Background

In Australia, medical students usually undertake a series of 6-8 weeks long clinical specialty placements, and mainly in urban teaching hospitals. As part of a strategy to increase interest in rural careers, students at some medical schools may instead choose longer, more generalist clinical placements through either rural medical schools or rural clinical schools that are affiliated with urban medical schools. These placements involve varying combinations of rotations for periods up to a whole academic year in more generalist hospital and family practice settings. Models include rural longitudinal integrated clerkships (LICs), rural clinical schools, and rural medical schools. Little is known about the effect of these longer placements on career outcomes in Australia.

Method

Student category and placement data from the Medical Student Outcomes Database project was sourced for three categories of medical students commencing in 2008 and 2009: 276 students with at least 700 h (about half an academic year) in rural clinical placements; 772 students at the same medical schools with less than 700 h in rural clinical placements; and 5326 students at 16 medical schools that either did not offer longer rural placements or had very small numbers undertaking them. Data were compared from all three groups using the Chi Square statistic.

Results

There were a total of 3483 students in commonwealth supported places without a rural obligation (CSP); 1375 students in CSPs with a rural obligation; 414 in domestic full fee (DFF) places; and 926 in international full fee (IFF) places. CSP students are more likely, and IFF students are less likely to choose an LRP (χ 2 statistic 56.4, P < 0.05). Students choosing a LRP are more likely to have a rural background (χ 2 statistic 124.5, P < 0.05) and a preference for careers outside metropolitan areas, particularly in smaller communities (χ 2 statistic 182.2, P < 0.05). Future specialty preferences of LRP students are similar to other students, except for emergency medicine and rural medicine, but not for family practice (chi-squared statistic 53.4, P < 0.05).

Discussion and conclusions

Longer rural placements appear to be associated with stronger preference at graduation for rural careers, and appear to be a valid strategy for enhancing rural workforce outcomes. More research is needed to determine the outcomes of all models of longer rural placements, including a comparison of the different models that include longer rural placements. The relevance to other education systems and national contexts also needs examining.