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Background: Inadequate distribution of the medical workforce in rural regions remains a key global challenge. Evidence of the importance of postgraduation (after medical school) rural immersion time and subsequent rural practice, particularly after accounting for other key factors, remains limited. This study investigated the combined impact of three key training pathway factors: (1) rural background, (2) medical school rural immersion, and (3) postgraduation rural immersion, and duration time of each immersion factor on working rurally., Methods: Data from a cross-sectional national survey and a single university survey of Australian doctors who graduated between 2000 to 2018, were utilised. Key pathway factors were similarly measured. Postgraduation rural training time was both broad (first 10 years after medical school, national study) and specific (prevocational period, single university). This was firstly tested as the dependent variable (stage 1), then matched against rural practice (stage 2) amongst consultant doctors (national study, n = 1651) or vocational training doctors with consultants (single university, n = 478)., Results: Stage 1 modelling found rural background, > 1 year medical school rural training, being rural bonded, male and later choosing general practice were associated with spending a higher proportion (> 40%) of their postgraduation training time in a rural location. Stage 2 modelling revealed the dominant impact of postgraduation rural time on subsequent rural work for both General Practitioners (GPs) (OR 45, 95% CI 24 to 84) and other specialists (OR 11, 95% CI 5-22) based on the national dataset. Similar trends for both GPs (OR 3.8, 95% CI 1.6-9.1) and other specialists (OR 2.8, 95% CI 1.3-6.4) were observed based on prevocational time only (single university)., Conclusions: This study provides new evidence of the importance of postgraduation rural training time on subsequent rural practice, after accounting for key factors across the entire training pathway. It highlights that developing rural doctors aligns with two distinct career periods; stage 1-up to completing medical school; stage 2-after medical school. This evidence supports the need for strengthened rural training pathways after medical school, given its strong association with longer-term decisions to work rurally., (© 2023. The Author(s).)

Background: The medical degree is a long and challenging program, not just academically, but regarding the expectations engrained in the culture of medical education. The recent proliferation of literature on the poor mental well-being among students suggests a dilemma that often lays the onus on students to improve their health. The link between personality and vulnerability to psychological distress is acknowledged. This longitudinal study looked at personality in 1 st -year and changes in levels of certain psychological traits, as proxy indicators of well-being, in 4 th -year. We aimed to determine to what extent changes in psychological traits over time may be attributed to personality., Methods: Medical students completed surveys at the start (1 st -year: baseline) and finish (4 th -year: follow-up) of their medical degree (N = 154). Temperament and character personality, Perfectionism-Concern over mistakes (CoM), Ambiguity Tolerance, Resilience, Calling to medicine, and demographic variables were measured. Paired t-tests compared changes in psychological traits from baseline to follow-up. Linear regression examined whether personality at baseline would predict levels of psychological traits at follow-up., Results: The temperament and character profile of the sample was as expected, and congruent with previous studies, which describe a mature personality. Over four years, levels of Perfectionism-CoM significantly increased, while Resilience, Ambiguity Tolerance and Calling to medicine decreased. Harm Avoidance, Persistence, Self-Directedness and Cooperativeness at baseline significantly predicted levels of these traits at follow-up, but effect sizes were weak. Correlations were in the expected direction and weak., Conclusions: Most commencing medical students, including this cohort, have mature personalities with an industrious temperament and an adaptable character. Yet over four years of medicine, Ambiguity Tolerance, Resilience and Calling declined while Perfectionism-CoM, already elevated at baseline, continued to increase to the final year. Of concern is the increased perfectionism that is strongly associated with poor mental health and psychological distress. The findings suggest a closer look at the entirety of the education environment and how its culture, including secondary school and the medical school admissions processes may influence these trends in students. As medical educators we should question why the pathway to medicine places such unhealthy pressure on students who aspire to be doctors., (© 2022. The Author(s).)

Objective: Medical students have personalities that are often shown to be perfectionistic. Perfectionism can manifest as maladaptive and lead to psychological distress. This study examined the mediating role of perfectionism on the association between personality trait profiles and levels of psychological distress., Methods: First-year medical students completed a questionnaire containing measures of personality, perfectionism (Concern over Mistakes: CoM), stress, anxiety and depression. Latent profile analysis classified students based on their personality traits and identified a profile vulnerable to psychological distress. Structural equation models examined the mediation effects of perfectionism on the relationship between the vulnerable personality profile and distress., Results: The sample totalled 376 (84% response). The vulnerable personality profile was highest in Harm Avoidance, lowest in Self-Directedness, and significantly correlated with the highest Perfectionism-CoM. High Perfectionism-CoM was associated with the highest levels of stress, anxiety and depression. Perfectionism-CoM was a significant mediator for the relationship between personality and higher levels of psychological distress., Conclusion: Certain personality profiles are predisposed to psychological distress such as anxiety, stress and depression. Perfectionism, as a mediator between personality and psychological distress, may be a target strategy to help increase students' self-acceptance, and self-awareness of their perfectionistic tendencies and lower their vulnerability to poor mental health.

Having 'good' doctors is important to everybody. How to select medical students better has been discussed repeatedly for more than seventy years, implying that prevailing methods could be improved. A significant body of research exists about selection methods and their application in medicine. Yet most medical schools world-wide continue to use prior academic performance and cognitive ability as their major criteria for selection, with minor or no consideration of personal qualities and interpersonal skills (possibly assuming they will develop naturally during training and practice). We describe the main methods available for assessing personal qualities of applicants to medical school and have attempted to identify some reasons and systemic disincentives working against their adoption.

Introduction: The success of rural longitudinal integrated clerkship (LIC) programs has contributed to our understanding of selecting and training students for rural practice. Studies have explored the personality traits of students who participate in rural LICs although few have compared them with classmates who have not. The purpose is to compare personalities of four successive cohorts of students in the LIC Rural Physician Associate Program (RPAP) with their non-RPAP classmates. Methods: In a longitudinal cross-sectional design, medical students RPAP and non-RPAP, from 2013 to 2017 completed identical questionnaires comprising measures of personality, perfectionism, ambiguity tolerance, and resilience. T-tests, ANOVA, and post-hoc tests compared groups. K-means cluster analysis identified profiles of traits. Results: Total sample 286; RPAP = 128; non-RPAP = 158. Gender and age proportions were not different between groups. RPAP students were significantly lower in levels of perfectionism and higher in cooperativeness compared to non-RPAP classmates. Similar proportions of both groups were distributed across three personality profiles detected. Conclusions: Lower perfectionism implies advantages for rural practice. Nevertheless, similarities between groups suggest that most students would be successful in rural practice. More encouragement to all students may improve uptake of rural LICs. Greater attention to issues that affect decisions to explore rural medical education, particularly for our next generation of students, is required.

Background: Clinician-scientist training represents the epitome of preparation for biomedical scientific discovery. The significance of, and need for, clinician-scientists is universally recognised as essential to progress medical research across what is regarded as the 'translational gap'. Despite a rich history of cutting-edge biomedical research, Australia has no infrastructure or career pathway for training clinician-scientists., Discussion: The Clinician-scientist Track (CST) was developed to address this concern at the University of Queensland. The CST concept began in 2010 with the Concurrent MD-Masters that allowed students to undertake a research Masters concurrently with their medical program. The rationale was to offer an attractive and realistic option to recruit our highest performing students into a research higher degree, with the underlying aim of encouraging those most capable, to transfer to the MD-PhD. The Concurrent MD-Masters was immediately popular and remains so. Over 8 years, enrolments rose seven-fold (60 MD-Masters, 36 MD-PhDs). The transfer rate from MD-Masters to MD-PhD is 28% supporting our original aim., Conclusions: Many challenges remain for the future of the program. These challenges are underpinned by a culture that values clinician-scientists as crucial to ensuring that high quality health and medical research is undertaken and translated to patient care, but lags behind in establishing an infrastructure to develop and maintain a new generation of this vital workforce. A future challenge is to develop a coordinated approach to a supported Australian MD-PhD pathway for our most talented and committed students beginning in the undergraduate Bachelor's degree into the medical degree and throughout specialty training. Shared responsibility is necessary between institutions and stakeholders to support and nurture newly trained MD-PhDs into the post-graduate years. Flexibility across this medical training continuum that allows integration of both degrees will help ensure students make the most meaningful connections between the research and the medicine. What is paramount will be acknowledging the career expectations of an emerging cohort of medical students, in particular females, wishing to pursue research. Without these considerations we risk losing our next generation of potential clinician-scientists.

Background: Clinician-scientists are in decline worldwide. They represent a unique niche in medicine by bridging the gap between scientific discovery and patient care. A national, integrated approach to training clinician-scientists, typically programs that comprise a comprehensive MD-PhD pathway, are customary. Such a pathway is lacking in Australia. The objective was to gather perceptions from Australian medical students on factors they perceive would influence their decision to pursue clinician-scientist training., Methods: A cross-sectional mixed methods design used quantitative and qualitative questions in an online self-report survey with medical students from a four-year MD program. Quantitative measures comprised scaled response questions regarding prior experience and current involvement in research, and short- and long-term opinions about factors that influence their decisions to undertake a research higher degree (RHD) during medical school. Qualitative questions gathered broader perceptions of what a career pathway as a clinician-scientist would include and what factors are most conducive to a medical student's commitment to MD-PhD training., Results: Respondents (N = 418; 51% female) indicated Time, Funding and Pathway as the major themes arising from the qualitative data, highlighting negative perceptions rather than possible benefits to RHD training. The lack of an evident Pathway was inter-related to Time and Funding. Themes were supported by the quantitative data. Sixty percent of students have previous research experience of varying forms, and 90% report a current interest, mainly to improve their career prospects., Conclusions: The data emphasise the need for an MD-PhD pathway in Australia. A model that provides an early, integrated, and exclusive approach to research training pathways across all stages of medical education is suggested as the best way to rejuvenate the clinician-scientist. A national pathway that addresses factors influencing career decision making throughout the medical education continuum should include an appropriate funding structure, and provide early and continuing advice and mentoring. It should be flexible, gender equitable, and include post-graduate training. The implications of implementing MD-PhD programs represent a substantial investment. However this should not be a deterrent to Australia's commitment to an MD-PhD pathway, but rather a challenge to help ensure our future healthcare is guided by highly trained and competent clinician-scientists.

Purpose: Resilience, coping with uncertainty and learning from mistakes are vital characteristics for all medical disciplines - particularly rural practice. Levels of coping constructs were examined in medical students with and without a rural background or an interest in rural practice., Methods: Cross-sectional surveys identified two personality profiles, and their association with levels of Tolerance of Ambiguity, Resilience, Perfectionism-High Standards and Concern over mistakes as constructs indicative of coping. Medical students (N = 797) were stratified by rural background and degree of rural interest. Mediation analysis tested the effect of personality profile on levels of the coping constructs., Results: More (72%) rural background students had Profile 1 which was associated with higher levels of Tolerance of Ambiguity, High standards, and Resilience, but lower Concern over mistakes. Non-rural background students reporting a strong rural interest also had Profile 1 (64%) and similar levels of coping constructs. Personality profile mediated the association between rural interest and levels of coping constructs regardless of background., Conclusions: Having a rural background or strong rural interest are associated with a personality profile that indicates a better capacity for coping. Personality may play a part in an individual's interest in rural practice. Rural workforce initiatives through education should encourage and nurture students with a genuine interest in rural practice - regardless of background.

Purpose: There is a high prevalence of stress, depression, and burn-out in medical students. Medical students differ widely in personality traits, self-perceptions, and values that may have an impact on their well-being. This study aimed to investigate variability in their personality profiles in relation to their potential for well-being and resilience., Method: Participants were 808 medical students from The University of Queensland. An online questionnaire collected socio-demographics and the Temperament and Character Inventory to assess personality traits. Latent profile analyses identified students' trait profiles., Results: Two distinct personality profiles were identified. Profile 1 ("Resilient") characterized 60% of the sample and was distinguished by low Harm Avoidance combined with very high Persistence, Self-Directedness and Cooperativeness compared to Profile 2 ("Conscientious"). Both Profiles had average levels of Reward Dependence and Novelty Seeking and low levels of Self-Transcendence. Profiles did not differ by age, gender, or country of birth, but rural background students were more likely to have Profile 1. While both Profiles indicate mature and healthy personalities, the combination of traits in Profile 1 is more strongly indicative of well-being and resilience., Conclusions: Finding two distinct profiles of personality highlights the importance of considering combinations of traits and how they may interact with medical students' potential for well-being. Although both profiles of students show healthy personalities, many may lack the resilience to maintain well-being over years of medical training. Programs that develop character and personality self-awareness would enhance their well-being and prepare them to promote the health of their patients.

Background: Pathology is a discipline that provides the basis of the understanding of disease in medicine. The past decades have seen a decline in the emphasis laid on pathology teaching in medical schools and outdated pathology curricula have worsened the situation. Student opinions and thoughts are central to the questions of whether and how such curricula should be modernized., Methods: A survey was conducted among 1018 German medical students regarding their preferences in pathology teaching modalities and their satisfaction with lecture-based courses. A qualitative analysis was performed comparing a recently modernized pathology curriculum with a traditional lecture-based curriculum. The differences in modalities of teaching used were investigated., Results: Student satisfaction with the lecture-based curriculum positively correlated with student grades (spearman's correlation coefficient 0.24). Additionally, students with lower grades supported changing the curriculum (spearman's correlation coefficient 0.47). The majority supported virtual microscopy, autopsies, seminars and podcasts as preferred didactic methods., Conclusions: The data supports the implementation of a pathology curriculum where tutorials, autopsies and supplementary computer-based learning tools play important roles.

Background and Objectives: Physician workforce projections fuel interest in addressing the shortage of family physicians. Copious research has investigated personality as a variable influencing specialty intention. Medical school rural longitudinal integrated clerkships (LICs) nurture interest in family medicine. This study examined whether rural LIC students who intended to and eventually matched into family medicine portrayed a personality trait profile different from rural LIC students who intended or matched to all other specialities. The profiles of four successive cohorts are described in relation to their intended and eventual specialty match., Methods: A cross-sectional design sampled 145 third-year students from 2008--2011. A survey measured demographics, temperament and character personality traits, and Other-Oriented Empathy. Multivariate analysis compared family medicine versus all other specialty matches and original specialty intention with eventual match., Results: Match groups did not differ in gender, age, or marital status. Rural LIC students who matched in family medicine had lower levels of Harm Avoidance, higher Reward Dependence, and nonsignificant higher levels of every other personality trait in comparison to other matches. Rural LIC students who intended and matched to family medicine showed the highest levels of Reward Dependence (warm sociability) and Other-Oriented Empathy compared to any other specialty., Conclusions: Lower levels of Harm Avoidance are conducive to less anxiety, more composure and confidence in making decisions, and being relaxed in accepting a degree of risk and uncertainty. Such calm optimism along with higher Reward Dependence showing social warmth and empathy are desirable traits for family physicians regularly confronted with a wide range of presentations from the obvious to complex. Further investigation of what influences sustainability of the intention to enter family medicine may be useful to educators for counseling.

Background: The continuing decline in clinician scientists is a global concern. This paper reports on a two-fold rationale to address this decline by increasing the number of students on a formal pathway to an academic research career, and building a 'teaching-research nexus' using the research intensive environment at our University., Methods: The University of Queensland has implemented a research intensive program, the Clinician Scientist Track (CST), for a select cohort of students to pursue a part time research Masters degree alongside their full time medical degree. To this end, the support of clinical academics and the research community was vital to achieve a 'teaching-research-clinical nexus' - most appropriate for nurturing future Clinician Scientists., Results: In three years, the CST has 42 enrolled research Masters' students with the majority (90%) upgrading to a PhD. Research represents 33 different areas and over 25 research groups/centres across this University and internationally., Conclusions: Other research intensive institutions may similarly build their 'teaching-research nexus' by purposeful engagement between their medical school and research community. The CST offers a feasible opportunity for outstanding students to build their own 'field of dreams' through an early start to their research career while achieving a common goal of rejuvenating the ethos of the clinician scientist.

Objective: A major challenge for medical schools is the provision of clinical skills training for increasing student numbers. This case study describes the expansion of the clinical school network at The University of Queensland (UQ). The purpose of the study was to investigate consistency in medical education standards across a regional clinical teaching network, as measured by academic performance., Methods: A retrospective analysis of academic records for UQ medical students (n = 1514) completing clinical rotations (2009-2012) was performed using analysis of covariance (ANCOVA) for comparisons between clinical school cohorts and linear mixed-effects modelling (LEM) to assess predictors of academic performance., Results: In all, 13 036 individual clinical rotations were completed between 2009 and 2012. ANCOVA found no significant differences in rotation grades between the clinical schools except that Rural Clinical School (RCS) cohorts achieved marginally higher results than non-RCSs in the general practice rotation (5.22 vs 5.10-5.18; P = 0.03) and on the final clinical examination (objective structured clinical examination; 5.27 vs 5.01-5.09; P < 0.01). LEM indicated that the strongest predictor of academic performance on clinical rotations was academic performance in the preclinical years of medical school (= 0.38; 95% confidence interval 0.35-0.41; P < 0.001)., Conclusions: The decentralised UQ clinical schools deliver a consistent standard of clinical training for medical students in all core clinical rotations across a range ofurban, regional and rural clinical settings. Further research is required to monitor the costs versus benefits of regionalised clinical schools for students, local communities and regional healthcare services.

Over the past decade, the medical education literature has recognized the need to develop a culture that nurtures wellbeing and resilience in students. However, the introduction of or increase in student fees precipitated a shift in higher education policies toward a consumer model of education. Importantly, it has altered the expectations of students and promoted a sense of "entitlement", rather than "striving" for something where success is not guaranteed. This model is consistent with materialism and status, and removed from intrinsic goals that are associated with mental and physical wellbeing. This article challenges medical educators to reconsider the current context of student learning and realign it with the graduate attributes needed to be a competent and responsible medical practitioner by enabling students to develop the 3Rs of resilience, responsibility and resolve. We propose that brave decisions and actions must be made by medical educators to provide students with opportunities to learn independence, self-management, and self-regulation and guarantee their role in helping medical students become resilient and responsible doctors of tomorrow.

Background: Although contentious most medical schools interview potential students to assess personal abilities such as communication., Aims: To investigate any differences in clinical communication skills (CCS) between first year students admitted to UQ medical school with or without an admissions interview., Methods: A retrospective analysis of 1495 student assessment scores obtained after structured communication skills training (CCS) between 2007 and 2010., Results: The average assessment score was 3.76 ([95% CI, 3.73-3.78]) and adjusting for student characteristics, showed no main effect for interview (p = 0.89). The strongest predictor of scores was gender with females achieving significantly higher scores (3.91 [95% CI, 3.54-4.28] vs. 3.76 [95% CI, 3.39-4.13]; p ≤ 0.001)., Conclusions: Data show no differences in post-training assessment measures between students who were interviewed during selection or not. Further research about the quality and retention of communications skills after training is warranted.

Purpose: Medical schools worldwide have developed rural primary care immersive experiences to nurture students' interest in future rural careers and address workforce shortages. Few studies have looked at the students who participate in these programs. This study explores personality traits in US and Australian students who undertake rural-focused medical training., Methods: A cross-sectional cohort design used the Temperament and Character Inventory to identify levels of the 7 basic dimensions of personality. Data were collected in successive cohorts over 2007-2011. Multivariate analysis compared trait levels between groups and by demographic variables., Findings: The majority of the 302 students (US-167; Australia-135) were female, aged 20-29 years and single. A greater proportion of US students reported being partnered, living longest in a small rural/remote community and having a rural background. Significant differences between groups were detected in several traits but effect sizes were small. The personality pattern of the combined sample indicates students with a mature and stable personality high in Self-Directedness, Persistence, and Cooperativeness. Rural background and marital status enhanced this pattern., Conclusions: Despite coming from different educational and societal backgrounds, similar personality patterns are evident in US and Australian students who pursue rural medical education. Data provide support for a pattern of traits associated with a rural background and its predictive influence on interest in rural practice. Considering the international expansion of rural longitudinal integrated clerkships, understanding student attributes may assist in identifying strategies to enhance the rural workforce that are relevant across cultures and continents., (© 2013 National Rural Health Association.)

Objective: To report, and determine reasons for, a change in the gender ratio observed among enrolled medical students after removal of the interview from the selection process., Design, Setting and Participants: Cross-sectional study of 4051 students admitted to the medical program at the University of Queensland between 2004 and 2012. Students are enrolled either directly as graduates or via a school-leaver pathway., Main Outcome Measures: Change in proportions of male and female students over time, and gender-specific scores in the three sections of the GAMSAT (Graduate Medical School Admissions Test)., Results: Between 2004 and 2008 (when an interview was part of the selection process), 891 enrolled students (51.4%) were male, whereas between 2009 and 2012 (no interview), 1134 (57.7%; P < 0.001) were male. This change in gender ratio was limited to domestic direct graduate-entry students, and the male proportion in this group rose from 50.9% (705 students) before the interview was removed to 64.0% (514 students; P < 0.001) after removal of the interview (reaching 73.8% in 2012). Between 2004 and 2012, male students consistently performed better than female students on GAMSAT section III (mean score, 71.5 v 68.5; P < 0.001)., Conclusion: The proportion of males enrolled in the medical program at this university increased markedly after removal of the interview from the selection process. This change is limited to domestic direct graduate-entry students, and seems to be due to higher scores by male students in section III of the GAMSAT. The interview may play an important role in ensuring gender equity in selection, and medical schools should carefully monitor the consequences of changes to selection policy.

Background: Medical schools worldwide are challenged to address the rural primary care workforce shortage by creating community-engaged curricula to nurture student interest in rural practice., Aim: To examine the personal characteristics of six consecutive rural longitudinal integrated clerkship student cohorts to understand whom the programs attract and select and thus inform the development of such programs., Method: A cross-sectional cohort design was used. Six cohorts (2007-2012) completed a survey on demographics and factors that influenced their choice of rural primary care. The Temperament and Character Inventory was used to measure personality. Analysis was mainly descriptive. Where appropriate univariate analysis compared variables between groups., Results: Sample size was 205 with the majority female (61%), between 25 and 29 years (64%), single (60%) and lived longest in rural communities with populations less than 20,000 (60%). Rural lifestyle, background and desire to work in underserved areas were noted to impact rural medicine interest. Professional satisfaction, personal and professional goals and family needs had the highest impact on career decisions, and financial concerns lowest., Conclusion: The stability of students' personal characteristics across cohorts and the workforce outcomes of this program suggest the recruitment process successfully nurtures students who will fit well into future rural practice.

Introduction: While there have been studies exploring the impact of personality on medical student selection and performance there has not been an investigation of the personality of students at different schools., Method: Demographic data and responses to the NEO measure of personality traits were collected from medical students in the first two weeks of their enrolment (2011) in seven medical schools in Australia. Personality traits were analysed by school features, gender and age using logistic regression., Results: Differences were detected between schools in the personality traits of Agreeableness and Conscientiousness. Higher Agreeableness and Conscientiousness were associated with attending an Undergraduate school (OR = 1.07 and 1.03, respectively) and a rural or community focussed school (1.06 and 1.03). Students attending a school that used interviews for selection had higher levels of Agreeableness (1.04) and lower levels of Neuroticism (0.96)., Discussion: This is the first study to demonstrate that personality traits differ between students entering different medical schools. While there seems to be logic behind some differences, others are perplexing. Further research should expand on these findings and the implications to schools in regards to attracting students through selection processes, mission statements and their broader social focus.

Objective: Recent efforts to redress the deficit of rural medical practitioners have considered the problem of recruitment and retention of rural doctors as one of influencing individuals' career choices. Exposure to rural medical environments during basic medical training is one long-standing example of an initiative aimed in this direction and there is some evidence that it is effective. This study sought to determine whether or not various domains of personality are related to medical students' attitude to practising as rural doctors after graduation., Design: The sample comprised 914 students commencing medical studies in Australian universities. They were recruited as part of the Medical Schools Outcomes Database project and indicated intended location of future medical practice., Setting: Seven Australian basic medical training programs., Main Outcome Measures: All students completed the NEO five-factor index (NEO-FFI) and Adjective Checklist (ACL) personality instruments., Results: A preference for a rural practice location was associated with a combination of six domains of personality. The probability of rural preference was greater with higher scores on openness to experience, agreeableness and self-confidence but lower with higher scores on extraversion, autonomy and intraception. Taken together these six domains of personality provide useful although imperfect discrimination between students with a rural versus urban location preference. After controlling for student age the associations with extraversion and agreeableness failed to reach statistical significance., Conclusions: While personality does not fully explain medical students' attitude towards practicing as a rural doctor, the data suggest it is an important factor and that some individuals may be better suited to a rural medical career than others. Considering personality along with other characteristics of the individual might allow targeted 'marketing' of rural practice., (© 2013 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.)

Introduction: The Australian Rural Clinical School (RCS) initiative has been addressing the rural medical workforce shortage at the medical education level for over a decade. A major expectation of this initiative is that it will improve rural medical workforce recruitment and subsequent retention through a rurally based undergraduate clinical training experience. The longitudinal nature of these workforce initiatives means that definitive evidence of its impact on the shortage of rural doctors is yet to be provided; however, to date cross-sectional studies are accumulating a measure of efficacy for these initiatives by monitoring early career factors such as internship location choice and speciality choice of RCS graduates. This article reports on a study in one RCS that is monitoring the impact of rural undergraduate clinical training on trends in workforce participation patterns of its graduates as long as 9 years in the workforce. Career location and speciality choice are reported as well as perspectives on early career intentions and the reality of making career and life decisions as a doctor in the medical workforce., Methods: A longitudinal mixed methods sequential explanatory design employed a quantitative data collection phase followed by a qualitative phase with the merging of data sources during the interpretation and analysis. In 2007 a database was established that maintained the contact details of all former graduates since 2002. Every 2 years graduates are invited to participate in a survey and provide an update on the influences on their current career intentions/decisions. The qualitative sample was recruited through a survey question asking for interest in participating in an interview., Results: The whole-sample survey results showed that out of a 64% (N = 115) response rate, 40% of respondents were currently working in non-urban locations. The majority (

Introduction: This longitudinal tracking project by the University of Queensland Rural Clinical School (UQRCS) provides data on the early career pathways of alumni since its inception in 2002. Specifically we report on; (1) perceptions of the UQRCS regarding its influence on current career choice, (2) current speciality choices, and (3) factors that influenced these choices., Methods: A retrospective web-based survey of all graduates who undertook clinical Year 3, Year 4 or Years 3 & 4 at UQRCS from 2002 to 2006. Associations with demographics, Year(s) at UQRCS, current workplace and speciality choice were assessed., Results: Response rate was 69%, (N=180). Alumni who spent two years (Years 3 & 4) at UQRCS reported significantly higher degrees of encouragement to pursue a rural career. Alumni currently working in a non-urban location had spent two years at UQRCS and were significantly higher in desire to remain rural. 'Time spent at the UQRCS' contributed most to interest in a rural career. General practice and emergency medicine were most preferred specialities., Conclusions: Findings confirm that a longer rural clinical experience is more effective in eventual choice of workplace location and future interest in a rural career. This corroborates the positive impact of Australian rural clinical schools toward rural medical workforce improvement.

Background: This study explored temperament and character traits in medical students to identify the possible predictive value of these traits to students with varying levels of intention to pursue rural medicine. This work is the precursor to a better understanding of personality traits associated with medical disciplines within specific environments such as rural medicine., Aims: The long term aim is to increase the recruitment of students who are best suited, and choose to practice in rural locations., Methods: Medical students (272) completed a demographic survey and the Temperament and Character Inventory (TCI-R 140) to identify levels of the seven basic dimensions of temperament and character. Multivariate statistics explored differences between students' TCI levels based on gender, rural origin and level of intention to pursue rural medicine., Results: Analysis showed only main effects and confirmed significant differences in certain TCI dimensions between students with a high compared to a low or medium intention to practice rural medicine and between males and females., Conclusions: Preliminary findings suggest that certain temperament and character traits may be related to interest in rural medicine however the efficacy of assessing personality traits as an adjunct to medical school training and career counselling remains uncertain.

Background: Rural Clinical Schools in Australia are a government initiative to help address the rural workforce shortage at the medical school level. This article reports on the approaches and outcomes from one Rural Clinical School., Description: The program is underpinned by an 8-week rural rotation for all 3rd-year students and a yearlong program of core clinical rotations for 25% of the Year 3 cohort. Aspects of experiential, situated, service, and self-directed learning along with interprofessional study are integrated to provide unique rural-focused learning opportunities., Evaluation: Compared to their urban counterparts, rural students see more patients, perform a greater number of procedures, and achieve as well in exam results., Conclusions: Early indications suggest that our program is attracting more Year 3 students to explore the rural pathway as an option to a future career. The program demonstrates that rural students achieve as well as their urban counterparts.

Objective: To use short-term indicators (hospital internship choice, and interest in a future rural career) to assess how the University of Queensland rural clinical school is meeting its program objectives., Design: Cross-sectional quantitative data collected through self-report questionnaires., Setting: University of Queensland rural clinical school (UQRCS)., Participants: Year 4 students who attended the UQRCS for their entire clinical year in 2006., Results: Most students were from an urban background. Over the year, interest in a future rural medical career increased measurably across the cohort. The most important factors in choosing to study at the UQRCS were the quality of teaching, level of student contact with clinical teachers, increased patient access, and accommodation facilities. Comparison of graduates' choice of internship location for 2006 compared with 2005 showed a trend away from urban or metropolitan toward regional or rural hospitals., Conclusions: Our results suggest that the primary attraction of UQRCS is the quality of education, and rural undergraduate training is a popular choice for urban students. Although the long-term effect on rural medical workforce remains to be determined, the trend at UQRCS of new graduates choosing non-urban internships is encouraging.

Objective: In-depth exploration of the perceptions, experiences and expectations of current long-term rural GPs and medical students intent on a rural career, regarding the current and future state of rural medicine., Design: Qualitative study using semistructured interviews., Setting: Rural and remote towns in Central and Southern Queensland and the School of Medicine, University of Queensland., Participants: Thirteen rural GPs with 10-40 years experience. Medical students (five second- and seven third-year), all of whom are members of a rural students' club and have an intention to pursue rural practice. Interviews were conducted between August and December 2004., Main Outcome Measures: Emergent themes relating to participant perceptions of the current and future state of rural medicine., Results: Despite large differences in generation and experience, medical students and rural GPs hold similar perceptions and expectations regarding the current and future state of rural practice. In particular, they cite a lack of professional support at the systems level. This includes specific support for: continuing medical education to obtain and retain the skills necessary for rural practice; dealing with the higher risks associated with procedural work; and consequences of medico-legal issues and workforce shortage issues such as long hours and availability of locums., Conclusions: Issues relating to recruitment and retention of the rural health workforce are identified by both cohorts as relating to professional support. Medical schools and institutional support systems need to join forces and work together to make rural practice a viable career in medicine.