A review of characteristics and outcomes of Australia’s undergraduate medical education rural immersion programs

Background: A key strategy for increasing the supply of rural doctors is rurally located medical education. In 2000, Australia introduced a national policy to increase rural immersion for undergraduate medical students. This study aims to describe the characteristics and outcomes of the rural immersion programs that were implemented in Australian medical schools. Methods: Information about 19 immersion programs was sourced in 2016 via the grey and published literature. A scoping review of the published peer-reviewed studies via Ovid MEDLINE and Informit (2000-2016) and direct journal searching included studies that focused on outcomes of undergraduate rural immersion in Australian medical schools from 2000 to 2016. Results: Programs varied widely by selection criteria and program design, offering between 1- and 6-year immersion. Based on 26 studies from 10 medical schools, rural immersion was positively associated with rural practice in the first postgraduate year (internship) and early career (first 10years post-qualifying). Having a rural background increased the effects of rural immersion. Evidence suggested that longer duration of immersion also increases the uptake of rural work, including by metropolitan-background students, though overall there was limited evidence about the influence of different program designs. Most evidence was based on relatively weak, predominantly cross-sectional research designs and single-institution studies. Many had flaws including small sample sizes, studying internship outcomes only, inadequately controlling for confounding variables, not using metropolitan-trained controls and providing limited justification as to the postgraduate stage at which rural practice outcomes were measured. Conclusions: Australia's immersion programs are moderately associated with an increased rural supply of early career doctors although metropolitan-trained students contribute equal numbers to overall rural workforce capacity. More research is needed about the influence of student interest in rural practice and the duration and setting of immersion on rural work uptake and working more remotely. Research needs to be more nationally balanced and scaled-up to inform national policy development. Critically, the quality of research could be strengthened through longer-term follow-up studies, adjusting for known confounders, accounting for postgraduate stages and using appropriate controls to test the relative effects of student characteristics and program designs

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Faculties to support general practitioners working rurally at broader scope: a national cross-sectional study of their value

Strategies are urgently needed to foster rural general practitioners (GPs) with the skills and professional support required to adequately address healthcare needs in smaller, often isolated communities. Australia has uniquely developed two national-scale faculties that target rural practice: the Fellowship in Advanced Rural General Practice (FARGP) and the Fellowship of the Australian College of Rural and Remote Medicine (FACRRM). This study evaluates the benefit of rural faculties for supporting GPs practicing rurally and at a broader scope. Data came from an annual national survey of Australian doctors from 2008 and 2017, providing a cross-sectional design. Work location (rurality) and scope of practice were compared between FACRRM and FARGP members, as well as standard non-members. FACRRMs mostly worked rurally (75–84%, odds ratio (OR) 8.7, 5.8–13.1), including in smaller rural communities

Financial characteristics and security of podiatry work in Victoria: the PAIGE cross sectional study of Australian podiatrists

Abstract Background Podiatrists’ earnings have an important influence on workforce dynamics. This includes the profession’s ability to attract and retain workers so the population’s healthcare needs can be met. This study aimed to describe financial characteristics of podiatry work and factors relating to a sense of financial security. Methods This was a cross sectional study using data from Victorian podiatrists who participated in Wave 1 of the Podiatrists in Australia: Investigating Graduate Employment (PAIGE) survey. Demographic and financial characteristics were described. The outcome measure, financial security, was collected through a self-reported belief based on current financial situation and prospects, respondents’ perception of having enough income to live on when they retire. Univariate logistic regression was used to determine associations with rural or metropolitan practice locations. Multiple ordered logistic regression was performed to explore associations between factors relating to financial security and retirement prospects. Results There were 286 Victorian podiatrist (18% of n = 1,585 Victorian podiatrists) respondents. Of these, 206 (72% of n = 286) identified as female, 169 (59% of 286) worked in the private sector and the mean (SD) age was 33.4 (9.5) years. The mean (SD) annual gross income was $79,194 ($45,651) AUD, and 243 (87% of 279) made regular superannuation contributions. Multiple ordered logistic regression analyses identified factors associated with podiatrists’ perception of having adequate retirement income. These included being an owner/partner of their main workplace (adj OR = 2.70, 95% CI = 1.49–4.76), growing up in a rural location (adj OR = 2.27, 95% CI = 1.38–3.70), perceiving a moderate overall health rating (adj OR = 2.03 95% CI = 1.51–2.75), not having financial debt related to education and training (adj OR = 2.02, 95% CI = 1.24–3.32) and regular contributions to a superannuation scheme (adj OR = 4.76, 95% CI = 2.27–10.00). Conclusion This is the first known study to explore podiatrists’ earnings and perceptions regarding financial security. Findings suggest modifiable ways to improve financial security of podiatrists including support and education about personal and business finances including debt management, understanding the importance of contributions to superannuation when self-employed, and developing skills and supports for podiatrists to run their own businesses. This research is exploratory and is relevant for understanding the impact that income and financial security have on workforce dynamics

Rural training pathways: the return rate of doctors to work in the same region as their basic medical training

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Limited evidence exists about the extent to which doctors are returning to rural region(s) where they had previously trained. This study aims to investigate the rate at which medical students who have trained for 12 months or more in a rural region return to practice in that same region in their early medical career. A secondary aim is to investigate whether there is an independent or additional association with the effect of longer duration of rural exposure in a region (18-24 months) and for those completing both schooling and training in the same rural region. Methods: The outcome was rural region of work, based on postcode of work location in 2017 for graduates spanning 1-9 years post-graduation, for one large medical program in Victoria, Australia. Region of rural training, combined with region of secondary schooling and duration of rural training, was explored for its association with region of practice. A multinomial logistic regression model, accounting for other covariates, measured the strength of association with practising in the same rural region as where they had trained. Results: Overall, 357/2451 (15%) graduates were working rurally, with 90/357 (25%) working in the same rural region as where they did rural training. Similarly, 41/170 (24%) were working in the same region as where they completed schooling. Longer duration (18-24 vs 12 months) of rural training (relative risk ratio, RRR, 3.37, 1.89–5.98) and completing both schooling and training in the same rural region (RRR: 4.47, 2.14-9.36) were associated with returning to practice in the same rural region after training. Conclusions: Medical graduates practising rurally in their early career (1-9 years post-graduation) are likely to have previous connections to the region, through either their basic medical training, their secondary schooling, or both. Social accountability of medical schools and rural medical workforce outcomes could be improved by policies that enable preferential selection and training of prospective medical students from rural regions that need more doctors, and further enhanced by longer duration of within-region training.University funds only