A longitudinal integrated placement and medical students' intentions to practise rurally

Medical Education 2012: 46 : 179–191 Context Integrated longitudinal rural placements are designed to promote favourable student attitudes towards and facilitate return to rural practice upon graduation. We explored the impact of an integrated placement on medical students’ attitudes towards rural practice. Methods Data were available from interviews with 10 medical students, 15 clinical supervisors and teachers, three community health staff, and focus groups made up of medical students. Socio‐cognitive career theory gave insight into the personal, contextual and experiential factors, as well as the career barriers, that influence students’ rural practice intentions. Framework analysis was used to develop a thematic framework illustrating the key findings. Results The longitudinal placement enabled students to achieve personal goals, and enhanced self‐efficacy beliefs and orientation towards the complex personal and professional demands of rural practice. The informal curriculum, including multifaceted interactions with patients and their families, clinical teachers and other health care staff, was a vital experiential component. Students assimilated these rich experiences into their practice and evolving notions of professional identity as rural practitioners. Some students had little intention of practising rurally, partly as a result of contextual barriers such as geographic isolation, family and relationship needs, restricted postgraduate training opportunities and limited opportunities for specialist practice. Conclusions The richness of the informal curriculum in a longitudinal rural placement powerfully influenced students’ intentions to practise rurally. It provided an important context for learning and evolving notions of professionalism and rural professional identity. This richness could be reinforced by developing formal curricula using educational activities based around service‐led and interprofessional learning. To overcome the contextual barriers, the rural workforce development model needs to focus on socialising medical students into rural and remote medicine. More generic issues include student selection, further expansion of structured vocational training pathways that vertically integrate with longitudinal rural placements and the maintenance of rurally focused support throughout postgraduate training.     

Doctors in vocational training: rural background and rural practice intentions

Objective: To report the findings of a national survey of Australian doctors in vocational training about their rural practice intentions and their plans to work full time or part time. Design: A self‐administered mailed survey. Setting: Vocational training: general practice and other medical college training programs. Subjects: Australian doctors (i.e. Australian citizens and permanent residents) registered with one of Australia's 17 medical college vocational training programs in September 2002. Main outcome measures: Intention to practise in a rural area on completion of vocational training; full‐time or part‐time practice plans; views about rural practice. Results: Of the 7899 doctors who met the criteria for inclusion in the study, 4259 (54%) responded. In total:14% indicated a preference for rural practice on completion of vocational training; 17% were GP trainees of which 31% preferred rural practice; 83% were registered with one of the other 16 specialist training programs (e.g. adult medicine, paediatric medicine and surgery) of which 10% preferred rural practice; 50% of general practice trainees and 23% of trainees in other specialist training programs with a rural background indicated a preference for rural practice in the long term, compared with 25% and 7%, respectively, of doctors with an urban background; 46% of general practice trainees with intentions to practise in a rural area plan to practise part time. A positive association was observed between rural background and preference for rural practice (odds ratio (OR) 2.9) and between preference for rural practice and enrolment in the rural general practice training pathway (OR 3.1) and involvement in rural education and training activities (OR 5.1). Conclusions: The findings of this study support initiatives to increase the number of rural background students entering medical school and rural education and vocational training initiatives. Australia's rural doctor shortage is not likely to be addressed by this cohort of doctors in vocational training. General practice workforce plans, rural and urban, need to take note of the high proportion of doctors who plan to practise part time.     

医学影像工程专业毕业实习的研究与探索

本文通过对医学影像工程专业毕业实习的研究与探索，提出了毕业实习的目的、要求与方法。     

Examining college students' intentions to become organ donors

502 university students completed survey items on attitudes, experiences, knowledge, and behaviors related to organ and tissue donation (OTD). Despite positive attitudes toward organ donation, only 11% of students formally have declared their intentions to donate through the state registry or by signing an organ card. When asked to report why they have not signed an organ donor card/registry, students reported, "not considering the topic," "intentions to donate in the future," and "general negative attitudes" among other reasons. Students also reported a generally positive attitude toward the topic of OTD and moderate to strong intentions to become organ donors in the future despite feeling somewhat uninformed on the topic. The results are discussed in relation to future campaign message strategies to promote OTD to university students.     

Influences on medical students' decisions to study at a rural clinical school

Objective: To identify factors that influenced medical students at Monash University to undertake their first year of clinical training (third year of the medical course) at a rural clinical school (RCS). Design: Third‐year Monash University medical students undertaking clinical placements at a RCS were surveyed in 2005. A semistructured questionnaire was used to ask students to rate the influence of a list of factors on their decision to undertake their year‐long placement at a RCS. Results: Under half (48%) of students studying at an RCS reported that they were of rural background. All surveyed items were identified as having had a positive influence. Greater clinical experience, learning opportunities and patient access were identified as having the greatest positive influence followed closely by free accommodation and other financial and supportive incentives. Future rural career intention was eight times more likely to be a positive influence in rural compared with urban background students. Conclusion: The most important positive influence on Monash third‐year medical students' decision to study at an RCS is the perception of high‐quality clinical experiences and education. This perception arises from rural exposure during pre‐clinical years.     

Student perception about working in rural Nepal after graduation: a study among first- and second-year medical students

ABSTRACT: BACKGROUND: The Federal Democratic Republic of Nepal is a developing country in South Asia with a population of 29.8 million. In September 2011, there were 18 medical schools with 14 being in the private sector. KIST Medical College is a private school in Lalitpur district. The present study was conducted to obtain information on student perceptions about working in rural Nepal after graduation. METHODS: The study was conducted among first- and second-year undergraduate medical students using a semi-structured questionnaire developed by the authors using inputs from the literature and their experiences of teaching medical students. Year of study, gender, method of financing of medical education, place of family residence and occupation of parents were noted. Participant responses were analysed, grouped together and the number of respondents stating a particular response was noted. RESULTS: Of the 200 students, 185 (92.5%) participated with 95 being from the first year and 90 from the second. Most students were self-financing and from urban areas. Regarding the question of working in rural Nepal after graduation, 134 (72.4%) said they will work after their undergraduate course. Students preferred to work in the government or nongovernmental sector. Student felt doctors are reluctant to serve in rural Nepal due to inadequate facilities, low salary, less security, problems with their professional development, less equipment in health centres, decreased contact with family and difficulties in communicating with an illiterate, rural population. About 43% of respondents felt medical education does not adequately prepare them for rural service. Repeated rural exposure, postings in rural hospitals and health centres, and training students to diagnose and treat illness with less technology were suggested. The median monthly salary expected was 60 000Nepalese rupees (US$ 820) and was significantly higher among first-year students. CONCLUSIONS: The majority of respondents were in favour of working in rural Nepal after graduation. They wanted facilities in rural areas and health centres to be improved. Changes in the education system were suggested. Providing relatively better facilities for rural doctors compared with urban doctors and reorienting medical education for producing doctors for rural Nepal can be considered. Further studies are required in other private medical schools.     

乡村医生医疗服务行为研究

目的了解乡村医生使用药物类型情况,为发展农村中、西医药市场提供决策依据.对象安徽省4县市5个乡镇随机调查的63名乡村医生.方法乡村医生按设计的调查项目连续记录50例左右病例.结论中医药发展形势在农村地区不容乐观;乡村医生的学历、年龄、从医年限是医生选择药物类型的重要影响因素.     

Video games and adolescents' intentions to take risks in traffic.

In a sample of 2193 adolescents the impact of racing games and drive'em up games on the intention to engage in risky driving was examined. The results indicated that playing video games is a small predictor of attitudes (standardized total effect of .171), which in turn, predict fun riding intentions (R(2) = .555).