Student perceptions of rural placement – Australia to Aberystwyth

Dear Sir

As fourth year medical students from Cardiff University Surgical Society (CUSS) we discussed your article (Daly et al. 2013) with interest.

We acknowledge that our experiences in this field differ from those in Australia. However, regarding medical education in the UK, placements allocated by Cardiff University are geographically vast and remote. These include exposure to rural South Wales and North Wales where Welsh language is predominantly spoken. Therefore, we feel uniquely positioned to comment on experiences of rural placements because such 5–8 week attachments are integrated into our core-curriculum.

CUSS agrees with Daly et al. that rural placements may enhance preparedness for practice (P4P) specifically in reference to clinical skills, personal, professional and cultural development. Factors contributing to our increased P4P differ from those at Broken Hill. Anecdotally we have identified these as: increased devoted clinician teaching time, lower student-patient ratio, and a more culturally, pathologically and socially diverse spectrum of patients.

Within CUSS we discussed various negative aspects of rural placements absent from the original article. We believe student experience is a key criterion in determining perceived placement success, which in turn may affect the knowledge and P4P acquired during attachments. Firstly, logistical obstacles specifically affecting Cardiff students include language barriers, unsubsidized travel costs and social isolation from peers.

Additionally, in Cardiff, we rotate through specialty specific placement blocks each situated at discrete locations. This means rurally placed students will lack exposure to specialist teaching, patients requiring complex management and advanced procedures only offered at tertiary centres.

Daly et al. mentioned using Video-conferencing to overcome these issues. This method is currently employed by Cardiff University. However, based on our experience this format is a poor substitute when compared to face-to-face interactions.

We conclude that students should experience a balance between rural and tertiary care settings. While rural placements can potentially increase P4P, the aforementioned detrimental features should be considered as these may negatively affect student satisfaction, learning opportunities and therefore reflect poorly on P4P. Furthermore, we call for an objective measure of P4P to determine whether students’ perceptions are reflected in subsequent clinical practice.

Declaration of interest: The authors report no conflicts of interest.