Does recruitment lead to retention? Rural Clinical School training experiences and subsequent intern choices

[Abstract]: The Australian Rural Clinical Schools, established nationally in 2000-2001, have provided an opportunity for medical students to undertake their clinical training across a network of hospitals, general practice surgeries and community medical centres in locations throughout Australia. The Rural Clinical School at the University of Queensland was established in 2002, as the Rural Clinical Division (RCD) of the School of Medicine, which provides a four-year graduate MB BS program. Students may elect to train in their 3rd and/or 4th year in one of three clinical divisions, namely Central, Southern (both based in Brisbane) or Rural which comprises teaching sites in south west Queensland and central Queensland region. Training must be of an equivalent nature throughout these three divisions, because students all sit the same examinations. Rigorous evaluation of the RCD teaching program underpins the goals of continuing improvement of both education and resources, and is also a key component of the reporting mechanisms linked to ongoing Commonwealth funding. Students' perception of their medical education at the RCD is the major focus of such evaluations in order to assist both educational improvement and required student recruitment. With this in mind, a questionnaire, the 'Year 4 Exit Survey' was developed to evaluate medical student perceptions of their 4th year experience at the RCD. Coupled to this was an analysis of internship choices to evaluate the important related issue of medical graduate retention. Objective: The increasing popularity of the RCD has prompted further investigation into the intern placement choice by these students. The provision of a positive medical education experience in a Rural Clinical School might be expected to influence this intern choice to favour a rural location. This preliminary report provides the results of the evaluations by one cohort of year 4 students and explores the relationship between rural undergraduate medical training experiences and subsequent recruitment and retention of junior medical personnel within local rural hospitals. Methods: The Year 4 Exit Survey contained 63 questions and was a combination of open-ended and forced answer items. The survey was divided into the following sections: demographics, career interests, experience of rural living, interest in rural medical practice, perceptions of rural communities, perceptions of the RCD, rating of their medical training, the impact of the RCD on their desire to practice medicine in a rural area, their opinions on the most and least valuable study experiences at either site and their suggestions on how that experience might be improved. A final question asked them their choice of internship location and the reasons why they were or were not staying at their present RCD site. Results: Overall there was a high degree of student satisfaction with all aspects of their medical education. However there was a discrepancy between these findings and subsequent internship choices. Reasons for this discrepancy were associated with the students' adverse perceptions of their future workforce environment and professional support. Conclusions: Provision of positive rural training experiences and quality medical education has been shown to increase interest in rural medicine and encourage a desire to pursue a medical career in a rural area. However a quality undergraduate rural medical education does not guarantee immediate transition to rural internship. If the ultimate goal of improving the rural medical workforce is to be achieved, the present high levels of recruitment by the Rural Clinical Schools and their provision of a positive rural training experience must be matched by a supportive clinical workplace environment. Studies are needed to look more closely at the transition period between medical graduate and intern

Does Recruitment Lead to Retention? Rural Clinical School Training Experiences and Subsequent Intern Choices

The Australian Rural Clinical Schools, established nationally in 2000-2001, have provided an opportunity for medical students to undertake their clinical training across a network of hospitals, general practice surgeries and community medical centres in locations throughout Australia. The Rural Clinical School at the University of Queensland was established in 2002, as the Rural Clinical Division (RCD) of the School of Medicine, which provides a four-year graduate MB BS program. Students may elect to train in their 3rd and/or 4th year in one of three clinical divisions, namely Central, Southern (both based in Brisbane) or Rural which comprises teaching sites in south west Queensland and central Queensland region. Training must be of an equivalent nature throughout these three divisions, because students all sit the same examinations. Rigorous evaluation of the RCD teaching program underpins the goals of continuing improvement of both education and resources, and is also a key component of the reporting mechanisms linked to ongoing Commonwealth funding. Students' perception of their medical education at the RCD is the major focus of such evaluations in order to assist both educational improvement and required student recruitment. With this in mind, a questionnaire, the 'Year 4 Exit Survey' was developed to evaluate medical student perceptions of their 4th year experience at the RCD. Coupled to this was an analysis of internship choices to evaluate the important related issue of medical graduate retention.The increasing popularity of the RCD has prompted further investigation into the intern placement choice by these students. The provision of a positive medical education experience in a Rural Clinical School might be expected to influence this intern choice to favour a rural location. This preliminary report provides the results of the evaluations by one cohort of year 4 students and explores the relationship between rural undergraduate medical training experiences and subsequent recruitment and retention of junior medical personnel within local rural hospitals.The Year 4 Exit Survey contained 63 questions and was a combination of open-ended and forced answer items. The survey was divided into the following sections: demographics, career interests, experience of rural living, interest in rural medical practice, perceptions of rural communities, perceptions of the RCD, rating of their medical training, the impact of the RCD on their desire to practice medicine in a rural area, their opinions on the most and least valuable study experiences at either site and their suggestions on how that experience might be improved. A final question asked them their choice of internship location and the reasons why they were or were not staying at their present RCD site.Overall there was a high degree of student satisfaction with all aspects of their medical education. However there was a discrepancy between these findings and subsequent internship choices. Reasons for this discrepancy were associated with the students' adverse perceptions of their future workforce environment and professional support.Provision of positive rural training experiences and quality medical education has been shown to increase interest in rural medicine and encourage a desire to pursue a medical career in a rural area. However a quality undergraduate rural medical education does not guarantee immediate transition to rural internship. If the ultimate goal of improving the rural medical workforce is to be achieved, the present high levels of recruitment by the Rural Clinical Schools and their provision of a positive rural training experience must be matched by a supportive clinical workplace environment. Studies are needed to look more closely at the transition period between medical graduate and intern

Accommodation needs for carers of and adults with intellectual disability in regional Australia: Their hopes for and perceptions of the future

Introduction: This article provides an in-depth investigation of the accommodation circumstances of a population of aging adults with intellectual disability living at home with parents or in supported accommodation in an Australian regional centre. Given the ageing of both the carer and adult population with intellectual disability our research explored the accommodation needs and perceptions of future lifestyle issues from the perspective of both the carers and the adults with intellectual disability. This study aimed to describe these accommodation circumstances related to a regional/rural location and did not make direct comparisons with urban/metropolitan situations. Methods: A mixed methods approach, specifically an explanatory design, participant selection model was utilised for the overall study. This article reports on the qualitative study consisting of data from both free response open-ended survey questions and semi-structured interviews with selected adults with intellectual disability and their carers. This study explored and described participants’ experiences and perceptions regarding their accommodation needs and future lifestyle issues. A purposive sampling technique was used to identify a representative sample of participants for interviews. The interview questions were guided by the results of the quantitative first study phase. Data were analysed by content analysis for major themes emerging from the interview and free response survey data. Results: A total of 146 carers (mean age 61.5 years; range 40–91 years) and 156 adults with intellectual disability (mean age 37.2 years; range 18–79 years) participated in the study. Data saturation was reached after 10 interviews were undertaken with carers (mean age 60 years) and 10 with adults with intellectual disability (no age criteria applied). Six major themes were identified: ageing, family issues, living at home, living away from home, government support and funding, and future needs. The perceptions and views of both adults with intellectual disability and their carers around these major themes are reported and discussed. Conclusions: This study indicates that there is a lack of suitable, available, supported accommodation for people aged 18 years and older with intellectual disability in this Australian regional centre. Consequently, aging parents caring at home have little choice but to continue in their caring role. For those caring away from home, existing services are decreasingly seen as fitting the ideal life they want for the person with intellectual disability for whom they care. The told experiences, perceptions and views of older carers of and adults with intellectual disability have highlighted their increasing vulnerability to the ‘disability system’. The findings suggest that government and disability services must acknowledge the changing needs of people with intellectual disability in connection with their advancing age and the urgency of increasing care needs due to the advancing age of their carer/s. The overwhelming feeling is that the carer’s voice will only be heard when the situation reaches crisis point. For many carers and their families this has already occurred

Exploring resilience in rural GP registrars – implications for training

Background: Resilience can be defined as the ability to rebound from adversity and overcome difficult circumstances. General Practice (GP) registrars face many challenges in transitioning into general practice, and additional stressors and pressures apply for those choosing a career in rural practice. At this time of international rural generalist medical workforce shortages, it is important to focus on the needs of rural GP registrars and how to support them to become resilient health care providers. This study sought to explore GP registrars' perceptions of their resilience and strategies they used to maintain resilience in rural general practice

Identifying the dominant personality profiles in medical students: Implications for their well-being and resilience

Purpos