Outcomes of rural generalist internship training in Victoria, Australia

Introduction: Victoria commenced its first Rural Community Internship Training program in 2012 to support the development of rural generalist (RG) doctors. Unlike most internships that are wholly hospital-based and delivered mostly within larger metropolitan and regional centres, this RG internship training model involves completing General Practice experience in smaller rural communities working with RGs and visiting specialists. This study aimed to explore the characteristics and satisfaction of doctors who participate in RG internship training in Victoria and their workforce outcomes.
Methods: Between October and November 2021, a retrospective ten-minute anonymous survey invitation was sent to all contactable interns (n=222) who had completed/were completing the RG internship training (2012-2021). The survey was co-designed with RG internship managers and other stakeholders of a state-wide evaluation advisory group, informed by the latest evidence regarding RG medicine and rural training predictors and outcomes of interest. Participants completed the survey via MS Forms, with three invitations circulated to an up-to-date email address which was maintained by the Internship Program. Collected data were analysed descriptively, by sub-groups to explore training pathway outcomes by region, training stage and specialty choice. Workforce distribution outcomes were defined in line with objectives of the program and pre-determined indicators of RG scope. Results were compared with the benchmarks of rural workforce training outcomes in Australia using recent research.
Results: There were 59 participants (27% response rate); 81% were in their 3-7th postgraduate year. Respondents included 54% male, 17% rural bonded, 39% of rural origin, 34% having had over 3 months rural undergraduate training and 48% doing RG training where they previously did undergraduate training. All were satisfied/very satisfied with the RG training and 61% were working in General Practice (excluding the prevocational group). Overall, 40% were currently working in the same rural region as their internship (including 3 who were currently interns), 56% continued to complete some prevocational training in the same region as their RG internship, whilst 20% went on to be currently based in smaller rural communities (MMM 4-7) and 44% to be working part-time in smaller rural communities. Overall, 42% self-identified as working as an RG and nearly all (97%) met at least one of the key indicators of extended (RG) scope. In all areas the RG internship outcomes were better than the national benchmarks from published evidence about rural training.
Conclusion: This study provides evidence from doctors up to 9 years after completing their RG internship. Compared with industry benchmarks, the RG internships attract rurally intentioned and rurally experienced doctors who may be likely to remain in the same rural region as their undergraduate rural medical training and continue their postgraduate training in the same region. They were all satisfied with rural generalist internship training, had high propensity to follow a GP career and work at broad scope in smaller communities. Importantly, they intend to stay in the region where they trained. This suggests RG internship programs are a positive intervention for promoting an RG workforce.

Keywords: rural generalist, interns, general practice, Victoria, Rural doctors