How rural immersion training influences rural work orientation of medical students: Theory building through realist evaluation

Abstract

Aim

To develop theory about how contexts and mechanisms interact to contribute to openness to future rural practice by medical students undertaking immersive rural training.

Methods

A realist evaluation based on RAMESES II protocol. We interviewed 23 students exploring Contexts (C) which were external (place-based) and internal (the student’s characteristics), Mechanisms (M) (that drive a response) and Outcomes (O) (openness to rural work).

Results

‘Openness to rural work’ related to: a desire to live rurally, work in rural medicine, or consider this as a possibility. This was triggered by responses to experience in rural places of an aspirational, intellectual and emotional nature (mechanisms). Students most affected were those with a strong motivation to help others and who value teamwork. Students with clearly envisaged career paths suited to metropolitan areas, or those retaining/prioritising strong social and community ties in metropolitan areas were less likely to commit to future rural work.

Conclusion

Our theory indicates multi-level stimuli activates openness. Implications are that rural immersion programs could select students with an orientation towards teamwork, without pre-set professional ideation, and with a strong commitment to helping others. Experiencing rural immersion will trigger aspirational, intellectual and emotional responses leading to rural work openness for such students.

Keywords:

• Undergraduate
• Medicine
• General Learning Outcomes
• Medical Education Research
• Evaluation

Disclosure statement

The authors declare that they have no competing interests. This research was not funded but was conducted by researchers employed through the Australian Government’s Rural Health Multidisciplinary Training Fund.

Glossary

Below are some definitions of common terms used in realist evaluation which may not be familiar to all readers.

Context: Describes the features of situations into which programs are implemented, which affect the operation of program mechanism. Contexts ‘do not refer to places, people, time or institutions per se, but to the social relationships, rules, norms and expectations that constitute them.’ (The RAMESES II Project 2017b)

Mechanism: Mechanisms are an account of how/why programs give rise to actions. A mechanism is the ‘interaction between program resources and the ways that participants interpret and respond (or not) to them’. (The RAMESES II Project 2017a)

Additional information

Notes on contributors

Amie Bingham

Amie Bingham, MPH, is a researcher at the School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.

Belinda O’Sullivan

Belinda O’Sullivan, PhD, is a Research Fellow at the Rural Clinical School, Faculty of Medicine at the University of Queensland, Toowoomba, Queensland, Australia.

Danielle Couch

Danielle Couch, PhD, is an Adjunct Research Fellow at the School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Bendigo, Australia.

Samuel Cresser

Samuel Cresser, MBBS, is a junior doctor working in Obstetrics and Gynaecology at Bendigo Health, Bendigo, Victoria, Australia.

Matthew McGrail

Matthew McGrail, PhD, is an Associate Professor and Senior Research Fellow with the University of Queensland Rural Clinical School, where he is the Head of Regional Training Hubs Research.

Laura Major

Laura Major is the Rural Health Education Manager at the School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.