Beattie Jessica, Fuller Lara, Binder Marley J, Gray Laura, Versace Vincent L, Rogers Gary D
Rural Community Clinical School, School of Medicine, Deakin University, Colac, VIC 3250, Australia.
Department of Rural Health, School of Medicine, Deakin University, Warrnambool, VIC 3280, Australia.
Int J Environ Res Public Health. 2024 Dec 18;21(12):1688. doi: 10.3390/ijerph21121688.
(1) Background: Medical graduates who have undertaken longitudinal rural training have consistently been found to be more likely to become rural doctors and work in primary care settings. A limitation of such findings is the heterogeneous nature of rural medical education and contested views of what constitutes 'rurality', especially as it is often reported as a binary concept (rural compared to metropolitan). To address the identified gaps in workforce outcomes for rural medical training and to demonstrate accountability to the communities we serve, we investigated whether Longitudinal Integrated Clerkship (LIC) graduates are practicing in communities with similar rural classification to those where they trained. Within an LIC, students learn the curriculum in an integrated, simultaneous manner. (2) Material and Methods: A retrospective cohort study analysing variables associated with working in smaller rural communities. (3) Results: LIC graduates who undertook an additional year of rural training were five times more likely to work in communities of similar rurality to the program's training footprint. (4) Conclusions: The duration of rural training alone did not lead to optimal rural workforce outcomes. However, graduates who had trained in a combination of rural settings, an LIC, and block rotation were the most likely to practice in communities of similar rurality to the clerkship's training footprint. This highlights the impact of both the training duration and setting inclusive of an LIC on fostering positive rural workforce outcomes and the need to develop innovative solutions to expand these models of training in smaller rural communities.
(1) 背景：一直以来，人们发现接受过长期农村培训的医学毕业生更有可能成为乡村医生并在基层医疗环境中工作。此类研究结果的一个局限性在于农村医学教育的性质各异，以及对于“农村性”的构成存在争议观点，尤其是因为它常常被报道为一个二元概念（农村与大都市相对）。为了弥补农村医学培训劳动力成果方面已发现的差距，并向我们所服务的社区展示问责制，我们调查了纵向整合实习（LIC）毕业生是否在与他们接受培训的地区农村分类相似的社区执业。在纵向整合实习中，学生以综合、同步的方式学习课程。(2) 材料与方法：一项回顾性队列研究，分析与在较小农村社区工作相关的变量。(3) 结果：接受了额外一年农村培训的纵向整合实习毕业生在与该项目培训范围农村分类相似的社区工作的可能性高出五倍。(4) 结论：仅农村培训的时长并不能带来最佳的农村劳动力成果。然而，在农村环境、纵向整合实习和集中轮转相结合的方式下接受培训的毕业生最有可能在与实习培训范围农村分类相似的社区执业。这凸显了培训时长和包括纵向整合实习在内的培训环境对促进积极的农村劳动力成果的影响，以及开发创新解决方案以在较小农村社区扩展这些培训模式的必要性。
