Key for More Rural Physicians: Rural Medical Tracks and Students with Rural Background

DOI: 10.3238/zfa.2019.0080-0086

german translation / full article

Jens Holst

Keywords: health care medical training rural internship shortage of rural practitioners systematic review

Background: The German healthcare system is facing challenges to safeguard medical care in rural areas. In addition to supply control, financial incentives and other control mechanisms, rural-health interventions in undergraduate medical education are expected to increase the number of rural physicians.Methods: This paper presents the results of a systematic literature search in relevant databases looking for measurable effects of rural training tracks in medical school on later practice in rural areas. Results: The search identified 38 studies which matched the inclusion criteria. These studies showed quite heterogeneous interventions, endpoints and outcomes. The majority were cross-sectional and controlled studies (39.5 % each); in addition, five were longitudinal, two mixed-methods and one quasi-experimental studies. Overall, there were predominantly positive, but rather weak correlations between rural internships or placements during undergraduate medical education, and later rural practice. The largest effect was seen in students with a rural background. The review confirmed rural upbringing being the strongest predictor of later taking up rural practice.Conclusions: Rural-health tracks during undergraduate medical education contribute only to a small or moderate extent to improving the availability of medical staff in rural areas. At best, they can measurably increase the share of rural practitioners if combined with other measures, and they are particularly effective for students with rural upbringing.

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