How effective is community-based education in retaining graduates in rural service? The literature on retention focuses mainly on approaches that are in the hands of the government – increased financial incentives, housing, good work environment, opportunities for professional growth and development and more. So what can medical schools do to address the issue of retention? Most of the literature supports rural recruitment programs – suggesting that students recruited from rural or remote areas are more likely to return to work there.
That said, Ethiopia is one example where recruiting is centralized. High school students take a national exam, those with the highest grades can attend medical school but there is no specific rural recruitment quota. The government does have a compulsory service program where graduates are required to do public service after graduate. For those who choose to go rural, they can complete their rural service in a shorter time.
So what can the medical schools do to encourage rural service? According to a WHO technical document on rural retention strategies training in the community can work. But how much community training and what kind of community training is effective? Does one short rotation work or do students need a longer experience of several months duration to really appreciate the impact they can have? Many medical students do one community-health rotation where they do both clinical and public health research. Other medical schools like Jimma University in Ethiopia, have threaded community training throughout their curriculum, facilitated by their location closer to community/rural clinic.
So for medical schools based in urban settings, is a short community rotation enough to convince students to work there or are the scant accommodations, the social isolation and the lack of IT connectivity a deterrent?
As I survey medical programs across Africa, the majority of schools have some form of community training yet the literature has very little about the impact of this training on rural retention. Given the continent-wide crisis accessing a physician in rural areas, training programs should do a better job of evaluating the impact of these experiences and publishing the positive and negative results. Is it frequent short-bursts of exposure or one long-term exposure that has a better chance of retaining medical graduates? Time to figure this out….