Starting rural, staying rural: how can we strengthen the pathway from rural upbringing to rural practice?

OBJECTIVE

To determine if selecting rural background students into the Monash Bachelor of Medicine and Bachelor of Surgery (MBBS) program affects vocational training location and intended practice location after training.

DESIGN

Retrospective cohort mail survey.

SETTING

Australia.

PARTICIPANTS

Rural-background students at Monash 1992-1994 (n=24/40) and 1995-1999 (n=59/120) and urban background students (n=36/93 and 104/300, respectively). Overall study population: 62% female, average age of 28 years; 79% Australian-born; and 60% married/partnered.

INTERVENTIONS

Rural or urban background, rural undergraduate exposure.

MAIN OUTCOME MEASURES

Intent towards rural medical practice, vocational training location and subsequent practice location.

RESULTS

There was a positive and significant (P ≤0.05) association between rural background and rural practice intent when respondents began (10-times higher than urban graduates) and completed (three times higher) their MBBS course. Rural practice intent increased fourfold in urban background graduates. There was a positive and significant association between rural background and preferred place of practice in 5-10 years in a Rural, Remote and Metropolitan Area (RRMA) 3-7 community (three times higher). There was a positive, but non-significant association between rural background and RRMA 3-7 community as their current location and first place of practice once vocationally qualified.

CONCLUSIONS

Interest in rural practice is not fully reflected in location during or after vocational training. The beneficial effects of rural undergraduate exposure might be lost if internship and vocational training programs provide insufficient rural clinical experiences and curriculum content. Continuation of the rural pathway might be needed to maintain rural practice intent.