Intern insights: Career decisions, aspirations and perspectives from interns in a regional hospital setting

Intern insights: Career decisions, aspirations and perspectives from interns in a regional hospital setting | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Intern insights: Career decisions, aspirations and perspectives from interns in a regional hospital setting Emma Hodge, Jo McDougall, Vanessa Greig, Alan Sandford This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5134499/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To identify the factors influencing the decision of interns to pursue prevocational training at a regional hospital, and gain insights into their career aspirations, expectations and concerns as they commence their internship. Methods The study involved retrospective analysis of welcome interviews with Postgraduate Year 1 (PGY1) interns during their first rotation at a regional hospital in Queensland, Australia in 2024. The main outcome measures included factors influencing the decision to complete internship at a regional hospital, career aspirations, expectations and concerns for internship. Results Interns primarily chose the regional hospital for its positive reputation of being a supportive environment, opportunities for broad generalist clinical experience, and comprised a smooth transition from local regionally based university sites. Career aspirations varied, with popular interests in rural generalism, general practice, emergency medicine, anaesthetics and paediatrics. Interns expected and received hands-on learning experiences, regular patient interaction and broad exposure to various clinical specialties, while concerns included managing workload and adapting to new hospital systems. Conclusion Addressing the workforce nurturing and pastoral care needs of interns is crucial for a supportive and fulfilling internship experience. Promoting pastoral care and learning opportunities, are potential points of difference that may imbue reputational growth and ultimately attract interns to regional hospitals and enhance retention, optimising the medical workforce in these areas. internship regional hospitals medical workforce prevocational training Introduction The maldistribution of doctors in Australia is a persistent challenge and sees rural and regional areas facing chronic medical workforce shortages. Factors contributing to this include perceptions around career progression, training and professional development opportunities and more comprehensive healthcare infrastructure in urban settings ( 1 – 3 ). Barriers to regional prevocational training are multifaceted and include perceptions of professional, educational deficiencies and personal challenges. Professionally, rural and regional hospitals may have fewer resources and less infrastructure than that found in urban centres, leading to perceived concerns about the quality of training and supervision available ( 4 ). Educationally, there may be limited access to subspecialty training opportunities ( 5 ). Personal barriers may include isolation from close networks, with the lifestyle and social amenities available in metropolitan areas possibly outweighing the perceived benefits of practicing in regional areas ( 6 ). These perceptions develop the attitude and behaviour of prevocational medical officers and form the foundation for their decision making for when choosing postgraduate training bases. Despite these perceived barriers, several enablers can be highlighted to facilitate choosing regional prevocational training postings. Strong workplace culture and supportive training providers are critical in attracting and retaining prevocational doctors in regional settings ( 7 ). Furthermore, targeted incentives such as relocation allowances and career development opportunities can mitigate some of the perceived disadvantages associated with rural practice ( 8 ). Successful regional training programs often emphasise the unique benefits of rural practice, such as the opportunity to work closely with a diverse patient population, develop a broad skill set and have a more personalised learning experience ( 9 ). This study aims to explore the factors influencing Postgraduate Year 1 (PGY1) interns’ decisions to choose regional hospitals for their internship, and to understand their career aspirations, expectations, concerns and retention factors. By examining these factors, the study seeks to provide insights that can ameliorate the workforce issue of maldistribution of medical officers and enhance recruitment by making is more attractive and beneficial to choose prevocational training programs in regional sites. Methods Study Design and Setting This study is a retrospective analysis of data collected from welcome interviews conducted with PGY1 interns based at a regional hospital in Queensland, Australia. The hospital provides a range of healthcare services and has a growing reputation for offering a supportive environment for medical training, especially with the recent implementation of the Regional Medical Pathway (10). Participants The participants (n=18) were all PGY1 interns who commenced their internship at in 2024. All interns preferences the facility as their first preference when applying for internship positions. Interns were invited to participate in the welcome interviews during their first rotation. Participation was voluntary, withdrawal could occur at any time, and all interns who attended the interviews were included in the study. Participants were informed results would be deidentified and aggregated prior to sharing. Data Collection Data was collected through structured welcome interviews conducted during the first rotation for interns 2024. Data Analysis The data analysis employed thematic analysis to systematically examine and review the interview records. Thematic codes were grouped into broader themes based on overarching concepts and refined through discussion among the research team. Ethics approval Ethical exemption for this audit with intent to publish and a waiver of informed consent for access to information contained within the WBPHU data repository was granted by the Human Research Ethics Committee at Central Queensland Hospital and Health Service on 12/09/2024 (EX/2024/111471). Results Participant Demographics A total of 17 PGY1 interns participated in the welcome interviews at the regional hospital in 2024. The majority of interns graduated from Australian universities (70%), with the remaining 30% from universities outside Australia. Due to the small sample size, participant gender and age was not recorded. Reasons for choosing a regional hospital for internship Interns cited several key reasons for selecting this regional hospital for their internship. A predominant theme was the hospital’s reputation for a supportive and nurturing work and learning environment. Interns emphasised the importance of a workplace that prioritises their wellbeing and offers robust pastoral care. The opportunity for hands-on learning and exposure to various medical specialties was another frequently mentioned factor, as interns outlined this would provide a strong foundation for their future careers. Graduates from local universities appreciated the smooth transition to the regional hospital, facilitated by established connections and familiarity with hospital practices. Additional reasons included personal or family ties to the region and a preference for the lifestyle associated with a regional setting. The hospital's commitment to career development was also a significant factor in their decision-making, including a greater likelihood of receiving preferred rotational allocations. Career aspirations Interns expressed diverse career aspirations, with some specialties standing out. Many interns were drawn to rural generalism, valuing the broad skill set and the ability to serve diverse communities. General practice was another popular choice, with interns appreciating the variety of cases and long-term patient relationships. Emergency medicine attracted interns due to its fast-paced and dynamic nature. Other frequently mentioned specialties included anaesthetics and paediatrics, with interns looking forward to specific procedural skills and patient interactions in these fields. Some interns were still exploring potential career pathways and were open to various specialties based on their internship experiences. Expectations and concerns about internship Interns had several key expectations for their internship experience. They anticipated significant hands-on clinical experiences, including performing procedures and managing patient care directly. Regular patient interactions were expected to enhance their clinical skills and confidence. Interns also looked forward to rotating through various disciplines to gain a broad clinical perspective. Specific rotations or procedures of interest included emergency department shifts, surgical procedures and managing critical or deteriorating patients. Common concerns among interns included managing workload demands and maintaining a suitable work-life balance. Many were apprehensive about adapting to new hospital systems and protocols, and some worried about their clinical competence and ability to perform under pressure. Retention factors Factors interns thought may influence their decision to stay in a regional area at the start of the year included a supportive work environment and career development opportunities. Interns valued a workplace that offers a balance between professional growth and personal wellbeing. Many emphasised the importance of mentorship and support throughout their internship and beyond. Personal and family ties to the region may also influence their decision to stay in the region beyond internship. Discussion The findings from this retrospective analysis of welcome interviews with interns at the regional hospital provide critical insights into the factors influencing the decision to choose a regional hospital for internship. These findings have important implications for medical education and workforce planning in regional settings. A predominant theme in the interviews was the hospital’s reputation for a supportive and nurturing environment. This aligns with existing literature which emphasises that supportive work environments, characterised by effective support systems and a positive workplace culture, are essential for the wellbeing of medical trainees ( 11 ). The regional hospital’s emphasis on intern wellbeing and pastoral care appears to be a key factor in attracting interns, which is consistent with prior research indicating supportive supervision and collegial atmospheres significantly impact the overall experience and retention of medical trainees ( 7 , 12 ). Interns’ expectations for hands-on learning and broad clinical exposure reflect the core educational goals of medical internships. Studies have shown diverse clinical rotations are highly valued by medical trainees and vital for developing practical skills and clinical competence ( 4 ). Regional hospitals offer valuable opportunities to gain broad generalist clinical experience and hands-on learning, which renders them a highly effective training provider for prevocational doctors ( 13 ). Furthermore, such learning opportunities closely align with the recently implemented National Prevocational Framework for Medical Training ( 14 ). Career aspirations among interns varied widely, with a notable interest in rural generalism and general practice. This interest is particularly relevant in the context of addressing healthcare disparities in rural and underserved areas and underpins the ethos of the Rural Generalist Pathway. Exposure to regional medical practice during training increases the likelihood of medical graduates choosing to work in rural settings ( 9 ). The popularity of general practice among interns also reflects the increasing recognition of the importance of primary care in the healthcare system. Interns expressed concerns about managing workload and adapting to new hospital systems, which are consistent with findings from other studies on the stressors faced by medical interns. High workload and the steep learning curve associated with adapting to new clinical environments can contribute to burnout and reduced job satisfaction among medical trainees ( 15 ). Addressing these concerns through structured support systems, reducing overtime and ensuring manageable workloads is crucial for mitigating these stressors and enhancing the internship experience ( 16 – 17 ). Factors influencing the decision of interns to continue working at a regional hospital included a supportive work environment, career development opportunities and work-life balance. These factors are well-documented in the literature as key determinants of job satisfaction and retention among healthcare professionals, suggesting that recruitment strategies could benefit from highlighting these aspects to potential interns ( 18 ). Personal and family ties to the region also play a role in retention, along with work-life balance and supportive workplace culture as crucial aspects of retaining medical professionals ( 19 ). The insights gained from this study have several implications for policy and practice. Regional hospitals should continue to prioritise and invest in creating supportive environments that emphasise doctor wellbeing and career development. Providing diverse clinical exposure and hands-on learning opportunities should be promoted as valuable core components of internship programs. Addressing intern concerns about workload and system adaptation through structured support and orientation programs is essential. Recruitment and retention strategies should specifically identify and promote the benefits of working in regional settings, including lifestyle advantages and personal connections to the community. Promoting the reputation of this regional hospital as a holistically supportive and nurturing internship is key consideration, including leveraging the existing career interest and regional opportunities in rural generalism and general practice. The limitations of this study include its setting in a single regional hospital which may limit the generalisability of the findings, while the retrospective nature of the analysis poses a risk of bias. Future research should explore these factors across multiple regional hospitals to extend these findings. Additional research into incentive schemes that would further attract regional internship would support regional recruitment strategies. Longitudinal studies tracking prevocational doctor career trajectories and retention in regional settings would also provide valuable insights. Conclusion These findings underscore the importance of a supportive workplace culture, personalised career support, diverse clinical experiences and effective workload management in attracting and retaining medical interns at regional hospitals. By aligning training programs with interns' career aspirations and providing robust support systems, regional hospitals can enhance the internship experience and contribute to a more sustainable medical workforce in rural and regional Australia. Declarations Ethics approval and consent to participate Ethical exemption for this audit with intent to publish and a waiver of informed consent for access to information contained within the WBPHU data repository was granted by the Human Research Ethics Committee at Central Queensland Hospital and Health Service on 12/09/2024 (EX/2024/111471). All methods were performed in accordance with Queensland Health regulations and the NHMRC Guidelines for the Ethical Considerations in Quality Assurance and Evaluation Activities. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding This project was funded using in-kind support only. No additional funding was sought. Author Contribution EH designed the project and completed the initial data collection, analysis and write up of the manuscript. VG and JM reviewed the data to generate themes and edited the manuscript. All authors read and approved the final manuscript. Acknowledgement The authors would like to acknowledge the Medical Education Unit team who supported this project and the interns who participated in the welcome interviews. Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Murray RB, Craig H. A sufficient pipeline of doctors for rural communities is vital for Australia's overall medical workforce. Med J Aust. 2023;219 Smith T, Cross M, Waller S, Chambers H, Farthing A. Ruralization of students' horizons: Insights into Australian health professional students' rural and remote placements. J Multidiscip Healthc. 2018;11:85-97. Wakerman J, Humphreys JS. Sustainable workforce and sustainable health systems for rural and remote Australia. Med J Aust. 2019;210(3):119-21. O'Sullivan B, McGrail M, Russell D. Rural exposure and attitudes to rural practice: A national study of medical students. Aust J Rural Health. 2017;25(4):176-83. Woolley T, Sen Gupta T, Murray RB. Positive impacts of an immersion program for regional and rural medical education. Rural Remote Health. 2017;17(4):4262. Wilson NW, Couper ID, De Vries E, Reid S, Fish T, Marais BJ. A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas. Rural Remote Health. 2009;9(2):1060. Hill J, Rolfe H, Pearson D, Heathcote C, Jackson B. Mentorship and wellbeing support: Perceptions of junior doctors working in rural Australia. Aust J Rural Health. 2020;28(3):235-42. Larkins S, Michielsen K, Iputo J, Elsanousi S, Mammen M, Graves L, et al. Impact of selection strategies on representation of underserved populations and intention to practise: International findings. Med Educ. 2015;49(1):60-72. May J, Walker J, Johnston C. Impact of rural training on the intention of medical students to practice rurally: A comparison with metropolitan-trained students. Med J Aust. 2019;210(5):212-7. Wide Bay Hospital and Health Service. Leading the way in medical education and wellbeing with the regional medical pathway [Internet]. Wide Bay Hospital and Health Service; 2022 [cited 2024 Sep 23]. Available from: https://www.widebay.health.qld.gov.au/about-us/news/leading-the-way-in-medical-education-and-wellbeing-with-the-regional-medical-pathway Hodge E, Sandford A. Workforce nurturing: an approach to improving wellbeing, burnout and professional fulfilment among Australian doctors. Int J Med Educ. 2024;15:59-65. Available from: https://doi.org/10.5116/ijme.6639.1a23 West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. Lancet. 2018;388(10057):2272-81. Dornan T, Littlewood S, Margolis SA, Scherpbier A, Spencer J, Ypinazar V. How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Med Teach. 2019;28(1):3-18. Australian Medical Council. AMC accreditation standards [Internet]. Australian Medical Council; 2022 [cited 2024 Sep 23]. Available from: https://www.amc.org.au/framework/ Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Acad Med. 2019;91(6):749-59. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, Oreskovich MR. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2020;172(18):1377-85. Raj KS. Well-being in residency: A systematic review. J Grad Med Educ. 2019;8(5):674-84. Scott A, Witt J, Humphreys J. What factors influence the recruitment and retention of general practitioners in rural and remote areas of Australia? A systematic review. Aust J Rural Health. 2018;26(5):387-94. Keeton K, Fenner DE, Johnson TR, Hayward RA. Predictors of physician career satisfaction, work-life balance, and burnout. Obstet Gynecol. 2018;109(4):949-55. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5134499","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":363799578,"identity":"6904f854-0130-4658-bc94-f50b179f2072","order_by":0,"name":"Emma Hodge","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABJklEQVRIiWNgGAWjYLACxgYQYj4GZFowGAD5B3iI08KWBmRKSAC1MBCrhceMOC38YqcTPzDusJGd797z7cGHGok6cwbmDQfeMNTKGRxgfiaBRYvk7NzNEoxn0ow3njm73XDGMQkJywa2goNzGI4bGxxgM8OmxeB27gYJxrbDiRtn5G6T5mEDOuwAj8FhHoZjiTMbGLBqsb+du/kHWMv8N8+k//xD0cL+Dast0rnbwLbMl+Bhk2Zsg2upSewHBgg2LRK3c7dZJLalGW/gSTOT7O2TkNxwGOQXgwPG/Mw8xRbYQgzo/Rsf24Ah1n74mcSPbzb8BsebNz54U1Enx8bevvEGrpBOALnwAIzHDEoABodBDPxAvgHJg0BcR0D9KBgFo2AUjCAAABwDZkGc7zHnAAAAAElFTkSuQmCC","orcid":"","institution":"Queensland Health","correspondingAuthor":true,"prefix":"","firstName":"Emma","middleName":"","lastName":"Hodge","suffix":""},{"id":363799579,"identity":"7f1451a1-822e-47e2-96b5-8cb9ca18be2a","order_by":1,"name":"Jo McDougall","email":"","orcid":"","institution":"Queensland Health","correspondingAuthor":false,"prefix":"","firstName":"Jo","middleName":"","lastName":"McDougall","suffix":""},{"id":363799580,"identity":"b785b4ae-c1b5-44cb-b725-f8d141e60ccd","order_by":2,"name":"Vanessa Greig","email":"","orcid":"","institution":"Queensland Health","correspondingAuthor":false,"prefix":"","firstName":"Vanessa","middleName":"","lastName":"Greig","suffix":""},{"id":363799581,"identity":"3c127e69-202e-4293-a22c-ad05a8550dba","order_by":3,"name":"Alan Sandford","email":"","orcid":"","institution":"Queensland Health","correspondingAuthor":false,"prefix":"","firstName":"Alan","middleName":"","lastName":"Sandford","suffix":""}],"badges":[],"createdAt":"2024-09-23 02:27:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5134499/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5134499/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73421967,"identity":"bf1fe6ed-8f2e-4ca9-8201-66cc9f22d613","added_by":"auto","created_at":"2025-01-09 18:53:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":464472,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5134499/v1/4d94fa72-2619-4ba0-9aa3-53e86dd21253.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Intern insights: Career decisions, aspirations and perspectives from interns in a regional hospital setting","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe maldistribution of doctors in Australia is a persistent challenge and sees rural and regional areas facing chronic medical workforce shortages. Factors contributing to this include perceptions around career progression, training and professional development opportunities and more comprehensive healthcare infrastructure in urban settings (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBarriers to regional prevocational training are multifaceted and include perceptions of professional, educational deficiencies and personal challenges. Professionally, rural and regional hospitals may have fewer resources and less infrastructure than that found in urban centres, leading to perceived concerns about the quality of training and supervision available (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Educationally, there may be limited access to subspecialty training opportunities (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Personal barriers may include isolation from close networks, with the lifestyle and social amenities available in metropolitan areas possibly outweighing the perceived benefits of practicing in regional areas (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). These perceptions develop the attitude and behaviour of prevocational medical officers and form the foundation for their decision making for when choosing postgraduate training bases.\u003c/p\u003e \u003cp\u003eDespite these perceived barriers, several enablers can be highlighted to facilitate choosing regional prevocational training postings. Strong workplace culture and supportive training providers are critical in attracting and retaining prevocational doctors in regional settings (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Furthermore, targeted incentives such as relocation allowances and career development opportunities can mitigate some of the perceived disadvantages associated with rural practice (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Successful regional training programs often emphasise the unique benefits of rural practice, such as the opportunity to work closely with a diverse patient population, develop a broad skill set and have a more personalised learning experience (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study aims to explore the factors influencing Postgraduate Year 1 (PGY1) interns\u0026rsquo; decisions to choose regional hospitals for their internship, and to understand their career aspirations, expectations, concerns and retention factors. By examining these factors, the study seeks to provide insights that can ameliorate the workforce issue of maldistribution of medical officers and enhance recruitment by making is more attractive and beneficial to choose prevocational training programs in regional sites.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is a retrospective analysis of data collected from welcome interviews conducted with PGY1 interns based at a regional hospital in Queensland, Australia. The hospital provides a range of healthcare services and has a growing reputation for offering a supportive environment for medical training, especially with the recent implementation of the Regional Medical Pathway (10).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants (n=18) were all PGY1 interns who commenced their internship at in 2024. All interns preferences the facility as their first preference when applying for internship positions. Interns were invited to participate in the welcome interviews during their first rotation. Participation was voluntary, withdrawal could occur at any time, and all interns who attended the interviews were included in the study. Participants were informed results would be deidentified and aggregated prior to sharing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData was collected through structured welcome interviews conducted during the first rotation for interns 2024.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data analysis employed thematic analysis to systematically examine and review the interview records. Thematic codes were grouped into broader themes based on overarching concepts and refined through discussion among the research team.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical exemption for this audit with intent to publish and a waiver of informed consent for access to information contained within the WBPHU data repository was granted by the Human Research Ethics Committee at Central Queensland Hospital and Health Service on 12/09/2024 (EX/2024/111471).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eParticipant Demographics\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA total of 17 PGY1 interns participated in the welcome interviews at the regional hospital in 2024. The majority of interns graduated from Australian universities (70%), with the remaining 30% from universities outside Australia. Due to the small sample size, participant gender and age was not recorded. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReasons for choosing a regional hospital for internship\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInterns cited several key reasons for selecting this regional hospital for their internship. A predominant theme was the hospital\u0026rsquo;s reputation for a supportive and nurturing work and learning environment. Interns emphasised the importance of a workplace that prioritises their wellbeing and offers robust pastoral care. The opportunity for hands-on learning and exposure to various medical specialties was another frequently mentioned factor, as interns outlined this would provide a strong foundation for their future careers. Graduates from local universities appreciated the smooth transition to the regional hospital, facilitated by established connections and familiarity with hospital practices. Additional reasons included personal or family ties to the region and a preference for the lifestyle associated with a regional setting. The hospital\u0026apos;s commitment to career development was also a significant factor in their decision-making, including a greater likelihood of receiving preferred rotational allocations. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCareer aspirations\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInterns expressed diverse career aspirations, with some specialties standing out. Many interns were drawn to rural generalism, valuing the broad skill set and the ability to serve diverse communities. General practice was another popular choice, with interns appreciating the variety of cases and long-term patient relationships. Emergency medicine attracted interns due to its fast-paced and dynamic nature. Other frequently mentioned specialties included anaesthetics and paediatrics, with interns looking forward to specific procedural skills and patient interactions in these fields. Some interns were still exploring potential career pathways and were open to various specialties based on their internship experiences.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExpectations and concerns about internship\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInterns had several key expectations for their internship experience. They anticipated significant hands-on clinical experiences, including performing procedures and managing patient care directly. Regular patient interactions were expected to enhance their clinical skills and confidence. Interns also looked forward to rotating through various disciplines to gain a broad clinical perspective. Specific rotations or procedures of interest included emergency department shifts, surgical procedures and managing critical or deteriorating patients. Common concerns among interns included managing workload demands and maintaining a suitable work-life balance. Many were apprehensive about adapting to new hospital systems and protocols, and some worried about their clinical competence and ability to perform under pressure. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRetention factors\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFactors interns thought may influence their decision to stay in a regional area at the start of the year included a supportive work environment and career development opportunities. Interns valued a workplace that offers a balance between professional growth and personal wellbeing. Many emphasised the importance of mentorship and support throughout their internship and beyond. Personal and family ties to the region may also influence their decision to stay in the region beyond internship.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings from this retrospective analysis of welcome interviews with interns at the regional hospital provide critical insights into the factors influencing the decision to choose a regional hospital for internship. These findings have important implications for medical education and workforce planning in regional settings.\u003c/p\u003e \u003cp\u003eA predominant theme in the interviews was the hospital\u0026rsquo;s reputation for a supportive and nurturing environment. This aligns with existing literature which emphasises that supportive work environments, characterised by effective support systems and a positive workplace culture, are essential for the wellbeing of medical trainees (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The regional hospital\u0026rsquo;s emphasis on intern wellbeing and pastoral care appears to be a key factor in attracting interns, which is consistent with prior research indicating supportive supervision and collegial atmospheres significantly impact the overall experience and retention of medical trainees (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInterns\u0026rsquo; expectations for hands-on learning and broad clinical exposure reflect the core educational goals of medical internships. Studies have shown diverse clinical rotations are highly valued by medical trainees and vital for developing practical skills and clinical competence (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Regional hospitals offer valuable opportunities to gain broad generalist clinical experience and hands-on learning, which renders them a highly effective training provider for prevocational doctors (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Furthermore, such learning opportunities closely align with the recently implemented National Prevocational Framework for Medical Training (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCareer aspirations among interns varied widely, with a notable interest in rural generalism and general practice. This interest is particularly relevant in the context of addressing healthcare disparities in rural and underserved areas and underpins the ethos of the Rural Generalist Pathway. Exposure to regional medical practice during training increases the likelihood of medical graduates choosing to work in rural settings (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The popularity of general practice among interns also reflects the increasing recognition of the importance of primary care in the healthcare system.\u003c/p\u003e \u003cp\u003eInterns expressed concerns about managing workload and adapting to new hospital systems, which are consistent with findings from other studies on the stressors faced by medical interns. High workload and the steep learning curve associated with adapting to new clinical environments can contribute to burnout and reduced job satisfaction among medical trainees (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Addressing these concerns through structured support systems, reducing overtime and ensuring manageable workloads is crucial for mitigating these stressors and enhancing the internship experience (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFactors influencing the decision of interns to continue working at a regional hospital included a supportive work environment, career development opportunities and work-life balance. These factors are well-documented in the literature as key determinants of job satisfaction and retention among healthcare professionals, suggesting that recruitment strategies could benefit from highlighting these aspects to potential interns (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Personal and family ties to the region also play a role in retention, along with work-life balance and supportive workplace culture as crucial aspects of retaining medical professionals (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe insights gained from this study have several implications for policy and practice. Regional hospitals should continue to prioritise and invest in creating supportive environments that emphasise doctor wellbeing and career development. Providing diverse clinical exposure and hands-on learning opportunities should be promoted as valuable core components of internship programs. Addressing intern concerns about workload and system adaptation through structured support and orientation programs is essential. Recruitment and retention strategies should specifically identify and promote the benefits of working in regional settings, including lifestyle advantages and personal connections to the community. Promoting the reputation of this regional hospital as a holistically supportive and nurturing internship is key consideration, including leveraging the existing career interest and regional opportunities in rural generalism and general practice.\u003c/p\u003e \u003cp\u003eThe limitations of this study include its setting in a single regional hospital which may limit the generalisability of the findings, while the retrospective nature of the analysis poses a risk of bias. Future research should explore these factors across multiple regional hospitals to extend these findings. Additional research into incentive schemes that would further attract regional internship would support regional recruitment strategies. Longitudinal studies tracking prevocational doctor career trajectories and retention in regional settings would also provide valuable insights.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThese findings underscore the importance of a supportive workplace culture, personalised career support, diverse clinical experiences and effective workload management in attracting and retaining medical interns at regional hospitals. By aligning training programs with interns' career aspirations and providing robust support systems, regional hospitals can enhance the internship experience and contribute to a more sustainable medical workforce in rural and regional Australia.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eEthical exemption for this audit with intent to publish and a waiver of informed consent for access to information contained within the WBPHU data repository was granted by the Human Research Ethics Committee at Central Queensland Hospital and Health Service on 12/09/2024 (EX/2024/111471). All methods were performed in accordance with Queensland Health regulations and the NHMRC Guidelines for the Ethical Considerations in Quality Assurance and Evaluation Activities.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis project was funded using in-kind support only. No additional funding was sought.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eEH designed the project and completed the initial data collection, analysis and write up of the manuscript. VG and JM reviewed the data to generate themes and edited the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eThe authors would like to acknowledge the Medical Education Unit team who supported this project and the interns who participated in the welcome interviews.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMurray RB, Craig H. A sufficient pipeline of doctors for rural communities is vital for Australia\u0026apos;s overall medical workforce. Med J Aust. 2023;219\u003c/li\u003e\n \u003cli\u003eSmith T, Cross M, Waller S, Chambers H, Farthing A. Ruralization of students\u0026apos; horizons: Insights into Australian health professional students\u0026apos; rural and remote placements. J Multidiscip Healthc. 2018;11:85-97.\u003c/li\u003e\n \u003cli\u003eWakerman J, Humphreys JS. Sustainable workforce and sustainable health systems for rural and remote Australia. Med J Aust. 2019;210(3):119-21.\u003c/li\u003e\n \u003cli\u003eO\u0026apos;Sullivan B, McGrail M, Russell D. Rural exposure and attitudes to rural practice: A national study of medical students. Aust J Rural Health. 2017;25(4):176-83.\u003c/li\u003e\n \u003cli\u003eWoolley T, Sen Gupta T, Murray RB. Positive impacts of an immersion program for regional and rural medical education. Rural Remote Health. 2017;17(4):4262.\u003c/li\u003e\n \u003cli\u003eWilson NW, Couper ID, De Vries E, Reid S, Fish T, Marais BJ. A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas. Rural Remote Health. 2009;9(2):1060.\u003c/li\u003e\n \u003cli\u003eHill J, Rolfe H, Pearson D, Heathcote C, Jackson B. Mentorship and wellbeing support: Perceptions of junior doctors working in rural Australia. Aust J Rural Health. 2020;28(3):235-42.\u003c/li\u003e\n \u003cli\u003eLarkins S, Michielsen K, Iputo J, Elsanousi S, Mammen M, Graves L, et al. Impact of selection strategies on representation of underserved populations and intention to practise: International findings. Med Educ. 2015;49(1):60-72.\u003c/li\u003e\n \u003cli\u003eMay J, Walker J, Johnston C. Impact of rural training on the intention of medical students to practice rurally: A comparison with metropolitan-trained students. Med J Aust. 2019;210(5):212-7.\u003c/li\u003e\n \u003cli\u003eWide Bay Hospital and Health Service. Leading the way in medical education and wellbeing with the regional medical pathway [Internet]. Wide Bay Hospital and Health Service; 2022 [cited 2024 Sep 23]. Available from: https://www.widebay.health.qld.gov.au/about-us/news/leading-the-way-in-medical-education-and-wellbeing-with-the-regional-medical-pathway\u003c/li\u003e\n \u003cli\u003eHodge E, Sandford A. Workforce nurturing: an approach to improving wellbeing, burnout and professional fulfilment among Australian doctors. Int J Med Educ. 2024;15:59-65. Available from: https://doi.org/10.5116/ijme.6639.1a23\u003c/li\u003e\n \u003cli\u003eWest CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. Lancet. 2018;388(10057):2272-81.\u003c/li\u003e\n \u003cli\u003eDornan T, Littlewood S, Margolis SA, Scherpbier A, Spencer J, Ypinazar V. How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Med Teach. 2019;28(1):3-18.\u003c/li\u003e\n \u003cli\u003eAustralian Medical Council. AMC accreditation standards [Internet]. Australian Medical Council; 2022 [cited 2024 Sep 23]. Available from: https://www.amc.org.au/framework/\u003c/li\u003e\n \u003cli\u003eDyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Acad Med. 2019;91(6):749-59.\u003c/li\u003e\n \u003cli\u003eShanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, Oreskovich MR. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2020;172(18):1377-85.\u003c/li\u003e\n \u003cli\u003eRaj KS. Well-being in residency: A systematic review. J Grad Med Educ. 2019;8(5):674-84.\u003c/li\u003e\n \u003cli\u003eScott A, Witt J, Humphreys J. What factors influence the recruitment and retention of general practitioners in rural and remote areas of Australia? A systematic review. Aust J Rural Health. 2018;26(5):387-94.\u003c/li\u003e\n \u003cli\u003eKeeton K, Fenner DE, Johnson TR, Hayward RA. Predictors of physician career satisfaction, work-life balance, and burnout. Obstet Gynecol. 2018;109(4):949-55.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"internship, regional hospitals, medical workforce, prevocational training","lastPublishedDoi":"10.21203/rs.3.rs-5134499/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5134499/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo identify the factors influencing the decision of interns to pursue prevocational training at a regional hospital, and gain insights into their career aspirations, expectations and concerns as they commence their internship.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study involved retrospective analysis of welcome interviews with Postgraduate Year 1 (PGY1) interns during their first rotation at a regional hospital in Queensland, Australia in 2024. The main outcome measures included factors influencing the decision to complete internship at a regional hospital, career aspirations, expectations and concerns for internship.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eInterns primarily chose the regional hospital for its positive reputation of being a supportive environment, opportunities for broad generalist clinical experience, and comprised a smooth transition from local regionally based university sites. Career aspirations varied, with popular interests in rural generalism, general practice, emergency medicine, anaesthetics and paediatrics. Interns expected and received hands-on learning experiences, regular patient interaction and broad exposure to various clinical specialties, while concerns included managing workload and adapting to new hospital systems.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAddressing the workforce nurturing and pastoral care needs of interns is crucial for a supportive and fulfilling internship experience. Promoting pastoral care and learning opportunities, are potential points of difference that may imbue reputational growth and ultimately attract interns to regional hospitals and enhance retention, optimising the medical workforce in these areas.\u003c/p\u003e","manuscriptTitle":"Intern insights: Career decisions, aspirations and perspectives from interns in a regional hospital setting","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-05 09:22:55","doi":"10.21203/rs.3.rs-5134499/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"898f1796-46f9-41fe-af82-15b582e5ea61","owner":[],"postedDate":"December 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-09T18:53:13+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-05 09:22:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5134499","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5134499","identity":"rs-5134499","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}