Effective dimensions of rural undergraduate training and the value of training policies for encouraging rural work

Context: The implementation of rural undergraduate medical education can be improved by collecting national evidence about the aspects of these programmes that work well and the value of investing in national policies.

Objectives: This study aimed to explore how different durations, degree of remoteness and number of rural undergraduate medical training placements relate to working rurally, and to investigate differences after the introduction of formal national training policies that fund short- and long-term rural training experiences for medical students.

Methods: A cohort of 6510 Australian-trained doctors who completed the Medicine in Australia: Balancing Employment and Life survey recalled their participation in rural undergraduate medical training. Responses were categorised by duration, remoteness as defined by the Modified Monash Model levels 3-4 and 4-7 compared with 1, and total number of placements. Multivariate regression was used to test associations with working rurally in 2017, and differences between cohorts of students who graduated pre- and post-2000, of which the latter were exposed to formal national training policies.

Results: Any rural undergraduate training was associated with working rurally (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.3-1.9) with incrementally stronger associations for longer duration (>1 year: OR 3.0, 95% CI 2.3-4.0), greater remoteness (OR 1.8, 95% CI 1.5-2.1) and three placements (OR 2.4, 95% CI 1.9-3.0) compared with none. Rural background (OR 2.6, 95% CI 2.3-3.0) and general practice (OR 2.6, 95% CI 2.2-2.9) were independently associated with working rurally; being female was negatively associated with rural work (OR 0.7, 95% CI 0.6-0.8). The cohort of doctors who trained in a period when national rural training policies had been implemented included more graduates with a rural background and experience of undergraduate rural training but returned equivalent proportions of rural doctors to pre-policy cohorts, and included proportionally more women and fewer general practitioners.

Conclusions: Rural undergraduate training should focus on multiple dimensions of duration, remoteness and number of rural undergraduate training experiences to grow the rural medical workforce. Formal national rural training policies may be an important part of the broader system for rural workforce development, but they rely on the uptake of general practice and the participation of female doctors in rural medicine.