Predictors of remote practice location in the first seven cohorts of James Cook University MBBS graduates

Introduction: This article describes factors predicting James Cook University (JCU) medical graduates undertaking at least 1 year of remote practice. The cross-sectional design involved point-in-time (2015) analysis of the JCU medical school's ongoing longitudinal graduate tracking database. Participants were the first seven cohorts of graduates from the JCU medical school who had completed at least their postgraduate year (PGY) 4 in Australia (n=529); that is, PGY 4 to PGY 10 graduates. Methods: Multiple logistic regression and Classification and Regression Tree (CART) analysis of medical graduate application data (age, gender, hometown, interview score, ethnicity), undergraduate data (scholarships awarded, clinical school location) and postgraduation data (internship location, specialty training) was performed. Analysis identified independent predictors of having practised for at least 1 year in a 'remote' Australian town (Australian Standard Geographic Classification Remoteness Area 4-5). Results: Forty-seven (9%) of JCU Bachelor of Medicine and Bachelor of Surgery graduates in the first seven cohorts had practised for at least 1 year in a remote location between PGY 4 and 10. Practice in a 'remote' town was predicted by undertaking rural generalist training (p<0.001; prevalence odds ratio (POR)=17.0), being awarded an 'above average' interview score at medical school selection (p=0.006; POR=5.1), attending the Darwin clinical school in years 5-6 (p=0.005; POR=4.7), being female (p=0.016, POR=3.6) and undertaking an outer-regional or remotely based internship (p=0.006; POR=3.5). CART analysis identified Indigenous graduates as another key subgroup of remote practice graduates. Conclusions: This study provides the first Australian evidence that likelihood of remote medical practice is enhanced by investment in a 'remote pipeline' - medical education via clinical schools and internships in rural/remote locations, with a later option of a rural generalist pathway. The proportion of medical graduates working in remote practice may also be increased by preferentially selecting Indigenous Australian applicants and applicants who score highly for communication, teamwork, self-reliance and motivation for rural and remote practice

Positive impacts on rural and regional workforce from the first seven cohorts of James Cook University medical graduates

Introduction: The regionally-based James Cook University (JCU) School of Medicine aims to meet its mission to address the health needs of the region by combining selection and curriculum strategies shown to increase rural career recruitment outcomes. The School has graduated 536 students in its first seven cohorts from 2005 to 2011. This paper presents the early career practice locations and the specialty training undertaken by these cohorts, and describes the association between later practice location with both hometown at application and internship location. Methods: 'Hometown at application' data for JCU Bachelor of Medicine, Bachelor of Surgery (MBBS) graduates was retrieved from administrative databases held by the university, while postgraduate location and career data were obtained either from personal contact via email, telephone, Facebook or electronically from the Australian Health Practitioner Regulation Authority website. Practice location was described across Australian Standard Geographical Classification Remoteness Area (RA) categories. Results: Data for the primary practice location of 536 JCU MBBS graduates across postgraduate years (PGY) 1 to 7 is 99% complete. A total of 65% of JCU graduates undertook their internship in non-metropolitan locations including 20% in RA 2 and 44% in RA 3–5, a pattern of practice different to that of other Australian clinicians. For the internship year, 'non-metropolitan-origin' JCU MBBS graduates predominantly worked in RA 2–5 locations, while 'metropolitan origin' graduates were more likely to work in major cities. However, by PGY 7, the distribution of 'rural' and 'metropolitan' origin JCU graduates across RA categories was similar. The RA category of internship location – either 'metropolitan' (RA 1) or 'non-metropolitan' (RA 2–5) – was associated with the location of subsequent practice across PGY 2–7. Conclusions: This comprehensive data set provides the first real evidence from one of Australia's new medical schools on actual postgraduate practice location, as compared to 'intent to practice'. The geographic profile by RA of JCU graduates' hometown and patterns of postgraduate practice is different to that of other Australian medical students and doctors. This early evidence supports the JCU model of distributed non-metropolitan medical education, and suggests more regionally-located internship and specialty training places would further increase the medical workforce in northern and/or rural Australia. The workforce impact of the seven cohorts of graduates in this study is starting to be felt in rural and regional Australia, and, if these trends continue, will result in significant workforce improvements over the next decade. These results support further investment in regional and rural medical education

A successful longitudinal graduate tracking system for monitoring Australian medical school graduate outcomes

Context: Maintaining an adequate health workforce in rural and remote Australia is challenging. The Australian Government has addressed this challenge by encouraging the admission of rural background students and supporting the growth of regionally based academic health faculties and clinical schools. Issue: It is imperative to assess the relevance and effectiveness of regionally based academic health faculties and clinical schools so standards can be maintained and health workforce supply and distribution can be maximised to benefit local populations. Approach: The James Cook University (JCU) College of Medicine and Dentistry, the first regional Australian medical school, has developed a longitudinal tracking system for its medical graduates. Processes include administering an exit survey to each cohort immediately prior to graduation (which also collects each graduate's details and consent to be contacted for follow-up studies and practice/career choice data), a Facebook (TM) page to search for hard-to-trace graduates, and accessing the Australian Health Practitioner Regulation Authority (AHPRA) website. Conclusions: The comprehensive personal contact tracking system backed by the AHPRA website has resulted in a 98% complete longitudinal tracking database, and thus a comprehensive picture of the practice location of JCU medical graduates from 2006 to 2013, enabling exploration of the patterns of practice to be conducted with considerable confidence. It is intended that the tracking database will be maintained for many years to allow regular follow-up of graduates well into their established careers. However, as graduate numbers increase at the JCU medical school, personal contact will be made with the majority of graduates on a less frequent basis

Black Hole Decay as Geodesic Motion

We show that a formalism for analyzing the near-horizon conformal symmetry of Schwarzschild black holes using a scalar field probe is capable of describing black hole decay. The equation governing black hole decay can be identified as the geodesic equation in the space of black hole masses. This provides a novel geometric interpretation for the decay of black holes. Moreover, this approach predicts a precise correction term to the usual expression for the decay rate of black holes.Comment: 7 pages, latex file, numerical factors corrected, text revised accordingl

Production of genuine multimode entanglement in circular waveguides with long-range interactions

Starting with a product initial state, squeezed (coherent squeezed) state in one of the modes, and vacuum in the rest, we report that a circular waveguide comprising modes coupled with varying interaction strength is capable of producing genuine multimode entanglement (GME), quantified via the generalized geometric measure (GGM). We demonstrate that for a fixed interaction and squeezing strength, the GME content of the resulting state increases as the range of interactions between the waveguides increases, although the GGM collapses and revives with the variation of interaction strength and time. To illustrate the advantage of long-range interactions, we propose a quantity, called accumulated GGM, measuring the area under the GGM curve, which clearly illustrates the growing trends with the increasing range of interactions. We analytically determine the exact expression of GGM for systems involving an arbitrary number of modes, when all the modes interact with each other equally. The entire analysis is performed in phase-space formalism. We manifest the constructive effect of disorder in the coupling parameter, which promises a steady production of GME, independent of the interaction strength.Comment: 13 pages, 6 figure