Title:
A decade of Australian Rural Clinical School graduates--where are they and why?

Abstract:
The Australian Rural Clinical School (RCS) initiative has been addressing the rural medical workforce shortage at the medical education level for over a decade. A major expectation of this initiative is that it will improve rural medical workforce recruitment and subsequent retention through a rurally based undergraduate clinical training experience. The longitudinal nature of these workforce initiatives means that definitive evidence of its impact on the shortage of rural doctors is yet to be provided; however, to date cross-sectional studies are accumulating a measure of efficacy for these initiatives by monitoring early career factors such as internship location choice and speciality choice of RCS graduates. This article reports on a study in one RCS that is monitoring the impact of rural undergraduate clinical training on trends in workforce participation patterns of its graduates as long as 9 years in the workforce. Career location and speciality choice are reported as well as perspectives on early career intentions and the reality of making career and life decisions as a doctor in the medical workforce.
A longitudinal mixed methods sequential explanatory design employed a quantitative data collection phase followed by a qualitative phase with the merging of data sources during the interpretation and analysis. In 2007 a database was established that maintained the contact details of all former graduates since 2002. Every 2 years graduates are invited to participate in a survey and provide an update on the influences on their current career intentions/decisions. The qualitative sample was recruited through a survey question asking for interest in participating in an interview.
The whole-sample survey results showed that out of a 64% (N = 115) response rate, 40% of respondents were currently working in non-urban locations. The majority (<n = 51, 53%) had been out in the workforce for 5 to 7 years and general practice was the most frequent speciality choice. Out of 29 interviewees, just over half (n = 16, 55%) were currently working in non-urban locations and primarily in general practice. The majority (n = 17, 58%) had been out in the workforce for 5 to 6 years. Overall they perceived that the primary drivers influencing their early career/life decisions were personal/family reasons and speciality training requirements.
The study highlighted what is obvious but often overlooked in recruitment strategies for medical students and prevocational doctors: the significance of the inevitable life decisions that frequently take precedence over career intentions. A decade on there is strong endorsement for the positive influence that rural undergraduate clinical training has on promoting rural career intentions. However the fulfilment of these intentions is at risk when competing with concurrent personal/life choices and while based in an urban training environment. Provision of a continuum of postgraduate training opportunities in rural and regional settings that include a rural focus for specialties such as surgery, anaesthetics and obstetrics could: (1) satisfy speciality training requirements; (2) focus life decisions in a rural environment; and (3) keep rural career intentions viable and congruent with other life goals. The overriding message is: the longer the exposure to training in the rural context, the greater the impact on interest in future rural practice and, particularly, the greater the likelihood that important life decisions will also be made in the rural context.