A qualitative study of the incentives and barriers that influence preferences for rural placements during surgical training in Australia.

Background: Rural exposure of long durations during clinical training is positively associated with rural career uptake and is a central strategy to addressing the geographical maldistribution of Australia's surgical workforce. However, the incentives and barriers to trainees undergoing surgical training preferencing repeated rural placements in Australia are not well understood. This qualitative study explores the incentives and barriers that influence preference for rural placements during surgical training in Australia.

Methods: This qualitative study employed online semi-structured in-depth interviews. Participants were recruited using an online survey, and interviews were conducted between October 2020 and November 2020. Transcripts were transcribed and de-identified, and thematically analysed.

Results: Twenty-nine semi-structured interviews were conducted with trainees and 12 Fellows. Twenty-five participants identified as male, and four identified as female. Four main incentives identified were: (1) broad scope of learning opportunities, (2) quality of supervision, (3) positive work environment and (4) lifestyle. Seven barriers identified were: (1) inadequate preparation for placement, (2) limited case mix to support learning outcomes, (3) lack of formally structured learning opportunities, (4) workload and safe hours concerns, (5) lack of peer support, (6) childcare and educational needs and (7) partner career development.

Conclusion: The strategy of encouraging trainees to undertake rural placements to address the maldistribution of the surgical workforce should include initiatives that support learning outcomes across their training levels. In addition, improving trainees' ability to prepare adequately for placements may also improve the number and duration of rural placements trainees undertake during their training.