Interpreting rural career intention in medical workforce research

Rural medical educators have devised strategies based on research evidence to help shape a medical workforce that will choose to serve in rural and other under-served communities, where the health care needs are often high. Based on evidence that students from rural communities are more likely to work later in rural practice, many medical programmes now have targets for rural background students in addition to rural curriculum and placement initiatives. However, just how strong is the evidence that this is effective? Australian medical schools now have data for up to 20 years since the rural medical education initiatives were first introduced. Rural background still appears to be a strong predictor or rural practice outcomes, although combining multiple strategies appears strongest. There remain some methodological issues, such as defining both 'rural' and 'background', and determining how intention relates to ultimate location of practice. We may yet have to await longer follow-up periods before we can be confident about what works best in rural medical education.