Medical student selection criteria and socio-demographic factors as predictors of ultimately working rurally after graduation
Abstract (provisional)
Background We have previously demonstrated that both coming from a rural background
and spending a year-long clinical rotation in our Rural Clinical School (RCS) have
independent and additive effects to increase the likelihood of medical students practicing
rurally following graduation. The current study assesses the extent to which medical
school selection criteria and/or the socio-demographic profile of medical students
may further facilitate or hamper the selection of students ultimately destined for
the rural medical workforce. Methods The study comprised 729 students, admitted from
secondary school since 1999 and having graduated by 2011, whose actual workplace location
in 2014 was classified as either urban or rural using the Australian Health Practitioner
Regulation Agency database. Selection factors on entry (score from a standardised
interview, percentile scores for the 3 components of the Undergraduate Medicine and
Health Sciences Admission Test (UMAT) and prior academic performance as assessed by
the Australian Tertiary Admissions Rank) together with socio-demographic factors (age,
gender, decile for the Index of Relative Socioeconomic Advantage and Disadvantage
(IRSAD)), were examined in relation to ultimate rural destination of practice. Results
In logistic regression, those practicing in a rural location in 2014 were more likely
to have come from the lower 6 IRSAD deciles (OR 2.75, 95% CI 1.44, 5.23, P = 0.002),
to be older (OR 1.86, 95% CI 1.09, 3.18, p = 0.023) and to have a lower UMAT-3 (Non-verbal
communication) score (OR 0.98, 95% CI 0.97, 0.99, P = 0.005). After further controlling
for either rural background or RCS participation, only age and UMAT-3 remained as
independent predictors of current rural practice. Conclusions In terms of the socio-demographic
profiles of those selected for medical school entry from secondary school, only older
age weakly augmented the selection of graduates likely to ultimately work in a rural
destination. Among the selection factors, having achieved higher scores in UMAT-3
tended to mitigate this outcome. The major focus in attempts to grow the rural medical
workforce should therefore remain on recruiting medical students from a rural background
together with providing maximal opportunity for prolonged immersion in rural clinical
environments during their training.
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