Effects of compulsory rural vocational training for Australian general practitioners: a qualitative study

Abstract

Background. Increasing the recruitment of doctors, including general practitioners (GPs), to rural areas is recognised as a health priority internationally. Australian GP trainees (registrars) complete a mandatory minimum of 6 months training in a rural area. The rationale for this includes the expectation of increased likelihood of a future choice of rural practice location. Method. A qualitative study employing semistructured in-depth interviews and a modified grounded methodology. Participants were 15 registrars from an Australian GP postgraduate training program. Results. Though generally a rewarding clinical learning experience, negative aspects of the rural placement included the disruption to personal lives of rural relocation and the stresses involved in higher levels of clinical responsibility. These stressors could undermine rather than enhance clinical confidence. Anxiety and depression were accompaniments for some registrars. Intention to practice rurally was little influenced by this compulsory placement. Conclusions. Findings of positive effects on rural practice destination in studies of medical undergraduates should not be generalised to GP registrars. The positive clinical learning experience of most registrars in rural terms must be balanced with the social dislocation involved in rural relocation and the adverse effects of the rural experience, for some registrars, on professional confidence and psychological well being. What is known about the topic? The rationale for compulsory rural placements during general practitioner vocational training includes an assumption that this will increase rural GP workforce. Undergraduate training in rural environments is known to enhance recruitment to rural practice. What does this paper add? Despite considerable positive educational and training outcomes for many registrars, compulsory rural training placements cause significant social dislocation for many registrars and were in this study associated with psychological morbidity in some registrars. Placements are unlikely to significantly increase rural GP workforce. What are the implications for practitioners? Compulsory rural placements can be a negative experience for GP registrars. Findings of positive effects of rural training experience on career intentions and rural workplace destination in studies of medical undergraduates should not be generalised to compulsory rural placements for general practice registrars.