title: Effect of medical student preference on rural clinical school experience and rural career intentions.
abstract: The key parameter for rural clinical schools (RCSs) is to provide at least 1 year of clinical training in rural areas for 25% of Australian Commonwealth supported medical students with the intent to influence future rural medical workforce outcomes. The objective of this study was to describe the association between a medical student's selection preference and their RCS experience and rural career intent.
  
  
  
  Medical students completing an RCS placement in 2012 and 2013 were encouraged to complete a survey regarding their experience and future career intent. Data were analysed to compare medical students for whom the RCS was their first choice with students who described the RCS as other than their first preference.
  
  
  
  Students for whom RCS was their first choice (724/1092) were significantly more likely to be female, come from a rural background and be from an undergraduate program. These students reported more positive experiences of all aspects of the RCS program (costs, access, support and networks, safety) and were 2.36 times more likely to report intentions to practice in a non-metropolitan area (odds ratio(OR)=2.36 (95% confidence interval(CI)=1.82-3.06),p<0.001). This was true for students of rural (OR=3.11 (95%CI=1.93-5.02),p<0.001) and metropolitan backgrounds (OR=2.07 (95%CI=1.48-2.89),p<0.001). More students in the first-choice group (68.8%) intended to practice in a regional area (not a capital or major city), significantly higher than the 48.4% of participants in the other-preference group (χ2 (1) 42.79,p<0.001).
  
  
  
  The decision to choose an RCS placement is a marker of rural career intention and a positive rural training experience for students of both rural and metropolitan backgrounds. It may be important to identify other-preference students and their specific social support needs to ensure a positive perception of a future rural career.
authors.affiliation: Flinders University Rural Clinical School, Mount Gambier, South Australia, Australia. lucie.walters@flinders.edu.au.
authors.forename: Lucie
authors.initials: L
authors.lastname: Walters
authors.affiliation: School of Medicine Sydney, University of Notre Dame, Wagga Wagga, New South Wales, Australia. alexa.seal@nd.edu.au.
authors.forename: Alexa
authors.initials: A
authors.lastname: Seal
authors.affiliation: School of Medicine Sydney, University of Notre Dame, Wagga Wagga, New South Wales, Australia. joe.mcgirr@nd.edu.au.
authors.forename: Joe
authors.initials: J
authors.lastname: McGirr
authors.affiliation: Cairns Clinical School, Atherton Clinical School, Atherton, Queensland, Australia. ruthalison.stewart@jcu.edu.au.
authors.forename: Ruth
authors.initials: R
authors.lastname: Stewart
authors.affiliation: Elson S Floyd College of Medicine, Washington State University, Spokane, Washington, USA. dawn.dewitt@wsu.edu.
authors.forename: Dawn
authors.initials: D
authors.lastname: DeWitt
authors.affiliation: The Rural Clinical School of Western Australia, The University of Western Australia, Crawley, Western Australia, Australia. denese.playford@rcswa.edu.au.
authors.forename: Denese
authors.initials: D
authors.lastname: Playford
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D002321:Career Choice; D004504:Education, Medical, Undergraduate / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D011365:Professional Practice Location; D019035:Rural Health Services; D012424:Rural Population; D012938:Social Perception; D013337:Students, Medical / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014495:Universities; D000078329:Workforce; D055815:Young Adult
keywords: Australia/Pacific; Education; Undergraduate