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Rural Health System Resources

BY RURAL PEOPLE FOR RURAL PEOPLE

James Cook University's rurally orientated medical school selection process: quality graduates and positive workforce outcomes

Authors

Ray R, Woolley T, Sen Gupta T.

Description

The regionally based James Cook University (JCU) College of Medicine and Dentistry was set up to address the health needs of the region by using a medical student selection policy favouring rural and remote origin applicants and providing students with early and repeated exposure to rural and remote experiences during training. This study aimed to determine if preferentially selecting rural and remote background students increases the chances of students going into rural and remote medical practice. The research found that medical students coming from a rural or remote hometown (not a regional or metropolitan city) were significantly more likely to practise in rural towns than graduates from metropolitan or regional cities. For example, the odds that a rural or remote student would work in a rural or remote town were 2.6 and 1.8 times metropolitan and regional city students. Nine years after graduation that had increased to 4.2 and 9.5 times metropolitan and regional city students. The study found that bonded medical place students were significantly less like to work rural practice based on the 5 years of data available.

Why is this useful for rural and remote people?

Twenty years ago the Commonwealth government allocated an additional 25% medical student places to primarily major city universities. These rural places were meant to be given to students from regional, rural and remote communities. The aim was to increase the number of medical graduates working in rural and remote towns as GPs. James Cook University (JCU) was the first, and for a long time only, rural university to get rural medical places. JCU took a completely different approach to its city counterparts in recruiting and educating medical students for rural and remote general practice. First, it admitted the majority of its students from rural and remote areas, while city universities admitted most of their students from major cities and regional cities. Second, it did not require rural students to get an ATAR of 95-99.9, but rather opened medical education as a real opportunity for rural and remote kids. Third, 100% of the education and training provided by JCU is undertaken in rural and remote areas, compared to city and many regional universities where the bulk of education and training is done in cities and large population centred, or delivered by academics based in cities. Fourth, JCU introduced a rural-specific curriculum that identified the positive opportunities of working rurally as a GP, while most city universities continue to struggle to present rural practice as a positive career pathway. As a result of this approach, more than 65% of JCU graduates move into medical practice in rural and remote towns, compared to other universities where more than 90-98% move to metropolitan cities (and some to regional cities). This research is critical for rural and remote people to understand. To be successful in growing the rural medical workforce, rural medical programs must have all 4 elements of the JCU approach. But most metropolitan, and some new regional universities, have not followed the evidence. This has contributed to a failure of these programs to deliver comparable outcomes to JCU. For example, they may base students at rural clinical schools in regional areas, but these students may be primarily from major cities or regional centres, not rural and remote towns. No medical school has abandoned ATAR, which excludes rural and remote students who lack the subject choice at rural schools to be able to compete with city students. The evidence overwhelmingly shows that all 4 components must be present in rural medical programs, or the programs will fail to deliver medical graduates into rural practice. This means, of course, that rural medical programs should be delivered by rural universities that are under a performance obligation to educate doctors for rural general practice. There are only 2 programs in Australia today known to conform to best practice in rural recruitment and retention - James Cook University in Queensland and Charles Sturt University in NSW. If the best practice approach was consistently applied, rural and remote doctor shortages would be a thing of the past. But it would also result in significant amounts of funding currently flowing into major cities instead going into the bush , which is why such an approach has been forcefully resisted by universities and governments for decades. It is important for rural and remote people to engage with the evidence about what works in rural medical education, and to challenge their local university medical school if they are not applying that evict in their practice. Just because a medical program is based in a regional city does not mean that it has been designed to support rural GP workforce growth. Rural and remote communities need to ask regional universities in particular about how many students from rural and remote communities they admit each year, how their curriculum is different to city curriculums, how they ensure 100% of training is done rurally, and if they are using ATAR as an entry requirement, which is known to discriminate against rural and remote kids, what they will do to change their admissions policies. Holding regional universities accountable is essential if the billions of dollars spent on rural medical workforce programs is not to be wasted growing the medical workforce in our cities.

Suggested Citation

Ray R, Woolley T, Sen Gupta T. James Cook University's rurally orientated medical school selection process: quality graduates and positive workforce outcomes. Rural and Remote Health 2015; 15: 3424.

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