Grasping the Ongaonga: When will New Zealand really integrate rural clinical education?

A Qualitative and Semiquantitative Exploration of the Experience of a Rural and Regional Clinical Placement Programme

In many countries, including New Zealand, recruitment of medical practitioners to rural and regional areas is a government priority, yet evidence for what determines career choice remains limited. We studied 19 newly qualified medical practitioners, all of whom had participated in a year-long undergraduate rural or regional placement (the Pūkawakawa Programme). We explored their placement experiences through focus groups and interviews and aimed to determine whether experiential differences existed between those who chose to return to a rural or regional location for early career employment (the Returners) and those who did not (the Non-Returners). Focus group and interview transcripts were a mean (range) length of 6485 (4720-7889) and 3084 (1843-4756) words, respectively, and underwent thematic analysis. We then used semiquantitative analysis to determine the relative dominance of themes and subthemes within our thematic results. Placement experiences were overwhelming positive - only four themes emerged for negative experiences, but five themes and nine subthemes emerged for positive experiences. Many curricular aspects of the placement experience were viewed as similarly positive for Returners and Non-Returners, as were social aspects with fellow students. Hence, positive experiences per se appear not to differentiate Returner and Non-Returner groups and so seem unlikely to be related to decisions about practice location. However, Returners reported a substantially higher proportion of positive placement experiences related to feeling part of the clinical team compared with Non-Returners (11% vs 4%, respectively) - a result consistent with Returners also reporting more positive experiences related to learning and knowledge gained and personal development.