title: Are rural placements positively associated with rural intentions in medical graduates?
abstract: BACKGROUND
  Medical school curricula remain one of the key levers in increasing the future supply of rural doctors. Data from Australia and overseas have suggested exposure to rural practice via rural placements during basic medical training is positively associated with graduates becoming rural doctors. However, previous studies have suffered from serious methodological limitations.
  
  
  OBJECTIVE
  This study sought to determine whether rural clinical placements are associated with a higher proportion of graduating students planning rural careers and to explore associations with timing, duration and location of placements.
  
  
  METHODS
  Data were obtained from the Medical Schools Outcomes Database and Longitudinal Tracking Project, which is a longitudinal study with a high response rate that prospectively collects data, including practice location intention, from all Australian medical schools. Using logistic regression analysis, the association between placements and rural career intention was assessed, controlling for a number of demographic and contextual variables.
  
  
  RESULTS
  The association between rural/remote placements later in the programme and rural practice intention was strongly positive whether viewed as simple occurrence or as duration, in contrast to later urban placements, which were strongly negative. A longer duration of placement enhanced the associations reported. Non-metropolitan medical schools were also associated with higher odds of intention to take up rural practice. However, the association with rural placements was overshadowed by the strong positive associations with rural background of students and their stated intention to become a rural doctor at the start of their studies.
  
  
  CONCLUSIONS
  Exposure to rural practice during basic medical training, and the location and curriculum focus of a medical school are confirmed as factors that are positively associated with students' intention to become rural doctors after graduation. However, rural origin and the early intentions at the start of their medical training are better predictors of expressed intention to take up rural practice than rural clinical placements.
authors.affiliation: Psychology Department, Macquarie University, North Ryde, New South Wales, Australia; Centre of Excellence in Rural and Remote Primary Health Care, School of Rural Health, Monash University, Bendigo, Victoria, Australia.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Jones
authors.forename: John A
authors.initials: JA
authors.lastname: Bushnell
authors.forename: John S
authors.initials: JS
authors.lastname: Humphreys
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001315:Australia; D002321:Career Choice; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D033182:Intention; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D016017:Odds Ratio; D012111:Residence Characteristics / Q000706:statistics & numerical data; D019035:Rural Health Services; D013337:Students, Medical / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult