Why does a rural background make medical students more likely to intend to work in rural areas and how consistent is the effect? A study of the rural background effect

Objective: Evidence indicates that medical graduates with a rural background are more likely to become rural doctors than those with an urban background (the rural background effect (RBE)). Exactly why this is so has rarely been studied. This study sought to identify the role of social, environmental and economic factors in addition to isolation characterising rural environments that either explain or modify the association between rural background and becoming a rural doctorrural practice intention. Design and setting: Secondary analysis of linked databases from the Medical Schools Outcomes Database (MSOD), Australian Bureau of Statistics and other government sources. Participants: Seven thousand four hundred twenty‐two commencing medical students who took part in the MSOD survey and for whom external data could be linked. Results: No social, environmental or economic factor studied or isolation significantly contributed to explaining the RBE, although there is some evidence that areas of more attractive climate strengthen the RBE. However, even when the RBE is at its weakest, it remains a strong, positive predictor of attraction to rural practice. Conclusion: Why the RBE occurs remains unexplained. Evidence was found of a reduced RBE under certain climatic conditions and personal circumstances, but further work is required to better understand why rural background is so strongly related with rural medical intention and practice.     

PADDOCK TO CAMPUS: RURAL HIGH SCHOOL AND MEDICAL UNDERGRADUATE PROGRAMS IN SOUTH AUSTRALIA

ABSTRACT: This paper outlines the programs that support country high school students with the potential to take tertiary health training, particularly in medicine and the details of mentor support and the transition into medical undergraduate training. Also, the establishment of rural clubs in Adelaide and Flinders Universities, together with their aims, objectives and activities are highlighted together with details of the evaluation process which has confirmed the success of rural clubs. The establishment of an effective database is described, with a summary of its objectives and scope.     

Undergraduate Rural Medical Education Program Development: Focus Group Consultation With the NRHA Rural Medical Educators Group

Context: Over a decade ago, leaders in rural medical education established the Rural Medical Educators (RME) Group, an interest group within the National Rural Health Association, to support faculty in rural medical education programs. This group has convened an annual RME conclave since 2006. In 2008, this conclave convened 15 national leaders in rural medical education at The University of Alabama. Methods: In preparation for the conclave, potential participants were e‐mailed a set of questions regarding their respective medical education program's initiating motivation, support, resistance, resources, accomplishments, and continuation plans. Analysis of participants’ responses resulted in a question guide that was used at a focus group conducted at the conclave. Purpose: The purpose of the focus group was to explore the experiences of established rural medical educators related to program development and maintenance. The focus group was recorded and transcribed, and then analyzed using the constant comparative method. Findings: Five essential elements for rural medical education programs emerged from the analysis. The elements were: admit the right student, include curricular elements that occur and are required in rural training sites, establish a cadre of rural physicians who are dedicated to education of their successors, secure financial and relational support for the program, and evaluate program progress. Discussion and Conclusions: Discussion about these 5 elements can provide program guidance to neophyte rural medical education programs. Five recommendations are presented in an effort to continue discussion about the essential elements and identify actions that rural medical educators can take to further assist developing programs.     

Recruiting and Retaining Physicians in Very Rural Areas

Context: Recruiting and retaining physicians is a challenge in rural areas. Growing up in a rural area and completing medical training in a rural area have been shown to predict decisions to practice in rural areas. Little is known, though, about factors that contribute to physicians’ decisions to locate in very sparsely populated areas. Purpose: In this study, we investigated whether variables associated with rural background and training predicted physicians’ decisions to practice in very rural areas. We also examined reasons given for plans to leave the study state. Methods: Physicians in the State of Wyoming (N = 693) completed a questionnaire assessing their background, current practice, and future practice plans. Findings: Being raised in a rural area and training in nearby states predicted practicing in very rural areas. High malpractice insurance rates predicted planning to move one's practice out of state rather than within state. Conclusions: Rural backgrounds and training independently predict practice location decisions, but high malpractice rates are the most crucial factor in future plans to leave the state.     

Trends in Nurse Practitioner and Physician Assistant Practice in Nursing Homes, 2000–2010

Objective

To examine nurse practitioner (NP) and physician assistant (PA) practice in nursing homes (NHs) during 2000–2010.

Data Sources

Data were derived from the Online Survey Certification and Reporting system and Medicare Part B claims (20 percent sample).

Methods

NP/PA state average employment, visit per bed year (VPBY), and providers per NH were examined. State fixed‐effect models examined the association between state regulations and NP/PA use.

Principal Findings

NHs using any NPs/PAs increased from 20.4 to 35.0 percent during 2000–2010. Average NP/PA VPBY increased from 1.0/0.3 to 3.0/0.6 during 2000–2010. Average number of NPs/PAs per NH increased from 0.2/0.09 to 0.5/0.14 during 2000–2010. The impact of state scope‐of‐practice regulations was mixed.

Conclusions

NP and PA scope‐of‐practice regulations impact their practice in NHs, not always as intended.     

我国医师多点执业的现状及政策问题确认

目的明确我国医师多点执业的现状,并进行政策问题确认。方珐定性研究与定量研究相结合。结果当前我国医师多点执业政策尚处于试点推行阶段,各方反响不一：政策的推行面临一系列诸如人事制度、医疗质量保障和医疗争议追究等体制、机制上的政策问题。结论推行医师多点执业政策是优化资源配置、调动医务人员的积极性、推动公立医院改革的重要举措．但需夯实基础、合理规划、加强监督,逐步深化人事制度改革,促进政策的稳步推行。     

Medical students' reported barriers to training at a Rural Clinical School

OBJECTIVE: To understand and address students' concerns about attending one of the new Commonwealth-funded Rural Clinical Schools. DESIGN: Analysis of students' reported reasons for clinical school selection from 2003 to 2004. SETTING: The School of Medicine and the Rural Clinical School, University of Melbourne. PARTICIPANTS: Data were obtained from de-identified preference documents submitted by the medical student cohort assigned to the University of Melbourne clinical schools to begin in July, 2004. RESULTS: Thirteen categories of student concerns (social) were identified from written student preference documents. CONCLUSIONS: Evaluation of the students' concerns about social dislocation if they were assigned to a rural clinical school has provided important information about perceived barriers to rural training. These issues must be systematically addressed at the school, university and community level.     

Nature or nurture: the effect of undergraduate rural clinical rotations on pre-existent rural career choice likelihood as measured by the SOMERS Index

Objective: Do undergraduate rural clinical rotations increase the likelihood of medical students to choose a rural career once pre‐existent likelihood is accounted for? Design: A prospective, controlled quasi‐experiment using self‐paired scores on the SOMERS Index of rural career choice likelihood, before and after 3 years of clinical rotations in either mainly rural or mainly urban locations. Setting: Monash University medical school, Australia. Participants: Fifty‐eight undergraduate‐entry medical students (35% of the 2002 entry class). Main outcome measures: The SOMERS Index of rural career choice likelihood and its component indicators. Results: There was an overall decline in SOMERS Index score (22%) and in each of its components (12–41%). Graduating students who attended rural rotations were more likely to choose a rural career on graduation (difference in SOMERS score: 24.1 (95% CI, 15.0–33.3) P < 0.0001); however, at entry, students choosing rural rotations had an even greater SOMERS score (difference: 27.1 (95% CI, 18.2–36.1) P < 0.0001). Self‐paired pre–post reductions in likelihood were not affected by attending mainly rural or urban rotations, nor were there differences based on rural background alone or sex. Conclusions: While rural rotations are an important component of undergraduate medical training, it is the nature of the students choosing to study in rural locations rather than experiences during the course that is the greater influence on rural career choice. In order to improve the rural medical workforce crisis, medical schools should attract more students with pre‐existent likelihood to choose a rural career. The SOMERS Index was found to be a useful tool for this quantitative analysis.     

An analysis of the development of a successful medical collaboration to create and sustain family physician anaesthesiology capacity in rural Canada

BACKGROUND: Initial efforts to increase the availability of training positions, standardise training, and obtain national recognition for family physicians who wished to practise anaesthesia had stalled. OBJECTIVE: To describe the work undertaken to create and sustain family medicine anaesthesiology capacity in Canada. METHODS: In our review, we examined the critical aspects of successful intersectoral work, namely, involvement by key stakeholders; the development of decision-making mechanisms; clearly defined objectives, roles and responsibilities; official support and legitimisation from participating organisations and adequate resources for partnership building. SETTING: Canadian rural family medicine anaesthesiology practice. RESULTS: A small steering committee obtained funding for a national meeting of stakeholders and subsequent committee work over an 18-month period. The national meeting brought together the necessary stakeholders to review and discuss the issues and agree on a group-determined agenda, determine a work plan, identify priority areas and allow the College of Family Physicians of Canada to be the lead organisation in moving the work ahead. Within 18 months, the boards of the key organisations had accepted a common set of standards for training and a national curriculum. Work remains in the longer term to identify sustainable funding for training of family physician as well as the provision of continuing medical education for those trained. CONCLUSIONS: Appropriate attention to the key components of successful intersectoral work may enable previously stalled and complex work to move ahead despite opposition.