Vocational career paths of graduate entry medical students at Flinders University: a comparison of rural, remote and tertiary tracks.
ABSTRACT To provide data on the career trajectories of medical students from rural and remote workforce programs at Flinders University (the Parallel Rural Community Curriculum [PRCC] and the Northern Territory Clinical School [NTCS]), comparing them with students at the urban Flinders Medical Centre (FMC).
Retrospective postal survey of all 150 graduates who undertook their Year 3 study in the period 1998-2000.
Associations with career preference, assessed using univariate analyses and multivariate regression.
PRCC and NTCS graduates were more likely to choose rural career paths than graduates from FMC. The odds ratios were 19.1 (95% CI, 3.4-106.3; P < 0.001) and 4.3 (95% CI, 1.2-14.8; P = 0.026), respectively, after adjusting for age and rural background. There was no difference in the specialty choices of graduates of the three programs.
This study provides evidence that clinical attachments designed to increase the rural and remote medical workforce do fulfil this objective.
- [Show abstract] [Hide abstract]
ABSTRACT: Medical school curricula remain one of the key levers in increasing the future supply of rural doctors. Data from Australia and overseas have suggested exposure to rural practice via rural placements during basic medical training is positively associated with graduates becoming rural doctors. However, previous studies have suffered from serious methodological limitations. This study sought to determine whether rural clinical placements are associated with a higher proportion of graduating students planning rural careers and to explore associations with timing, duration and location of placements. Data were obtained from the Medical Schools Outcomes Database and Longitudinal Tracking Project, which is a longitudinal study with a high response rate that prospectively collects data, including practice location intention, from all Australian medical schools. Using logistic regression analysis, the association between placements and rural career intention was assessed, controlling for a number of demographic and contextual variables. The association between rural/remote placements later in the programme and rural practice intention was strongly positive whether viewed as simple occurrence or as duration, in contrast to later urban placements, which were strongly negative. A longer duration of placement enhanced the associations reported. Non-metropolitan medical schools were also associated with higher odds of intention to take up rural practice. However, the association with rural placements was overshadowed by the strong positive associations with rural background of students and their stated intention to become a rural doctor at the start of their studies. Exposure to rural practice during basic medical training, and the location and curriculum focus of a medical school are confirmed as factors that are positively associated with students' intention to become rural doctors after graduation. However, rural origin and the early intentions at the start of their medical training are better predictors of expressed intention to take up rural practice than rural clinical placements.Medical Education 04/2014; 48(4):405-416. · 3.62 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Objectives This study was intended to determine if previously identified educational benefits of the Harvard Medical School (HMS) Cambridge Integrated Clerkship (CIC) endure over time.Methods The authors’ earlier work compared the 27 graduates in the first three cohorts of students undertaking the CIC with a comparison group of 45 traditionally trained HMS students; CIC graduates emerged from their clerkship year with a higher degree of patient-centredness and felt more prepared to deal with numerous domains of patient care. Between April and July 2011, at 4–6 years post-clerkship, the authors asked these original study cohorts to complete an electronic survey which included measures used in the original study. The authors also reviewed data from the National Residency Match Program to compare career paths in the two groups.ResultsThe response rate was 62% (42/68). The immediate post-clerkship finding that CIC students held more patient-centred attitudes was sustained over time (p < 0.035). Reflecting retrospectively on their clerkship experiences, CIC graduates continued to report that their clerkship year had better prepared them in a wide variety of domains. Graduates of the CIC attained awards and published papers at the same rates as peers, and were more likely to engage in health advocacy work. Both groups chose a wide range of residency programmes. Among those expressing a preference, no CIC graduates said they would choose a traditional clerkship, but 6 (27%) of the traditionally trained graduates said they would choose a longitudinal integrated clerkship.Conclusions This paper indicates that benefits of longitudinal integrated clerkship training are sustained over time across multiple domains.Medical Education 02/2014; · 3.62 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Medical schools worldwide have developed rural primary care immersive experiences to nurture students' interest in future rural careers and address workforce shortages. Few studies have looked at the students who participate in these programs. This study explores personality traits in US and Australian students who undertake rural-focused medical training. A cross-sectional cohort design used the Temperament and Character Inventory to identify levels of the 7 basic dimensions of personality. Data were collected in successive cohorts over 2007-2011. Multivariate analysis compared trait levels between groups and by demographic variables. The majority of the 302 students (US-167; Australia-135) were female, aged 20-29 years and single. A greater proportion of US students reported being partnered, living longest in a small rural/remote community and having a rural background. Significant differences between groups were detected in several traits but effect sizes were small. The personality pattern of the combined sample indicates students with a mature and stable personality high in Self-Directedness, Persistence, and Cooperativeness. Rural background and marital status enhanced this pattern. Despite coming from different educational and societal backgrounds, similar personality patterns are evident in US and Australian students who pursue rural medical education. Data provide support for a pattern of traits associated with a rural background and its predictive influence on interest in rural practice. Considering the international expansion of rural longitudinal integrated clerkships, understanding student attributes may assist in identifying strategies to enhance the rural workforce that are relevant across cultures and continents.The Journal of Rural Health 04/2014; 30(2):164-74. · 1.77 Impact Factor
MJA • Volume 188 Number 3 • 4 February 2008
The Medical Journal of Australia ISSN:
0025-729X 4 February 2008 188 3 177-
©The Medical Journal of Australia 2007
The second, the Northern Territory Clinical
School (NTCS), enabled volunteer students
to undertake their entire Year 3 study in the
remote tertiary referral centre at Royal Dar-
win Hospital, 3000km from Adelaide.3 All
other students undertook the standard Year
3 program based at Flinders Medical Centre
(FMC), the urban tertiary teaching hospital
affiliated with the university.
The PRCC and NTCS programs were
funded with the expectation that the experi-
ences would encourage students to choose
careers outside capital cities. The graduates
of the first three cohorts are now at least 6
years post-graduation. We aimed to deter-
mine the career path trajectories of these
three cohorts, particularly in relation to
general and rural practice.
n 1996, Flinders University School of
Medicine was the first Australian medical
school to introduce a 4-year graduate-
entry medical program.1 Simultaneously, it
piloted two new clinical teaching programs.
The first, the Parallel Rural Community Cur-
riculum (PRCC), enabled volunteer students
to undertake their entire Year 3 study based
in primary care in small rural communities
in the Riverland, 250km from Adelaide.2
In late 2005, we conducted a retrospective
postal survey of graduates who undertook
their Year 3 study in the period 1998–2000.
There were 150 eligible graduates with con-
tact details on the School of Medicine’s
alumni database. We developed survey
questions using items consistent with the
nationally developed FRAME question-
naire.4 Ethics approval was obtained from
the Flinders University Social and Behav-
ioural Ethics Committee.
The main outcome was preference for
rural versus urban practice. Age at admis-
sion, sex, having lived in a rural community
for at least 5 years, and location of Year 3
study were assessed as independent varia-
bles. Graduates were also asked to indicate
which specialty training program they were
either enrolled in or had completed.
Data were analysed using SPSS, version
14.0.0 (SPSS Inc, Chicago, Ill, USA). Associ-
ations with career preference were assessed
in univariate analysis using t tests for contin-
uous variables and χ2 tests of association for
categorical variables. Variables that were sig-
nificant at P<0.1 were entered into a multi-
variate logistic regression model that
included an adjustment for age.
We distributed 150 questionnaires. Overall,
74 graduates (49%) returned usable data: 45
of 105 FMC students (43%), 16 of 30 NTCS
students (53%), and 13 of 15 PRCC stu-
dents (87%). The median age of respond-
ents at admission to medical school was 24
years (range, 19–42 years) and 54% were
women. These data are consistent with the
profile of the non-respondents.
Preference for a rural medical career
Graduates were asked whether they were
either already in, or training for, practice in a
rural location, an urban location, or both.
Respondents who indicated either “both” or
“unsure” were excluded. In univariate ana-
lysis, there were significant associations
between practice location and age at admis-
sion (P<0.001), medical education program
location (P=0.001) (Box), and rural back-
ground (P<0.001). Of the 19 graduates with
a rural background, 15 (79%) reported a
rural career path, compared with 10 (30%) of
the other 33 graduates. There was no associ-
ation between practice location and sex.
In multivariate analysis, PRCC graduates
were 19.1 (95% CI, 3.4–106.3) times more
likely to choose a rural career path than
FMC graduates after adjusting for age and
rural background (P<0.001). Similarly,
graduates from NTCS were more likely than
FMC graduates to choose a rural career
(odds ratio, 4.3; 95% CI, 1.2–14.8; P=0.026).
Despite the apparently higher percentage of
PRCC and NTCS graduates who chose gen-
eral practice, there was no significant differ-
ence between these programs and FMC
(PRCC v FMC: P=0.067; NTCS v FMC: P=
0.24). In univariate regression, for each 1-
year increase in age at admission, there was
an increased likelihood of choosing general
practice of 15% (95% CI, 4%–27%; P=
0.007). There was no association between
specialty choice and either sex or rural
We report, for the first time, vocational
career choice data for students undertaking
the two most popular forms of rural clinical
school attachment — a longitudinal rural
community-based year, and a year based in
a regional tertiary referral hospital. Our data
Vocational career paths of graduate entry medical students
at Flinders University: a comparison of rural,
remote and tertiary tracks
Paul Worley, Anne Martin, David Prideaux, Richard Woodman, Elizabeth Worley and Michael Lowe
Objective: To provide data on the career trajectories of medical students from rural and
remote workforce programs at Flinders University (the Parallel Rural Community
Curriculum [PRCC] and the Northern Territory Clinical School [NTCS]), comparing them
with students at the urban Flinders Medical Centre (FMC).
Design: Retrospective postal survey of all 150 graduates who undertook their Year 3
study in the period 1998–2000.
Outcome measure: Associations with career preference, assessed using univariate
analyses and multivariate regression.
Results: PRCC and NTCS graduates were more likely to choose rural career paths than
graduates from FMC. The odds ratios were 19.1 (95% CI, 3.4–106.3; P<0.001) and 4.3
(95% CI, 1.2–14.8; P=0.026), respectively, after adjusting for age and rural background.
There was no difference in the specialty choices of graduates of the three programs.
Conclusion: This study provides evidence that clinical attachments designed to increase
the rural and remote medical workforce do fulfil this objective.
MJA 2008; 188: 177–178
178MJA • Volume 188 Number 3 • 4 February 2008
show that students who
chose the PRCC and NTCS
programs were more likely
to choose a rural career after
graduation, even accounting
for age at admission and
Inevitably, small, single
studies such as this suffer
from significant limitations.
Caution should be used in
generalising these findings
to other institutions. Career
choices are made before,
during or after undergradu-
ate rotations, and are there-
fore subject to other
influences. As the students
were volunteers for both
programs, there may have
been a selection bias
towards students with a
prior preference towards
rural practice. Our regres-
sion analysis accounted for
the known influence of
A further limitation is to
what extent this result is
generalisable to non-gradu-
ate-entry courses. The
observation that both rural
and general practice choices
were positively associated
with age suggests that differences between
the career choices of graduates from these
two course types should be the subject of
Of interest is the finding that 39% of the
graduates of the PRCC program and 47% of
the NTCS graduates chose specialties other
than general practice. This is reassuring, as
one requirement of all Australian medical
schools is that their graduates are capable of
undertaking subsequent specialty training
across the breadth of medicine. Previous
research has demonstrated the excellent aca-
demic performance of students in Flinders
University’s rural clinical school programs.7
Although the emphasis on general and rural
practice is one key aim of the PRCC and
NTCS programs, clearly these graduates are
also prepared to pursue careers in urban
environments and other specialties. Our
study shows that these graduates can con-
tribute to meeting the shortfall that exists
across many specialties in rural areas.
The PRCC is supported by funding from the Aus-
tralian Government’s Rural Clinical Schools pro-
gram. The NTCS is supported by funding from the
Northern Territory Government.
Paul Worley, MBBS, FRACGP, FACRRM, Dean1
Anne Martin, PhD, Research Fellow,
Department of Medical Education1
David Prideaux, BEd, PhD,
Professor, Department of
Richard Woodman, PhD,
MBiostat, MSportsSci, Senior
Lecturer in Biostatistics,
Department of General
Elizabeth Worley, BN, MEd,
Michael Lowe, MBBS, FRACP,
1 School of Medicine, Flinders
University, Adelaide, SA.
2 Healthcare and Education
Innovations Pty Ltd,
3 Northern Territory Clinical
School, School of Medicine,
Flinders University, Darwin,
1 Finucane P, Nichols F, Gan-
non B, et al. Recruiting prob-
lem-based learning (PBL)
tutors for a PBL-based curric-
ulum: the Flinders University
experience. Med Educ 2001;
2 Worley P, Silagy C, Prideaux D,
et al. The Parallel Rural Com-
munity Curriculum: an inte-
grated clinical curriculum
based in rural general practice.
Med Educ 2000; 34: 558-565.
3 McDonnel Smedts A, Lowe
M. Clinical training in the Top
End: impact of the Northern Territory Clinical
School, Australia, on the Territory’s health work-
force. Rural Remote Health 2007; 7: 723.
4 DeWitt DE, McLean R, Newbury J, et al. Devel-
opment of a common national questionnaire to
evaluate student perceptions about the Aus-
tralian Rural Clinical Schools Program. Rural
Remote Health 2005; 5: 486.
5 Rabinowitz HK, Diamond JJ, Markham FW,
Paynter NP. Critical factors in designing pro-
grams to increase the supply and retention of
rural primary care physicians. JAMA 2001; 286:
6 Laven GA, Beilby JJ, Wilkinson D, McElroy HJ.
Factors associated with rural practice among
Australian-trained general practitioners. Med J
Aust 2003; 179: 75-79.
7 Worley P, Esterman A, Prideaux D. Cohort study
of examination performance of undergraduate
medical students learning in community set-
tings. BMJ 2004; 328: 207-209.
(Received 10 Jun 2007, accepted 28 Aug 2007)
Career preferences and backgrounds of graduates*
Male20 (44%) 6 (46%)8 (50%)34 (46%)
Median age at admission to medical school (range)
24 (19–38)25 (20–42)24 (20–34) 24 (19–42)
Years lived in rural area before medical school (n=52)
Preferred practice location (n=74)
Obstetrics and gynaecology
*Values are number (%) except for age (years). FMC=Flinders Medical Centre.
NTCS=Northern Territory Clinical School. PRCC=Parallel Rural Community Curriculum. ◆