1
|
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.
Collapse
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
| |
Collapse
|
2
|
Il'Giovine ZJ, Higgins A, Rali AS, Abdul-Aziz AA, Lee R. Training Pathways in Critical Care Cardiology: Competencies and Considerations for Cardiologists. Curr Cardiol Rep 2023; 25:1381-1387. [PMID: 37695412 DOI: 10.1007/s11886-023-01952-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE OF REVIEW Critical care cardiology (CCC) is a rapidly developing field undergoing a renaissance of interest and growth to meet the well-documented population shift in the cardiac intensive care unit (CICU). With this has come the emergence of novel training paradigms that seek to combine specialties with meaningful overlap. RECENT FINDINGS The benefit of having critical care expertise in the CICU has been clearly established; however, there is no formal or uniform CCC training pathway. Contemporary approaches seek to provide appropriate clinical and procedural experience while minimizing opportunity cost. The combination of additional cardiology subspecialties, specifically advanced heart failure or interventional cardiology, has been demonstrated. Educational tracks that integrate critical care training have generated interest but have not yet manifested. CCC training strives to meet the needs of an increasingly sick and diverse patient population while preparing trainees for fulfilling and meaningful careers. The hope is for ongoing development of novel training pathways to satisfy evolving needs.
Collapse
Affiliation(s)
- Zachary J Il'Giovine
- Centennial Heart, Tristar Centennial Medical Center, 2400 Patterson St Ste 502, Nashville, TN, 37203, USA.
| | - Andrew Higgins
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Aniket S Rali
- Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ahmad A Abdul-Aziz
- Inova Fairfax Medical Center, Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - Ran Lee
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| |
Collapse
|
3
|
McGrail MR, Gurney T, Fox J, Martin P, Eley D, Nasir B, Kondalsamy-Chennakesavan S. Rural medical workforce pathways: exploring the importance of postgraduation rural training time. Hum Resour Health 2023; 21:31. [PMID: 37081430 PMCID: PMC10120195 DOI: 10.1186/s12960-023-00819-3] [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: 11/24/2022] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Inadequate distribution of the medical workforce in rural regions remains a key global challenge. Evidence of the importance of postgraduation (after medical school) rural immersion time and subsequent rural practice, particularly after accounting for other key factors, remains limited. This study investigated the combined impact of three key training pathway factors: (1) rural background, (2) medical school rural immersion, and (3) postgraduation rural immersion, and duration time of each immersion factor on working rurally. METHODS Data from a cross-sectional national survey and a single university survey of Australian doctors who graduated between 2000 to 2018, were utilised. Key pathway factors were similarly measured. Postgraduation rural training time was both broad (first 10 years after medical school, national study) and specific (prevocational period, single university). This was firstly tested as the dependent variable (stage 1), then matched against rural practice (stage 2) amongst consultant doctors (national study, n = 1651) or vocational training doctors with consultants (single university, n = 478). RESULTS Stage 1 modelling found rural background, > 1 year medical school rural training, being rural bonded, male and later choosing general practice were associated with spending a higher proportion (> 40%) of their postgraduation training time in a rural location. Stage 2 modelling revealed the dominant impact of postgraduation rural time on subsequent rural work for both General Practitioners (GPs) (OR 45, 95% CI 24 to 84) and other specialists (OR 11, 95% CI 5-22) based on the national dataset. Similar trends for both GPs (OR 3.8, 95% CI 1.6-9.1) and other specialists (OR 2.8, 95% CI 1.3-6.4) were observed based on prevocational time only (single university). CONCLUSIONS This study provides new evidence of the importance of postgraduation rural training time on subsequent rural practice, after accounting for key factors across the entire training pathway. It highlights that developing rural doctors aligns with two distinct career periods; stage 1-up to completing medical school; stage 2-after medical school. This evidence supports the need for strengthened rural training pathways after medical school, given its strong association with longer-term decisions to work rurally.
Collapse
Affiliation(s)
- Matthew R. McGrail
- Rural Clinical School, The University of Queensland, Rockhampton, QLD 4700 Australia
| | - Tiana Gurney
- Rural Clinical School, The University of Queensland, Toowoomba, QLD 4350 Australia
| | - Jordan Fox
- Rural Clinical School, The University of Queensland, Rockhampton, QLD 4700 Australia
| | - Priya Martin
- Rural Clinical School, The University of Queensland, Toowoomba, QLD 4350 Australia
| | - Diann Eley
- Academy for Medical Education, The University of Queensland, Herston, QLD 4006 Australia
| | - Bushra Nasir
- Rural Clinical School, The University of Queensland, Toowoomba, QLD 4350 Australia
| | | |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Eley DS, Jensen C, Thomas R, Benham H. What will it take? Pathways, time and funding: Australian medical students' perspective on clinician-scientist training. BMC Med Educ 2017; 17:242. [PMID: 29216896 PMCID: PMC5721615 DOI: 10.1186/s12909-017-1081-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 01/27/2017] [Accepted: 11/21/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND Clinician-scientists are in decline worldwide. They represent a unique niche in medicine by bridging the gap between scientific discovery and patient care. A national, integrated approach to training clinician-scientists, typically programs that comprise a comprehensive MD-PhD pathway, are customary. Such a pathway is lacking in Australia. The objective was to gather perceptions from Australian medical students on factors they perceive would influence their decision to pursue clinician-scientist training. METHODS A cross-sectional mixed methods design used quantitative and qualitative questions in an online self-report survey with medical students from a four-year MD program. Quantitative measures comprised scaled response questions regarding prior experience and current involvement in research, and short- and long-term opinions about factors that influence their decisions to undertake a research higher degree (RHD) during medical school. Qualitative questions gathered broader perceptions of what a career pathway as a clinician-scientist would include and what factors are most conducive to a medical student's commitment to MD-PhD training. RESULTS Respondents (N = 418; 51% female) indicated Time, Funding and Pathway as the major themes arising from the qualitative data, highlighting negative perceptions rather than possible benefits to RHD training. The lack of an evident Pathway was inter-related to Time and Funding. Themes were supported by the quantitative data. Sixty percent of students have previous research experience of varying forms, and 90% report a current interest, mainly to improve their career prospects. CONCLUSIONS The data emphasise the need for an MD-PhD pathway in Australia. A model that provides an early, integrated, and exclusive approach to research training pathways across all stages of medical education is suggested as the best way to rejuvenate the clinician-scientist. A national pathway that addresses factors influencing career decision making throughout the medical education continuum should include an appropriate funding structure, and provide early and continuing advice and mentoring. It should be flexible, gender equitable, and include post-graduate training. The implications of implementing MD-PhD programs represent a substantial investment. However this should not be a deterrent to Australia's commitment to an MD-PhD pathway, but rather a challenge to help ensure our future healthcare is guided by highly trained and competent clinician-scientists.
Collapse
Affiliation(s)
- Diann S. Eley
- Faculty of Medicine, The University of Queensland Office of Medical Education, 288 Herston Road, Brisbane, 4006 Queensland Australia
| | - Charmaine Jensen
- Faculty of Medicine, The University of Queensland Office of Medical Education, 288 Herston Road, Brisbane, 4006 Queensland Australia
| | - Ranjeny Thomas
- The University of Queensland, Translational Research Institute, Australian Academy of Health and Medical Sciences, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Helen Benham
- Department of Rheumatology, The University of Queensland, Diamantina Institute, Princess Alexandra Hospital and Translational Research Institute, Woolloongabba, Australia
| |
Collapse
|