Medical students' attitudes towards rural practice post-rural placement: a 10-year national survey.

INTRODUCTION: Rural and remote communities in Australia continue to face challenges in attracting and retaining doctors, highlighting the need for medical graduates who feel confident and motivated to practise rurally. This study explored medical students' emotional responses to future rural practice after completing a rural clinical school (RCS) placement, and identified demographic and placement factors associated with both anxiety and positive attitudes. METHODS: This retrospective, cross-sectional study analysed data from 6371 medical students who completed RCS placements between 2013 and 2022, using responses from the Federation of Rural Australian Medical Educators survey. Feelings were assessed using Likert scale responses to statements about experiencing anxiety (a 'sinking feeling') and positive attitudes towards rural work. Associations with sociodemographic characteristics and placement experiences were examined using χ2 tests and multinomial logistic regression. RESULTS: Most students (76%) did not report anxious feelings, while 68% expressed positive feelings about future rural practice. Males were more likely than females to report neutral feelings towards rural practice regarding anxiety (odds ratio (OR)=1.23, 95%CI 1.04-1.45). International fee-paying students had significantly higher odds of reporting both neutral (OR=1.95, 95%CI 1.28-2.98) and anxious feelings (OR=2.41, 95%CI 1.46-3.98). Students with rural backgrounds were less likely to report neutral feelings (OR=0.75, 95%CI 0.60-0.94) and more likely to express positive feelings. Having a rural-based mentor was associated with lower odds of anxiety and higher odds of positive feelings. Students who identified rural generalism as a career aspiration were more likely to report positive feelings than those who preferred a specialist career. CONCLUSION: RCS placements were associated with positive feelings and confidence in rural practice among medical students. However, specific student groups, such as international students, remained more apprehensive. Mentorship was identified as a significant modifiable factor associated with reduced anxiety and higher rural positivity, suggesting that structured mentorship programs could nurture a commitment to rural practice. In addition, a rural background was strongly associated with positive sentiment towards rural practice. Targeted recruitment and supported pathways to expand the proportion of rural-origin students in medical programs could therefore foster rural intent in the pipeline.