Identifying the experience of geographical narcissism during medical education and training

Inequality of healthcare provision between metropolitan and rural communities is an enduring international concern. Geographical narcissism (GN) in medicine is a belief that the best healthcare provision only occurs in the big cities. In healthcare education and workforce development, there is a growing sentiment that GN exists, and is likely contributing to access inequalities and rural workforce shortages. This qualitative study aimed to explore if and understand how, where, when and why GN was experienced by medical students and prevocational doctors during their medical education and training. A constructivism research paradigm was applied, and reflexive thematic analysis was utilised for inductive coding of the different experiences and perceptions of GN. Semi-structured interviews with 29 Australian medical students and prevocational doctors were undertaken. Four key themes, with ten subthemes, were identified. First, GN is part of the hidden curriculum of medical education and training. Second, GN occurs across the continuum of medical education and training. Third, GN occurs with medical career advice. Fourth, GN is demonstrated by models of healthcare and health systems. This exploratory study confirmed previous anecdotal evidence that GN exists in healthcare and has outlined how, where, when and why it is experienced during medical education and training. Ignoring the potential damage and consequences of GN perpetuates the established metrocentric models of medical education, training, workplace culture, healthcare service provision and investment. The cycle of inequality will persist for rural populations, including poorer health outcomes and the rural medical workforce shortfall will continue - in part due to GN.