Department of Community Medicine, Ehime University Graduate School of Medicine, Toon-city, Ehime, 791-0295, Japan.
Department of Internal Medicine, Seiyo Municipal Nomura Hospital, 9-53 Nomura, Nomura-cho, Seiyo-city, Ehime, 797-1212, Japan.
BMC Med Educ. 2022 Jun 8;22(1):445. doi: 10.1186/s12909-022-03511-7.
In Japan, community medicine clerkships facilitate positive attitudes toward rural medical practice and encourage rural recruitment. Rural self-efficacy has been shown to influence rural career intent following a rural clinical placement. However, the impact of subjective difficulties of living in a rural area on future rural career intent is also important. This study aims to explore whether rural self-efficacy influences the relationship between difficulty with living in a rural area and rural career intent. METHODS: The subjects included 308 male and 255 female participants aged 20-41 [median (interquartile range): 22 (21-22)] years. Rural self-efficacy was based on a validated scale consisting of 15 questions. Difficulty with living in a rural area was measured asking students. A cohort survey was conducted to evaluate the effect of the rural self-efficacy score on the rural career intent of Japanese medical students after they completed their rural clinical training.
The following variables were significantly associated with a higher rural self-efficacy score: female sex (p = 0.003), age < 21 years (p = 0.013), having a doctor as a role model (p < 0.001), gaining admission through a school recommendation (p = 0.016), living in a rural or remote area until the age of 18 years (p = 0.018), and orientation towards general medicine (p < 0.001). In addition, baseline difficulty with living in a rural area was significantly associated with a lower self-efficacy score (p < 0.001). Participants with a stronger intent to practice in a rural area before rural clinical training had higher rural self-efficacy and showed a stronger positive rural career intent after rural clinical training (p < 0.001). A multivariable logistic regression analysis demonstrated that difficulty with living in a rural area [odds ratio (OR): 0.61; 95% confidence interval (CI), 0.39-0.84] was still associated with lower rural career intent after rural clinical training, independent of all confounders such as gender, age, scholarship for regional duty, rural background, and orientation towards general medicine. However, when rural self-efficacy (OR, 1.12; 95% CI, 1.07-1.16) was added as a factor for rural career intent, difficulty with living in a rural area (OR, 0.68; 95% CI, 0.43-1.06) was no longer observed as an associated factor.
Subjective difficulty with living in a rural area was shown to reduce future rural career intent, but high rural self-efficacy ameliorated this decline.
在日本，社区医学实习有助于培养学生对农村医疗实践的积极态度，并鼓励他们在农村地区工作。农村自我效能感已被证明会影响农村临床实习后农村职业意向。然而，居住在农村地区的主观困难对未来农村职业意向的影响也很重要。本研究旨在探讨农村自我效能感是否会影响居住在农村地区的难度与农村职业意向之间的关系。
研究对象包括 308 名男性和 255 名女性，年龄在 20-41 岁之间[中位数（四分位数间距）：22（21-22）岁]。农村自我效能感基于一个包含 15 个问题的经过验证的量表。通过询问学生来测量居住在农村地区的困难程度。对日本医学生进行了一项队列研究，以评估农村自我效能评分对他们完成农村临床培训后农村职业意向的影响。
以下变量与较高的农村自我效能评分显著相关：女性（p=0.003）、年龄<21 岁（p=0.013）、以医生为榜样（p<0.001）、通过学校推荐入学（p=0.016）、18 岁前居住在农村或偏远地区（p=0.018）、以及对全科医学的倾向（p<0.001）。此外，基线居住在农村地区的难度与较低的自我效能评分显著相关（p<0.001）。在农村临床培训前有更强的农村执业意向的参与者具有更高的农村自我效能感，并在农村临床培训后表现出更强的积极农村职业意向（p<0.001）。多变量逻辑回归分析表明，居住在农村地区的难度[比值比（OR）：0.61；95%置信区间（CI）：0.39-0.84]在农村临床培训后仍与农村职业意向较低相关，独立于所有混杂因素，如性别、年龄、地区服务奖学金、农村背景和对全科医学的倾向。然而，当将农村自我效能感（OR，1.12；95%CI，1.07-1.16）作为农村职业意向的一个因素加入时，居住在农村地区的难度（OR，0.68；95%CI，0.43-1.06）不再被视为相关因素。
居住在农村地区的主观难度被证明会降低未来的农村职业意向，但较高的农村自我效能感可以减轻这种下降。
