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Abstract online early

Encouragers and discouragers affecting medical graduates’ choice of regional and rural practice locations      [ Original Research ]

Submitted: 14 October 2016
Accepted: 15 July 2017

Author(s) : McKillop AM, Webster CS, Bennett W, O'Connor B, Bagg W.


Introduction: Access to health care as near to where people live as possible is desirable. However, not enough medical graduates choose to work in rural and regional areas, especially in general practice. The career decisions of recent medical graduates are known to be affected by a variety of professional, societal and personal factors. Internationally, medical programmes have exposed students to regional/rural experiences partly to encourage them to seek employment in these areas after graduation. As such, the Pūkawakawa programme is a year-long regional/rural experience for selected Year 5 students from the University of Auckland‘s Medical Programme in New Zealand in partnership with the Northland District Health Board and two Primary Health Organisations. A lack of clarity about the drivers of rural/regional career decisions underpinned this study which aimed to explore the barriers and encouragers for students of the programme to return as resident medical officers to the regional hospital where they had gained clinical experience.
Methods: A mixed-method, descriptive design was used including a short survey, followed by participation in a focus group discussion or a one-on-one interview. Survey data were summarised in tabular form and inductive, thematic analysis was applied to transcripts of focus groups and interviews.
Results: Nineteen doctors in their first or second year following graduation participated, 15 who had returned to the hospital where they had clinical experience in the programme and four who were employed elsewhere. A match of personal goals and intended career intentions was the reason most frequently ranked for their choice of early career employment. Other frequently ranked items were lifestyle, friends and family close by, and the reputation and experience of the Pūkawakawa programme. Qualitative data revealed that the learning experience, the unique design of the curriculum and associated support from clinicians were identified as important factors in encouraging students to work in regional and rural environments. However, discouraging factors included separation from friends and families, geographical isolation and the lack of opportunities for partners to find work.
Conclusions: This study has confirmed the value of the Pūkawakawa programme as an important contributor to the regional and rural workforce of the Northland district. The value of an academic-clinical partnership has been shown to support a regional and rural clinical learning environment. Evidence is provided of one way of having overcome barriers to building regional and rural workforce capacity in this district.

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