Can rural exposure to general practice influence career aspirations? A study with former participants of the ‘Excellence-Project’, Germany

Early Abstract:

Objective: The shortage of general practitioners (GPs) and the aging population in Germany that requires increasing amounts of medical care is creating considerable strain on the German healthcare system. The lack of young doctors in general practice poses challenges to the healthcare of the population . The 'Excellent-Project' aims to draw interest in the field of general practice/family medicine and rural work among medical students. The project provides structured and supervised internships designed to present general practice not only as a valuable professional choice and as an attractive and fulfilling career option in rural settings.
Design: This cross-sectional study investigated the impact of a structured internship program in a rural general practice. The internship combined intensive one-on-one supervision by experienced GPs with an accompanying teaching program. To assess the impact, former students were asked using a questionnaire about their interest in general practice before and after participation, as well as their willingness to work in rural areas.
Setting and Participants: The project was offered as a 4-week internship as part of the block internship required by the German Licensing Regulations for Physicians. Participation in the project was open to all medical students at German universities. Participants were placed in rural general practices across the Bavarian Forest, a rural region in the south-east of Germany. As part of the internship, in addition to interactive teaching sessions and gaining experience in general practice, exploration and leisure activities in the rural environment also played a significant role. During the project, the students built connections with peers and mentors.
Main outcome measures: To evaluate the 'Excellent-Project', the evaluation focused on changes in students career aspirations towards general practice and rural work. Specifically, the main outcome measure was whether students reported greater interest in becoming GPs after completing the internship compared with before the program. Additional outcomes included self-reported growth on a personal and professional level.
Results: The internship promotes development on both personal and career-related levels. After completing the internship, the participants' preference for pursuing a career in general practice has increased. On a scale from -100 to +100, the wish of being a GP in the future went from median -40 (IQR: -70 to 20) before the project to median 30 (IQR: -12.5 to 52.5) after the project. The participants’ interest in working in rural areas was assessed on a scale of -100 to +100and showed that the further the participants progressed in their careers, the greater their desire to work in rural areas in the future (students: median 20 (IQR: -20 to 50); further training: median 35 (IQR: 0 to 60)). 24.3% of participants who have already obtained their medical license have decided to pursue further training in general practice.
Conclusion: A structured rural practice experience during the initial years of a medical career can sustainably increase medical students’ motivation to choose further training in general practice and work in rural areas, with lasting effects still observable years later. Initiatives such as the 'Excellence-Project' can help to address the shortage of GPs in rural areas.
Keywords: career choice, family medicine, general practitioner workforce, Germany, medical students.