College of Medicine & Dentistry, James Cook University, Townsville, Qld 4810, Australia
Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada
Rural Remote Health. 2020 Aug;20(3):5835. doi: 10.22605/RRH5835. Epub 2020 Aug 31.
The objective of this study was to identify commonalities between one regionally based medical school in Australia and one in Canada regarding the association between postgraduate training location and a doctor's practice location once fully qualified in a medical specialty.
Data were obtained using a cross-sectional survey of graduates of the James Cook University (JCU) medical school, Queensland, Australia, who had completed advanced training to become a specialist (a 'Fellow') in that field (response rate = 60%, 197 of 326). Medical education, postgraduate training and practice data were obtained for 400 of 409 (98%) fully licensed doctors who completed undergraduate medical education or postgraduate training or both at the Northern Ontario School of Medicine (NOSM), Ontario, Canada. Binary logistic regression used postgraduate training location to predict practice in the school's service region (northern Australia or northern Ontario). Separate analyses were conducted for medical discipline groupings of general/family practitioner, general specialist and subspecialist (JCU only).
For JCU graduates, significant associations were found between training in a northern Australian hospital at least once during postgraduate training and current (2018) northern Australian practice for all three discipline subgroups: family practitioner (p<0.001; prevalence odds ratio (POR)=30.0; 95% confidence interval (CI): 6.7-135.0), general specialist (p=0.002; POR=30.3; 95%CI: 3.3-273.4) and subspecialist (p=0.027; POR=6.5; 95%CI: 1.2-34.0). Overall, 38% (56/149) of JCU graduates who had completed a Fellowship were currently practising in northern Australia. For NOSM-trained doctors, a significant positive effect of training location on practice location was detected for family practice doctors but not for general specialist doctors. Family practitioners who completed their undergraduate medical education at NOSM and their postgraduate training in northern Ontario had a statistically significant (p<0.001) POR of 36.6 (95%CI: 16.9-79.2) of practising in northern Ontario (115/125) versus other regions, whereas those who completed only their postgraduate training in northern Ontario (46/85) had a statistically significant (p<0.001) POR of 3.7 (95%CI: 2.1-6.8) relative to doctors who only completed their undergraduate medical education at NOSM (28/117). Overall, 30% (22/73) of NOSM's general speciality graduates currently practise in northern Ontario.
The findings support increasing medical graduate training numbers in rural underserved regions, specifically locating full specialty training programs in regional and rural centres in a 'flipped training' model, whereby specialty trainees are based in rural or regional clinical settings with some rotations to the cities. In these circumstances, the doctors would see their regional or rural centre as 'home base' with the city rotations as necessary to complete their training requirements while preparing to practise near where they train.
本研究旨在确定澳大利亚一所区域性医学院和加拿大一所医学院之间的共同点，即研究生培训地点与医生在完成医学专业培训后的实践地点之间的关联。
通过对澳大利亚詹姆斯·库克大学（JCU）医学院毕业生的横断面调查获得数据，这些毕业生完成了高级培训，成为该领域的“研究员”（应答率=60%，326 人中的 197 人）。为了获得完全许可的医生的医学教育、研究生培训和实践数据，对在加拿大安大略省北部安大略医学院（NOSM）完成本科医学教育或研究生培训或两者兼有的 409 名医生中的 400 名医生（98%）进行了调查。使用二元逻辑回归，根据研究生培训地点预测在学校服务区域（澳大利亚北部或安大略省北部）的实践情况。针对 JCU 的一般/家庭医生、普通专家和专科医生（仅 JCU）的医学学科分组分别进行了分析。
对于 JCU 的毕业生，在研究生培训期间至少在澳大利亚北部医院接受过一次培训，与所有三个学科亚组的当前（2018 年）澳大利亚北部实践存在显著关联：家庭医生（p<0.001；患病率优势比（POR）=30.0；95%置信区间（CI）：6.7-135.0）、普通专家（p=0.002；POR=30.3；95%CI：3.3-273.4）和专科医生（p=0.027；POR=6.5；95%CI：1.2-34.0）。总体而言，JCU 毕业生中，有 38%（56/149）的人目前在澳大利亚北部行医。对于 NOSM 培训的医生，发现培训地点对实践地点的积极影响在家庭医生中显著，但在普通专家医生中不显著。在 NOSM 完成本科医学教育和在安大略省北部完成研究生培训的家庭医生中，在安大略省北部行医的患病率优势比（POR）具有统计学意义（p<0.001），为 36.6（95%CI：16.9-79.2）（115/125），而仅在安大略省北部完成研究生培训的家庭医生（46/85）的 POR 具有统计学意义（p<0.001），为 3.7（95%CI：2.1-6.8），而仅在 NOSM 完成本科医学教育的医生（28/117）。总体而言，NOSM 的普通专业毕业生中有 30%（22/73）目前在安大略省北部行医。
这些发现支持增加农村服务不足地区的医学毕业生培训人数，特别是在农村和地区中心以“翻转培训”模式定位全专业培训项目，即专业培训生在农村或地区临床环境中进行培训，并有一些轮转到城市。在这种情况下，医生会将他们的地区或农村中心视为“大本营”，城市轮训是完成培训要求的必要条件，同时为在培训地附近行医做准备。
