Choosing final-year placement: Why students decide not to go rural

Background: Stellenbosch University established a rural clinical school (RCS) in 2011 whereby fifth-year MB,ChB students can choose to spend their final year on a rural platform in the Cape Winelands/Overberg districts, either in traditional, specialty-based rotations or in an integrated programme under the supervision of the district hospital family physician. The present study aims to gain a deeper understanding of the factors influencing medical students’ choice of placement.Methods: A survey questionnaire was designed to determine demographics, future practice intentions and the factors regarded as important in choice of site. A set of open-ended questions was provided regarding students’ choice and ways to make the RCS more attractive.Results: Questionnaires were issued to 168 fifth-year students and completed by 109 (65%) students, all of whom had already decided not to come to the RCS. The students considered that 13 of the 15 factors determining choice of site would be better met in the urban environment, while only two needs were perceived to be better met at the RCS. However, other than access to subspecialist tutorials, opinion was divided about where these needs would be better met. Other issues emerged from open-ended questions: a perceived higher standard of education at the urban teaching hospital, fear of the demands of the RCS, uncertainty about the RCS programme, and a preference for an urban lifestyle.Conclusion: In addition to family and social reasons for not joining the rural platform, many students still feel they will be placed at an academic disadvantage by choosing the RCS, despite evidence to the contrary. More needs to be done to communicate the maintained academic standards at the RCS