Extended rural medical placements deliver value

The peer-reviewed study, by Dr Torres Woolley, Professor Tarun Sen Gupta, Prof Ruth Stewart and Dr Aaron Hollins, assigned a dollar value to the educational and workforce benefits of sixth year JCU Medicine students undertaking five-month Integrated Rural Placement (IRP) or 10-month Longitudinal Integrated Clerkship (LIC) programs.

Dr Woolley said the study, published in the Rural and Remote Health Journal, was the first social return on investment (SROI) study of the impact of health professional education in Australia. He said the methodology, combining quantitative and quasi-qualitative data collected via a survey, was unique and accounted for prior student intention to work rurally.

The SROI from JCU’s extended rural programs between 2013 and 2019, after students graduated and entered the workforce, was calculated at $7.60 for every dollar spent, taking into account the benefit of the students’ increased clinical skills and confidence for their internship year, and the rural medical workforce benefit of increased willingness to work in a rural or remote town as a doctor specialising in rural medicine.

“This positive return-on-investment from extended rural placements is important evidence for shifting the conversation around supporting these programs from one of cost to one of value,” the authors concluded in the study.

Professor Sen Gupta, Head of the JCU Clinical School in Townsville, said the extended placements allowed final-year students to develop their skills, live in a rural town, develop their interest in rural medicine, and form their identity as rural doctors.

The sought-after extended placements have grown to involve about 20-25 students each year. They are in addition to the 20 weeks every JCU medical student spends on rural placement during their degree as part of the JCU College of Medicine and Dentistry’s commitment to building a fit-for-purpose medical workforce for underserved communities in Queensland.

“The bottom line here is that, beyond the educational benefits of the longitudinal placements, there is a substantial economic benefit in terms of increased likelihood of people working rurally and working for longer,” Professor Sen Gupta said.

“Spending a dollar on this program is actually returned many times over. There are benefits to the individuals, but there are benefits to society as well. That argues the case for more investment in our programs.”

He said JCU Medicine graduates were much more likely to practise in non-metropolitan settings and to be generalist specialists.

“The old-fashioned view was always you learned everything in the big hospitals, whereas we've turned that on its head,” Professor Sen Gupta said. “We've said ‘actually you learn where the patients are because you’re close to the decision making’. We’ve got some strong evidence of that. Our commitment to rural people is about providing workforce, offering access to education, and offering placement in those towns so all of our graduates understand rural medicine."

“We have an obligation, particularly to the most underserved, the rural and remote communities. What it means is, firstly, providing a workforce. We try to recruit kids from those communities, and one reason is they’re more likely to go back, but it is also democratising education. We think we've got a duty to prepare people who are technically good but also see that they have a responsibility to address workforce needs. They’ve had a values-driven medical education, so they understand social accountability and responsibility to communities.”

James Cook University is making rural health matter. We believe everybody deserves access to a doctor, no matter where they live. Find out more about how JCU is strengthening the health workforce in rural, regional and remote Queensland. Read about Georgia Bulley's extended placement on Thursday Island.

Woolley T, Sen Gupta T, Stewart RA, Hollins A.  A return-on-investment analysis of impacts on James Cook University medical students and rural workforce resulting from participation in extended rural placements. Rural and Remote Health 2021; 21: 6597. https://doi.org/10.22605/RRH6597

Go deeper: Read our white paper