(To be read in the context of the WONCA Policy on Training for Rural
Practice 1995)
Recruitment to rural practice will increase when high school students, medical
students and new medical graduates see rural practice as a positive career
option. This can be achieved by carefully encouraging and selecting school
students, sensitising medical students to rural practice early on and providing
appropriate clinical teaching in the latter part of the undergraduate course
and in the immediate postgraduate period.
Experience around the world shows that students from a rural origin are much
more likely to enter rural practice after graduation than urban origin
students. In most current medical courses, the proportion of students from a
rural origin is significantly less than the proportion of the population which
lives in the country. It is important to implement a broad range of strategies
that recruit more medical students from a rural background, and provide them
with the support and training which will fit them for rural practice.
Support strategies for medical students are also vital. Financial support of
medical students from rural areas and encouragement for those going to rural
areas is important, particularly in the light of the poorer economic situation
of rural people. Strategies such as "Rural Practice Clubs" have been shown to
encourage city origin students to develop an interest in rural practice and
support rural background students in adjusting to the challenges of city living
and university studies. Students with an interest in rural practice can be
assisted further through rural doctor mentor schemes whereby each student is
attached to a physician practising in the rural town or area. The mentor
provides the student with ongoing personal support and encouragement as well as
a professional role model.
Strategies
1.1.1 Early exposure of rural school pupils to medical practice
1.1.2 Introduction of programs promoting medicine as a career to rural
secondary students
1.1.3 Establishment of scholarships and educational support programs which
identify potential medical students in rural areas and assist them with
secondary and tertiary education in preparation for medical school entry.
1.1.4 Admission of more students of rural background. This can be achieved by
selection processes that encourage admission of students from rural areas.
Student selection should target ethnic groups prevalent in rural communities
1.1.5 When selecting and recruiting staff and potential students and trainees,
universities should take cognisance not only of academic prowess but also
matters of commitment, vision and a willingness to take risks and if necessary,
make sacrifices
1.1.6 Bonding/scholarship schemes offering rural service/repayment options
1.1.7 Establishment and support of rural student interest groups such as
"Rural Practice Clubs"
1.1.8 Facilitation of international links between such rural student interest
groups. This initiative should further increase the sharing of information and
enhance relations between rural orientated students from various backgrounds.
It is recommended that this include specific programs funded by WONCA and
should include research and exchange programs.
1.1.9 Establishment of rural doctor mentor schemes
Clinical experience in a rural setting is an important factor associated with
entering rural practice. Early positive exposure to rural practice encourages
more students to develop an interest in rural practice as a career option and
fosters a better understanding of rural practice even for those who choose not
to work in a rural setting. All students should be introduced to rural
practice early in the medical course and have clinical rotations to rural
hospitals and rural general practice later in the course.
Decentralised medical schools that allow medical students to take a major part
or all of their studies at centres located outside major metropolitan areas are
more likely to attract students from rural areas and be successful in producing
doctors to practice in rural areas.
Given the shortage of women in rural practice, attachments should provide
models that encourage women to consider a career in rural practice.
Strategies
General practice and specifically rural practice should be included in the
curriculum by:
1.2.1 Introducing rural health issues early in the curriculum including
specific rural practice attachments in rural communities for students early in
the medical course and including further clinical rotations to rural hospitals
and rural general practice later in the course.
1.2.2 Ensuring that adequate support and resources follow the students in
rural placements.
1.2.3 Developing enhanced rural training experience for a selected group of
students who indicate an early commitment to rural practice.
1.2.4 Establishing decentralised medical schools that allow students to take
most or all of their medical school education in centres outside major
metropolitan areas.
1.2.5 Developing specific initiatives that encourages women into rural
practice.
1.2.6 Ensuring that significant periods of undergraduate learning and teaching
should be multiprofessional and take place within the rural health team.
1.2.7 Encouraging multidisiplinary links in the training of medical students.
The participation of nurses and other health professionals in the education of
undergraduates and junior doctors will improve the relationship between doctors
and other health professionals and facilitate a greater diversity of approaches.
Medical schools should assume a responsibility to educate appropriately trained
doctors to meet the needs of their general geographic region including
underserved areas. As well, they should play a key role in providing regional
support for health professionals and in providing accessible tertiary heath
care. The inclusion of practising rural doctors in medical schools as educators
and researchers is integral to the development of an improved understanding of
and a supportive attitude towards rural practice.
Strategies
1.3.1 Governments need to provide financial incentives which reward medical
schools whose graduates become rural doctors.
1.3.2 Universities should create academic posts for rural doctors
1.3.3 Medical schools should be allocated responsibility for support and
training in defined geographical areas in a way which ensures adequate coverage
of all parts of a country.
1.3.4 There should be integration and co-ordination of the use of resources for
education for all health professionals