Country practice: rural experience shapes graduate doctor destinations

When it comes to attracting graduate doctors to the country, new research has found the more time students spend in rural placement, the greater their chance of a rural career.

Monash School of Rural Health research has found a link between the length of time and type of placement that students undertake with their longer-term decision to go rural.

As part of the curriculum across all Australian medical schools, students are required to undertake rural immersion programs designed to steer graduates into the rural workforce. But until now there has been limited research about how the design of these immersion programs affect rural work outcomes.

Monash University research published in Medical Education has revealed the impact of these programs – showing the longer students spend undertaking rural medical school training, the greater their chances of choosing a rural career. Students who completed up to three years of rural placement were significantly more likely to pursue rural work.

The study also found a positive correlation between student placements in both regional hospitals and rural general practices. More than one years’ immersion in a mix of regional hospitals and rural general practices was associated with the increased likelihood of students going on to rural work.

Study author, Dr Belinda O’Sullivan, School of Rural Health Bendigo, said a combination of longer rural immersion and experience in both regional hospitals and rural general practice was a good model.

“The evidence suggests that getting students to do longer placements where they gain experience in both regional hospitals and rural general practice has the strongest outcome in terms of graduates going on to work in rural and regional Australia,” Dr O’Sullivan said.

"It might be that diverse clinical, rural and regional exposures over time helps in developing a stronger sense of security in rural practice, giving them the networks and professional mentors they need for effective rural practice.”

Dr O’Sullivan said that findings could inform government in the design and structure of rural immersion programs as it outlines the most effective strategies for encouraging graduating doctors to ‘go rural’.

“We knew that medical students often returned to rural areas given some rural immersion, but we weren’t able to pin down the effects of longer duration and immersion in different settings, or whether these factors affect students working in smaller communities. This study drills down into this nuance and will help universities and government in program design, as it points to the most effective strategies for encouraging graduating doctors to ‘go rural’,” Dr O’Sullivan said.

Head of Monash Rural Health, Professor Robyn Langham, said the findings were highly relevant given that rural medical workforce issues will continue to be a major challenge in the coming decades.

“This study supports the understanding that rural medical school immersion programs play a key role in bolstering doctors for rural and regional communities. By better understanding the variety of pull and push factors influencing medical workforce distribution, including the impact of student rural experience and rural program design, educators and policymakers are in a better position to make informed decisions that bring benefits to all,” Professor Langham said.

The findings come as Monash welcomes last night’s Federal Budget funding for a new rural medical degree at Monash. The end-to-end rural medical degree will allow our students to undertake their entire education and training in rural areas.