title: Longitudinal rural clerkships: increased likelihood of more remote rural medical practice following graduation.
abstract: BACKGROUND
  Extended rural clerkships clearly increase the likelihood of rural practice post-graduation. What has not been determined is whether such rural interventions increase the likelihood of graduates practicing in more remote, versus inner regional, locations.
  
  
  METHODS
  The Australian Health Practitioner Regulation Agency database was used to identify the current workplace of every graduate of the Medical School of Western Australia, 1980 to 2011. There were 324 graduates working in a primary practice location defined by the Australian Standard Geographical Classification as inner regional to very remote. They were divided into 3 groups - 200 graduates who entered medical school before commencement of the Rural Clinical School of Western Australia (RCSWA), 63 who entered after the RCSWA had started, but not participated in RCSWA, and 61 who participated in the RCSWA. The RCSWA offers a longitudinal rural clinical clerkship throughout level 5 of the MBBS course.
  
  
  RESULTS
  The two groups not participating in the RCSWA had 45.5% and 52.4% of subjects in outer regional/very remote locations, respectively. In comparison, 78.7% of those who had participated in the RCSWA were currently practicing in outer regional/very remote locations. When the 3 groups were compared, the significant predictors of working in a more remote practice compared to working in an inner regional area were being female (OR 1.75 95% CI 1.13, 2.72, P = 0.013) and participating in the RCSWA (OR 4.42, 95% CI 2.26, 8.67, P < 0.001). In multivariate logistic regression that corrected for gender and remoteness of rural address before entry to medical school, participation in the RCSWA still predicted a more than 4-fold increase in the odds of practicing in a more remote area (OR 4.11, 95% CI 2.04, 8.30, P < 0.001).
  
  
  CONCLUSIONS
  Extended rural clinical clerkship during an undergraduate MBBS course is related to a much greater likelihood of practicing in more remote, under-serviced rural locations.
authors: School of Primary, Aboriginal and Rural Health Care, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia. denese.playford@rcswa.edu.au.
authors: Denese E
authors: DE
authors: Playford
authors: School of Primary, Aboriginal and Rural Health Care, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia. 20954639@student.uwa.edu.au.
authors: Asha
authors: A
authors: Nicholson
authors: School of Primary, Aboriginal and Rural Health Care, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia. Geoff.Riley@rcswa.edu.au.
authors: Geoffrey J
authors: GJ
authors: Riley
authors: Faculty Office, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia. Ian.Puddey@uwa.edu.au.
authors: Ian B
authors: IB
authors: Puddey
mesh_terms: D002321:Career Choice; D002982:Clinical Clerkship / Q000458:organization & administration*; D002983:Clinical Competence; D003479:Curriculum; D016208:Databases, Factual; D004503:Education, Medical, Graduate / Q000379:methods; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008507:Medically Underserved Area; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D019035:Rural Health Services / Q000458:organization & administration*; D013337:Students, Medical / Q000706:statistics & numerical data; D014904:Western Australia