Medical students' perceptions of barriers to training at a rural clinical school.
BACKGROUND
In response to concerns about the decreasing rural health workforce, the Australian Government has funded a number of clinical schools in rural locations across Australia. The University of Melbourne established its Rural Clinical School (RCS) in 2000, at Shepparton, population 42,000, 175 km north of Melbourne, Victoria. The University of Melbourne also has three metropolitan-based clinical schools. Rural clinical schools in Australia generally have experienced difficulty in recruiting students. This has also been the experience of the University of Melbourne's Shepparton-based RCS. This study focuses on student perceptions in an attempt to understand the reasons behind this difficulty.


METHODS
All medical students at The University of Melbourne were sent an internet-based questionnaire and invited to participate in this study. The survey included information-gathering questions focused on the following areas: demographic details, whether or not the student chose to study at the RCS, factors that were of importance to them in selection of a clinical school, and the reasons why they did or did not prefer the RCS. Participants were asked to rank their three most important issues and were then asked to comment on what would make training at the University of Melbourne RCS attractive to them.


RESULTS
The response rate was 49% (n = 785 of 1599). The most common concerns relating to the students' selection of a clinical school were the quality of teaching and education at the school, transport and location issues, and patient access. Other major issues included the ability to obtain the student's preferred internship, family and partner issues, and the lack of incentives, such as financial incentives. The most common issues for students who did not chose the RCS were of a non-clinical nature, such as family and partner commitments, financial issues, and housing commitments. The most common factors students identified as making the RCS more attractive to them were greater financial support and incentives, demonstrating value-added teaching, and teaching that was seen as better than that available in the metropolitan centres, and improvement in the flow of information, and promotion of the RCS's programs. Finally, students who chose to study at a RCS are more likely to be female, of graduate entry, and of rural origin.


CONCLUSIONS
Although little can be done regarding family and financial issues, these remain important concerns for students when considering relocation to a RCS. In addition, academic results and quality of teaching remain important concerns for students, despite evidence that, for the RCS, these are equal to or better than at The University of Melbourne metropolitan clinical schools.
Jones
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GI
School of Rural Health, University of Melbourne, Shepparton, Victoria, Australia. gij@unimelb.edu.au
DeWitt
D E
DE
Cross
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M
D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia / Q000453:epidemiology; D002321:Career Choice; D004504:Education, Medical, Undergraduate / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D011365:Professional Practice Location; D019035:Rural Health Services / Q000458:organization & administration; D012938:Social Perception; D013337:Students, Medical / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D000078329:Workforce