'The word that comes to mind is polymath': medical students' perceptions of rural postgraduate careers

Abstract

Introduction: Physician shortages in rural and remote areas challenge accessibility and delivery of care to rural and remote communities, including within Scotland. Medical education is a reform priority to establish a sustainable medical workforce. Although there is evidence to support aspects of medical education that enhance the likelihood of practising rurally, the mechanism by which these educational initiatives work is not clearly understood. This study aimed to examine medical students' perceptions of rural and remote practice, how these perceptions motivate their interest to practise rurally, and what aspects of education are thought to influence these perceptions. Methods: This cross-sectional study utilised semistructured interviews with 10 University of St Andrews medical students enrolled in undergraduate or graduate-entry medical education programs. Feldman and Ng's theoretical framework was deductively applied. Interviews informed additional subthemes, which were integrated into the original framework. The final framework helped examine medical students' perceptions of rural medicine and mechanisms that shape these perceptions. Results: Structural (countrywide) themes included geographical barriers affecting patients and physicians. Organisational themes included perceptions of inequitable allocation of resources between urban and rural areas, as well as limited staff and support in rural practices. Occupational themes included the perception of rural clinical generalists. Personal life themes included the perception of community in rural areas. Mechanisms shaping medical students' perceptions most profoundly were their experiences (educational, personal experience or working). Conclusion: Medical students' perceptions align with other professionals' reasons for staying in a particular job. Perceptions regarding rural careers included challenges due to geographical proximity to patients, resource allocation in rural areas, and the potential to subspecialise as a general rural practitioner. Identified mechanisms, which shape perceptions, can be addressed and strengthened by educators, policy-makers and governments to optimise medical education that promotes rural recruitment and retention.

Keywords

• graduate level training
• medical curriculum
• medical education
• rural recruitment
• Scotland.