Roger Strasser

Starting rural, staying rural: how can we strengthen the pathway from rural upbringing to rural practice?

OBJECTIVE   To determine if selecting rural background students into the Monash Bachelor of Medicine and Bachelor of Surgery (MBBS) program affects vocational training location and intended practice location after training. DESIGN   Retrospective cohort mail survey. SETTING   Australia. PARTICIPANTS   Rural-background students at Monash 1992-1994 (n=24/40) and 1995-1999 (n=59/120) and urban background students (n=36/93 and 104/300, respectively). Overall study population: 62% female, average age of 28 years; 79% Australian-born; and 60% married/partnered. INTERVENTIONS   Rural or urban background, rural undergraduate exposure. MAIN OUTCOME MEASURES   Intent towards rural medical practice, vocational training location and subsequent practice location. RESULTS   There was a positive and significant (P ≤0.05) association between rural background and rural practice intent when respondents began (10-times higher than urban graduates) and completed (three times higher) their MBBS course. Rural practice intent increased fourfold in urban background graduates. There was a positive and significant association between rural background and preferred place of practice in 5-10 years in a Rural, Remote and Metropolitan Area (RRMA) 3-7 community (three times higher). There was a positive, but non-significant association between rural background and RRMA 3-7 community as their current location and first place of practice once vocationally qualified. CONCLUSIONS   Interest in rural practice is not fully reflected in location during or after vocational training. The beneficial effects of rural undergraduate exposure might be lost if internship and vocational training programs provide insufficient rural clinical experiences and curriculum content. Continuation of the rural pathway might be needed to maintain rural practice intent.

Rehabilitation Following Spinal Cord Injury: The Facilitatory Impact of the Rural Social Setting

While recent discussions have tended to focus on the negative health consequences associated with living in rural areas, there is evidence to suggest that there are factors associated with rural areas that compensate for the difficulties encountered. This article details positives associated with the rural social environment as encountered by 47 agricultural industry workers who suffered a spinal cord injury and returned to a community setting. Results indicate that there are a number of factors related to the rural social environment that can facilitate a positive rehabilitation experience and assist individuals to make rehabilitation gains. These include a culture of involvement and support, the attitudes of health-service providers and the willingness of employers to make a place for those with a limitation. With an understanding of the benefits rural residents may derive from their social setting, people planing health and rehabilitation services can better develop strategies for the optimal use of resources and thus improve the health of country residents.