Development of a rural strategy for an urban-based medical program: a pragmatic reality

Introduction: Health disparities between rural and urban areas in Aotearoa New Zealand are exacerbated by rural workforce issues. Traditionally, undergraduate medical programmes are urban-based, and reconfiguring the curriculum to meet the needs of rural communities is challenging. The aim of this project is explore how urban-located universities might develop and implement a rural strategy. Evaluation of a rural strategy may lead to its ongoing improvements designed to increase the rural workforce.
Methods: This is a qualitative study involving semi-structured interviews with purposively selected key stakeholders. Enquiry included the systematic identification of processes required to develop a rural strategy, including possible facilitators and challenges to be addressed. Qualitative analysis of de-identified data was conducted using a thematic approach.
Results: Fourteen stakeholders were interviewed: four rural general practitioners, two rural hospital doctors, four administrators involved in placing students, and four senior medical academics with involvement in the regional and rural programmes. Five over-arching themes were identified: (1) developing rural pathways into medical school; (2) improving and expanding rural exposures; (3) developing rural structures; (4) implementing interprofessional education. and (5) having a social mission.
Conclusion: These findings align to the literature relating to developing rural strategies for universities. However, this study also suggested that rural health interprofessional programmes may have a role. A key finding was that the social mission of a university may not be visible to rural stakeholders. Reorientating an urban-located university to having a rural strategy requires moving past having policy around social accountability to operationalising it.
Keywords: Aotearoa New Zealand; Education, medical, undergraduate; rural health; rural health workforce, rural curriculum