Abid Y, Connell CJW, Sijnja B, Verstappen AC, Poole P. National study of the impact of rural immersion programs on intended location of medical practice in New Zealand. Rural Remote Health [Internet]. 2020 Nov 1 [cited 2020 Dec 3];20(4):5785. Available from:https://www.rrh.org.au/journal/article/5785/
Open access paper
This recent piece of observational research combined data from the Medical Students Outcome Database (MSOD) for New Zealand graduates of both Medical Schools with University rural experience data. They looked at graduate’s future intentions to work in Rural, Regional or Urban location, comparing those who participated in long rural immersion programmes (RMIP and Pūkawakawa), short interprofessional programmes (RHIP and TIPE) and those who didn’t participate in any specific rural programme.
Why is this important?
Essentially this is proof in the value of long rural immersion programmes in Aotearoa! This study has shown that those who participated in long rural immersion programmes were over 6 times more likely to show an intention to work rurally and over 4 times more likely to show an intention to work regionally! This is consistent with overseas research but one of the first pieces to show this in New Zealand.
This study also supports ongoing importance of rural background on career choice while also demonstrating that through long rural immersion programmes we can still convert plenty of city kids.
This paper only looked at workforce intentions. Next we need to look to see if this finding persists further into postgraduate years and actual changes in workforce outcomes.
Introduction:New Zealand (NZ) faces an ongoing shortage of rural medical professionals. In an effort to increase interest in rural practice, both of the medical schools in NZ offer rural immersion programs as well as rural entry pathways. The aim of this study was to compare the effect of long (>33-week) rural immersion with a short (5-week interprofessional) rural immersion or no rural immersion on the career location intentions of NZ medical students.
Methods: This observational study used linked data from the Commencing Medical Students Questionnaire (CMSQ) and Exit Questionnaire (EQ), collected between 2011 and 2017 as part of the Medical Schools Outcomes Database project, along with information on whether or not a student undertook a rural immersion program. The main outcome measure was EQ career location intention (Rural (population <25 000), Regional (25 000–100 000) or Urban (>100 000)). The explanatory variables were rural immersion (long, short, none), age, ethnicity, background, CMSQ career location intention, gender, specialisation preferences and interest in rural medicine. In addition to univariate analysis, data were used to build a multinomial model to determine relative associations of these variables with the outcome.
Results: Full data were available for 1367 NZ medical students (47% of all students during the time period). Of these, 17.4% had undertaken a long or short rural immersion program. In univariate analysis, age was the only variable that did not significantly predict EQ rural intention outcome. In the multivariate model, rural immersion was a significant independent predictor of EQ career location intention. Students taking a long rural immersion were 6.4 and 4.4 times more likely to select a Rural or Regional intention, respectively, than those with no rural immersion. This strong effect on rural intentions was seen regardless of background. CMSQ career location intention, background, ethnicity, rural club membership and preference for general practice were also significant predictors. While short rural immersion did not have an independent effect, this finding should be interpreted with caution given the smaller number of students and the response rate.
Conclusions:Long rural immersion is highly beneficial for increasing interest in rural work, increasing the likelihood that medical students will intend to work outside an urban setting. Students who signal an early rural intention are strong candidates for such programs later in their course, regardless of their background. A three-category classification for geographic background and career location intention permitted a more detailed understanding of the interplay among demographic variables and rural immersion in influencing career intentions. Following cohorts into their postgraduate years is needed to ascertain if these career location intentions persist.
Thank you to Katelyn Costello for the review of this paper.