title: Preferred practice location at medical school commencement strongly determines graduates' rural preferences and work locations.
abstract: OBJECTIVE
  To identify factors influencing whether Australian medical graduates prefer to, or actually, work rurally.
  
  
  METHODS
  Secondary analysis of longitudinal data from Medical Schools Outcomes Database (MSOD) using univariate and multivariate logistic regression.
  
  
  METHODS
  Twenty Australian medical schools.
  
  
  METHODS
  Australian or New Zealand citizens and Australian permanent residents who completed MSOD questionnaires between 2006 and 2013.
  
  
  METHODS
  Preferred and actual work locations 1 (PGY1) and 3 (PGY3) years postgraduation.
  
  
  RESULTS
  Of 20 784 participants, 4028 completed a PGY1 or PGY3 questionnaire. Self-reported preference for rural practice location at medical school commencement was the most consistent independent predictor of whether a graduate would have a rural location preference at PGY1 (odds ratio (OR) 6.07, 95% confidence interval (CI) 4.91-7.51) and PGY3 (OR 7.95, 95% CI 4.93-12.84), and work rurally during PGY1 (OR 1.38, 95% CI 1.01-1.88) and PGY3 (OR 1.86, 95% CI 1.30-2.64). The effect of preferred practice location at medical school commencement is independent of, and enhances the effect of, rural background. Graduates of graduate-entry programs or with dependent children were less likely to have worked rurally during PGY1 and PGY3 respectively.
  
  
  CONCLUSIONS
  The most consistent factor associated with rural preferences and work location was students' preferred location of practice at medical school commencement; this association is independent of, and enhances the effect of, rural background. Better understanding of what determines rural preference at medical school commencement and its influence on rural workplace outcomes beyond PGY3 is required to inform Australian medical school selection policies and rural health curricula.
authors.affiliation: School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.
authors.forename: Marie S
authors.initials: MS
authors.lastname: Herd
authors.affiliation: Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia.
authors.forename: Max K
authors.initials: MK
authors.lastname: Bulsara
authors.affiliation: Psychology Department, Faculty of Human Sciences, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Jones
authors.affiliation: School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.
authors.forename: Donna B
authors.initials: DB
authors.lastname: Mak
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D002321:Career Choice; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration; D016015:Logistic Models; D008297:Male; D009520:New Zealand; D011365:Professional Practice Location / Q000706:statistics & numerical data*; D019035:Rural Health Services; D013337:Students, Medical / Q000523:psychology / Q000706:statistics & numerical data
keywords: Australia; medical schools; medical students; professional practice location; rural health services