Remote and rural surgery training and recruitment: a national attitudinal survey of Scottish surgical trainees.

Introduction: Scotland's healthcare system includes six rural general hospitals (RGHs) which provide a full surgical service to the most remote and rural populations. Constraints of geography and finance, and population need, mean that local delivery of surgical services will be required for the foreseeable future. These RGHs face difficulties in recruiting suitably trained general surgeons. This study aimed to describe Scottish surgical trainees' attitudes towards training and working in remote and rural surgery, perceived barriers to recruitment and potential solutions.

Methods: A survey was distributed in paper and electronic forms to all Scottish trainees in core surgery (early-stage trainees) and general surgery (later-stage trainees). The survey collected data describing demographics, life and career experiences, and attitudes towards training in remote and rural environments. Univariate and multivariate analyses of influences on interest in rural training and recruitment were carried out, and thematic analysis of free-text responses.

Results: There were 152 respondents (response rate 59%). Most (81%) felt that surgical training should be offered in rural environments and 43% were personally interested in some rural training. On multivariate analysis, interest in rural training was associated with being a core trainee (odds ratio (OR) 7.54, 95% confidence interval (CI) 2.79-22.76), and rural work experience following graduation (OR 5.12, 95%CI 1.85-15.39). Respondents stating that they were likely to work in a rural environment (9.2%), were more likely on multivariate analysis to be core trainees (OR 5.70, 95%CI 1.37-28.99) and to have previously lived in a rural location (OR 5.49, 95%CI 1.33-25.93). When trainees were asked for their views on how RGH jobs could be made more attractive, themes identified were as follows: increasing and improving training opportunities in RGHs, increasing the breadth of surgical training, optimising links with referral centres, and improving pay and conditions.

Conclusion: This is the first study in a UK setting to describe the views of surgical trainees towards training and working in rural environments. There is substantial support and interest for rural surgical training among Scottish surgical trainees. A minority are interested in a rural surgical career, with interest more likely in core trainees and in those who have lived rurally. Increasing surgical training opportunities in rural environments and maximising medical school intake from rural areas may be important in addressing recruitment concerns.