Seal Alexa N, Playford Denese, McGrail Matthew R, Fuller Lara, Allen Penny L, Burrows Julie M, Wright Julian R, Bain-Donohue Suzanne, Garne David, Major Laura G, Luscombe Georgina M
Rural Clinical School, School of Medicine Sydney, the University of Notre Dame Australia, Wagga Wagga, NSW.
Rural Clinical School of Western Australia, University of Western Australia, Perth, WA.
Med J Aust. 2022 Jun 20;216(11):572-577. doi: 10.5694/mja2.51476. Epub 2022 Apr 1.
To examine associations between extended medical graduates' rural clinical school (RCS) experience and geographic origins with practising in rural communities five and eight years after graduation.
DESIGN, PARTICIPANTS: Cohort study of 2011 domestic medical graduates from ten Australian medical schools with rural clinical or regional medical schools.
Practice location types eight years after graduation (2019/2020) as recorded by the Australian Health Practitioner Regulation Agency, classified as rural or metropolitan according to the 2015 Modified Monash Model; changes in practice location type between postgraduate years 5 (2016/2017) and 8 (2019/2020).
Data were available for 1321 graduates from ten universities; 696 were women (52.7%), 259 had rural backgrounds (19.6%), and 413 had extended RCS experience (31.3%). Eight years after graduation, rural origin graduates with extended RCS experience were more likely than metropolitan origin graduates without this experience to practise in regional (relative risk [RR], 3.6; 95% CI, 1.8-7.1) or rural communities (RR, 4.8; 95% CI, 3.1-7.5). Concordance of location type five and eight years after graduation was 92.6% for metropolitan practice (84 of 1136 graduates had moved to regional/rural practice, 7.4%), 26% for regional practice (56 of 95 had moved to metropolitan practice, 59%), and 73% for rural practice (20 of 100 had moved to metropolitan practice, 20%). Metropolitan origin graduates with extended RCS experience were more likely than those without it to remain in rural practice (RR, 2.0; 95% CI, 1.3-2.9) or to move to rural practice (RR, 1.9; 95% CI, 1.2-3.1).
The distribution of graduates by practice location type was similar five and eight years after graduation. Recruitment to and retention in rural practice were higher among graduates with extended RCS experience. Our findings reinforce the importance of longitudinal rural and regional training pathways, and the role of RCSs, regional training hubs, and the rural generalist training program in coordinating these initiatives.
研究医学专业延长学制毕业生的农村临床学校（RCS）经历及地理来源与毕业后五年和八年在农村社区执业之间的关联。
设计、研究对象：对来自澳大利亚十所设有农村临床学校或地区医学学校的医学院校的2011年国内医学毕业生进行队列研究。
澳大利亚卫生从业人员监管局记录的毕业后八年（2019/2020年）的执业地点类型，根据2015年改良莫纳什模型分为农村或大都市地区；研究生阶段第5年（2016/2017年）和第8年（2019/2020年）之间执业地点类型的变化。
十所大学的1321名毕业生的数据可用；其中696名是女性（52.7%），259名有农村背景（19.6%），413名有延长的RCS经历（31.3%）。毕业后八年，有延长RCS经历的农村生源毕业生比没有这种经历的大都市生源毕业生更有可能在地区（相对风险[RR]，3.6；95%置信区间，1.8 - 7.1）或农村社区执业（RR，4.8；95%置信区间，3.1 - 7.5）。毕业后五年和八年执业地点类型的一致性，大都市地区执业为92.6%（1136名毕业生中有84名转到地区/农村执业，7.4%），地区执业为26%（95名中有56名转到大都市执业，59%），农村执业为73%（100名中有20名转到大都市执业，20%）。有延长RCS经历的大都市生源毕业生比没有这种经历的毕业生更有可能留在农村执业（RR，2.0；95%置信区间，1.3 - 2.9）或转到农村执业（RR，1.9；95%置信区间，1.2 - 3.1）。
毕业后五年和八年按执业地点类型划分的毕业生分布相似。有延长RCS经历的毕业生在农村执业的招募和留用率更高。我们的研究结果强化了纵向农村和地区培训路径的重要性，以及农村临床学校、地区培训中心和农村全科医生培训项目在协调这些举措中的作用。
