If you build it who will come? Widening access through a place-based Rural Training Stream to address local medical workforce shortages

BACKGROUND: The establishment of end-to-end rural medical education provides an opportunity to embed place-based strategies to address rural workforce disparities. Deakin University established a Rural (medical) Training Stream (RTS) in 2022, prioritising applicants from the school’s rural footprint in Western Victoria. From 2024, the RTS was extended to a rural end-to-end program (RTS E2E) utilising blended learning to enable students to remain living in their rural communities. This study evaluates the impact of these programs on widening access for under-represented populations and implications for regional workforce development. METHODS: Cross-sectional admissions data (2020-2025) collected at application to Deakin’s. Doctor of Medicine (MD) course were examined according to five entry cohorts: 2020-21 pre-RTS General, 2022-23 General, 2022-23 RTS, 2024-25 General, 2024-25 RTS E2E. Student demographic variables examined included gender, age, rural background location, residence at course application and undergraduate degree. Descriptive statistics, Fisher’s exact test and the Fisher-Freeman-Halton test were used to analyse cohort differences. RESULTS: Data for 783 students were included in the analysis. Prior to the RTS (2020-21), 5% (n = 12) of MD students were from the rural footprint. This increased to 15% (n = 37) across both cohorts in 2022-23. In 2024-25, 100% of RTS E2E students were from the rural footprint, increasing their proportion in the MD cohort to 28% (n = 77). There were significantly more female students in the RTS E2E (77%) than the RTS (55%) or the General cohorts (range 45–48%). Significantly more students aged over 29 were in the RTS E2E (69%), than the RTS (20%) or General cohorts (range 13–24%). More students entering the RTS E2E had undergraduate health professional degrees (48%) than the RTS (15%) or General cohorts (range 18–25%). CONCLUSION: The RTS E2E program has successfully widened access for a distinct cohort of students from the rural footprint, predominantly mature-aged, female, health professionals returning to study. With consideration of tailored strategies to support success, there is an opportunity to strengthen students’ existing connections to their rural communities during their rural E2E MD and retain them as medical practitioners for the region, with the depth of understanding of their communities required for locally contextualised, patient-centred care.