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Determinants of rural practice: positive interaction between rural background and rural undergraduate training

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In reply: We agree that institutional differences may limit the generalisability of the findings of our recent study.1 However, direct comparison of the results of our study with those of earlier studies2,3 is problematical because the studies differ in many ways, including definition of rural background, outcome measures, adjustment for confounders, and statistical methods and power. Importantly, neither study collected and tested for interactions among all variables that could potentially confound the results. However, the Western Australian study did note that the dual exposure of rural background and rural clinical school (RCS) placement was the strongest predictor of rural practice.2 The Sydney study did not show an association between rural background and their rural workforce outcome,3 a result inconsistent with most extant data.

We did not recommend “restricting” RCS placements to rural background students but that an increase in the proportion with rural background be considered. The results of our study, and in fact the Western Australian study, support such a consideration. We note that Arnold does not object to our proposals for longer RCS placements and recruitment of students with longer rural background.