探讨对农村医学实习的偏好和接受度，这是支持农村培训途径的关键问题。
Exploring preference for, and uptake of, rural medical internships, a key issue for supporting rural training pathways.
机构信息
Rural Clinical School, The University of Queensland, Cnr Cambridge & Canning Street, Rockhampton, Queensland, 4700, Australia.
School of Rural Health, Monash University, PO BOX 666, Bendigo, Victoria, 3550, Australia.
出版信息
BMC Health Serv Res. 2020 Oct 8;20(1):930. doi: 10.1186/s12913-020-05779-1.
BACKGROUND
Improved medical care access for rural populations continues to be a major concern. There remains little published evidence about postgraduate rural pathways of junior doctors, which may have strong implications for a long-term skilled rural workforce. This exploratory study describes and compares preferences for, and uptake of, rural internships by new domestic and international graduates of Victorian medical schools during a period of rural internship position expansion.
METHODS
We used administrative data of all new Victorian medical graduates' location preference and accepted location of internship positions for 2013-16. Associations between preferred internship location and accepted internship position were explored including by rurality and year. Moreover, data were stratified between 'domestic graduates' (Australian and New Zealand citizens or permanent residents) and 'international graduates' (temporary residents who graduated from an Australian university).
RESULTS
Across 2013-16, there were 4562 applicants who filled 3130 internship positions (46% oversubscribed). Domestic graduates filled most (69.7%, 457/656) rural internship positions, but significantly less than metropolitan positions (92.2%, p < 0.001). Only 20.1% (551/2737) included a rural location in their top five preferences, less than for international graduates (34.4%, p < 0.001). A greater proportion of rural compared with metropolitan interns accepted a position not in their top five preferences (36.1% versus 7.4%, p < 0.001). The proportion nominating a rural location in their preference list increased across 2013-2016.
CONCLUSIONS
The preferences for, and uptake of, rural internship positions by domestic graduates is sub-optimal for growing a rural workforce from local graduates. Current actions that have increased the number of rural positions are unlikely to be sufficient as a stand-alone intervention, thus regional areas must rely on international graduates. Strategies are needed to increase the attractiveness of rural internships for domestic students so that more graduates from rural undergraduate medical training are retained rurally. Further research could explore whether the uptake of rural internships is facilitated by aligning these positions with protected opportunities to continue vocational training in regionally-based or metropolitan fellowships. Increased understanding is needed of the factors impacting work location decisions of junior doctors, particularly those with some rural career intent.
背景
改善农村人口的医疗服务可及性仍然是一个主要关注点。尽管农村初级医生的研究生涯途径发表的文献很少，但这可能对长期的农村技术劳动力具有重要影响。本探索性研究描述并比较了维多利亚州医学院的新国内和国际毕业生在农村实习岗位增加期间对农村实习的偏好和接受情况。
方法
我们使用了所有新维多利亚州医学毕业生的位置偏好和 2013-16 年实习位置接受情况的行政数据。通过农村地区和年份探索了首选实习地点与接受实习地点之间的关联。此外，数据在“国内毕业生”（澳大利亚和新西兰公民或永久居民）和“国际毕业生”（从澳大利亚大学毕业的临时居民）之间进行了分层。
结果
在 2013-16 年期间，有 4562 名申请人填补了 3130 个实习岗位（超额录取率为 46%）。国内毕业生填补了大多数（69.7%，457/656）农村实习岗位，但远低于大都市岗位（92.2%，p<0.001）。只有 20.1%（551/2737）的人将农村地区列入前五名首选地点，低于国际毕业生（34.4%，p<0.001）。与大都市实习生相比，更多农村实习生接受了不在前五名首选地点的职位（36.1%对 7.4%，p<0.001）。2013-2016 年期间，在首选名单中提名农村地点的比例有所增加。
结论
国内毕业生对农村实习岗位的偏好和接受程度不理想，无法从当地毕业生中培养出更多的农村劳动力。目前增加农村岗位数量的措施不太可能作为单独的干预措施发挥作用，因此农村地区必须依赖国际毕业生。需要采取策略来提高农村实习对国内学生的吸引力，以便更多的农村本科医学培训毕业生留在农村。进一步的研究可以探讨这些实习岗位与区域或大都市奖学金中受保护的职业培训机会相匹配是否有助于增加农村实习的接受度。需要进一步了解影响初级医生工作地点决策的因素，特别是那些有一定农村职业意向的医生。
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