matthew R McGrail
- Rural Clinical School, University of Queensland, Rockhampton, Queensland, Australia
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Bartlett M, Couper I, Poncelet A, Worley P. The do's, don'ts and don't knows of establishing a sustainable longitudinal integrated clerkship. Perspect Med Educ 2020; 9:5-19. [PMID: 31953655 PMCID: PMC7012799 DOI: 10.1007/s40037-019-00558-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
INTRODUCTION The longitudinal integrated clerkship is a model of clinical medical education that is increasingly employed by medical schools around the world. These guidelines are a result of a narrative review of the literature which considered the question of how to maximize the sustainability of a new longitudinal integrated clerkship program. METHOD All four authors have practical experience of establishing longitudinal integrated clerkship programs. Each author individually constructed their Do's, Don'ts and Don't Knows and the literature that underpinned them. The lists were compiled and revised in discussion and a final set of guidelines was agreed. A statement of the strength of the evidence is included for each guideline. RESULTS The final set of 18 Do's, Don'ts and Don't Knows is presented with an appraisal of the evidence for each one. CONCLUSION Implementing a longitudinal integrated clerkship is a complex process requiring the involvement of a wide group of stakeholders in both hospitals and communities. The complexity of the change management processes requires careful and sustained attention, with a particular focus on the outcomes of the programs for students and the communities in which they learn. Effective and consistent leadership and adequate resourcing are important. There is a need to select teaching sites carefully, involve students and faculty in allocation of students to sites and support students and faculty though the implementation phase and beyond. Work is needed to address the Don't Knows, in particular the question of how cost-effectiveness is best measured.
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Affiliation(s)
- Maggie Bartlett
- Education in General Practice, Dundee University School of Medicine, Dundee, UK.
| | - Ian Couper
- Faculty of Medicine and Health Sciences, Ukwanda Centre for Rural Health, Stellenbosch University, Stellenbosch, South Africa
| | - Ann Poncelet
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Paul Worley
- Department of Health, GPO Box 9848, 2601, Canberra, Australian Capital Territory, Australia
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McGrail MR, O’Sullivan BG, Russell DJ. Rural Work and Specialty Choices of International Students Graduating from Australian Medical Schools: Implications for Policy. Int J Environ Res Public Health 2019; 16:E5056. [PMID: 31835846 PMCID: PMC6950190 DOI: 10.3390/ijerph16245056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 11/21/2022]
Abstract
Almost 500 international students graduate from Australian medical schools annually, with around 70% commencing medical work in Australia. If these Foreign Graduates of Accredited Medical Schools (FGAMS) wish to access Medicare benefits, they must initially work in Distribution Priority Areas (mainly rural). This study describes and compares the geographic and specialty distribution of FGAMS. Participants were 18,093 doctors responding to Medicine in Australia: Balancing Employment and Life national annual surveys, 2012-2017. Multiple logistic regression models explored location and specialty outcomes for three training groups (FGAMS; other Australian-trained (domestic) medical graduates (DMGs); and overseas-trained doctors (OTDs)). Only 19% of FGAMS worked rurally, whereas 29% of Australia's population lives rurally. FGAMS had similar odds of working rurally as DMGs (OR 0.93, 0.77-1.13) and about half the odds of OTDs (OR 0.48, 0.39-0.59). FGAMS were more likely than DMGs to work as general practitioners (GPs) (OR 1.27, 1.03-1.57), but less likely than OTDs (OR 0.74, 0.59-0.92). The distribution of FGAMS, particularly geographically, is sub-optimal for improving Australia's national medical workforce goals of adequate rural and generalist distribution. Opportunities remain for policy makers to expand current policies and develop a more comprehensive set of levers to promote rural and GP distribution from this group.
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Affiliation(s)
- Matthew R. McGrail
- Rural Clinical School, The University of Queensland, Rockhampton 4700, Australia;
| | - Belinda G. O’Sullivan
- Rural Clinical School, The University of Queensland, Rockhampton 4700, Australia;
- School of Rural Health, Monash University, Bendigo, 3550, Australia
| | - Deborah J. Russell
- Northern Territory Medical Program, Flinders University, Darwin 800, Australia;
- Menzies School of Health Research, Darwin 800, Australia
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Shulruf B, Velan G, Forster L, O’Sullivan A, Harris P, Taylor S. Insights into student assessment outcomes in rural clinical campuses. BMC Med Educ 2019; 19:380. [PMID: 31627749 PMCID: PMC6798341 DOI: 10.1186/s12909-019-1828-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND There is an ongoing debate about the impact of studying medicine in rural vs. metropolitan campuses on student assessment outcomes. The UNSW Medicine Rural Clinical School has five main campuses; Albury-Wodonga, Coffs Harbour, Griffith, Port Macquarie and Wagga Wagga. Historical data of student assessment outcomes at these campuses raised concerns regarding potential biases in assessment undertaken, as well as the availability and quality of learning resources. The current study aims to identify the extent to which the location of examination (rural versus metropolitan) has an impact on student marks in OSCEs. METHODS Assessment data was employed for this study from 275 medical students who sat their final examinations in Years 3 and 6 of the undergraduate Medicine program at UNSW in 2018. The data consists of matched student assessment results from the Year 3 (Y3) MCQ examination and OSCE, and from the Year 6 (Y6) MCQ, OSCE and management viva examinations. The analysis used Univariate Analysis of Variance and linear regression models to identify the impact of site of learning and site of examination on assessment outcomes. RESULTS The results demonstrate that neither site of learning nor site of examination had any significant impact on OSCE or Management Viva assessment outcomes while potential confounders are controlled. CONCLUSION It is suggested that some of the supposed disadvantages inherent at rural campuses are effectively mitigated by perceived advantages; more intensive interaction with patients, the general and medical communities at those sites, as well as effective e-learning resources and moderation of assessment grades.
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Affiliation(s)
- Boaz Shulruf
- Office of Medical Education, University of New South Wales, Sydney, 2052 Australia
| | - Gary Velan
- Office of Medical Education, University of New South Wales, Sydney, 2052 Australia
| | - Lesley Forster
- Office of Medical Education, University of New South Wales, Sydney, 2052 Australia
| | - Anthony O’Sullivan
- Office of Medical Education, University of New South Wales, Sydney, 2052 Australia
| | - Peter Harris
- Office of Medical Education, University of New South Wales, Sydney, 2052 Australia
| | - Silas Taylor
- Office of Medical Education, University of New South Wales, Sydney, 2052 Australia
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Sidibé CS, Touré O, Broerse JEW, Dieleman M. Rural pipeline and willingness to work in rural areas: Mixed method study on students in midwifery and obstetric nursing in Mali. PLoS One 2019; 14:e0222266. [PMID: 31498819 PMCID: PMC6733462 DOI: 10.1371/journal.pone.0222266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/25/2019] [Indexed: 11/18/2022] Open
Abstract
The availability and retention of healthcare professionals in rural areas and remote areas is a challenge to the health sector worldwide. Attracting people who are most likely to be interested in rural practice can be conducive to the sustainable availability of health services in rural areas where health facilities are typically understaffed and existing professionals often underqualified. This article aims to contribute to the rural pipeline evidence, and reports on the findings of a study that investigated the career choices of midwifery and obstetric nurse students in Mali. The article enquires into the relationship between their intention to practice in rural areas and the different components of the rural pipeline. A mixed method study using a survey, semi-structured interviews, and document analysis was conducted from October to December 2017 on third-year midwifery and obstetric nurse students and school-managers. Descriptive statistics and bivariate analysis were performed for quantitative data, and content analysis was carried out for the qualitative data. Key findings suggest that students prefer urban locations for living and for work. The intention to work in rural areas seems to be influenced by the current living situation (currently living in a rural area) or having attended secondary school or professional training in rural areas.
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Affiliation(s)
- Cheick Sidya Sidibé
- Institut National de Formation en Sciences de la Santé, Bamako, Mali
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands
- * E-mail:
| | - Ousmane Touré
- Institut National de Formation en Sciences de la Santé, Bamako, Mali
| | - Jacqueline E. W. Broerse
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Marjolein Dieleman
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands
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Worley PS, O'Sullivan B, Ellis R. From locum-led outposts to locally led continuous rural training networks: the National Rural Generalist Pathway. Med J Aust 2019; 211:57-59.e1. [PMID: 31250926 DOI: 10.5694/mja2.50225] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Paul S Worley
- Office of the National Rural Health Commissioner, Adelaide, SA.,Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, SA
| | - Belinda O'Sullivan
- Office of the National Rural Health Commissioner, Adelaide, SA.,School of Rural Health, Monash University, Bendigo, VIC
| | - Rose Ellis
- Office of the National Rural Health Commissioner, Adelaide, SA
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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. Med Teach 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Young L, Peel R, O'Sullivan B, Reeve C. Building general practice training capacity in rural and remote Australia with underserved primary care services: a qualitative investigation. BMC Health Serv Res 2019; 19:338. [PMID: 31138189 PMCID: PMC6537426 DOI: 10.1186/s12913-019-4078-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/08/2019] [Indexed: 11/10/2022] Open
Abstract
Background Australians living in rural and remote areas have access to considerably fewer doctors compared with populations in major cities. Despite plentiful, descriptive data about what attracts and retains doctors to rural practice, more evidence is needed which informs actions to address these issues, particularly in remote areas. This study aimed to explore the factors influencing General Practitioners (GPs), primary care doctors, and those training to become GPs (registrars) to work and train in remote underserved towns to inform the building of primary care training capacity in areas needing more primary care services (and GP training opportunities) to support their population’s health needs. Methods A qualitative approach was adopted involving a series of 39 semi-structured interviews of a purposeful sample of 14 registrars, 12 supervisors, and 13 practice managers. Fifteen Australian Medical Graduates (AMG) and eleven International Medical Graduates (IMG), who did their basic medical training in another country, were among the interviewees. Data underwent thematic analysis. Results Four main themes were identified including 1) supervised learning in underserved communities, 2) impact of working in small, remote contexts, 3) work-life balance, and 4) fostering sustainable remote practice. Overall, the findings suggested that remote GP training provides extensive and safe registrar learning opportunities and supervision is generally of high quality. Supervisors also expressed a desire for more upskilling and professional development to support their retention in the community as they reach mid-career. Registrars enjoyed the challenge of remote medical practice with opportunities to work at the top of their scope of practice with excellent clinical role models, and in a setting where they can make a difference. Remote underserved communities contribute to attracting and retaining their GP workforce by integrating registrars and supervisors into the local community and ensuring sustainable work-life practice models for their doctors. Conclusions This study provides important new evidence to support development of high-quality GP training and supervision in remote contexts where there is a need for more GPs to provide primary care services for the population.
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Affiliation(s)
- Louise Young
- College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, QLD, 4811, Australia.
| | - Raquel Peel
- College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, QLD, 4811, Australia
| | | | - Carole Reeve
- College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, QLD, 4811, Australia
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Bartlett M, Dowell J, Graham F, Knight K, Law S, Lockwood P, Muir F, Robson J, Watson E. Dundee’s Longitudinal Integrated Clerkship: drivers, implementation and early evaluation. Education for Primary Care 2019; 30:72-79. [DOI: 10.1080/14739879.2018.1564889] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Jon Dowell
- University of Dundee School of Medicine, Dundee, UK
| | | | - Kara Knight
- University of Dundee School of Medicine, Dundee, UK
| | - Susan Law
- University of Dundee School of Medicine, Dundee, UK
| | | | - Fiona Muir
- University of Dundee School of Medicine, Dundee, UK
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McGrail MR, O’Sullivan BG, Russell DJ. Rural training pathways: the return rate of doctors to work in the same region as their basic medical training. Hum Resour Health 2018; 16:56. [PMID: 30348164 PMCID: PMC6198494 DOI: 10.1186/s12960-018-0323-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/10/2018] [Indexed: 05/28/2023]
Abstract
BACKGROUND Limited evidence exists about the extent to which doctors are returning to rural region(s) where they had previously trained. This study aims to investigate the rate at which medical students who have trained for 12 months or more in a rural region return to practice in that same region in their early medical career. A secondary aim is to investigate whether there is an independent or additional association with the effect of longer duration of rural exposure in a region (18-24 months) and for those completing both schooling and training in the same rural region. METHODS The outcome was rural region of work, based on postcode of work location in 2017 for graduates spanning 1-9 years post-graduation, for one large medical program in Victoria, Australia. Region of rural training, combined with region of secondary schooling and duration of rural training, was explored for its association with region of practice. A multinomial logistic regression model, accounting for other covariates, measured the strength of association with practising in the same rural region as where they had trained. RESULTS Overall, 357/2451 (15%) graduates were working rurally, with 90/357 (25%) working in the same rural region as where they did rural training. Similarly, 41/170 (24%) were working in the same region as where they completed schooling. Longer duration (18-24 vs 12 months) of rural training (relative risk ratio, RRR, 3.37, 1.89-5.98) and completing both schooling and training in the same rural region (RRR: 4.47, 2.14-9.36) were associated with returning to practice in the same rural region after training. CONCLUSIONS Medical graduates practising rurally in their early career (1-9 years post-graduation) are likely to have previous connections to the region, through either their basic medical training, their secondary schooling, or both. Social accountability of medical schools and rural medical workforce outcomes could be improved by policies that enable preferential selection and training of prospective medical students from rural regions that need more doctors, and further enhanced by longer duration of within-region training.
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Affiliation(s)
- Matthew R. McGrail
- University of Queensland, Rural Clinical School, 78 on Canning Street, Rockhampton, QLD 4700 Australia
| | - Belinda G. O’Sullivan
- Monash Rural Health, Monash University, 26 Mercy Street, Bendigo, VIC 3550 Australia
| | - Deborah J. Russell
- Flinders University, Northern Territory, PO Box 41326, Casuarina, NT 0815 Australia
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Affiliation(s)
- Lisa Graves
- Department of Family and Community Medicine, Western Michigan University, Kalamazoo, Michigan, USA
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