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Source publication
Background:
The diverse rural medical education initiatives that have been developed in Australia to address the medical workforce maldistribution have been less successful in many smaller and remote communities. This study explored the factors that attract and retain GP registrars and supervisors and the impact that localised training (i.e., rura...
Contexts in source publication
Context 1
... more registrars in smaller rural and remote communities using a distributed model, so-called localised GP training. The JCU GPT localised training incorporates a distributed model that provides workplace based training and increased support from administrative offices in 14 towns throughout central, northern and western Queensland, as shown in Fig. ...
Context 2
... more registrars in smaller rural and remote communities using a distributed model, so-called localised GP training. The JCU GPT localised training incorporates a distributed model that provides workplace based training and increased support from administrative offices in 14 towns throughout central, northern and western Queensland, as shown in Fig. ...
Citations
... Recruitment strategies should maximise opportunities for practitioners to embed rurally. This may be by selecting doctors with personality attributes, such as having a rural identity and having high cooperativeness, associated with rural practice, and by ensuring training programmes are geographically circumscribed to facilitate practitioners, and their families, building relationships locally [46,47]. This is also relevant to IMGs who, rather than being seen as a short-term stopgap, could be offered longer-term opportunities, inclusive of professional development, to practice rurally [48]. ...
Australia, in common with many countries globally, has a shortage of doctors working rurally. Whilst strategies and current research focus on recruitment, attrition from rural practice is a significant determinant of such shortages. Understanding doctors’ decisions to stay or leave, once recruited, may provide further insights on how to address this rural differential. This study comprises a qualitative study of 21 recently recruited nationally-trained doctors and international medical graduates to a rural area of New South Wales, Australia. Interviews focused on their experiences prior to and within rural practice, and how these influenced their future career intentions. We used reflexive thematic analysis with each interview coded by two researchers to build an explanatory framework. Our findings comprise five themes which applied differentially to nationally-trained doctors and international medical graduates: connectedness across professional, personal and geographic domains, how multi-faceted connectedness was, and dissonance between participants’ expectations and experiences. Amongst nationally-trained doctors, connectedness stemmed from prior rural experiences which engendered expectations founded upon their ability to develop community-level relationships. Experiences were mixed; some described difficulties maintaining a boundary between their personal and professional lives, which encroached upon their ability to embed within the community. International medical graduates’ expectations were cultivated by their pre-conceptions of Australian postgraduate training but they lamented a lack of professional opportunities once in practice. Moreover, they described a lack of professional relationships with local, nationally-trained, doctors that could help them embed into rural practice. This study highlighted that when connectedness occurs across professional, geographic and personal domains doctors are more likely to continue rural practice, whilst illustrating how the importance of each domain may differ amongst different cadres of doctor. Supporting such cadres develop supportive interrelationships may be a low hanging fruit to maximise retention.
... Research shows that the reasons for this are both personal and professional. Factors of a personal nature are fear of social isolation and limited work opportunities for their partners [7,[15][16][17]. Regarding the work conditions, these include the fear of a higher level of responsibility, less support from a team and fewer opportunities for networking [7]. ...
... In addition to the effects of such programs, research has also been done to determine which students are interested in working in rural areas. Mostly students with rural backgrounds themselves, or with a partner of rural origin are motivated to work in rural areas after graduation [2,15,18,19,22,[29][30][31]. Financial support can also contribute positively to this decision [31]. ...
... Especially graduates from a humanities, commerce, business or law background are significantly more likely to choose a rural area to work after graduation from medical school [32]. Other personal factors supporting the decision to work as a general practitioner in rural areas are experience with working in developing countries or other social activities, doing volunteer work prior to medical school, a desire for a broad spectrum of practice, a holistic work approach, lower social class background, having young children and a stronger interest in social problems [2,15,33]. ...
Background
In many countries, not enough students are interested to work as general practitioners in rural areas. To solve this problem, several, sometimes partly extracurricular, programs have been developed. Most of these programs are based on continuity, which means that students stay in a rural region for an extended period of time, by completing clerkships. Although the effects of these programs are positive, it is often difficult to motivate students to participate. The purpose of the present study is to get insight into the reasons why students choose not to participate in these programs.
Methods
We carried out a questionnaire study among medical students in the clinical phase of the Technical University of Munich in Germany. First, we asked the students whether they actively informed themselves about the program which aims to reduce the shortage of general practitioners in rural areas in Bavaria. Furthermore, the questionnaire focused on the reasons for not participating in this program.
Results
Based on the answers of 442 students from study years 3–6, the most frequently chosen reason for not participating in the program is “identification with another discipline” with 61.0%, directly followed by “not willing to commit long-term” (56.1%). In third place is “personal connections to another region” with 30.5%. In the open comments, we find the same reasons: many students do not want to commit to a certain direction too early. In addition, students indicate that the number of regions where this program is offered is too limited for them.
Conclusions
Offering programs to prepare and motivate students for work as general practitioners in rural areas can contribute to increasing the pool of future general practitioners. To encourage students to participate in such a program, it is important to consider the motives of students. Many students who might be interested in general practice do not choose to take part in such a program because they do not want to commit to a particular specialty or region at an early stage. It is important to take these insights into account when designing and implementing these programs.
... In these instances, the early career doctors felt their training needs were not being met. "In some practices, tutorials were not given priority on the timetable and so did not occur, or else were held outside of work hours" pg 8 [59] "it is far away from everywhere, so you have got to add a whole day for travel just because of the time of flights and the cost" pg 5 [54] Personal and community influences make a difference ...
Background
Maintaining a health professional workforce in rural and remote areas poses a significant challenge internationally. A range of recruitment and retention strategies have had varying success and these are generally developed from the collective experience of all health professions, rather than targeted to professional groups with differing educational and support contexts. This review explores, compares and synthesises the evidence examining the experience of early career rural and remote allied health professionals and doctors to better understand both the profession specific, and common factors that influence their experience.
Methods
Qualitative studies that include early career allied health professionals’ or doctors’ experiences of working in rural or remote areas and the personal and professional factors that impact on this experience were considered. A systematic search was completed across five databases and three grey literature repositories to identify published and unpublished studies. Studies published since 2000 in English were considered. Studies were screened for inclusion and critically appraised by two independent reviewers. Data was extracted and assigned a level of credibility. Data synthesis adhered to the JBI meta-aggregative approach.
Results
Of the 1408 identified articles, 30 papers were eligible for inclusion, with one rated as low in quality and all others moderate or high quality. A total of 23 categories, 334 findings and illustrations were aggregated into three synthesised findings for both professional groups including: making a difference through professional and organisational factors, working in rural areas can offer unique and rewarding opportunities for early career allied health professionals and doctors, and personal and community influences make a difference. A rich dataset was obtained and findings illustrate similarities including the need to consider personal factors, and differences, including discipline specific supervision for allied health professionals and local supervision for doctors.
Conclusions
Strategies to enhance the experience of both allied health professionals and doctors in rural and remote areas include enabling career paths through structured training programs, hands on learning opportunities, quality supervision and community immersion.
Systematic review registration number
PROSPERO CRD42021223187.
... [15][16][17][18][19][20][21] In addition, several qualitative studies reported links between health professionals with rural upbringings and the intention to enter or remain in practice in rural areas. [22][23][24][25] One study, supporting this association, reported that rural background had a limited influence on turnover intention compared to other factors such as previous professional experiences. 23 However, given the multiple methods used across separate studies and the convergence of results indicating rural upbringing is associated with the intent to enter or remain in practice in a rural area, this association is an important, consistent finding and worthy of further investigation. ...
... 39 For those with family commitments, the dependence on place relies on factors such as a spousal employment and dependent children's access to quality education. 25,28,34,[40][41][42] Not surprisingly, negative relational factors within the work environment were also identified as influencing the decision to consider working. A lack of management support, poor leadership skills of supervisors, lack of mentoring opportunities, problematic human resource approaches, and a perceived problematic workplace culture were identified as aspects that were a deterrent continuing to work in a rural area. ...
... 50 Similarly, fulfilment of life aspirations and lifestyle aspects of rural practice is consistent not only with place dependence on resources but also on bonding to the natural environment which affords a lifestyle of choice. For example, factors associated with lifestyle behaviours and lifestyle activities desired by health professionals, such as activities within a pleasant natural environment 13,25,45 and the match between actual lifestyle opportunities and the expectations held by the health professional, were important factors in retaining and attracting health professionals. With respect to place identity and social bonding, this review found evidence that a rural upbringing, a sense of rurality and identity, and relational integration in the workplace and community as identifiable influences on practitioners' careers. ...
Introduction:
Personal, community, and environmental factors can influence the attraction and retention of regional, rural, and remote health workers. However, the concept of place attachment needs further attention as a factor affecting the sustainability of the rural health workforce.
Objective:
The purpose of this rapid review was to explore the influence of a sense of place in attracting and retaining health professionals in rural and remote areas.
Design:
A systematic rapid review was conducted based on an empirical model using four dimensions: place dependence, place identity, social bonding and nature bonding. English-language publications between 2011 and 2021 were sought from academic databases, including studies relevant to Australian health professionals.
Findings:
A total of 348 articles were screened and 52 included in the review. Place attachment factors varied across disciplines and included (a) intrinsic place-based personal factors; (b) learning experiences enhancing self-efficacy and rural health work interest; (c) relational, social and community integration; and (d) connection to place with lifestyle aspirations.
Discussion:
This rapid review provides insight into the role of relational connections in building a health workforce and suggests that community factors are important in building attachment through social bonding and place identity. Results indicate that future health workforce research should focus on career decision-making and psychological appraisals including place attachment.
Conclusion:
An attachment to place might develop through placement experiences or from a strong rural upbringing. The importance of the relational interactions within a work community and the broader community is seen as an important factor in attracting, recruiting, and sustaining a rural health workforce.
... Interactions of health systems and Indigenous cultural domains in these 2 states would be interesting for it to warrant justification for this study. Further, other states, that is Victoria, 8 Tasmania 2 and Queensland, 25 have been subject to research investigations with Queensland Health hailed in the Lost in the Labyrinth report as an example of best practice for an orientation program of International Medical Graduates Scheme (RAPTS). 12 Rural and remote location was defined by the Modified Monash Model (MMM), 26 and the location was chosen in terms of the visa by employment field. ...
Objective
The over‐reliance on overseas‐trained doctors remains a pressing problem in a handful of countries. This study aimed to explore the experience of rural and remote overseas‐trained doctors as regards to their migration, recruitment and ongoing support in Australia as the basis for more effective health workforce governance.
Design
Qualitative interviews were undertaken with overseas‐trained doctors in rural and remote Australia. Interview questions focused on the experiences of overseas‐trained doctors.
Setting
Migrant doctors working in general practice in rural and remote Australia.
Participants
Overseas‐trained doctors who met inclusion criteria participated in interviews (n=14), which were digitally recorded and transcribed. Thematic coding and analysis were conducted with input from the study's Expert Policy Stakeholder Group.
Results
Overseas‐trained doctors enjoyed the relative autonomy of working in rural or remote general practice and were grateful to be in Australia. Specialised rural and remote skills such as cultural competence in matters of Indigenous health and specialised emergency rural skills was a key finding as was the deskilling or lack of career development opportunities. Our analysis pointed to the mismatch in expectations and experiences between overseas‐trained doctors, policy‐makers and employers, as some doctors experienced obstacles with registration, or the location was not ideal, or there was a lack of awareness of Indigenous‐related health and cultural challenges.
Conclusions
In the context of Australia's continuing reliance on overseas‐trained doctors, this study revealed the need for improved communication and coordination between overseas‐trained doctors, policy‐makers (education, health, employment and immigration) and employers, as a basis for more effective health workforce governance.
... [19][20][21] The JCU GPT programme provides training for registrars across different rural and remote communities and places emphasis on individualised support for the registrars,including access to a training supervisor per registrar, resources, community-based infrastructure and review of progress at regular intervals. 22 23 According to Peel et al 23 , the JCU GPT localised training mitigated issues (such as social and professional isolation and accessing professional development) associated with rural and remote practice. It was reported that the localised training programme increased the attractors to rural and remote practice and fostered community engagement and professional network. ...
... It was reported that the localised training programme increased the attractors to rural and remote practice and fostered community engagement and professional network. 23 It is believed that this localised training programme with its unique model of individualised support can promote and improve the recruitment and retention of GPs in underserved/ remote areas. 23 Given that job satisfaction is a significant predictor of retention, 14 it is important to investigate the level of satisfaction and perceptions of the registrars concerning the localised training model. ...
... 23 It is believed that this localised training programme with its unique model of individualised support can promote and improve the recruitment and retention of GPs in underserved/ remote areas. 23 Given that job satisfaction is a significant predictor of retention, 14 it is important to investigate the level of satisfaction and perceptions of the registrars concerning the localised training model. Therefore, this study examined JCU GP registrars' satisfaction with the educational environment and their perceptions of the work/educational environment. ...
Objectives
Evidence in the literature suggests that satisfaction with postgraduate general practice (GP) training is associated with the quality of the educational environment. This study aimed to examine GP registrars’ level of satisfaction with a distributed model of training in a regional educational environment and investigate the relationship between satisfaction and academic performance.
Study design
A longitudinal 3-year study was conducted among GP registrars at James Cook University using a sequential explanatory mixed methods research design. GP registrars’ satisfaction was obtained using the scan of postgraduate educational environment domains tool. A focus group discussion was conducted to explore GP registrars’ perceptions of satisfaction with the educational environment.
Setting
James Cook University General Practice Training (JCU GPT) programme.
Participants
Six hundred and fifty one (651) GP registrars enrolled between 2016 and 2018 at JCU GPT programme.
Results
651 registrars completed the satisfaction survey between 2016 and 2018. Overall, 92% of the registrars were satisfied with the educational training environment. Registrars who had become fellows reported higher satisfaction levels compared with those who were still in training (mean=4.39 vs 4.20, p=0.001). However, academic performance had no impact on level of satisfaction with the educational environment. Similarly, practice location did not influence registrars’ satisfaction rates. Four themes (rich rural/remote educational environment, supportive learning environment, readiness to continue with rural practice and practice culture) emerged from the thematic data analysis.
Conclusion
A clinical learning environment that focuses on and supports individual learning needs is vital for effective postgraduate medical training. This study suggests that JCU GPT programme’s distributed model fostered a satisfying and supportive training environment with rich educational experiences that enhance retention of GP registrars in rural/remote North Queensland, Australia. The findings of this study may be applicable to other settings with similar training models.
The health workforce is stretched to its limits in Aotearoa and abroad. Rural and remote communities, which are often the first to be impacted by workforce shortages, are struggling to recruit and retain staff. Targeted investment in academic, political, and financial strategies have aimed to increase the numbers of doctors and nurses entering the workforce, and to support them to stay. Comparatively little has been done for the professions that make up the umbrella group, Allied Health Scientific and Technical. This doctoral research explored ways to support recruitment and retention in rural communities in these workforces by answering the following questions: What do Allied Health Professionals (AHPs) identify as the attractive aspects of living and working rurally? How could this inform how we recruit and retain AHPs in rural and remote settings?
Reviews of the literature explored what was known about these workforce groups and how they chose rural practice. The reviews also sought to understand the strategies utilised by other health professions and to what effect. The literature review was followed by an Interpretive Descriptive study, using qualitative interviews to explore the perspectives and experiences of 18 allied health participants with rural and remote health experience. Utilising Reflexive Thematic Analysis, the interview transcripts were analysed for meaning in relation to the research questions.
The research identified four significant concepts which are critical to the experiences of AHPs. The first theme is Sense of Connection and Belonging which captures the ways that AHPs feel connected to their rural work and community setting. The second theme is Safe and Supported Practice and focuses on those components which enable AHPs to do their best work. The third theme is Creating Roles People Want to Come For which looks at the various elements that make roles attractive. These were interwoven with a fourth concept of Fit, a sense of being in the right space, place, and time.
In addition to identifying these themes, a collection of practical recommendations has been distinguished for those entities most able to change practice in ways that will enhance the experiences of rural AHPs and, in turn, increase the efficacy of recruitment and retention in rural and/or remote health settings. These entities are people leaders, organisations, recruiters, tertiary education providers, registering bodies and professional associations.
The findings and recommendations, which detail meaningful opportunities to enhance the relationships and resources of AHPs in rural and/or remote health settings, offer a significant contribution to knowledge. The research challenges the existing structures in health systems which privilege medicine and nursing, from resource allocation to scopes of practice, as the system that affects decision-making and empowerment. It has implications for those in leadership, recruitment, education, profession advocacy and governance. It shows that, given the chance, we can build an effective and stable AHP workforce to serve rural and remote communities throughout Aotearoa for years to come.
Objectives
To investigate the effects of extended short-term medical training placements in small rural and remote communities on postgraduate work location.
Design and setting
Cohort study of medical graduates of The University of Queensland, Australia.
Participants
Graduating medical students from 2012 to 2021 who undertook a minimum of 6 weeks training in a small rural or remote location. Some participants additionally undertook either or both an extended short-term (12-week) placement in a small rural or remote location and a long-term (1 or 2 years) placement in a large regional centre.
Primary outcome measure
Work location was collected from the Australian Health Practitioner Regulation Agency in 2022, classified as either rural, regional or metropolitan and measured in association with rural placement type(s).
Results
From 2806 eligible graduates, those participating in extended small rural placements (n=106, 3.8%) were associated with practising rurally or regionally postgraduation (42.5% vs 19.9%; OR: 2.2, 95% CI: 1.1 to 4.6), for both those of rural origin (50% vs 30%; OR: 4.9, 95% CI: 2.6 to 9.2) or metropolitan origin (36% vs 17%; OR: 2.8, 95% CI: 1.7 to 4.8). Those undertaking both an extended small rural placement and 2 years regional training were most likely to be practising in a rural or regional location (61% vs 16%; OR: 8.6, 95% CI: 4.5 to 16.3). Extended small rural placements were associated with practising in smaller rural or remote locations in later years (15% vs 6%, OR: 2.7, 95% CI: 1.3 to 5.3).
Conclusion
This work location outcome evidence supports investment in rural medical training that is both located in smaller rural and remote settings and enables extended exposure with rural generalists. The evaluated 12-week programme positively related to rural workforce outcomes when applied alone. Outcomes greatly strengthened when the 12-week programme was combined with a 2-year regional centre training programme, compared with either alone. These effects were independent of rural origin.
Background: Maintaining a health professional workforce in rural and remote areas pose a significant challenge internationally. A range of strategies have been used to improve recruitment and retention with varying levels of success. To date, strategies are generally developed based on the collective experience of all health professions, rather than targeted to professional groups with differing educational and support contexts. This review sought to explore, compare and synthesise the evidence examining the experience of early career rural and remote allied health professionals and doctors to better understand both the profession specific, and common factors that influence their experience. The results of this review will generate relevant workforce recommendations.
Methods: This review considered qualitative studies that include early career allied health professionals’ or doctors' experiences of working in rural or remote areas and the personal and professional factors that impact on this experience. A systematic search was completed (CINAHL (EBSCO), Embase, MEDLINE (Ovid), Web of Science, Informit, ProQuest Dissertations and Theses, Google Scholar, and WorldWideScience.org) to identify published and unpublished studies. Studies published since 2000 in English were considered for the review. Identified studies were screened for inclusion and critically appraised by two independent reviewers. Data was extracted and assigned a level of credibility. Data synthesis adhered to the JBI meta-aggregative approach.
Results: Of the 1408 identified articles, 32 papers were eligible for inclusion. One study was rated as low in quality and all other studies moderate or high quality. A total of 24 categories and 334 findings and associated illustrations were aggregated into three synthesised findings for both professional groups including: making a difference through professional and organisational factors, working in rural areas can offer unique and rewarding opportunities for early career allied health professionals and doctors, acknowledging personal and community influences that make a difference. The synthesised findings illustrate a range of similar and different experiences for early career allied health professionals and doctors in rural and remote areas.
Conclusions: Strategies to enhance the experience of both allied health professionals and doctors in rural and remote areas include enabling career paths through structured training programs, hands on learning opportunities, quality supervision and community involvement.
Systematic review registration number: PROSPERO CRD42021223187
