Department of Psychology, Macquarie University, North Ryde, New South Wales, Australia.
Med Educ. 2009 Oct;43(10):1001-9. doi: 10.1111/j.1365-2923.2009.03506.x.
Using a novel longitudinal tracking project, this study develops and evaluates the performance of a predictive model and index of rural medical practice intention based on the characteristics of incoming medical students.
Medical school entry survey data were obtained from the Medical Schools Outcome Database (MSOD) project implemented in all Australian and New Zealand medical schools and coordinated through Medical Deans Australia and New Zealand, the representative body for the Deans of 18 Australian and two New Zealand medical schools and faculties. The medical school commencement survey collects data on students' education and family background, including rural upbringing, personal circumstances and scholarships, and on their practice intentions in terms of location and specialty. The MSOD will also allow tracking of medical graduates after graduation. Logistic regression modelling was used to develop a predictive model of rural practice intention. Split-sample validation was used to gain some insight into the stability of performance of the model.
Response rates to the MSOD survey exceeded 90% on average. The model findings confirm and extend previous research examining the association of medical student characteristics with intention to take up rural medical practice. The statistically significant independent factors in the model included students' rural backgrounds, financial arrangements and intentions regarding specialist versus generalist practice upon graduation. Model performance was good, with an area under the receiver-operator characteristics curve of 0.86, and reproducible, with an area in a validation sample of 0.83.
The model and related index provide important insights into individual factors associated with rural practice intention among students commencing medical studies. The model can also provide a means for optimising the use of scarce medical programme resources, thereby helping to improve the supply of rural medical practitioners. This study illustrates the power and potential of a robust, consistent, systematic longitudinal tracking project.
本研究利用一项新颖的纵向跟踪项目，针对入学医学生的特点，开发并评估基于农村医疗实践意向的预测模型和指标。
从澳大利亚和新西兰所有医学院校实施的医学学校成果数据库（MSOD）项目中获取医学院入学调查数据，该项目由代表 18 所澳大利亚和 2 所新西兰医学院院长的澳大利亚和新西兰医学院长协会协调。医学院开学调查收集了学生教育和家庭背景的数据，包括农村背景、个人情况和奖学金，以及他们在地点和专业方面的实践意向。MSOD 还将允许跟踪医学生毕业后的情况。使用逻辑回归建模来开发农村实践意向的预测模型。通过样本分割验证来了解模型性能的稳定性。
MSOD 调查的平均回复率超过 90%。模型结果证实并扩展了之前研究检验医学生特征与农村医疗实践意向之间关联的研究。模型中的独立显著因素包括学生的农村背景、财务安排以及毕业时对专科医生和全科医生实践的意向。模型性能良好，接收者操作特征曲线下的面积为 0.86，具有可重复性，验证样本的面积为 0.83。
该模型和相关指标为学生开始医学学习时与农村实践意向相关的个体因素提供了重要见解。该模型还可以为优化稀缺医疗项目资源的利用提供手段，从而有助于增加农村医疗从业者的供应。本研究说明了强大、一致、系统的纵向跟踪项目的力量和潜力。
