Experience around the world shows that students from a rural origin are much
more likely to enter rural practice after graduation. 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. Clearly one
important strategy for increasing the numbers of rural doctors involves
recruitment of more medical students from a rural background.
In order for this to occur, secondary students in rural areas need to be
encouraged to consider medicine as a career option and to apply for entry to
medical school. Consequently there is a need for specific programs which
promote medicine to rural secondary schools. In many rural areas the academic
standards of the secondary schools may not be sufficiently high for their
graduates to qualify for medical school entry. Thus, programs need to be
developed which identify potential medical students and assist them with
secondary education in preparation for medical school entry.
In order to ensure an appropriate proportion of rural origin students are
recruited into medical schools, there need to be specific mechanisms included
in the selection process. Criteria for selection based on marks plus other
criteria are evolving. Selection processes which include interview of
applicants and give recognition and credit for rural background are to be
encouraged. Specific targets for admission of students from a rural background
may be needed.
After a rural background the next strongest factor associated with entering
rural practice is undergraduate and postgraduate clinical experience in a rural
setting. Consequently, rural exposure for all undergraduate medical students
should be maximised. Early positive exposure to rural practice will encourage
more students to develop an interest in rural practice as a career option and
foster a better understanding of rural practice for others. All
students should be introduced to rural health issues early in the medical
course and have clinical rotations to rural hospitals and rural family practice
later in the course.
As rural practitioners provide a wider range of services than their
metropolitan counterparts, rural practice attachments provide students with the
opportunity to develop a breadth of clinical skills. These include diagnostic
and therapeutic procedural skills as well as skills of clinical judgement and
self reliance in the practice setting. This rural experience also helps
students identify their own learning needs.
In addition, students should be encouraged to undertake optional attachments
and electives in rural health, ranging through rural hospital attachments,
rural family practice and other rural health services.
"Rural Practice Clubs" 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. Rural origin students would
be assisted further through rural doctor mentor schemes whereby each student is
attached to a physician practicing in the rural town or area from which the
student comes. The mentor provides the student with ongoing personal support
and encouragement as well as a professional role model.
For students who indicate an early commitment to rural practice then a "rural
medicine stream" in the medical school is recommended. This might take the
form of one to three years of the complete medical curriculum undertaken in the
rural setting, or a thread of rural attachments intertwined through the
clinical components of the curriculum.
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.
The development of community based family medicine curricula in medical
education should be encouraged, and should include significant rural
content.
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 accessible tertiary heath care. The
inclusion of rural doctors as educators and researchers is integral to the
development of an improved understanding of and a supportive attitude towards
rural practice.
The development of undergraduate and postgraduate education and training for
rural practice is greatly facilitated by the establishment of Rural Medical
Education Centres. These Centres should be established in rural areas with the
aim of co-ordinating undergraduate education, vocational training, continuing
education and university postgraduate studies for rural doctors. An important
function of these centres is to facilitate the development of reciprocal links
between rural hospitals/practices and medical schools/teaching hospitals. The
establishment of such Centres provides the opportunity for rural family
physicians to be actively involved in teaching students and vocational
trainees. They also provide a focus for other academic developments including
rural health research.