Rural Clinical School, The University of Queensland, Rockhampton, QLD, 4700, Australia.
Rural Clinical School, The University of Queensland, Toowoomba, QLD, 4350, Australia.
Hum Resour Health. 2023 Apr 20;21(1):31. doi: 10.1186/s12960-023-00819-3.
Inadequate distribution of the medical workforce in rural regions remains a key global challenge. Evidence of the importance of postgraduation (after medical school) rural immersion time and subsequent rural practice, particularly after accounting for other key factors, remains limited. This study investigated the combined impact of three key training pathway factors: (1) rural background, (2) medical school rural immersion, and (3) postgraduation rural immersion, and duration time of each immersion factor on working rurally.
Data from a cross-sectional national survey and a single university survey of Australian doctors who graduated between 2000 to 2018, were utilised. Key pathway factors were similarly measured. Postgraduation rural training time was both broad (first 10 years after medical school, national study) and specific (prevocational period, single university). This was firstly tested as the dependent variable (stage 1), then matched against rural practice (stage 2) amongst consultant doctors (national study, n = 1651) or vocational training doctors with consultants (single university, n = 478).
Stage 1 modelling found rural background, > 1 year medical school rural training, being rural bonded, male and later choosing general practice were associated with spending a higher proportion (> 40%) of their postgraduation training time in a rural location. Stage 2 modelling revealed the dominant impact of postgraduation rural time on subsequent rural work for both General Practitioners (GPs) (OR 45, 95% CI 24 to 84) and other specialists (OR 11, 95% CI 5-22) based on the national dataset. Similar trends for both GPs (OR 3.8, 95% CI 1.6-9.1) and other specialists (OR 2.8, 95% CI 1.3-6.4) were observed based on prevocational time only (single university).
This study provides new evidence of the importance of postgraduation rural training time on subsequent rural practice, after accounting for key factors across the entire training pathway. It highlights that developing rural doctors aligns with two distinct career periods; stage 1-up to completing medical school; stage 2-after medical school. This evidence supports the need for strengthened rural training pathways after medical school, given its strong association with longer-term decisions to work rurally.
农村地区医疗人员分布不足仍是全球面临的一个关键挑战。尽管已经认识到毕业后（医学院毕业后）农村实习时间和随后的农村实践的重要性，但在考虑到其他关键因素后，相关证据仍然有限。本研究调查了三个关键培训途径因素的综合影响：（1）农村背景，（2）医学院农村实习，以及（3）毕业后农村实习，以及每个实习因素的持续时间对农村工作的影响。
本研究利用了一项全国性横断面调查和一项针对 2000 年至 2018 年期间毕业的澳大利亚医生的单一大学调查的数据。同样测量了关键途径因素。毕业后农村培训时间既广泛（医学院毕业后的前 10 年，全国性研究），又具体（预备职业期，单一大学）。首先将其作为因变量进行测试（第 1 阶段），然后在全国性研究（n=1651）或有顾问医生的职业培训医生（单一大学，n=478）中，将其与农村实践进行匹配（第 2 阶段）。
第 1 阶段建模发现，农村背景、>1 年医学院农村培训、农村契约、男性和后来选择全科医学与毕业后培训时间的较高比例（>40%）在农村地区度过有关。第 2 阶段建模显示，基于全国数据集，毕业后农村时间对全科医生（GP）（OR 45，95%CI 24-84）和其他专科医生（OR 11，95%CI 5-22）后续农村工作的影响占主导地位。基于预备职业期（单一大学），观察到 GP（OR 3.8，95%CI 1.6-9.1）和其他专科医生（OR 2.8，95%CI 1.3-6.4）的相似趋势。
本研究提供了新的证据，表明在考虑整个培训途径的关键因素后，毕业后农村培训时间对后续农村实践具有重要意义。它强调，培养农村医生符合两个不同的职业阶段；阶段 1-完成医学院之前；阶段 2-医学院毕业后。鉴于毕业后农村培训途径与农村工作的长期决策具有很强的关联性，因此，该证据支持需要加强毕业后农村培训途径。
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