Table 7 Typology category 4: studies of impact of various durations of rural medical education and rural postgraduate internship

Clark et al. [22], Australia, University of Sydney

n = 448 (98 had completed 32 weeks rural placement). Questionnaire on entry and exit from medical school.

8.1 % accepted rural internship. Those that completed 32 weeks rural placement were twice as likely to accept rural internship (21.3% vs 9.9 %).

Those undertaking the long rural placement did so because they already intended to go rural. Students undertaking extended rural placement were more than three times as likely as those with rural backgrounds to express preference for a rural internship. (23.9% vs 7.7%; p = 0.008).

Eley and Baker [63] Australia, University of Queensland

n = 28 completed questionnaire (in aggregate). Year 4 exit questionnaire of rural clinical school (RCS) programme and data on internship choice. Statistical tests compared answers to questions about experience of rural clinical school with internship choice.

Six out of 27 chose to return to their undergraduate placement hospital for internship.

No. of participants was too small to detect differences between sites. Lack of information about the hospital sites.

Eley and Baker [64] Australia, University of Queensland

n = 27 Undergraduates exiting RCS programme. Questionnaire and data on internship choices.

14/27 went to internships in large rural centres with 25 000-100 000 population in 2006.

Eley et al. [65] Australia: University of Queensland (UQ)

n = 180. A retrospective web-based survey of all graduates who undertook clinical year 3, year 4 or years 3 and 4 at UQ rural clinical school 2002–2006.

124 replies (69% response). 29% working in rural places with population ≤100 000. Most important factor affecting rural workplace choice was spending 2, as opposed to 1, year at a rural clinical school.

69 % response rate so maybe selection bias possible in that rural workers respond to a rural focused research project. Only 7% of interns were in places with ≤25 000 population.

Eley et al. [65] Australia: Queensland

n = 631 internships. Analysis of number, source and location of interns by rural classification from university and health department records (2003–2008). Compared University of Queensland (UQ), UQ Rural Clinical School (UQRS) and James Cook University (JCU), which it implies is defined as equivalent to UQRS.

Rural clinical schools (JCU/UQRCS) were more likely to supply interns to hospitals in places with ≤100 000 than to major city hospitals.(OR, 8.8; 95% CI, 4.6–16.7; p < 0.000 1; OR, 6.5; 95% CI, 3.5–12.2; p < 0.000 1)

Study focus is on producing interns for Queensland from Queensland Universities.

McDonnel Smedts and Lowe [67] Australia: Flinders University Northern Territory (NT).

n = 452. Statistical analysis of de-identified data from a database of place of internship and medical registration of Flinders medical graduates 1999–2005.

Those doing final year in at NT clinical school were more than 10 times more likely to complete their residency in NT (54 % did so).

If students were from NT and attended NT clinical school, 70% completed residency in NT.

McDonnel Smedts and Lowe [68] Australia: Northern Territory Clinical School of Flinders University

n = 683. Retrospective analysis of medical school and hospital data on all medical students who completed a placement with the Northern Territory Clinical School (NTCS) between 1998 and 2007.

Placement length was a significant predictor of an NT internship (p < 0.05; OR, 1.08; 95% CI, 1.07–1.09).

Did not identify whether medical students had a rural background.

Playford and Cheong (2012) [27] Australia: University of Western Australia

n = 490. Undergraduate data were linked with postgraduate placements to provide dataset on rural exposure history of junior medical practitioners.

Participation in a longer rural placement at RCSWA was associated with significantly more postgraduate year 1 rural work compared with a short placement alone (OR = 1.5, CI 0.97–2.38).

Interns are classified as working in rural if they do 4 weeks in rural out of the year. This is a very short amount of time to classify as rural. Rural-origin practitioners were more likely to take rural rotations in postgraduate years.

Sen Gupta et al. [66] Australia: James Cook University (JCU) Queensland and other Australian medical schools.

n = 292. Exit survey of JCU graduates compared with Medical Students Outcomes Database data for eight other, largely metropolitan, schools.

67% of JCU graduates undertook their internship outside a metropolitan centre compared with 17% of others (OR: 10.0), and 47% in outer regional centres compared with 5% of others (OR: 16.6).

46% of JCU graduates intend to practise in outer-regional, remote or very remote areas, compared with 15% for other Australian universities.