How do rural placements affect urban-based Australian junior doctors’ perceptions of working in a rural area?

Abstract

Objectives. The aim of the present study was to provide qualitative insights from urban-based junior doctors (graduation to completion of speciality training) of the effect of rural placements and rotations on career aspirations for work in non-metropolitan practices.Methods. A qualitative study was performed of junior doctors based in Adelaide, Brisbane and Melbourne. Individual face-to-face or telephone semistructured interviews were held between August and October 2014. Thematic analysis focusing on participants' experience of placements and subsequent attitudes to rural practice was undertaken.Results. Most participants undertook rural placements in the first 2 years after graduation. Although experiences varied, positive perceptions of placements were consistently linked with the degree of supervision and professional support provided. These experiences were linked to attitudes about working outside metropolitan areas. Participants expressed concerns about being 'forced' to work in non-metropolitan hospitals in their first postgraduate year; many received little warning of the location or clinical expectations of the placement, causing anxiety and concern.Conclusions. Adequate professional support and supervision in rural placements is essential to encourage junior doctors' interests in rural medicine. Having a degree of choice about placements and a positive and supported learning experience increases the likelihood of a positive experience. Doctors open to working outside a metropolitan area should be preferentially allocated an intern position in a non-metropolitan hospital and rotated to more rural locations.

Understanding the Factors Influencing Junior Doctors’ Career Decision-Making to Address Rural Workforce Issues: Testing a Conceptual Framework

“…Our findings on lifestyle as a career choice driver are consistent with other research [20,21], as is our data on the positive impact of supportive training teams [22,23]. As Australia continues to face the challenge of addressing health workforce shortages in rural areas, our data suggests that 'selling' the rural training environment, including positive characteristics of both place and people, would be an effective strategy to attract junior doctors to the regions.…”

Extending a Conceptual Framework for Junior Doctors’ Career Decision Making and Rural Careers: Explorers versus Planners and Finding the ‘Right Fit’

“…Most of the Australian evidence on junior doctors' career choices, consists of quantitative data on current practice location [4,[7][8][9][10], and qualitative studies largely focused on the impact of rural training placement [3,11,12] or the identification of factors influencing career decision making [5,6,13]. To our knowledge, no evidence has been published on the exploration of junior doctors' internal decision-making processes, and there have been calls for more qualitative research to fully understand how medical graduates make choices along the different pathways to rural practice [14].…”

Could adoption of the rural pipeline concept redress Australian optometry workforce issues?

“…For instance, extended placements, typically defined as a continuous experience lasting 13 weeks or more, are thought to foster optimal conditions for rural connectedness, with the ultimate aim being rural workforce recruitment . Counter to this, where long placements have been compulsory, some authors suggest there is limited evidence that this increases future intentions to practise rurally and may in fact have a negative effect . However, few studies have investigated the comparative effectiveness of short block rural placements with extended rural placement in the field of allied health, and thus more investigation is required.…”

“…For example, Australian allied health students who undertook two to four week placements in rural Indigenous communities deemed the support of pre‐placement cultural training as vital, as they saw that it allowed them to engage fully with their patients thereby contributing to a positive learning experience . Likewise, students felt adequate supervision and support during rural placements is essential for placement satisfaction, and where students had some choice in their rural placement location, they reported positive experiences …”

“…A number of investigations have shown that rural clinical exposure can influence medical students toward a rural career path, with one study finding students of rural immersion programs 19 times more likely to practise rurally than their metropolitan‐based peers . Moreover, medical graduates of rural pipelines are four times more likely to practise in outer regional, remote and very remote locations where the need for practitioners is greatest .…”