{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T10:00:04Z","timestamp":1765879204348,"version":"3.48.0"},"reference-count":36,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T00:00:00Z","timestamp":1736726400000},"content-version":"unspecified","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,12,13]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Community-engaged immersive rural experiences were limited during the COVID-19 pandemic when online learning was instigated across medical institutions globally. This study aimed to explore the impact of online learning on medical students\u2019 satisfaction levels and intentions to practice in a rural area after graduation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting and participants<\/jats:title>\n                    <jats:p>We conducted a natural quasi-experimental longitudinal retrospective cross-sectional study during 2011\u20132022 for all Australian domestic medical students who undertook a Rural and Remote Medicine (RRM) placement at the University of Queensland. Anonymous administrative course evaluation data were collected for the same two questions in each cohort over 12 years, between 2011 and 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Change in students\u2019 intention to pursue a rural medical career and teaching and placement satisfaction levels was determined. Longitudinal data illustrated trends in students\u2019 intention and overall satisfaction across cohorts before and during COVID-19 disruptions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>2695 students participated in the surveys with an average response rate of 81%. Intention levels remained steady between 2011 and 2019, during which students experienced a consistent face-to-face orientation and rural placement immersion. During the COVID-19 disruption phase, primarily in 2020 and 2021, students\u2019 intention to pursue a rural medical career significantly decreased when online-only learning placements were implemented, with only 25% of students in the most impacted rotation indicating a strong positive intention, compared with a previous steady 75%. Comparatively, students\u2019 satisfaction with the RRM programme remained steady across all the years at about 85\u201390%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There appears to be a detrimental impact of a lack of immersive community-engaged education experiences on medical student\u2019s intention to pursue a rural medical career. This natural experiment demonstrates that while online learning maintains student satisfaction levels, it lacks value and authenticity and does not inspire students to consider future rural careers. The value of face-to-face and immersive community-engaged experiences is fundamentally an important contributor to inspiring students to work in rural areas in the future.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-087383","type":"journal-article","created":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T21:55:36Z","timestamp":1736891736000},"page":"e087383","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["You cannot be what you cannot see: a retrospective natural longitudinal cohort study exploring the impact of face-to-face rural immersion on student medical training satisfaction and intention to practice rurally"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8372-4877","authenticated-orcid":false,"given":"Bushra F","family":"Nasir","sequence":"first","affiliation":[{"name":"Mayne Academy of Rural and Remote Medicine, Medical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia"},{"name":"Toowoomba Regional Clinical Unit, Medical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan Bruce","family":"Chater","sequence":"additional","affiliation":[{"name":"Mayne Academy of Rural and Remote Medicine, Medical School, Faculty of Medicine, The University of Queensland, Theodore, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Srinivas","family":"Kondalsamy-Chennakesavan","sequence":"additional","affiliation":[{"name":"Toowoomba Regional Clinical Unit, Medical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6901-8845","authenticated-orcid":false,"given":"Matthew R","family":"McGrail","sequence":"additional","affiliation":[{"name":"Rockhampton Regional Clinical Unit, Medical School, Faculty of Medicine, The University of Queensland, Rockhampton, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,1,14]]},"reference":[{"key":"2025121601552741000_15.1.e087383.1","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1097\/ACM.0000000000000765","article-title":"Putting communities in the driver\u2019s seat: the realities of community-engaged medical education","volume":"90","author":"Strasser","year":"2015","journal-title":"Acad Med"},{"key":"2025121601552741000_15.1.e087383.2","doi-asserted-by":"crossref","first-page":"405","DOI":"10.4103\/1357-6283.108732","article-title":"Advances in rural medical education in three countries: Canada, the United States and Australia","volume":"18","author":"Tesson","year":"2005","journal-title":"Educ Health (Abingdon)"},{"key":"2025121601552741000_15.1.e087383.3","unstructured":"McGrail M , Nasir B , Fox J . Populations at Special Health Risk: Rural Populations. Amsterdam, Netherlands: Elsevier, 2023."},{"key":"2025121601552741000_15.1.e087383.4","doi-asserted-by":"crossref","first-page":"568","DOI":"10.5694\/mja2.51525","article-title":"Beyond rural clinical schools to \u201cby rural, in rural, for rural\u201d: immersive community engaged rural education and training pathways","volume":"216","author":"Strasser","year":"2022","journal-title":"Med J Aust"},{"key":"2025121601552741000_15.1.e087383.5","first-page":"S5","article-title":"Building a sustainable rural physician workforce","volume":"215 Suppl 1","author":"Ostini","year":"2021","journal-title":"Med J Aust"},{"key":"2025121601552741000_15.1.e087383.6","doi-asserted-by":"publisher","DOI":"10.1080\/0142159X.2020.1713309"},{"key":"2025121601552741000_15.1.e087383.7","doi-asserted-by":"crossref","unstructured":"Strasser R , Strasser S . Reimaging primary health care workforce in rural and underserved settings . In: Health, Nutrition and Population Global Practice of the World Bank. 2020. Available: https:\/\/hdl.handle.net\/10986\/34906","DOI":"10.1596\/34906"},{"key":"2025121601552741000_15.1.e087383.8","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1111\/medu.13578","article-title":"Duration and setting of rural immersion during the medical degree relates to rural work outcomes","volume":"52","author":"O\u2019Sullivan","year":"2018","journal-title":"Med Educ"},{"key":"2025121601552741000_15.1.e087383.9","doi-asserted-by":"crossref","DOI":"10.1186\/s12909-018-1287-y","article-title":"The impact of rural outreach programs on medical students\u2019 future rural intentions and working locations: a systematic review","volume":"18","author":"Johnson","year":"2018","journal-title":"BMC Med Educ"},{"key":"2025121601552741000_15.1.e087383.10","doi-asserted-by":"crossref","first-page":"154","DOI":"10.5694\/mja16.01322","article-title":"Opting for rural practice: the influence of medical student origin, intention and immersion experience","volume":"207","author":"Playford","year":"2017","journal-title":"Med J Aust"},{"key":"2025121601552741000_15.1.e087383.11","doi-asserted-by":"crossref","DOI":"10.1186\/s12909-015-0332-3","article-title":"Longitudinal rural clerkships: increased likelihood of more remote rural medical practice following graduation","volume":"15","author":"Playford","year":"2015","journal-title":"BMC Med Educ"},{"key":"2025121601552741000_15.1.e087383.12","doi-asserted-by":"publisher","DOI":"10.1080\/0142159X.2021.1992372"},{"key":"2025121601552741000_15.1.e087383.13","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s40670-021-01464-y","article-title":"Online or Blended Learning: the COVID-19 Pandemic and First-Year Medical Students\u2019 Academic Motivation","volume":"32","author":"Bolatov","year":"2022","journal-title":"Med Sci Educ"},{"key":"2025121601552741000_15.1.e087383.14","doi-asserted-by":"crossref","first-page":"2459","DOI":"10.1111\/jocs.14761","article-title":"COVID and a call to reinventing medical education","volume":"35","author":"Lattouf","year":"2020","journal-title":"J Card Surg"},{"key":"2025121601552741000_15.1.e087383.15","doi-asserted-by":"publisher","DOI":"10.1111\/MEDU.14641"},{"key":"2025121601552741000_15.1.e087383.16","doi-asserted-by":"crossref","DOI":"10.1016\/j.ppedcard.2020.101320","article-title":"Online education in a hurry: Delivering pediatric graduate medical education during COVID-19","volume":"60","author":"Teele","year":"2021","journal-title":"Prog Pediatr Cardiol"},{"key":"2025121601552741000_15.1.e087383.17","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1111\/imj.14882","article-title":"How COVID-19 has pushed us into a medical education revolution","volume":"50","author":"Torda","year":"2020","journal-title":"Intern Med J"},{"key":"2025121601552741000_15.1.e087383.18","first-page":"3","article-title":"COVID-19: 20 countries\u2019 higher education intra-period digital pedagogy responses","volume":"3","author":"Crawford","year":"2020","journal-title":"JALT"},{"key":"2025121601552741000_15.1.e087383.19","doi-asserted-by":"crossref","DOI":"10.1186\/s12909-022-03367-x","article-title":"Medical teachers\u2019 experience of emergency remote teaching during the COVID-19 pandemic: a cross-institutional study","volume":"22","author":"Chan","year":"2022","journal-title":"BMC Med Educ"},{"key":"2025121601552741000_15.1.e087383.20","doi-asserted-by":"crossref","DOI":"10.1186\/s12909-022-03927-1","article-title":"Impact of the COVID-19 pandemic on student experiences during rural placements in Australia: findings from a national multi-centre survey","volume":"22","author":"Martin","year":"2022","journal-title":"BMC Med Educ"},{"key":"2025121601552741000_15.1.e087383.21","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1111\/ajr.12862","article-title":"Impact of the COVID-19 pandemic on medical student placements in rural Queensland: A survey study","volume":"30","author":"Martin","year":"2022","journal-title":"Aust J Rural Health"},{"key":"2025121601552741000_15.1.e087383.22","doi-asserted-by":"crossref","DOI":"10.1186\/s12909-018-1229-8","article-title":"Shaping medical student\u2019s understanding of and approach to rural practice through the undergraduate years: a longitudinal study","volume":"18","author":"Ray","year":"2018","journal-title":"BMC Med Educ"},{"key":"2025121601552741000_15.1.e087383.23","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1177\/1541344617715710","article-title":"Transformative Learning in Medical Education","volume":"16","author":"Greenhill","year":"2018","journal-title":"J Transform Educ"},{"key":"2025121601552741000_15.1.e087383.24","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1080\/0142159X.2021.1948520","article-title":"How rural immersion training influences rural work orientation of medical students: Theory building through realist evaluation","volume":"43","author":"Bingham","year":"2021","journal-title":"Med Teach"},{"key":"2025121601552741000_15.1.e087383.25","doi-asserted-by":"crossref","DOI":"10.1186\/s12960-018-0271-2","article-title":"A review of characteristics and outcomes of Australia\u2019s undergraduate medical education rural immersion programs","volume":"16","author":"O\u2019Sullivan","year":"2018","journal-title":"Hum Resour Health"},{"key":"2025121601552741000_15.1.e087383.26","unstructured":"Department of Health . Modified monash model. 2021. Available: https:\/\/www.health.gov.au\/health-topics\/rural-health-workforce\/classifications\/mmm"},{"key":"2025121601552741000_15.1.e087383.27","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.329.7469.770"},{"key":"2025121601552741000_15.1.e087383.28","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1080\/0142159X.2017.1408897","article-title":"Medical students and professionalism - Do the hidden curriculum and current role models fail our future doctors?","volume":"40","author":"Joynt","year":"2018","journal-title":"Med Teach"},{"key":"2025121601552741000_15.1.e087383.29","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000002004"},{"key":"2025121601552741000_15.1.e087383.30","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-068704","article-title":"The value of extended short-term medical training placements in smaller rural and remote locations on future work location: a cohort study","volume":"13","author":"McGrail","year":"2023","journal-title":"BMJ Open"},{"key":"2025121601552741000_15.1.e087383.31","doi-asserted-by":"crossref","first-page":"152","DOI":"10.5694\/mja17.00502","article-title":"Recruiting and retaining a rural medical workforce: the value of active community participation","volume":"207","author":"Strasser","year":"2017","journal-title":"Med J Aust"},{"key":"2025121601552741000_15.1.e087383.32","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.09.072462"},{"key":"2025121601552741000_15.1.e087383.33","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1111\/j.1748-0361.2000.tb00436.x","article-title":"Educating generalist physicians for rural practice: how are we doing?","volume":"16","author":"Geyman","year":"2000","journal-title":"J Rural Health"},{"key":"2025121601552741000_15.1.e087383.34","unstructured":"Australian Institute of Health and Welfare . Health workforce. Canberra Australian Institute of Health and Welfare; 2020."},{"key":"2025121601552741000_15.1.e087383.35","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1071\/AH19090","article-title":"Local and regional workforce return on investment from sponsoring rural generalist-based training for medical students","volume":"45","author":"Kitchener","year":"2021","journal-title":"Aust Health Rev"},{"key":"2025121601552741000_15.1.e087383.36","doi-asserted-by":"crossref","DOI":"10.1186\/s12960-021-00678-w","article-title":"Increasing doctors working in specific rural regions through selection from and training in the same region: national evidence from Australia","volume":"19","author":"McGrail","year":"2021","journal-title":"Hum Resour Health"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-087383","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T09:55:43Z","timestamp":1765878943000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-087383"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,14]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/bmjopen-2024-087383"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-087383","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}