We are writing in response to an article in the May edition of the NZMJ by Poole et al.1

The MSOD database, which tracks the career intentions of medical students and graduates, will over time generate a great deal of useful information to help guide medical education in New Zealand. But even this early paper is enough to demonstrate the value of the database. As the authors point out in their introduction, all of New Zealand’s diverse communities have an expectation that they will benefit equitably from the considerable investment they collectively make in medical education. The data published in this paper already highlights where the medical schools are achieving this goal and where work still needs to be done.

The considerable increase in the proportion of respondents intending to work in regional cities and large towns (pop. 25,000–100,000) between entering (18.3%) and exiting medical school (28.6%) reflects a strong dividend on the work of both medical schools in establishing programmes in regional centres. That rural and remote medicine (presumably the vocational scope of rural hospital medicine) is eighth on the list of intended careers for graduating New Zealand medical students (but does not appear on the Australian top 12) is also gratifying and likely a reflection of the RNZCGP/Uni Otago rural hospital medicine training programme.

These data are evidence that the medical schools and professional training colleges can make a difference in shaping the intended place of work of medical students.

What is less reassuring is the proportion of graduates that intend to work in New Zealand’s genuinely rural communities (those less than 25,000). This proportion is static for communities between 10,000 and 24,999, apparently unaffected by the undergraduate years (6.8% on entry and 6.1% on exit). Of even greater concern is those who intend to work in communities of less than 10,000. This proportion falls considerably over the undergraduate years (5.4% at entry and 1.6% on graduation).Approximately 20% of New Zealanders live in communities of less than 25,000 and rely on rural health services staffed by doctors vocationally trained in general practice and/or rural hospital medicine. These data suggest that we cannot rely on a trickle-down approach from the regional undergraduate programmes to generate the rural workforce, but instead need to develop programmes that specifically target the workforce needs of these smaller communities. International evidence suggests the best way to achieve that is via a coordinated rural ‘pipeline’ that includes enrolling students from rural communities, providing quality rural immersion programmes during the undergraduate years (longitudinal integrated clerkships being the programmes with the strongest evidence) and targeted rural vocational training, all supported in a rurally based academic community. This is what is behind the call by both medical schools, other tertiary institutions, the RNZCGP and the NZ Rural GP Network, for a National Interprofessional School of Rural Health.

We acknowledge again the important work of the MSOD team and look forward to seeing more data in the future.

‍

We are writing in response to an article in the May edition of the NZMJ by Poole et al.1

The MSOD database, which tracks the career intentions of medical students and graduates, will over time generate a great deal of useful information to help guide medical education in New Zealand. But even this early paper is enough to demonstrate the value of the database. As the authors point out in their introduction, all of New Zealand’s diverse communities have an expectation that they will benefit equitably from the considerable investment they collectively make in medical education. The data published in this paper already highlights where the medical schools are achieving this goal and where work still needs to be done.

The considerable increase in the proportion of respondents intending to work in regional cities and large towns (pop. 25,000–100,000) between entering (18.3%) and exiting medical school (28.6%) reflects a strong dividend on the work of both medical schools in establishing programmes in regional centres. That rural and remote medicine (presumably the vocational scope of rural hospital medicine) is eighth on the list of intended careers for graduating New Zealand medical students (but does not appear on the Australian top 12) is also gratifying and likely a reflection of the RNZCGP/Uni Otago rural hospital medicine training programme.

These data are evidence that the medical schools and professional training colleges can make a difference in shaping the intended place of work of medical students.

What is less reassuring is the proportion of graduates that intend to work in New Zealand’s genuinely rural communities (those less than 25,000). This proportion is static for communities between 10,000 and 24,999, apparently unaffected by the undergraduate years (6.8% on entry and 6.1% on exit). Of even greater concern is those who intend to work in communities of less than 10,000. This proportion falls considerably over the undergraduate years (5.4% at entry and 1.6% on graduation).Approximately 20% of New Zealanders live in communities of less than 25,000 and rely on rural health services staffed by doctors vocationally trained in general practice and/or rural hospital medicine. These data suggest that we cannot rely on a trickle-down approach from the regional undergraduate programmes to generate the rural workforce, but instead need to develop programmes that specifically target the workforce needs of these smaller communities. International evidence suggests the best way to achieve that is via a coordinated rural ‘pipeline’ that includes enrolling students from rural communities, providing quality rural immersion programmes during the undergraduate years (longitudinal integrated clerkships being the programmes with the strongest evidence) and targeted rural vocational training, all supported in a rurally based academic community. This is what is behind the call by both medical schools, other tertiary institutions, the RNZCGP and the NZ Rural GP Network, for a National Interprofessional School of Rural Health.

We acknowledge again the important work of the MSOD team and look forward to seeing more data in the future.

‍