Medical student selection criteria as predictors of intended rural practice following graduation.

BACKGROUND: Recruiting medical students from a rural background, together with offering them opportunities for prolonged immersion in rural clinical training environments, both lead to increased participation in the rural workforce after graduation. We have now assessed the extent to which medical students' intentions to practice rurally may also be predicted by either medical school selection criteria and/or student socio-demographic profiles. METHODS: The study cohort included 538 secondary school-leaver entrants to The University of Western Australia Medical School from 2006 to 2011. On entry they completed a questionnaire indicating intention for either urban or rural practice following graduation. Selection factors (standardised interview score, percentile score from the Undergraduate Medicine and Health Sciences Admission Test (UMAT) and prior academic performance (Australian Tertiary Admissions Rank), together with socio-demographic factors (age, gender, decile for the Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) and an index of rurality) were examined in relation to intended rural or urban destination of practice. RESULTS: In multivariate logistic regression, students from a rural background had a nearly 8-fold increase in the odds of intention to practice rurally after graduation compared to those from urban backgrounds (OR 7.84, 95% CI 4.10, 14.99, P < 0.001). Those intending to be generalists rather than specialists had a more than 4-fold increase in the odds of intention to practice rurally (OR 4.36, 95% CI 1.69, 11.22, P < 0.001). After controlling for these 2 factors, those with rural intent had significantly lower academic entry scores (P = 0.002) and marginally lower interview scores (P = 0.045). UMAT percentile scores were no different. Those intending to work in a rural location were also more likely to be female (OR 1.93, 95% CI 1.08, 3.48, P = 0.027), to come from the lower eight IRSAD deciles (OR 2.52, 95% CI 1.47, 4.32, P = 0.001) and to come from Government vs independent schools (OR 2.02, 95% CI 1.15, 3.55, P = 0.015). CONCLUSIONS: Very high academic scores generally required for medical school entry may have the unintended consequence of selecting fewer graduates interested in a rural practice destination. Increased efforts to recruit students from lower socioeconomic backgrounds may be beneficial in terms of an ultimate intended rural practice destination.

A seven-year retrospective analysis of students entering medicine via a Rural Student Recruitment program in Western Australia.

OBJECTIVE: This research aimed to evaluate the effectiveness of the Rural Student Recruitment (RSR) program. This program was an initiative to address the low number of rural students enrolled in medicine at the University of Western Australia. RSR identifies students throughout rural and remote areas of Australia interested in pursuing a career in medicine. The program provides support to these students through the various stages of the selection process and subsequently through the course. SETTING: Medical School, the University of Western Australia. PARTICIPANTS: Rural students enrolled in medicine at the University of Western Australia. RESULTS: Of the 1591 participants in the RSR program, 11.6% have been successful in being offered a place. Participation was consistently higher for women, although men were proportionately more successful at gaining entry (14.5% versus 10.4%). It was found that the distribution of successful students in the RSR program generally reflects population density across rural Western Australia, with the majority of students coming from the South West, and the minority from the Pilbara and Kimberley. However, over the last three years (2006-2008) an increase in access from very remote regions was noted. This has been associated with a modification to the entry process that now includes a remoteness weighting for the secondary school attended. CONCLUSIONS: The conclusion from this analysis was that the RSR program in concert with refinements in entry criteria has been effective in increasing the number of medical students from a rural background.