title: James Cook University's decentralised medical training model: an important part of the rural workforce pipeline in northern Australia.
abstract: BACKGROUND
  There has been much recent investment to improve the recruitment and retention of medical graduates in rural Australia. This paper describes the different outcomes of the strategies used at the James Cook University (JCU) medical school to improve the recruitment and retention of medical graduates in northern Australian towns: the decentralised model of four rural clinical schools, selecting students with a rural home town, enrolling students under the Bonded Medical Placements (BMP) scheme, and providing rurally orientated scholarships.
  
  
  METHODS
  Home town at application to medical school, clinical school location, scholarship, BMP and postgraduate practice location data for JCU medical graduates were retrieved from an ongoing longitudinal cohort study. Multivariate logistic regression analysis was used to identify independent predictors of intern practice location from 2006 to 2013, and current (2014) practice location for postgraduate year 4-9 graduates for each of the four rural clinical school sites of Townsville, Cairns, Darwin and Mackay.
  
  
  RESULTS
  The strongest predictor of JCU Bachelor of Medicine, Bachelor of Surgery (MBBS) graduates undertaking their internship in Townsville, Cairns, Mackay or Darwin hospitals was attending the JCU clinical school in that location (p<0.001, prevalence odds ratios (POR)=7.1; p<0.001, POR=11.5; p<0.001, POR=19.4; p<0.001, POR=85.7; respectively). Attending the JCU clinical school in the main town was also a strong predictor of JCU MBBS graduates currently practising (2014) in the Townsville, Cairns and Mackay health service districts (p<0.001, POR=2.9; p<0.001, POR=3.8; p=0.033, POR=3.6; respectively).
  
  
  CONCLUSIONS
  While this study supports the effectiveness of improving the rural medical workforce via the targeted selection of students with a rural background, the JCU medical school's decentralised medical education program also appears to be significantly associated with rural recruitment and retention, including in districts of workforce shortage and/or geographically remote locations. These findings support other evidence that decentralised medical training can assist recruitment to underserved regions, and have implications for other jurisdictions looking to invest in a decentralised training model.
authors.affiliation: College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia. torres.woolley@jcu.edu.au.
authors.forename: Torres
authors.initials: T
authors.lastname: Woolley
authors.affiliation: College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia. tarun.sengupta@jcu.edu.au.
authors.forename: Tarun
authors.initials: T
authors.lastname: Sen Gupta
authors.affiliation: College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia. richard.murray@jcu.edu.au.
authors.forename: Richard
authors.initials: R
authors.lastname: Murray
mesh_terms: D000328:Adult; D001315:Australia; D002983:Clinical Competence; D003479:Curriculum / Q000592:standards; D004501:Education, Medical / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education*; D008507:Medically Underserved Area; D011365:Professional Practice Location / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000458:organization & administration*; D012570:School Admission Criteria / Q000706:statistics & numerical data; D012577:Schools, Medical / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D000078329:Workforce; D055815:Young Adult
keywords: Australia/Pacific; Medical; Public Health; Undergraduate