title: Outcomes of Australian rural clinical schools: a decade of success building the rural medical workforce through the education and training continuum.
abstract: BACKGROUND
  The establishment of the rural clinical schools funded through the Commonwealth Department of Health and Ageing (now Department of Health) Rural Clinical Training and Support program over a decade ago has been a significant policy initiative in Australian rural health. This article explores the impacts of this policy initiative and presents the wide range of educational innovations contextualised to each rural community they serve.
  
  
  METHODS
  This article reviews the achievements of the Australian rural clinical and regional medical schools (RCS/RMS) through semi-structured interviews with the program directors or other key informants. The questions and responses were analysed according to the funding parameters to ascertain the numbers of students, types of student placements and range of activities undertaken by each university program.
  
  
  RESULTS
  Sixteen university medical schools have established 18 rural programs, creating an extensive national network of RCS and RMS in every state and territory. The findings reveal extensive positive impacts on rural and regional communities, curriculum innovation in medical education programs and community engagement activities. Teaching facilities, information technology, video-conferencing and student accommodation have brought new infrastructure to small rural towns. Rural clinicians are thriving on new opportunities for education and research. Clinicians continue to deliver clinical services and some have taken on formal academic positions, reducing professional isolation, improving the quality of care and their job satisfaction. This strategy has created many new clinical academics in rural areas, which has retained and expanded the clinical workforce. A total of 1224 students are provided with high-quality learning experiences for long-term clinical placements. These placements consist of a year or more in primary care, community and hospital settings across hundreds of rural and remote areas. Many programs offer longitudinal integrated clerkships; others offer block rotations in general practice and specialist clinics. Nine universities established programs prior to 2004, and these well-established programs are finding graduates who are returning to rural practice. Universities are required to have 25% of the students from a rural background. University admission policies have changed to encourage more applications from rural students. This aspect of the policy implements the extensive research evidence that rural-origin students are more likely to become rural practitioners. Additional capacity for research in RCS has influenced the rural health agenda in fields including epidemiology, population health, Aboriginal health, aged care, mental health and suicide prevention, farming families and climate change. There are strong research partnerships with rural workforce agencies, research centres for early career researchers and PhD students.
  
  
  CONCLUSIONS
  The RCS policy initiative has vastly increased opportunities for medical students to have long-term clinical placements in rural health services. Over a decade since the policy has been implemented, graduates are being attracted to rural practice because they have positive learning experiences, good infrastructure and support within rural areas. The study shows the RCS initiative sets the stage for a sustainable future Australian rural medical workforce now requiring the development of a seamless rural clinical training pipeline linking undergraduate and postgraduate medical education.
authors.affiliation: Flinders University Rural Clinical School, Renmark, South Australia, Australia. jennene.greenhill@flinders.edu.au.
authors.forename: Jennene A
authors.initials: JA
authors.lastname: Greenhill
authors.affiliation: School of Rural Health, Monash University, Melbourne, Victoria, Australia. judi.walker@monash.edu.
authors.forename: Judi
authors.initials: J
authors.lastname: Walker
authors.affiliation: The Rural Clinical School of Western Australia, Crawley, Western Australia, Australia. denese.playford@rcswa.edu.au.
authors.forename: Denese
authors.initials: D
authors.lastname: Playford
mesh_terms: D000288:Administrative Personnel / Q000523:psychology; D001315:Australia; D057191:Capacity Building; D002202:Capital Financing; D003159:Community-Institutional Relations; D003479:Curriculum / Q000592:standards* / Q000639:trends; D004497:Education, Dental; D006801:Humans; D007407:Interviews as Topic; D008505:Medical Staff, Hospital / Q000193:education*; D008507:Medically Underserved Area; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D011231:Preceptorship; D011365:Professional Practice Location; D015397:Program Evaluation; D036301:Qualitative Research; D019035:Rural Health Services / Q000191:economics / Q000592:standards; D012570:School Admission Criteria / Q000639:trends; D012577:Schools, Medical / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D012944:Social Support; D013192:Staff Development; D011795:Surveys and Questionnaires; D014495:Universities / Q000706:statistics & numerical data / Q000639:trends; D000078329:Workforce
keywords: Australia/Pacific; Education; Europe; Health Needs Assessment; Health Service reform; Medical; North America; Postgraduate; Public Health; Undergraduate; Workforce