Expectations and experiences of final-year medical students regarding family medicine rural rotations: Influence on intention to practise in a rural setting

Abstract

BACKGROUND : During recent years, a shortage of medical practitioners has been reported in rural underserved areas of South Africa (SA). The Division of Family Medicine, Faculty of Health Sciences, University of Cape Town (UCT), SA, implemented a voluntary 4-week rural rotation in Vredenburg, West Coast District, in 2011 in response to the need for rural training to be included in the medical curriculum. The reason for the decline in the number of students making use of this opportunity, is unknown; therefore, a compulsory 1-week rural rotation, as part of the final-year 4-week clerkship, was implemented in 2015. The rationale for this intervention was to ensure a sustainable rural learning environment and to highlight the need to explore students’ expectations and experiences with regard to the rural rotation. OBJECTIVES : To explore the expectations and experiences of 6th-year medical students regarding the family medicine rural rotation, and to identify factors that may influence return to a rural setting after graduation. METHODS : A qualitative study design was used. Sixth-year medical students (n=31) participated in the pre-rural focus group discussions (FGDs), and 28 in the post-rural FDGs. A content analysis method was used to identify key themes. RESULTS : Key themes for student expectations included programme content, clinical experiences, language barriers and physical environment. Themes for student experiences related to environment and resources, programme content and clinical experience, language barriers and logistics. Positive experiences included good mentorship, autonomy to perform procedures and improved preparedness for internship. Negative experiences included inadequate clinical exposure and time allocation. Most students expressed an intention to enter rural practice; reasons included effective teamwork and making a difference. CONCLUSIONS : Student expectations of the rural rotation varied from feelings of apprehension about language barriers to programme content and clinical experience. However, the majority were excited about the potential clinical exposure in a rural setting. Positive experiences related to student expectations being met and working independently while supervised by good mentors. Based on these findings, it can be concluded that all medical students, irrespective of geographical background, should be exposed to rural medicine in the undergraduate curriculum.