Assessing the Effect of Rural Placements Through a Pre-Post Approach With Different Temporal Targets: Are We Converting or Sustaining?

Abstract

Background: Rural placements are a key strategy to attract health students to rural practice. It is important that robust research methods are used to assess the effect of placements on rural career intentions to inform resource allocation and student supports.

Objectives: This study explored the utility of a novel rural attitude measurement approach to evaluate the direct impact of rural placements on students' perceptions and intentions. It also examined whether anticipated differences between students from city and rural backgrounds emerged across various future temporal reference points. Finally, the research investigated the characteristics of students who demonstrated desirable rural placement outcomes, specifically those who either 'converted' to or 'sustained' an early career attraction to rural practice.

Method: This research employed a pre-post cohort design, surveying health students who were commencing an Australian rural placement. Participants included those from Charles Sturt University as well as students from other universities receiving support from Three Rivers Department of Rural Health. A total of 163 matched pre- and post-placement surveys were collected. The survey measured ratings of the attractiveness of living and working outside of a Major City area across two future timepoints: (1) during the early years of practice (1-3 years after graduation) and (2) after establishing a career (10-15 years after graduation), using an 11-point scale.

Results: Most respondents were from a rural background (78%), 29% had care responsibilities, and 36% were aged 30 years and older. Overall, only mid-career attraction significantly increased from pre-placement levels; however, important differences were identified among subgroups.

Conclusions: Rural placement experiences serve a 'sustaining' function for those already committed to, and likely located in, rural areas. The desired 'converting' effect of rural placements may be constrained under current RHMT Program scope for health students, especially those from city areas.