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Selecting for a sustainable workforce to meet the future healthcare needs of rural communities in Australia

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Abstract

An undersupply of generalists doctors in rural communities globally led to widening participation (WP) initiatives to increase the proportion of rural origin medical students. In 2002 the Australian Government mandated that 25% of commencing Australian medical students be of rural origin. Meeting this target has largely been achieved through reduced standards of entry for rural relative to urban applicants. This initiative is based on the assumption that rural origin students will succeed during training, and return to practice in rural locations. One aim of this study was to determine the relationships between student geographical origin (rural or urban), selection scores, and future practice intentions of medical students at course entry and course exit. Two multicentre databases containing selection and future practice preferences (location and specialisation) were combined (5862), representing 54% of undergraduate medical students commencing from 2006 to 2013 across nine Australian medical schools. A second aim was to determine course performance of rural origin students selected on lower scores than their urban peers. Selection and course performance data for rural (461) and urban (1431) origin students commencing 2006–2014 from one medical school was used. For Aim 1, a third (33.7%) of rural origin students indicated a preference for future rural practice at course exit, and even fewer (6.7%) urban origin students made this preference. Results from logistic regression analyses showed significant independent predictors were rural origin (OR 4.0), lower Australian Tertiary Admissions Rank (ATAR) (OR 2.1), or lower Undergraduate Medical and Health Sciences Admissions Test Section 3 (non-verbal reasoning) (OR 1.3). Less than a fifth (17.6%) of rural origin students indicated a preference for future generalist practice at course exit. Significant predictors were female gender (OR 1.7) or lower ATAR (OR 1.2), but not rural origin. Fewer (10.5%) urban origin students indicated a preference for generalist practice at course exit. For Aim 2, results of Mann–Whitney U tests confirmed that slightly reducing selection scores does not result in increased failure, or meaningfully impaired performance during training relative to urban origin students. Our multicentre analysis supports success of the rural origin WP pathway to increase rural student participation in medical training. However, our findings confirm that current selection initiatives are insufficient to address the continuing problem of doctor maldistribution in Australia. We argue for further reform to current medical student selection, which remains largely determined by academic meritocracy. Our findings have relevance to the selection of students into health professions globally.

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Notes

  1. The research on which the following section of the report is based used data provided by the Medical Schools Outcomes Database and Longitudinal Tracking (MSOD) Project, Medical Deans Australia and New Zealand Inc. We are grateful to the medical schools, medical students, graduates and doctors who participated. The MSOD project was possible due to funding made available by Health Workforce Australia (2011 onwards) and The Australian Government Department of Health and Ageing (2004–2011).

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Acknowledgements

We gratefully acknowledge the UMAT Consortium for funding the UMAT Multicentre Predictive Validity Study.

Author’s contributions

MH and AM are chief investigators of the UMAT Multicentre Predictive Validity Study. MH wrote the first draft of the paper, and all listed authors contributed to subsequent drafts. ST and IL manage the UMAT study database and conducted the statistical analysis. WH, HTA, EA, and DG made significant contributions to the broader policy issues addressed in the discussion, and which motivated and framed this paper.

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Authors and Affiliations

  1. Monash Institute for Health and Clinical Education, Faculty of Medicine, Nursing, and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, VIC, Australia

    M. Hay, I. Lichtwark, S. Tran & W. C. Hodgson

  2. Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia

    A. M. Mercer

  3. Partners Healthcare, Boston, MA, USA

    H. T. Aretz

  4. Harvard Macy Institute, Harvard Medical School, Boston, MA, USA

    E. G. Armstrong

  5. University of Auckland, Auckland, New Zealand

    D. Gorman

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  1. M. Hay
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  7. E. G. Armstrong
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  8. D. Gorman
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Correspondence to M. Hay.

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Hay, M., Mercer, A.M., Lichtwark, I. et al. Selecting for a sustainable workforce to meet the future healthcare needs of rural communities in Australia. Adv in Health Sci Educ 22, 533–551 (2017). https://doi.org/10.1007/s10459-016-9727-0

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