Influence of rural clinical school experience and rural origin on practising in rural communities five and eight years after graduation

Abstract

Objective: 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. Main outcome measures: 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). Results: 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). Conclusion: 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. © 2022 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.

Keywords

Author Keywords

rural health services

Index Keywords

training adult female human male Humans Decision making Article risk factor Australia Career choice medical student Students, Medical human experiment professional practice workforce cohort analysis rural population rural health care Rural Health Services Cohort Studies Professional Practice Location

Author Affiliations

Rural Community Clinical School, Deakin University, Geelong, VIC, Australia

Rural Clinical School, The University of Queensland, Brisbane, QLD, Australia

The Rural Clinical School of WA, Kalgoorlie, WA, Australia

Rural Clinical School, The University of Notre Dame Australia, Fremantle, WA, Australia

Rural Clinical School, University of Tasmania, Hobart, TS, Australia

Rural Clinical School, The University of Newcastle, Australia, Callaghan, NSW, Australia

Rural Clinical School, University of Melbourne, Melbourne, VIC, Australia

Rural Clinical School, The Australian National University, Canberra, ACT, Australia

School of Medicine, Wollongong, NSW, Australia

Monash University, Melbourne, VIC, Australia

School of Rural Health, The University of Sydney, Sydney, NSW, Australia

Funding & Acknowledgements

Australian National University, ANU

Joe McGirr (former Associate Dean of the Rural Clinical School, School of Medicine Sydney, the University of Notre Dame Australia) and Amanda Barnard (Rural Clinical School, Australian National University) contributed to the development of the research concept and the methodology for the pilot study. We thank Rowena Ivers (School of Medicine, University of Wollongong) for her useful comments on the manuscript. Open access publishing facilitated by The University of Notre Dame Australia, as part of the Wiley - The University of Notre Dame Australia agreement via the Council of Australian University Librarians.

University of Notre Dame Australia, UNDA

Joe McGirr (former Associate Dean of the Rural Clinical School, School of Medicine Sydney, the University of Notre Dame Australia) and Amanda Barnard (Rural Clinical School, Australian National University) contributed to the development of the research concept and the methodology for the pilot study. We thank Rowena Ivers (School of Medicine, University of Wollongong) for her useful comments on the manuscript. Open access publishing facilitated by The University of Notre Dame Australia, as part of the Wiley - The University of Notre Dame Australia agreement via the Council of Australian University Librarians.

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Influence of rural clinical school experience and rural origin on practising in rural communities five and eight years after graduation

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