Thirty Years Training Rural Physicians

Wendling, Andrea; Phillips, Julie; Short, William R.; Fahey, Carolyn; Mavis, Brian

doi:10.1097/acm.0000000000000885

Cited by 44 publications

(48 citation statements)

References 29 publications

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“…did not adjust) Inferential statistics, unadjusted)[35, 37, 43, 46, 50, 54, 57, 67, 80, 86, 92, 94]12Sample Size (Includes both intervention/control/comparison group if applicable) Less than 100[37, 50, 73, 80–82, 84–89, 92, 93]14 100–500[12, 35, 39, 40, 42, 44, 45, 47–49, 54, 56–59, 62, 67, 68, 70, 83, 90, 91, 94, 95]24 500+[36, 38, 41, 43, 46, 51–53, 55, 60, 61, 63–66, 69, 71, 72, 74–79]24Consent or Participant Rate (Depending on the study/type of study and reporting) Below 50%[35, 47, 58, 59, 69, 71, 73, 79, 81, 88, 91]11 50–80%[39, 40, 44, 45, 48, 49, 51, 56, 64, …”

Section: Resultsmentioning

confidence: 99%

“…(For example, a RCS may be located in a metropolitan location but may be termed an RCSP, as they have rural campuses and rural initiative programs) [39–45, 47–49, 57, 58, 60, 63, 64, 67, 69, 70, 72, 77–79, 85, 87, 88, 92]. One study directly compared a RCSP to a RCP [44] and two studies looked at large populations that related to both RCP and RCSP programs, hence these programs have been placed in both classifications [58, 64].…”

Section: Resultsmentioning

confidence: 99%

“…Thirty five articles were from Australia, [12, 49, 63, 67–71, 73, 78–81, 84–90, 92] eighteen from the United States [50–55, 60–62, 64, 65, 72, 75–77, 93–95] five from Canada [56, 58, 59, 66, 83] two from New Zealand [82, 91], and one each from Thailand [74], and Africa [57]. …”

Section: Resultsmentioning

confidence: 99%

“…Forty-two of the studies were designed and implemented within a single medical school (rather than a partnership with multiple schools) [12, 36, 39–47, 49–56, 60–63, 68, 69, 72, 73, 76, 78, 80–89, 93–95], while twenty programs involved multiple medical schools [35, 37, 38, 48, 57–60, 64–67, 70, 71, 75, 77, 79, 90–92]. …”

Section: Resultsmentioning

confidence: 99%

“…The most commonly reported sample size was split between 500plus [36, 38, 41, 43, 46, 51–53, 55, 60, 61, 63–66, 69, 71, 72, 74–79], (24 studies) and between 100 and 500 participant sample size (24 studies) [12, 35, 39, 40, 42, 44, 45, 47–49, 54, 56–59, 62, 67, 68, 70, 83, 90, 91, 94, 95]. There was a wide spread in sample size from small to large population size programs across the literature.…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

The impact of rural outreach programs on medical students’ future rural intentions and working locations: a systematic review

2018

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BackgroundSignificant investment has been undertaken by many countries into ‘Rural Clinical Training Placement Schemes’ for medical students in order to deal with shortages of trained health care professionals in rural and remote locations. This systematic review examines the evidence base of rural educational programs within medical education and focusses on workforce intentions and employment outcomes. The study provides a detailed description of the methodological characteristics of the literature, thematic workforce outcomes and key related factors are identified, study quality is assessed, and the findings are compared within an international context.MethodsA systematic review looking at international literature of rural placement programs within medical education between January 2005 to January 2017 from databases including; Medline, Embase, NursingOVID, PubMed and Cochrane. The study adopted the PRISMA protocol. A quality assessment of the literature was conducted based on the Health Gains Notation Framework.ResultsSixty two papers met the inclusion criteria. The review identified three program classifications; Rural Clinical Placement Programs, Rural Clinical Placement Programs combined with a rural health educational curriculum component and Rural Clinical School Programs. The studies included were from Australia, United States, Canada, New Zealand, Thailand and Africa.Questionnaires and tracking or medical registry databases were the most commonly reported research tools and the majority were volunteer programs. Most studies identified potential rural predictors/confounders, however a number did not apply control groups and most programs were based on a single site. There was a clear discrepancy in the ideal rural clinical placement length. Outcomes themes were identified related to rural workforce outcomes. Most studies reported that an organised, well-funded, rural placement or rural clinical school program produced positive associations with increased rural intentions and actual graduate rural employment.ConclusionsFuture research should focus on large scale methodologically rigorous multi-site rural program studies, with longitudinal follow up of graduates working locations. Studies should apply pre-and post-intervention surveys to measure change in attitudes and control for predictive confounders, control groups should be applied; and in-depth qualitative research should be considered to explore the specific factors of programs that are associated with encouraging rural employment.Electronic supplementary materialThe online version of this article (10.1186/s12909-018-1287-y) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

The impact of rural outreach programs on medical students’ future rural intentions and working locations: a systematic review

2018

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Selecting for a sustainable workforce to meet the future healthcare needs of rural communities in Australia

Hay

Mercer

Lichtwark

et al. 2016

Adv in Health Sci Educ

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An undersupply of generalists doctors in rural communities globally led to widening participation (WP) initiatives to increase the proportion of rural origin medical students. In 2002 the Australian Government mandated that 25% of commencing Australian medical students be of rural origin. Meeting this target has largely been achieved through reduced standards of entry for rural relative to urban applicants. This initiative is based on the assumption that rural origin students will succeed during training, and return to practice in rural locations. One aim of this study was to determine the relationships between student geographical origin (rural or urban), selection scores, and future practice intentions of medical students at course entry and course exit. Two multicentre databases containing selection and future practice preferences (location and specialisation) were combined (5862), representing 54% of undergraduate medical students commencing from 2006 to 2013 across nine Australian medical schools. A second aim was to determine course performance of rural origin students selected on lower scores than their urban peers. Selection and course performance data for rural (461) and urban (1431) origin students commencing 2006-2014 from one medical school was used. For Aim 1, a third (33.7%) of rural origin students indicated a preference for future rural practice at course exit, and even fewer (6.7%) urban origin students made this preference. Results from logistic regression analyses showed significant independent predictors were rural origin (OR 4.0), lower Australian Tertiary Admissions Rank (ATAR) (OR 2.1), or lower Undergraduate Medical and Health Sciences Admissions Test Section 3 (non-verbal reasoning) (OR 1.3). Less than a fifth (17.6%) of rural origin students indicated a preference for future generalist practice at course exit. Significant predictors were female gender (OR 1.7) or lower ATAR (OR 1.2), but not rural origin. Fewer (10.5%) urban origin students indicated a preference for generalist practice at course exit. For Aim 2, results of Mann-Whitney U tests confirmed that slightly reducing selection scores does not result in increased failure, or meaningfully impaired performance during training relative to urban origin students. Our multicentre analysis supports success of the rural origin WP pathway to increase rural student participation in medical training. However, our findings confirm that current selection initiatives are insufficient to address the continuing problem of doctor maldistribution in Australia. We argue for further reform to current medical student selection, which remains largely determined by academic meritocracy. Our findings have relevance to the selection of students into health professions globally.

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Recruiting Rural Healthcare Providers Today: a Systematic Review of Training Program Success and Determinants of Geographic Choices

et al. 2017

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BackgroundRural areas have historically struggled with shortages of healthcare providers; however, advanced communication technologies have transformed rural healthcare, and practice in underserved areas has been recognized as a policy priority. This systematic review aims to assess reasons for current providers’ geographic choices and the success of training programs aimed at increasing rural provider recruitment.MethodsThis systematic review (PROSPERO: CRD42015025403) searched seven databases for published and gray literature on the current cohort of US rural healthcare practitioners (2005 to March 2017). Two reviewers independently screened citations for inclusion; one reviewer extracted data and assessed risk of bias, with a senior systematic reviewer checking the data; quality of evidence was assessed using the GRADE approach.ResultsOf 7276 screened citations, we identified 31 studies exploring reasons for geographic choices and 24 studies documenting the impact of training programs. Growing up in a rural community is a key determinant and is consistently associated with choosing rural practice. Most existing studies assess physicians, and only a few are based on multivariate analyses that take competing and potentially correlated predictors into account. The success rate of placing providers-in-training in rural practice after graduation, on average, is 44% (range 20–84%; N = 31 programs). We did not identify program characteristics that are consistently associated with program success. Data are primarily based on rural tracks for medical residents.DiscussionThe review provides insight into the relative importance of demographic characteristics and motivational factors in determining which providers should be targeted to maximize return on recruitment efforts. Existing programs exposing students to rural practice during their training are promising but require further refining. Public policy must include a specific focus on the trajectory of the healthcare workforce and must consider alternative models of healthcare delivery that promote a more diverse, interdisciplinary combination of providers.Electronic supplementary materialThe online version of this article (10.1007/s11606-017-4210-z) contains supplementary material, which is available to authorized users.

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Thirty Years Training Rural Physicians

Abstract: Program characteristics, including targeting rurally interested students, primary care focus, and substantial clinical training within a rural region, can successfully foster rural physician careers. The greatest benefit is to the rural region where the program is based.

Cited by 44 publications

References 29 publications

The impact of rural outreach programs on medical students’ future rural intentions and working locations: a systematic review

The impact of rural outreach programs on medical students’ future rural intentions and working locations: a systematic review

Selecting for a sustainable workforce to meet the future healthcare needs of rural communities in Australia

Recruiting Rural Healthcare Providers Today: a Systematic Review of Training Program Success and Determinants of Geographic Choices

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