Rural: Overview

Abstract
Background: In response to rural medical workforce shortages in Western and Southwestern Victoria, Australia, Deakin University's School of Medicine established a dedicated Rural Training Stream (RTS) within its graduate entry Doctor of Medicine course in 2022. Consistent with the school's intention to promote social accountability, the RTS embodies a place-based approach, aiming to recruit 30 local applicants annually and train them in situ, thereby maximising opportunities for deeper connections with their communities and enhancing the likelihood of future local workforce retention. To underpin and facilitate collaborative program evaluation and research conceptually, a Program Logic Model (PLM) was developed. A PLM was chosen as the basis of this evaluation framework due to its foundations in systems and complexity theory and its amenity to collaborative development.

Methods: The PLM was developed using a stepwise, participatory approach, incorporating the contributions of a broad range of educators involved in the RTS program. Over a period of three months, participant input was provided through individual submissions and group workshops, sequentially developing each component of the model. Data gathered were summarised, reviewed and validated by the group periodically.

Results: The development of the PLM brought together a diverse group of academic and professional educators during the early stages of delivery of a new program, providing an opportunity for consensus building and the development of a shared understanding of the goals and objectives of the program. The developed PLM provides three clear objectives related to recruitment, training and professional identity formation. Short, medium and long-term outcomes aligned with each of these areas provide key reference points for the design of a comprehensive program of evaluation and research that is clearly linked to the program's goals.

Conclusion: The development of a PLM for Deakin's new RTS has provided an accessible roadmap that transparently communicates the design of the program to enhance local workforce outcomes for the rural communities that Deakin serves. The PLM provides a shared foundation for program-related evaluation and research, that is aligned with the strategic goals and desired outcomes.

Trial registration: Clinical trial number: not applicable.

Abstract
The value of distributed training of the medical workforce is well documented. Australia's Remote Vocational Training Scheme (RVTS) provides a scalable approach to specialist training in general practice that utilizes distance education and remote supervision. RVTS enables trainees to stay in their rural, remote and First Nations communities while working toward specialist certification as a general practitioner. The program, which supports both international and domestically trained graduates through tailored supervision and education, has operated across Australia for 25 years. Trainees are supported both professionally and socially over 4 years. An independent evaluation (2023-24) demonstrated a 78% completion rate among participants who remained in the same rural or remote practice for an average of 5.2 years. Two years after completing the program, 49% were still working in the community where their training commenced, well above documented retention benchmarks for these settings. High levels of participant satisfaction were reported, ranging from 88 to 100% across various indicators. The evaluation found that the program supports retention by eliciting five participant responses: comfort, confidence, competence, belonging, and bonding. Engagement and connection between participants are maintained through accessible technology, real-time support, virtual small-group learning, and twice-yearly in-person workshops. Despite the program's focus on high-need areas, it is cost-effective compared to similar rural training schemes. The experience of RVTS can inform other countries seeking to enhance rural workforce retention, particularly for underserved populations and migrant healthcare workers. The adaptable structure of the program aligns with the global development goals of the World Health Organization.

Abstract
Aims: This commentary aims to address the critical shortage of surgeons in rural Australia and propose the development of a sustainable rural surgical training pathway. By examining current healthcare disparities and workforce challenges, it highlights the need for locally trained and retained rural surgeons to improve health outcomes and reduce healthcare inequities.

Context: Rural Australians experience significant healthcare disparities due to geographical isolation, lower socioeconomic status and limited availability of specialist care. The current model relies heavily on patient transfers to metropolitan centres, which are costly, logistically challenging and unsustainable. Current surgical training programmes offer some rural exposure; however, they remain metropolitan-centric, resulting in fewer surgeons practising in rural areas.

Approach: A dedicated rural surgical training pathway is proposed to address this gap. It would focus on selecting candidates with a demonstrated commitment to rural practice and provide tailored training, mentorship and guaranteed rural placements. Training must align with the specific healthcare needs of rural communities. Additionally, initiatives like the rural health equity strategy and regional training hubs must be supported by structural changes in the selection process to prioritise rural trainees.

Conclusion: Addressing the shortage of rural surgeons is essential to improving healthcare equity. A rural surgical training pathway can aid in long-term retention of surgeons in rural areas. This model supports both healthcare and economic sustainability, aligns with national rural health strategies and fosters stronger community connections. Investing in rural surgical training is a critical step towards reducing healthcare disparities and building a more resilient rural health system.