How Can Medical Schools Contribute to the Education, Recruitment and Retention of Rural Physicians in Their Region?
Rourke, James, Bulletin of the World Health Organization
Access to appropriate health care is often difficult for people living in rural areas because of a widespread shortage of appropriately educated local, rural healthcare workers and the distance, time and cost of travelling to larger urban health centres. This shortage is due to many factors including medical education, practice conditions, health system, regulatory, community, personal, family and financial considerations. (1,2) Developing a sufficient and sustainable rural physician workforce requires commitment and cooperation from communities, governments and medical schools..
Medical education can play an important role in the recruitment and retention of rural physicians. (3) Most of the world's medical schools, however, are situated in large cities; most medical students grow up in affluent urban areas, learn little about rural health-care needs and experience little or no medical learning in the rural context. Physician graduates flow almost entirely into large city practices with an insufficient trickle getting out into practice in rural areas.
Some medical schools in large cities have developed specific programmes for educating physicians for rural regions. A few medical schools are located in small cities within large rural regions and have a rural regional focus. Graduates of these medical schools often also serve rural populations well outside their own regions.
Unfortunately for many developing countries, especially in Africa, many graduates of their medical schools end up in rural practice, often not in Africa, but rather in developed countries where they have been enticed to serve the rural populations.
Medical schools should operate under a social accountability framework that includes responsibility to their regions. Four fundamental questions focus on how medical schools can contribute to the education, recruitment and retention of rural physicians in their region and beyond.
Students from rural areas
Can students from rural areas get admitted into medical school doctor education programmes? Importantly for rural physician workforce planning, physicians who practice in rural areas compared to physicians in urban practice are much more likely to come from a rural background. Students from racial areas, however, face many difficulties and, in most countries, are under-represented in medical schools especially compared to those whose parents are urban, wealthy and highly educated. People in rural regions should expect to have a fair opportunity to get into medical school.
Governments and medical schools need to implement cohesive strategies including premedical school outreach education preparatory courses; admission policies that recognize diversity of geographic backgrounds and experiences; and tuition and scholarship support to make medical school affordable.' In Australia, the percentage of students of rural origin in medical schools has more than doubled in response to national policies and incentives.
Aboriginal/indigenous people make up an important subset of the world's rural peoples and their health, education and economic status are often worse than the average for rural people. In addition, cultural differences and misunderstandings often create huge barriers. The Indigenous Physicians Association of Canada has partnered with the Association of Faculties of Medicine of Canada to increase the admission of and support for indigenous students in Canada's medical schools and to develop a First Nations, Inuit and Metis health competencies curriculum framework.
Ateneo de Zamboanga University School of Medicine in the Philippines and University of Malaysia Sabah are recent examples of small regional medical schools established with a focus on local indigenous health care.
Can medical students get education that is relevant to the rural context ? …