Diversity and consistency: a case study of regionalised clinical placements for medical students

Abstract

Objective A major challenge for medical schools is the provision of clinical skills training for increasing student numbers. This case study describes the expansion of the clinical school network at The University of Queensland (UQ). The purpose of the study was to investigate consistency in medical education standards across a regional clinical teaching network, as measured by academic performance. Methods A retrospective analysis of academic records for UQ medical students (n = 1514) completing clinical rotations (2009–2012) was performed using analysis of covariance (ANCOVA) for comparisons between clinical school cohorts and linear mixed-effects modelling (LEM) to assess predictors of academic performance. Results In all, 13 036 individual clinical rotations were completed between 2009 and 2012. ANCOVA found no significant differences in rotation grades between the clinical schools except that Rural Clinical School (RCS) cohorts achieved marginally higher results than non-RCSs in the general practice rotation (5.22 vs 5.10–5.18; P = 0.03) and on the final clinical examination (objective structured clinical examination; 5.27 vs 5.01–5.09; P < 0.01). LEM indicated that the strongest predictor of academic performance on clinical rotations was academic performance in the preclinical years of medical school (β = 0.38; 95% confidence interval 0.35–0.41; P < 0.001). Conclusions The decentralised UQ clinical schools deliver a consistent standard of clinical training for medical students in all core clinical rotations across a range of urban, regional and rural clinical settings. Further research is required to monitor the costs versus benefits of regionalised clinical schools for students, local communities and regional healthcare services. What is known about the topic? To help meet the demand of increasing numbers of students, Australian medical schools locate clinical training outside the traditional tertiary hospitals. However the viability of maintaining teaching standards across regional and rural locations is uncertain. What does this paper add? Maintaining teaching standards outside established urban teaching hospitals and across a diverse range of urban, regional and rural clinical settings is viable. What are the implications for practitioners? Decentralised clinical teaching networks provide consistent quality of clinical placements while diversifying exposure to different patient populations and clinical environments. These important outcomes may not only alleviate the strain on clinical teaching resources, but also help address the maldistribution of doctors in Australia.