The influences of background on beginning medical students’ perceptions of rural medical practice

BACKGROUND: Access to health care is an ongoing problem for underserved populations in rural and remote regions of Australia and North America. Despite medical schools educating more medical doctors, this maldistribution continues. While students entering medical programs with a rural focus purport to have an interest in rural medicine, their understanding of possible future rural practice is unclear. This study explored the differences in perception of rural practice between beginning medical students from rural and urban backgrounds to gain an indication of the usefulness of our selection process to meet the rural workforce mandate. METHODS: Beginning medical students completed a writing exercise about the life and work of a rural medical doctor as a test of their academic writing skills. After completing the task and receiving feedback, students were invited to submit their work for analysis. Template analysis using themes from a study of rural medical registrars was used to analyse 103 scripts. RESULTS: Students demonstrated foundational insight into some of the realities of rural life and practice. However, differences were noted in perspectives between rural background students and urban background students. Rural background students used everyday language to describe the practicalities of rural life, medical practice and the implications for families and communities. Urban background students generally used complex language and more negative descriptors. CONCLUSIONS: Beginning medical students from urban and rural backgrounds differ in their perceptions and expression of rural practice. These outcomes are important for medical schools that use interviews in their selection process. Rural background applicants' suitability may be overlooked because of the interviewer's expectations of language, while urban background applicants may score higher related to complex language and use of key phrases. Interviewer training should address this likely bias thereby increasing the potential to recruit rural background students.