Background: The uneven distribution of physicians between urban and rural areas remains a significant public health challenge. Rural clinical placements during medical training are increasingly viewed as a potential lever for enhancing the appeal of rural areas. The aim of this systematic review, supported by a meta-analysis, was to evaluate the real impact of rural placements on medical graduates’ decisions to practice in rural locations. Methods: A systematic search was conducted across four databases (PubMed, Embase, Web of Science, and Cochrane Library) covering the data available up to June 2024. Included studies evaluated the impact of rural clinical placements on the professional practice location of medical students or early-career physicians. A random-effects meta-analysis was performed to estimate the relative risk (RR) of rural practice. Additional variables analyzed included practice duration, placement length, participants’ rural background, their satisfaction with the placement, and their stated intention to practice in a rural area. Results: A total of 62 studies were selected, with 28 contributing to the meta-analysis, encompassing over 330 000 participants. The pooled analysis showed that students who completed a rural placement were more than twice as likely to establish practice in a rural area compared to their non-exposed peers (RR=2.683; 95% CI confidence interval: 2.255–3.192). This effect was further amplified by factors such as rural background, extended placement duration, and a satisfactory placement experience. A key strength of this review is that it synthesizes actual workforce outcomes rather than relying solely on stated intentions. Conclusion: Rural clinical placements have a significantly positive impact on the rural practice decisions of early-career physicians, particularly when these placements are of extended duration, well-structured, and accessible. Rural placements should be offered both to students from rural backgrounds, who consistently show the strongest effect, and to urban students who may develop an increased interest in rural practice when exposed to long, immersive placements. These findings support the integration of rural placements into a global policy aimed at achieving a more equitable geographic distribution of healthcare professionals. Although the effectiveness of rural placements is already recognized in international frameworks such as the World Health Organization (WHO) guidelines, their implementation remains uneven across countries.
Schirm et al. (Tue,) studied this question.