Sydney Medical School, University of Sydney, Sydney, NSW, 2050, Australia.
Concord Clinical School, University of Sydney, Sydney, Australia.
BMC Med Educ. 2018 Aug 14;18(1):196. doi: 10.1186/s12909-018-1287-y.
Significant investment has been undertaken by many countries into 'Rural Clinical Training Placement Schemes' for medical students in order to deal with shortages of trained health care professionals in rural and remote locations. This systematic review examines the evidence base of rural educational programs within medical education and focusses on workforce intentions and employment outcomes. The study provides a detailed description of the methodological characteristics of the literature, thematic workforce outcomes and key related factors are identified, study quality is assessed, and the findings are compared within an international context.
A systematic review looking at international literature of rural placement programs within medical education between January 2005 to January 2017 from databases including; Medline, Embase, NursingOVID, PubMed and Cochrane. The study adopted the PRISMA protocol. A quality assessment of the literature was conducted based on the Health Gains Notation Framework.
Sixty two papers met the inclusion criteria. The review identified three program classifications; Rural Clinical Placement Programs, Rural Clinical Placement Programs combined with a rural health educational curriculum component and Rural Clinical School Programs. The studies included were from Australia, United States, Canada, New Zealand, Thailand and Africa. Questionnaires and tracking or medical registry databases were the most commonly reported research tools and the majority were volunteer programs. Most studies identified potential rural predictors/confounders, however a number did not apply control groups and most programs were based on a single site. There was a clear discrepancy in the ideal rural clinical placement length. Outcomes themes were identified related to rural workforce outcomes. Most studies reported that an organised, well-funded, rural placement or rural clinical school program produced positive associations with increased rural intentions and actual graduate rural employment.
Future research should focus on large scale methodologically rigorous multi-site rural program studies, with longitudinal follow up of graduates working locations. Studies should apply pre-and post-intervention surveys to measure change in attitudes and control for predictive confounders, control groups should be applied; and in-depth qualitative research should be considered to explore the specific factors of programs that are associated with encouraging rural employment.
为了应对农村和偏远地区合格医疗保健专业人员短缺的问题，许多国家都对医学生的“农村临床培训计划”进行了大量投资。本系统评价审查了医学教育中农村教育计划的证据基础，并侧重于劳动力意向和就业结果。该研究详细描述了文献的方法学特征，确定了主题性劳动力结果和关键相关因素，评估了研究质量，并在国际背景下进行了比较。
对 2005 年 1 月至 2017 年 1 月期间医学教育中农村实习计划的国际文献进行系统评价，文献来源包括 Medline、Embase、NursingOVID、PubMed 和 Cochrane。该研究采用 PRISMA 方案。根据健康收益标注框架对文献进行质量评估。
有 62 篇论文符合纳入标准。该综述确定了三种计划分类；农村临床实习计划、农村临床实习计划与农村卫生教育课程部分相结合的计划和农村临床学校计划。研究对象来自澳大利亚、美国、加拿大、新西兰、泰国和非洲。问卷调查和跟踪或医学登记数据库是最常用的研究工具，大多数计划是志愿者计划。大多数研究确定了潜在的农村预测因素/混杂因素，但有些研究没有应用对照组，而且大多数计划都是基于单一地点。农村临床实习的理想长度存在明显差异。确定了与农村劳动力结果相关的结果主题。大多数研究报告称，组织良好、资金充足的农村实习或农村临床学校计划与增加农村意向和实际毕业生农村就业之间存在积极关联。
未来的研究应侧重于大规模、方法严谨、多地点的农村计划研究，并对毕业生的工作地点进行纵向随访。研究应在干预前后进行调查，以衡量态度的变化，并控制预测性混杂因素，应应用对照组；应考虑深入的定性研究，以探讨与鼓励农村就业相关的计划的具体因素。
