Evaluating medical training in a small country town

Developing a robust rural and remote medical workforce has many challenges. Along with factors such as a rural background, personality traits and personal circumstances, sustained rural exposure during training is strongly associated with eventual rural practice. In addressing this challenge the Australian Government now requires medical schools to recruit students of rural background, deliver mandatory short-term rural placements and, through Rural Clinical Schools (RCSs), provide opportunities for long-term rural placements. Evidence suggests that rural exposure, through local mentorship, recreation, long-term residence and education, allows doctors still in the formative years of their profession to gain a better understanding and appreciation of what being a rural doctor entails and promotes rural practice post-fellowship. Despite this understanding, the opportunity to train in a rural setting post-medical school is often limited to larger rural centres where the systems and staffing structures within the hospital emulate metropolitan training programs. 

In 2017, Cowra (population 12,730) in central-western NSW was funded under the first round of the Rural Junior Doctor Training Innovation Fund to support a rural primary care intern rotation from Orange Base Hospital. The rotation involved working in the Cowra District Hospital (a 30 bed GP–VMO procedural hospital) in the morning and then working in the local GP practice in the afternoon. In partnership with the SE NSW Regional Training Hub, the Australian National University RCS has evaluated the experience and efficacy of the rotation from the perspective of interns, registrars, supervisors and medical students.

The expectations and concerns of those involved were ascertained prior to the interns commencing their rotation. Most concerns aligned with previously published factors associated with reticent rural practice intention or unsustainable workload burden. The post-placement evaluation explored the lived reality of the previously identified expectations and concerns and identified the elements of the program that worked or did not work from various perspectives. It also explored participants’ views on the translational potential of such a program to similar-sized rural hospitals, in particular what assets were required to ensure success.

Finding opportunities to train our doctors in unique rural settings will lay the foundation of building an innovative, stable and committed workforce. Evidence to support the structure, methodology and efficacy of smaller centres in delivering exemplary training programs is valuable. Our study will specifically inform future policy and funding decisions associated with junior doctor training. These policies must address and reflect evidence that demonstrates a better chance towards creating equity in health delivery throughout Australia. By opening up rural training opportunities to different types of service models, more recently graduated doctors who are still deciding their career trajectory and exploring the opportunities for postgraduate training also become more informed in what can be a rewarding career as a rural practitioner.