title: Rural placements are effective for teaching medicine in Australia: evaluation of a cohort of students studying in rural placements.
abstract: BACKGROUND
  Medical education in Australia is increasingly delivered through longitudinal placements in general practice and other community settings. Early meaningful exposure to patients has been shown to improve the transition from medical student to junior doctor. This study examines the experience of the first year cohort of the University of Western Sydney (UWS) Medical School long-term rural placement students. Results have been placed in the context of other published results for rural training schemes, comparing and contrasting the present results to those of others.
  
  
  METHODS
  Students undertaking a rural placement in their final year of the UWS medical program (n = 21) participated in a mixed methods evaluation. Students filled out a quantitative survey, modified from a validated instrument, and also participated in a focus group. Class ranking of students, and changes over the time of their placement, were also examined.
  
  
  RESULTS
  Overall, students were very pleased with their rural experience, both clinically and socially. Students found the rural experience more comprehensive than they had expected. They considered that they had a stronger learning experience in most aspects than they expect they would have received in a metropolitan area. The smaller realm of the medical world in a rural area was considered an advantage in providing more hands-on experience and more interprofessional team approaches to healthcare provision. It was also considered a drawback by some that more advanced cases of all kinds were sent out of the area to metropolitan hospitals. Between their ranking in the end of Year 3 examination and the examination in the middle of Year 5, during which period students undertook their year-long placement, 14 of 22 students increased their class rank while two experienced no change and six decreased their class rank. Overall, the rural cohort advanced 4.2 places compared to their urban-placed peers.
  
  
  CONCLUSIONS
  The present results confirm that rural placements have come into their own in Australia. Curriculum content regarding Aboriginal health issues should emphasise the complexity of culture and range of living conditions that makes up Aboriginal Australia and avoid a 'deficit-based perspective' that emphasises extreme cases over routine presentations. Taken together, the results reported by Australian medical schools now offering long-term rural placements suggest that rural long-term placements are at least as effective, and may even be more effective, than metropolitan hospital placements as an effective means of providing clinical education to medical students in their senior years.
authors.affiliation: University Centre for Rural Health, North Coast, Lismore, New South Wales, Australia. hudson.birden@sydney.edu.au
authors.forename: Hudson H
authors.initials: HH
authors.lastname: Birden
authors.forename: Ian
authors.initials: I
authors.lastname: Wilson
mesh_terms: D001315:Australia; D015331:Cohort Studies; D004504:Education, Medical, Undergraduate / Q000379:methods*; D017144:Focus Groups; D058006:General Practice; D006801:Humans; D019035:Rural Health Services; D013337:Students, Medical / Q000706:statistics & numerical data*; D000078329:Workforce