Preparing medical graduates for Australian rural practice: a qualitative evaluation of shorter longitudinal integrated clerkships in small communities

Rural Australia is experiencing a medical workforce crisis. Strategies to increase the proportion of medical graduates who work rurally have been effective for larger rural towns and regional centres, however smaller rural communities still face critical workforce shortages. Longitudinal Integrated Clerkships (LIC) have been found to be effective in increasing student rural medicine exposure. There is evidence for the efficacy of 12-month placements with respect to readiness to practice as a medical graduate and to improve rural retention. However, longer placements limit the number of students able to access a LIC experience. One strategy to provide rural training opportunities for more students in small rural communities is to reduce the duration of LIC placement. This study evaluated the impact of a 6-month LIC program in small rural communities (population <10,000) on student preparedness for internship and long-term ambition to remain a rural medical practitioner, as well as the challenges and benefits of this program. Qualitative interviews with general practitioner supervisors and students/ recent graduates of the LIC program were undertaken, and reflexive thematic analysis was conducted. Interviews were conducted with 10 students/graduates, and 3 supervisors. Themes arising from the analysis included: learning environment, LIC program structure and work readiness. These themes supported LIC principles of continuity of relationships, transformational experiences, and development of professional identity. The results of this study provide qualitative support for a shorter, 6-month LIC program in small rural communities to facilitate student aspirations for rural practice and provide preparation for internship in the Australian context. These findings have implications for further development of LIC placements in small communities to expand rural training opportunities for medical students.