title: A multi-university study of which factors medical students consider when deciding to attend a rural clinical school in Australia.
abstract: BACKGROUND
  As in many developed nations, there is a shortage in the rural medical workforce in Australia. Research indicates that a strong relationship exists between rural educational exposure and an increased interest in pursuing a rural career or selecting a rural internship. Accordingly, in 2000 the Australian Commonwealth Government established the Rural Clinical Schools (RCS) program. Under this program, 25% of parent medical schools' Commonwealth Supported Place (CSP) medical students must spend at least 1 year of their clinical medical education in a rural setting. Research indicates that positive experiences are of vital importance in determining future rural practice. Arguably, if students are conscripted to a RCS, they may view their overall experience negatively. Thus, the development and sustainability of an adequate future rural medical workforce depends on medical schools understanding and fostering the factors that encourage voluntary student recruitment to the RCSs. The aim of the present study was to determine which factors Australian medical students consider in their decision to attend RCSs.
  
  
  METHODS
  This study employed survey research. The questionnaire, which used a 6 point Likert scale, addressed factors influencing students' decision to attend an RCS, including whether these factors were viewed as positive or negative. Open-ended questions provided students with an opportunity to make comments about their decision-making. The setting was the RCSs of six participating Australian universities. The participants were medical students enrolled at one of six Australian universities in 2006 (n=166) who had completed their RCS term; 125 students responded (75% response rate).
  
  
  RESULTS
  At least three-quarters of the respondents considered the following when deciding whether to attend an RCS: patient access, academic reputation, their friends, the availability of subsidized accommodation provided by the clinical school, extra-curricular activities, social opportunities and transport costs. The majority of students considered the following as positive considerations: 'patient access', 'academic reputation', and 'subsidized accommodation'. However, for other students these same factors were negative considerations.
  
  
  CONCLUSIONS
  Students consider both clinical and non-clinical factors in their decision to attend an RCS. The primary positive factor in the present study was patient access with 97% students (n=119) considering this to be important, and 84% students (n=81) stating that this was a positive factor in their decision-making. The other major factors, friends and academic reputation, appear equally considered. However, they differed in the degree to which they were regarded as a positive or negative consideration. Identifying and promoting positive factors is essential if the future rural medical workforce is to be enhanced. This study supports the importance of RCSs not being over-crowded and, thus, maintaining patient access, and also the importance of institutions having sufficient resources to support an excellent academic reputation. Interestingly, and perhaps somewhat contrary to expectations, students of metropolitan origin appear to be increasingly attracted to RCSs. Although numerous studies show that rural origin is a strong predictor of rural medical workforce membership, urban students who attend an RCS and have a positive experience may also be open to future rural practice.
authors.affiliation: The University of New South Wales, Rural Clinical School, New South Wales, Australia. l.krahe@unsw.edu.au
authors.forename: Lee M
authors.initials: LM
authors.lastname: Krahe
authors.forename: Alexander R
authors.initials: AR
authors.lastname: McColl
authors.forename: Julie F
authors.initials: JF
authors.lastname: Pallant
authors.forename: Chris E
authors.initials: CE
authors.lastname: Cunningham
authors.forename: Dawn E
authors.initials: DE
authors.lastname: Dewitt
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D002755:Choice Behavior; D005260:Female; D006801:Humans; D008297:Male; D011231:Preceptorship / Q000379:methods; D019035:Rural Health Services; D012577:Schools, Medical / Q000145:classification*; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D000078329:Workforce; D055815:Young Adult