Monash University School of Rural Health, Bendigo, Victoria, Australia.
Med Educ. 2018 Aug;52(8):803-815. doi: 10.1111/medu.13578. Epub 2018 Apr 19.
Providing year-long rural immersion as part of the medical degree is commonly used to increase the number of doctors with an interest in rural practice. However, the optimal duration and setting of immersion has not been fully established. This paper explores associations between various durations and settings of rural immersion during the medical degree and whether doctors work in rural areas after graduation.
Eligible participants were medical graduates of Monash University between 2008 and 2016 in postgraduate years 1-9, whose characteristics, rural immersion information and work location had been prospectively collected. Separate multiple logistic regression and multinomial logit regression models tested associations between the duration and setting of any rural immersion they did during the medical degree and (i) working in a rural area and (ii) working in large or smaller rural towns, in 2017.
The adjusted odds of working in a rural area were significantly increased if students were immersed for one full year (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.15-2.79), for between 1 and 2 years (OR, 2.26; 95% CI, 1.54-3.32) and for 2 or more years (OR, 4.43; 95% CI, 3.03-6.47) relative to no rural immersion. The strongest association was for immersion in a mix of both regional hospitals and rural general practice (OR, 3.26; 95% CI, 2.31-4.61), followed by immersion in regional hospitals only (OR, 1.94; 95% CI, 1.39-2.70) and rural general practice only (OR, 1.91; 95% CI, 1.06-3.45). More than 1 year's immersion in a mix of regional hospitals and rural general practices was associated with working in smaller regional or rural towns (<50 000 population) (relative risk ratios [RRR] 2.97; 95% CI, 1.82-4.83).
These findings inform medical schools about effective rural immersion programmes. Longer rural immersion and immersion in both regional hospitals and rural general practices are likely to increase rural work and rural distribution of early career doctors.
将为期一年的农村沉浸作为医学学位的一部分，通常用于增加对农村实践感兴趣的医生数量。然而，沉浸的最佳持续时间和设置尚未完全确定。本文探讨了医学学位期间农村沉浸的各种持续时间和设置与毕业后是否在农村地区工作之间的关联。
合格的参与者是莫纳什大学在 2008 年至 2016 年期间的医学毕业生，他们的特征、农村沉浸信息和工作地点已经前瞻性收集。分别使用多项逻辑回归和多项逻辑回归模型测试了他们在医学学位期间进行的任何农村沉浸的持续时间和设置与（i）在农村地区工作和（ii）在大或小的农村城镇工作之间的关联。2017 年。
与没有农村沉浸相比，如果学生沉浸一年（优势比 [OR]，1.79；95%置信区间 [CI]，1.15-2.79）、1-2 年（OR，2.26；95%CI，1.54-3.32）和 2 年或更长时间（OR，4.43；95%CI，3.03-6.47），在农村地区工作的可能性显著增加。最强的关联是在区域医院和农村全科医生之间进行混合沉浸（OR，3.26；95%CI，2.31-4.61），其次是仅在区域医院进行沉浸（OR，1.94；95%CI，1.39-2.70）和仅在农村全科医生进行沉浸（OR，1.91；95%CI，1.06-3.45）。在区域医院和农村全科医生的混合环境中进行一年以上的沉浸与在较小的区域或农村城镇（<50 000 人口）工作（相对风险比 [RRR] 2.97；95%CI，1.82-4.83）相关。
这些发现为医学院提供了有关有效农村沉浸计划的信息。更长时间的农村沉浸以及在区域医院和农村全科医生的参与可能会增加农村地区的工作机会，并增加早期职业生涯医生在农村地区的分布。
