Expectations and experiences associated with rural GP placements

Abstract

Introduction: Evidence indicates a need to recruit more GPs to a career in rural general practice (GP). Research has indicated that placement experiences have the potential to impact on medical career decision-making. Research also suggests that rural placements can raise both professional and psychosocial concerns, but there is no existing evidence about whether pre-placement expectations translate into actual placement experiences. This study aimed to explore both the pre-placement expectations and the post-placement experiences of GP registrars undertaking a rural placement. Method: A qualitative research design was used where 11 pre-rural placement and 19 post-rural placement GP registrars associated with the Adelaide to Outback GP Training Program (AOGP) were interviewed until no new information emerged. An even distribution of gender and training pathway was achieved. Transcripts were subjected to thematic analysis, which explored the pre-placement expectations and the post-placement experiences of GP registrars undertaking a rural placement. Rater consensus was achieved for the themes extracted. Results: Analysis resulted in positive and negative pre-placement expectation and post-placement experience themes. One-third of pre-placement expectations were positive. The overall trend was for negative expectation themes to be viewed positively by registrars interviewed post-placement. Five positive post-placement experience themes, relating to support received, were not identified at pre-placement. This demonstrates that there are positive rural placement experiences that are not understood by registrars before their placement (‘being known to all’, ‘support from AOGP’, ‘support from Division’, ‘support from family and friends’ and ‘self-initiated support’). The only negative expectations that were also discussed by registrars post-placement as negative experiences were ‘separation from family’, ‘busy workload’ and ‘driving’. The negative expectations that were also viewed as negative experiences were ‘separation from family’, ‘busy workload’ and ‘driving’, which are difficult to change but should be discussed and planned for pre-placement. Conclusions: Based on these results it is important for GP supervisors, regional training providers, Divisions and rural workforce agencies to work together to ensure that registrars are provided with information and support pre-placement to alleviate their unwarranted negative expectations, while confirming warranted positive expectations. Warranted negative expectations should also be discussed beforehand to plan strategies for managing them during the placement. If the findings are used in this way, an improvement in overall rural placement experience could be expected.