Longitudinal Assessment of Medical Students' Perceptions of Social Isolation and Wellbeing: A 5-Year Analysis of FRAME Surveys (2017-2022)

Longitudinal Assessment of Medical Students' Perceptions of Social Isolation and Wellbeing: A 5-Year Analysis of FRAME Surveys (2017-2022) | 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 Longitudinal Assessment of Medical Students' Perceptions of Social Isolation and Wellbeing: A 5-Year Analysis of FRAME Surveys (2017-2022) Minha Lee, Zelda Doyle, Tracy McFarlane, Jodie Bailie, Peter Simmons, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3958319/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 Background The geographical remoteness of rural clinical school (RCS) placements presents unique challenges to medical students, detrimentally impacting their well-being and potentially leading to social isolation. Understanding these challenges is essential for medical institutions to implement effective support mechanisms. Objective This study investigated the perceptions of rural medical students regarding well-being and social isolation during a five-year period (2017 to 2022) during their RCS placements. Methods Data from approximately 600 medical students (mostly females n = 2025, 57.7%) collected annually across 17 Australian universities, through self-administered FRAME (Federation of Rural Australian Medical Educators) surveys were extracted. Sociodemographic variables, their feelings of academic isolation and support, and the effect of COVID during their RCS were assessed. The main outcomes were social isolation and well-being which were derived from students’ responses to the statement, ‘ I felt socially isolated during my RCS placement’ , and ‘Overall, my RCS placement impacted positively on my well-being’, respectively. Data was analyzed using descriptive statistics and binomial logistic regressions to identify factors associated with their perception of social isolation and well-being during RCS placement. Results Over half of Australian rural medical students reported experiencing social isolation, with one-fifth expressing that rural placement had no positive impact on their wellbeing. Although the majority perceived a positive impact, this proportion decreased by 11.0% from 2017 to 2019, before rising again in subsequent years. Factors contributing to social isolation and negative impacts on well-being included academic isolation, non-rural background, preference to practice in a capital or major urban city upon entry to the RCS, and lack of academic, financial, or general support from the RCS. Positive influences were associated with active self-care role modeling and informal information regarding rural career options Notably, the years affected by the COVID-19 pandemic did not significantly alter perceived social isolation and well-being. Conclusions Addressing the challenges faced by medical students in rural placements is imperative to foster positive well-being and combat social isolation. These findings underscore the importance of tailored support mechanisms and educational programs to enhance resilience among future healthcare professionals. Moreover, improving the experiences of medical students in RCS placements may contribute to increased retention of doctors in rural and remote areas, thereby alleviating the nationwide shortage in these regions. Students rural medical schools medical education loneliness social connectedness mental health wellbeing stress COVID-19 rural health rural population Figures Figure 1 INTRODUCTION Medical education is a demanding and rigorous process that can significantly impact the mental well-being of aspiring healthcare professionals. There are increasing concerns about the mental well-being of medical students given the unique challenges and stressors they face during their training [ 1 ]. Wellbeing is defined as a positive state…[that] encompasses quality of life and the ability…to contribute to the world with a sense of meaning and purpose [ 2 ]. More specifically, mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community [ 3 ]. Research has highlighted the high prevalence of mental health problems among medical students [ 4 – 7 ], which is associated with poorer overall well-being [ 4 ]. A Beyondblue study [ 5 ] conducted in 2013 showed that more extreme levels of psychological distress were found among Australian medical students compared to the general population (9.2% vs 3.1%). Additionally, at the time of this study, 26.2% of medical students had been diagnosed with depression, and a further 20.2% with anxiety [ 5 ]. Another Australian study in 2016 found that 26.5% of medical students reported experiences of burnout during a rural clinical school (RCS) placement [ 6 ]. Suicidal ideation has been reported in a higher proportion of male (17.1%) and female (20.5%) medical students compared to the wider Australian population (1.9% of males and 2.7% of females) [ 7 ]. Social isolation is defined as ‘having objectively few social relationships or roles and infrequent social contact’. This is often conflated with but is distinct from loneliness, which is defined as ‘a subjective, unpleasant, or distressing feeling of a lack of connection to other people, along with a desire for more, or more satisfying, social relationships. The frequency of social contact has been declining across all age groups in Australia for decades, with a relative decline of 11% overall from 2001 to 2020. Although people aged 15 to 25 had the highest frequency of social contact, they also showed the greatest relative decline (17%) over this time period [ 1 ]. Medical students are at a higher risk of experiencing social isolation, especially those completing rural placements [ 8 ]. As shown in a cross-sectional study, 37.1% of medical students undertaking a rural placement in Australia reported feeling socially isolated [ 9 ], which can be attributed to the insulated nature of the degree [ 10 ], academic stress [ 11 ], personality traits such as lower levels of self-efficacy and self-esteem [ 12 ], internet addiction [ 13 ] and impact of the COVID-19 pandemic [ 14 ]. Past studies have documented the detrimental impact of the COVID-19 pandemic on individuals’ wellbeing and social connectedness [ 12 , 15 – 18 ]. The Australian National University study showed a 6.3% increase in psychological distress among individuals aged 18 years or older between February 2017 and April 2020, which marked the start of the pandemic [ 16 ]. Medical students faced numerous challenges during the pandemic such as social distancing, disrupted student societies and lack of in-person lectures and clinical teaching. These restrictions made it difficult for medical students to build friendships and seek support, increasing the likelihood of social isolation and poorer wellbeing [ 12 ]. However, other studies have highlighted some positive impacts of the pandemic on medical students such as improved family relationships [ 17 , 18 ]. Increased exposure to a rural clinical environment during medical school has been reported to increase medical students’ rural career interest and intent [ 19 ]. However, those who felt socially isolated during their placements were less likely to be interested in a rural internship opportunity and a future career in rural medicine [ 20 ]. Thus, effective interventions that minimise medical students’ social isolation during their rural clinical placements could influence their future career decision to going rural and alleviate the shortage of rural and remote doctors across Australia. Although studies [ 4 , 6 , 18 ] have demonstrated a clear psychological burden on medical students, researchers are yet to understand the trends and changes in student wellbeing across time, especially those located in rural or remote locations. The present study aimed to assess the level of wellbeing and social isolation reported among medical students at rural clinical schools across 17 universities in Australia, and changes over five years (2017 to 2022). Additionally, the study sought to identify the factors that influence medical students’ perceptions of wellbeing and social isolation during their rural clinical placements. Understanding the trends and contributing factors to medical students’ perceptions of social isolation and wellbeing can be used to identify areas of concern and develop interventions that will effectively alleviate the wellbeing challenges faced by medical students [ 7 ]. The findings of this study will inform medical institutions and policymakers about the efficacy of current support systems in rural clinical schools and help develop evidence-based strategies to improve future medical students’ wellbeing. MATERIALS AND METHODS Participants This was a self-administered cross-sectional survey of medical students who completed their RCS placements between 2017 and 2022 [ 20 ]. The Federation of Rural Australian Medical Educators (FRAME), a peak body representing 19 universities with RCS funded by the Australian Government Rural Health Multidisciplinary Training (RHMT) Program, conducts annual rural placement evaluations. Invitations to complete the FRAME survey are distributed to all relevant students on exit from RCS at the end of their placement and in their year of graduation [ 21 ]. Data from approximately 600 medical students per year who completed an extended RCS training placement (≥ 12 months) across 17 Australian institutions and participated in the survey was extracted for this study. A completed copy of the 2017–2022 survey instruments can be found on the FRAME website ( https://ausframe.org/publications-and-resources/ ) [ 22 ]. Inclusion and exclusion criteria Only data from medical students who responded to the survey, completed their RCS placements within the study period and responded to the two questions identified as the dependent variables in this study were included in the analysis. Data from medical students who were not on RCS at the time of this study, and those who may have participated in the survey but failed to respond to the two items used as dependent variables in this study were excluded. Ethical consideration Written informed consent was obtained from all participants prior to completing the survey. Ethics approval was obtained from the University of Notre Dame Australia (UNDA) (2020-196S) and from each of the participating universities. The custodian of the FRAME data also gave approval the use of the data set for the purpose of this study. The study was conducted in accordance with the tenets of the Declaration of Helsinki. Setting Rural clinical school (RCS) placements are rural training programs delivered by Australian medical schools, which aim to improve medical students’ intentions to practise rurally. These placements are funded by Australian Government’s Rural Clinical Training and Support (RCTS) program, which was established by the Department of Health in 2000. There are currently 17 Australian rural clinical/regional medical schools (RCS/RMS) delivering these placements, which are funded by the Australian Government’s Rural Clinical Training and Support (RCTS) program [ 23 ]. Survey design A sample of the FRAME survey is included as Appendix 1. The survey included 28 broader questions, out of which 16 were chosen as relevant to the aims of this study. Of these 16 items, only the 12 questions that were consistent across the 5 years were used in this study. The chosen survey items comprised of 9 sociodemographic items including year of study (2017–2022), gender (female, male or other), rural background on entry to the program (yes or no), lived outside a major city in Australia for 10 years cumulatively or 5 years consecutively (yes or no), was a member of their university’s rural health club (yes or no), year at the RCS (first year, second consecutive year, third consecutive year, fourth consecutive year or other), placement type (Commonwealth Supported HECS Place, Medical Rural Bonded Scholarship, Bonded Medical Place, Commonwealth Bonded Place, State Bonded Place, International Fee-paying Place, Australian Fee-paying place or other), type of location in Australia that they had lived the longest, and the geographical location in Australia they were most likely to practice after training (Capital city, Major urban centre, Regional city/large town, Smaller town, Small rural community or Remote centre/area). Due to the small number of respondents in the various categories, ‘Small rural community’ and ‘Remote centre/area’ were merged into a single category ‘Rural or remote community’, and those identifying as ‘Other’ gender were excluded from the analysis. Dependent variables Social isolation This was measured by students’ responses to the statement, ‘ I felt socially isolated during my RCS placement’ . Wellbeing Due to the lack of a clear definition in the FRAME surveys, we assume that ‘wellbeing’ encompasses both mental and physical sphere. Students self-reported on their sense of wellbeing was measured by their responses to the statement, ‘Overall, my RCS placement impacted positively on my well-being’. Student responses to both dependent variables were assessed on a five-point Likert-scale, dichotomised from 1 = ‘Strongly disagree’, 2 = ‘Disagree’, 3 = ‘Neutral’, 4 = ‘Agree’ to 5 = ‘Strongly agree’. Independent variables In addition to the sociodemographic variables, other independent variables included students’ perceptions of academic, financial, and overall support. These were assessed by their responses to the statements ‘ I felt well supported academically by my RCS’, ‘I felt well supported financially by my RCS’ and ‘Overall, I felt well supported by my RCS’ . Their feelings of academic isolation were gauged from their responses to the statement ‘ I felt academically isolated during my RCS placement . The effect of COVID was evaluated through the variable ‘COVID-year’, which was defined as a year in which medical students experienced lockdowns (2020 and 2021), or restricted access to hospitals or hospital teaching (2020 to 2022). Additionally, the study considered factors related to the services and programs provided by the medical school. Students reported their opinions on whether their medical school provided a ‘mindfulness course’, ‘other formal wellbeing/resilience training’, ‘structured support activities’, ‘informal/optional wellbeing activities’ or ‘active role modelling of self-care’. They also assessed whether they received ‘formal or informal tuition regarding career options for rural medical practice’ during their placement or ‘had the opportunity to work with junior doctors undertaking training for rural practice’. Rural-specific interventions were evaluated by students’ responses to the statements ‘ I have a rural-based clinician as a mentor ’ and ‘ Rural health club activities increased my intentions of practising in a rural area compared to when entering medical school’ (see Appendix 1). These items were assessed using a five-point Likert scale as described above. Data analyses For ease of data analysis, student responses to wellbeing ‘Strongly agree’ and ‘Agree’ were merged into a single category ‘Agree’. Similarly, the responses ‘Strongly disagree’, ‘Disagree’ and ‘Neutral’ were merged into a single category ‘Neutral’. However, for the social isolation variable, the responses ‘Strongly agree’, ‘Agree’ and ‘Neutral’ were merged into a single category ‘Agree’, while ‘Strongly disagree’ and ‘Disagree’ was merged into a single category ‘Disagree’. This was done under the assumption that students who felt neutral about a statement were unsure about their response and thus more likely to disagree with the statement of being impacted positively on their wellbeing or agree with the statement that they felt some form of social isolation, than the opposite response. Combining ‘Neutral’ responses into the ‘Disagree’ or ‘Agree’ category allows future interventions to focus on assisting those who felt socially isolated or that their RCS placement did not impact positively on their wellbeing. Statistical analysis was performed using SPSS Version 29 (SPSS IBM, New York, USA). Data was combined in Microsoft Excel (Microsoft Corporation, USA), and there were some missing data due to students not completing all questions on the survey, which was coded with ‘96’. Data was presented using descriptive statistics showing frequencies, proportions, and graphs for the variables. Chi-square analysis was conducted to examine differences between variables. To determine the factors associated with each of the dependent variables, binomial logistic regression using a forward conditional (stepwise) approach was conducted. This was necessary to examine the contribution of each of the independent variable categories to the model. Odd ratios and their 95% confidence interval were determined. For the regression, categorical variables included those with > 2 categories in no significant order, disagree or agree and yes or no. The positives were set as baseline (0 in coding) to consider students who felt negatively. Level of statistical significance was set at 5%. RESULTS Characteristics of respondents Table 1 presents the socio-demographic characteristics of the 3556 medical students who completed the FRAME surveys between 2017–2022 and had responses for the survey items used in this study. The table showed that the lowest student participation in the survey was in 2020 (464, 13.0%) and the highest in 2017 (696, 19.6%). More than half of students were females (57.7%), aged 19 years or older, mostly in their first year at the RCS (64.0%), came from a non-rural background (54.5%), but many of them (58.4%) had lived in a capital city for the longest. Majority of students had a Commonwealth Supported (HECS) Place with very few fee-paying students (45.5%) including international students (2.5%). Table 1 Socio-demographic characteristics of the students in the FRAME survey (n = 3556, otherwise stated). Variables Frequency (n,%) Year 2017 696 (19.6) 2018 658 (18.5) 2019 668 (18.8) 2020 464 (13.0) 2021 557 (15.7) 2022 513 (14.4) Gender, n = 3556 Male 1483 (42.3) Female 2025 (57.7) Age groups, n = 3356 19–22 years 505 (15.0) 23 years 625 (18.6) 24 years 633 (18.9) 25–26 years 747 (22.3) ≥ 27 years 846 (25.2) Placement type, n = 3524 Commonwealth Supported (HECS) Place 2276 (64.6) Medical Rural Bonded Scholarships (MRBS) 74 (2.1) Bonded Medical Place (BMP) 933 (26.5) Commonwealth Bonded Place 18 (0.5) State Bonded Place 19 (0.5) International Fee-paying Place 89 (2.5) Australian Fee-paying Place 107 (3.0) Other 8 (0.2) Rural background, n = 3514 No 1914 (54.5) Yes 1600 (45.5) Type of location in Australia lived longest, n = 3541 Capital or major urban city 2068 (58.4) Regional city/large town 571 (16.1) Smaller town 397 (11.2) Rural or remote community 505 (14.3) Lived outside major city in Australia for 10 years cumulatively or 5 years consecutively, n = 3540 No 1821 (51.4) Yes 1719 (48.6) Year at RCS, n = 3524 First year 2256 (64.0) Second consecutive year 771 (21.9) Third consecutive year 176 (5.0) Other 321 (9.1) Upon entry to RCS, geographical location in Australia mostly likely to practise after training, n = 3436 Capital or major urban city 2559 (74.5) Regional city/large town 495 (14.4) Smaller town 170 (4.9) Rural or remote community 212 (6.2) Member of university’s student rural health club during preclinical years, n = 3425 No 1819 (53.1) Yes 1606 (46.9) RCS=rural clinical school. FRAME=Federation of Rural Australian Medical Educators . Insert Table 1 here Change in perceived social isolation and wellbeing of medical students over time Figure 1 presents the percentage of students who disagreed or agreed with the statements ‘I felt socially isolated during my RCS placement’ and ‘My RCS placement impacted positively on my wellbeing’ between 2017 and 2022. Solid lines represent the proportion who agree with the statement; otherwise, dotted lines were used. Social isolation Figure 1 showed significant changes across years in the student perception of social isolation while in RCS placement (p = < 0.001). On average, more than 1 in 2 medical students reported feeling socially isolated during their RCS placement, with an increase of about 23.2% from 2017 to 2022. There was a dramatic increase of about 17.4% in the proportion who felt socially isolated between 2018 and 2019, before steadily increasing each year until 2022. From 2019 onwards, more than half of students consistently agreed that they felt socially isolated during their RCS placement. Wellbeing Across all years, significantly more students agreed that their RCS placement had a positive impact on their wellbeing (average of 80.9% over 5 years, p = < 0.001). The proportion of students who felt their wellbeing was positively impacted during their RCS placement decreased by 11.0% between 2017 (84.3%) and 2019 (75.0%), before rising again in subsequent years. By contrast, the proportion that disagreed with this statement rose by about 19.7% over the study period (from 15.7% in 2017 to 18.8% in 2022). Student perceptions of social isolation during their RCS placement Over the years, majority of students agreed that they felt well-supported financially (65.6%), and this was significantly associated with their lack of feelings of social isolation (p < 0.05 as seen in Table 2 ). Table 2 shows the percentage distribution of student responses regarding the statement ‘I felt socially isolated during my RCS placement’ by their sociodemographic variables. Table 2 Students responses on feeling of social isolation during RCS placement, derived from the statement ‘I felt socially isolated during my RCS placement’ (n = 3462, otherwise stated). Variables Outcome, n (%) Disagree Agree p-value Year 2017 378 (54.3) 318 (45.7) < 0.001 2018 359 (54.8) 296 (45.2) 2019 234 (37.4) 392 (62.6) 2020 167 (37.4) 280 (62.6) 2021 192 (35.6) 348 (64.4) 2022 155 (31.1) 343 (68.9) Gender, n = 3416 Male 604 (41.5) 852 (58.5) 0.20 Female 857 (43.7) 1103 (56.3) Age groups, n = 3356 19–22 years 212 (42.0) 293 (58.0) 0.86 23 years 247 (43.8) 351 (56.2) 24 years 282 (44.5) 351 (55.5) 25–26 years 318 (42.6) 429 (57.4) ≥ 27 years 357 (42.2) 489 (57.8) Placement type, n = 3437 Commonwealth Supported (HECS) Place 958 (43.0) 1270 (57.0) 0.04 Medical Rural Bonded Scholarships (MRBS) 42 (56.8) 32 (43.2) Bonded Medical Place (BMP) 385 (42.8) 514 (57.2) Commonwealth Bonded Place 11 (61.1) 7 (38.9) State Bonded Place 4 (23.5) 13 (76.5) International Fee-paying Place 33 (37.5) 55 (62.5) Australian Fee-paying Place 27 (35.2) 68 (64.8) Other 4 (50.0) 4 (50.0) Rural background, n = 3424 No 823 (44.1) 1043 (55.9) 0.12 Yes 645 (41.4) 913 (58.6) Type of location in Australia lived longest, n = 3452 Capital or major urban city 865 (43.0) 1145 (57.0) 0.83 Regional city/large town 248 (44.2) 313 (55.8) Smaller town 163 (41.7) 228 (58.3) Rural or remote community 205 (41.8) 285 (58.2) Lived outside major city in Australia for 10 years cumulatively or 5 years consecutively, n = 3452 No 781 (44.0) 994 (56.0) 0.15 Yes 697 (41.6) 980 (58.4) Year at RCS, n = 3434 First year 934 (42.4) 1269 (57.6) < 0.001 Second consecutive year 325 (43.3) 425 (56.7) Third consecutive year 98 (56.0) 77 (44.0) Other 112 (36.6) 194 (57.2) Upon entry to RCS, geographical location in Australia mostly likely to practise after training, n = 3390 Capital or major urban city 1109 (43.9) 1417 (56.1) 0.002 Regional city/large town 219 (45.0) 268 (55.0) Smaller town 72 (42.9) 96 (57.1) Rural or remote community 63 (30.1) 146 (69.9) I feel well supported academically by RCS, n = 3454 Disagree 207 (14.0) 249 (12.6) 0.24 Agree 1272 (86.0) 1726 (87.4) I feel well supported financially by RCS, n = 3422 Disagree 565 (38.4) 671 (34.4) 0.02 Agree 908 (61.6) 1278 (65.6) I felt academically isolated during my rural placement, n = 3455 Disagree 458 (30.9) 114 (5.8) < 0.001 Agree 1025 (69.1) 1858 (94.2) RCS informed me of health and counselling services that I could access for support if needed, n = 3434 Disagree 435 (29.5) 622 (31.8) 0.16 Agree 1040 (70.5) 1337 (68.2) I felt well supported by RCS, n = 3455 Disagree 211 (14.2) 248 (12.6) 0.15 Agree 1271 (85.8) 1725 (87.4) I have rural-based clinician as mentor, n = 3419 Disagree 588 (39.9) 684 (35.2) 0.01 Agree 887 (60.1) 1260 (64.8) Medical school provided mindfulness course, n = 3441 Disagree 885 (59.9) 1148 (58.5) 0.42 Agree 593 (40.1) 815 (41.5) Medical school provided other formal wellbeing/resilience training, n = 3441 Disagree 954 (64.5) 1210 (61.6) 0.08 Agree 524 (35.5) 753 (38.4) Medical school provided structured support activities, n = 3439 Disagree 798 (54.1) 1044 (53.2) 0.63 Agree 678 (45.9) 919 (46.8) Medical school provided informal/optional wellbeing activities, n = 3442 Disagree 621 (42.1) 809 (41.1) 0.60 Agree 855 (57.9) 1157 (58.9) Medical school provided active role modelling of self-care, n = 3422 Disagree 808 (55.0) 1030 (52.8) 0.21 Agree 662 (45.0) 922 (47.2) During my placement, I received formal tuition regarding career options for rural medical practice, n = 3375 Disagree 806 (55.8) 1023 (53.0) 0.11 Agree 638 (44.2) 908 (47.0) During my placement, I received informal information regarding career options for rural medical practice, n = 3369 Disagree 294 (20.4) 373 (19.3) 0.46 Agree 1146 (79.6) 1556 (80.7) During my placement, I had the opportunity to work with junior doctors undertaking training for rural practice, n = 3363 Disagree 242 (1.68) 312 (16.2) 0.63 Agree 1196 (83.2) 1613 (83.8) Member of university's student rural health club during preclinical years, n = 3377 No 738 (41.1) 1057 (58.9) 0.06 Yes 703 (44.4) 879 (55.6) Rural health club activities increased my intentions of practising in a rural area compared to when entering medical school, n = 1686 Disagree 426 (56.1) 527 (56.9) 0.73 Agree 334 (43.9) 399 (43.1) COVID-19 year. n = 3462 No 971 (65.4) 1006 (50.9) < 0.001 Yes 514 (34.6) 971 (49.1) RCS=rural clinical school. COVID−19 year was defined as 2020–2022 Insert Table 2 here. Over the years, majority of students agreed that they felt well-supported financially (65.6%), and few of these students felt socially isolated compared to their counterparts who felt not well-supported financially (p = 0.02)). Almost 95% of students agreed that they felt academically isolated which in turn significantly increased their feeling of social isolation compared to the students who did not feel academically isolated also. Compared to other placement types, significantly more students with a State Bonded Place and fewer students with a Commonwealth Bonded Place reported feeling socially isolated, during their RCS placement. Interestingly, majority of students (64.8%) who disagreed with the statement that they felt socially isolated during their RCS placement had a rural-based clinician as a mentor and did not belong to the university’s student rural health club during their preclinical years. This was also true for students who were part of the club but participated to a lesser extent (55.6%) in their activities. Compared to the students who completed their RCS placement during the non-COVID years, the proportion who reported feeling socially isolated was significantly higher during the COVID-years (p < 0.001). Student responses on their feeling of wellbeing by their sociodemographic variables Table 3 presents the percentage distribution of the student responses regarding the impact of RCS placement on their wellbeing sociodemographic variables. Across five years, a vast majority of students (75.0-84.3%) agreed that their RCS placement impacted positively on their wellbeing, especially those aged between 24 and 26 years, and more among females than males (82.3% vs 79.2%; p = 0.02). There were significantly more students with Medical Rural Bonded Scholarships (MRBS) who reported a positive impact on their wellbeing compared to those who were not on this scholarship, while fewer students with an International Fee-paying Place reported a positive impact on their wellbeing during RCS placement. Table 3 Students responses on how the rural clinical school placement years impacted their wellbeing, derived from the statement ‘RCS placement impacted positively on my wellbeing’ (n = 3451, otherwise stated). Variables Outcome (n, %) Disagree Agree p-value Year 2017 109 (15.7) 587 (84.3) < 0.001 2018 128 (19.6) 526 (80.4) 2019 156 (25.0) 467 (75.0) 2020 87 (19.4) 361 (80.6) 2021 84 (15.9) 445 (84.1) 2022 94 (18.8) 407 (81.2) Gender, n = 3407 Male 301 (20.8) 1146 (79.2) 0.02 Female 346 (17.7) 1614 (82.3) Age groups, n = 3348 19–22 years 120 (23.7) 386 (76.3) < 0.001 23 years 102 (16.3) 524 (83.7) 24 years 94 (15.0) 532 (85.0) 25–26 years 125 (16.8) 620 (83.2) ≥ 27 years 182 (21.5) 663 (78.5) Placement type, n = 3426 Commonwealth Supported (HECS) Place 429 (19.3) 1798 (80.7) 0.006 Medical Rural Bonded Scholarships (MRBS) 6 (8.1) 68 (91.9) Bonded Medical Place (BMP) 175 (19.6) 717 (80.4) Commonwealth Bonded Place 2 (11.1) 16 (88.9) State Bonded Place 2 (11.1) 16 (88.9) International Fee-paying Place 25 (28.7) 62 (71.3) Australian Fee-paying Place 9 (8.8) 93 (91.2) Other 2 (25.0) 6 (75.0) Rural background, n = 3414 No 350 (18.8) 1510 (81.2) 0.73 Yes 300 (19.3) 1254 (80.7) Type of location in Australia lived longest, n = 3443 Capital or major urban city 381 (19.0) 1624 (81.0) 0.64 Regional city/large town 112 (20.1) 446 (79.9) Smaller town 77 (19.8) 312 (80.2) Rural or remote community 84 (17.1) 407 (82.9) Lived outside major city in Australia for 10 years cumulatively or 5 years consecutively, n = 3442 No 333 (18.8) 1436 (81.2) 0.76 Yes 322 (19.2) 1351 (80.8) Year at RCS, n = 3424 First year 415 (18.9) 1779 (81.1) 0.33 Second consecutive year 134 (17.9) 614 (82.1) Third consecutive year 37 (21.1) 138 (78.9) Other 69 (22.5) 238 (77.5) Upon entry to RCS, geographical location in Australia mostly likely to practise after training, n = 3379 Capital or major urban city 517 (20.5) 2002 (79.5) 0.01 Regional city/large town 78 (16.1) 407 (83.9) Smaller town 24 (14.3) 144 (85.7) Rural or remote community 31 (15.0) 176 85.0) I feel well supported academically by RCS, n = 3444 Disagree 272 (41.6) 187 (6.7) < 0.001 Agree 382 (58.4) 2603 (93.3) I feel well supported financially by RCS, n = 3415 Disagree 369 (56.3) 868 (31.4) < 0.001 Agree 286 (43.7) 1892 (68.6) I felt academically isolated during my rural placement, n = 3441 Disagree 97 (14.8) 472 (16.9) 0.20 Agree 558 (85.2) 2314 (83.1) RCS informed me of health and counselling services that I could access for support if needed, n = 3426 Disagree 327 (50.0) 730 (26.3) < 0.001 Agree 327 (50.0) 2042 (73.7) I felt well supported by RCS, n = 3447 Disagree 325 (49.4) 140 (5.0) < 0.001 Agree 333 (50.6) 2649 (95.0) I have rural-based clinician as mentor n = 3408 Disagree 316 (48.5) 955 (34.6) < 0.001 Agree 335 (51.5) 1802 (65.4) Medical school provided mindfulness course, n = 3431 Disagree 430 (66.2) 1596 (57.4) < 0.001 Agree 220 (33.8) 1185 (42.6) Medical school provided other formal wellbeing/resilience training, n = 3431 Disagree 495 (75.8) 1665 (59.9) < 0.001 Agree 158 (24.2) 1113 (40.1) Medical school provided structured support activities, n = 3431 Disagree 468 (72.3) 1369 (49.2) < 0.001 Agree 180 (27.7) 1413 (50.8) Medical school provided informal/optional wellbeing activities, n = 3432 Disagree 399 (61.2) 1028 (37.0) < 0.001 Agree 253 (38.8) 1752 (63.0) Medical school provided active role modelling of self-care, n = 3414 Disagree 499 (77.5) 1338 (48.3) < 0.001 Agree 145 (22.5) 1431 (51.7) During my placement, I received formal tuition regarding career options for rural medical practice, n = 3365 Disagree 394 (62.1) 1436 (52.6) < 0.001 Agree 240 (37.9) 1295 (47.4) During my placement, I received informal information regarding career options for rural medical practice, n = 2908 Disagree 164 (25.8) 502 (18.4) < 0.001 Agree 471 (74.2) 2222 (81.6) During my placement, I had the opportunity to work with junior doctors undertaking training for rural practice, n = 3353 Disagree 144 (22.7) 408 (15.0) < 0.001 Agree 489 (77.3) 2312 (85.0) Member of university’s student rural health club during preclinical years, n = 3368 No 368 (20.6) 1419 (79.4) 0.01 Yes 267 (267) 1314 (83.1) Rural health club activities increased my intentions of practising in a rural area compared to when entering medical school, n = 1685 Disagree 186 (65.7) 769 (54.9) < 0.001 Agree 97 (34.3) 633 (45.1) COVID-19 year, n = 3451 No 393 (59.7) 1580 (56.6) 0.15 Yes 265 (40.3) 1213 (43.4) RCS=rural clinical school. COVID−19 year was defined as 2020–2022 . Insert Table 3 here Students were less likely to report that their RCS placement impacted positively on their wellbeing, if they felt well supported academically or financially. More than half of students who reported that their RCS informed them of health and counselling services or those who had a rural-based clinician as a mentor, reported a positive impact on their wellbeing compared to their counterparts. Of the students whose medical school did not provide a mindfulness course, formal wellbeing/resilience training, structured support activities, informal/optional wellbeing activities, active role-modelling of self-care or formal tuition regarding career options for rural medical practice majority did not feel that the RCS had a positive impact on their wellbeing. Over 80% of students who agreed their RCS placement impacted positively on their wellbeing received informal information regarding rural career options, had the opportunity to work with rurally-training junior doctors or were members of their university’s student rural health club during their preclinical years. Majority of students who felt that their rural health club activities did not increase their intentions of practising in a rural area compared to when entering medical school, disagreed with the statement that the RCS placement had a positive impact on their wellbeing. Univariate analysis of factors associated with social isolation and wellbeing of rural medical students. In the univariate analysis, placement type, perceived financial support, mentorship by rural-based clinician(s) and membership of the university’s student rural health club during preclinical years were significantly associated with feeling socially isolated and positive impact on wellbeing during their RCS placement. There were significant associations between gender, age, perceived academic support, perceived support by RCS, location and the students report of positive impact on wellbeing during RCS placement. Students report of social isolation was also significantly associated with the year at RCS, feeling of academic isolation and was higher during the COVID-year. Multivariable analysis of factors associated with social isolation and wellbeing of rural medical students. Table 4 displays the variables that are significantly associated with students feeling of social isolation identified by a forward (conditional) binomial logistic regression with ‘I felt socially isolated during my RCS placement’ as the outcome variable and ‘Year’ as the controlled variable. The non-significant variables in the model have been presented in Supplementary Table 1. Table 4 Binomial logistic regression of factors associated with self-reported social isolation during RCS placement with ‘Year’ as control. Variables B OR (95%CI) p-value Rural background -0.27 0.77 (0.60, 0.97) 0.03 Upon entry to RCS, geographical location in Australia mostly likely to practise after training is capital or major urban city 0.11 1.12 (0.82, 1.53) 0.47 Upon entry to RCS, geographical location in Australia mostly likely to practise after training is regional city/large town -0.24 0.78 (0.45, 1.36) 0.38 Upon entry to RCS, geographical location in Australia mostly likely to practise after training is smaller town -0.78 0.46 (0.26, 0.81) 0.01 I felt academically isolated during my rural placement 2.50 12.13 (8.07, 18.22) < 0.001 Constant 0.13 1.14 0.28 RCS=rural clinical school; OR= Odd ratios; CI=Confidence intervals. Year of study was controlled for in the analysis . Insert Table 4 here After controlling for the year of survey, students who felt feel academically isolated were 12.1 times more likely to report social isolation while those who come from a non-rural background were 1.3 times more likely to report social isolation during placement. Other factors associated with feeling of social isolation in this study included preferring practising in a capital or major urban city upon entry to the RCS, while students that preferred practising in a smaller town and regional city/large town were 2.18 times and 1.28 times less likely to feel socially isolated, respectively. Surprisingly, the COVID-19 year had no significant influence on the students’ feeling of social isolation in this study. Table 5 presents the variables that were significantly associated with positive wellbeing after controlling for year of study in the regression analysis. Table 5 Binomial logistic regression of factors associated with positive impact on students’ wellbeing during their RCS placement with ‘Year’ as the control. Variables B OR (95% CI) P-value Gender 0.49 1.64 (1.17, 2.29) 0.004 I feel well supported academically by RCS 0.94 2.57 (1.61, 4.10) < 0.001 I feel well supported financially by RCS 0.66 1.94 (1.39, 2.70) < 0.001 I felt well supported by RCS 1.73 5.63 (3.56, 8.89) < 0.001 Medical school provided active role modelling of self-care 0.77 2.15 (1.44, 3.22) < 0.001 Medical school provided informal/optional wellbeing activities 0.39 1.48 (1.03, 2.13) 0.04 During my placement, I had the opportunity to work with junior doctors undertaking training for rural practice 0.53 1.70 (1.12, 2.58) 0.01 Constant -0.21 RCS=rural clinical school; OR= odd ratio; CI= confidence interval. Year of study was controlled for in the analysis . Insert Table 5 here. From Table 5 , students who felt well supported academically, financially or in general were significantly more likely to agreed that their RCS placement impacted positively on their wellbeing. Medical students were 2.40 times and 1.66 times more likely to report a positive impact on their wellbeing when the medical school actively role-modelled self-care and provided informal information regarding rural career options respectively during their RCS placement. Also, the COVID-year was not significantly associated with the students’ report on their wellbeing in this study. DISCUSSION This study examined medical students' perceptions regarding their well-being and social isolation during RCS placements over a five-year period using the FRAME dataset. The study found that for most medical students, their RCS placement had a positive impact on their well-being, but in a small proportion of them, their experience was not positive, and this perception increased over time. On average, more than half of the students felt socially isolated during the study period, and this proportion also increased over the five years. Studies have found that about one in four medical students had depression, and another 20.2% had anxiety [ 5 ]. In another study, 26.5% of medical students had experienced burnout during their RCS placement [ 6 ], with a significant proportion of male (17.1%) and female (20.5%) medical students across Australia self-reporting suicidal ideation [ 7 ]. These findings agreed with the present study findings of a decrease over time with respect to the proportion of students who felt that RCS placement had a positive impact on their wellbeing. The findings attest to the rising mental health struggles faced by Australian medical students, signalling the need for effective wellbeing strategies. A major finding from this study was the lack of impact of the COVID-years (2020 to 2022) on students feeling of social isolation and well-being, which was contrary to a previous study [ 24 ]. In that study, the proportion that reported psychological distress increased by 6.25% among people aged 18 years or older between 2017 and 2020, which marked the beginning of the COVID pandemic [ 24 ]. The present study did not assess psychological distress, which is considered a mental health problem [ 25 ], and it was beyond the scope of this study to interrogate the reasons for our findings. Other potential explanations for the lack of COVID-19 impact on wellbeing may include the shorter duration of the lockdowns in some rural and regional areas, some states and territories, and the difference in rural training programs between universities. Also, the riming of data collection differed between studies in relation to pandemic progression which may explain some of the differences in findings. Another major finding of this study was that a sustained high proportion of students (more than one in every two students) felt socially isolated during their RCS placement. These figures are higher than previous reports in 2015, which found that 37.1% of medical students in Australia felt socially isolated during their RCS placement [ 9 ]. Furthermore, this increases in perceived social isolation among medical students mirrors the declining frequency of social contact across all age groups in Australia which may explain the rise in social isolation noted in this study, suggesting the need to foster social contact among medical students. Multivariable regression analysis revealed that students who felt academically isolated were more likely to report social isolation. Past research has reported that medical students often segregate themselves from non-medical students and may spend less time with friends and family due to the structure and time commitments required to excel academically and the high workload [ 10 ]. The smaller number of students in RCS may further contribute to students’ experience of academic isolation. In addition, social isolation was higher among students who came from a non-rural background or preferred to practise in a capital or major urban city after training. These findings corroborate a 2011 Western Australian study, which reported that medical students’ rural background was a strong motivation to go rural after graduation. [ 26 ] A 2022 Australian study also found that, 8 years after graduation, medical students of rural origin with extended rural clinical school experience were more likely to practise in regional or rural communities than graduates of metropolitan origin without such training. [ 27 ] Students who felt academically supported were more likely to report a positive impact on their well-being during their RCS placement. This is consistent with a previous report linking academic studies and exams to stress among medical students [ 28 ]. In another study, authors found that stress from can undo team cohesion as students often prioritise their own needs [ 28 ]. Considering that medical school is academically demanding, it is possible that feeling well supported academically would impact positively on the student wellbeing, further highlighting the need to improve academic support provided by medical schools and reduce academic isolation to alleviate social isolation and poor wellbeing among students. Positive wellbeing during the RCS placement was significantly associated with perceived financial support by the RCS. A past study found that two-thirds of medical students found financial concerns very or extremely stressful. [ 11 ] In 2023, the maximum HECS-HELP debt for medical students was $ 162 336, which is nearly 1.5 times that of other students. [ 29 ] In a 2013 study by Cardiff University, medical students revealed that the financial burden of medical school was a major stressor, stating that “the added cost of buying clothes for placement, as well as books and stethoscopes…[and] travelling can cause extra debt”. [ 30 ] The study went on to identify measures to alleviate the stress of finances for medical students such as teaching them how to manage finances effectively, travel reimbursements and subsidies or bulk discounts for medical equipment. [ 30 ] Active role-modelling of self-care and informal information regarding rural career options was significantly associated with a report of positive well-being in this study. These findings underscore the importance of having active demonstration of effective self-care practices to equip medical students with healthy habits and techniques to improve their wellbeing. Medical schools should also ensure that information regarding rural medical practice is readily available to students. Strengths and limitations This study had some limitations that should be considered when interpreting or comparing the findings with other studies. First, the voluntary nature of survey participation introduces potential selection bias, meaning that the sample population may not be representative of Australian medical students undertaking rural clinical placements at the time. Second, the assumption that students with 'Neutral' responses are more likely to agree or disagree with a particular statement may not hold true in all circumstances due to insufficient information about their perceptions. Third, the lack of clear definitions for 'well-being' and 'social isolation' in the FRAME surveys may affect data interpretation. Students may have different interpretations of these terms, resulting in an inconsistent frame of reference through which to view the questions. For example, social isolation may be incorrectly interchanged with loneliness and wellbeing could encompass mental and/or physical spheres. Fourth, restrictions that accompany the data sharing agreement in this study prevents any comparison between participating universities. State-based comparisons are not always available due to the unequal distribution of RCS between states. Fifth, there is a potential for self-reporting bias of social isolation, wellbeing and support since these concepts are subjective and may be influenced by individual expectations [ 9 ]. Finally, missing data could affect the accuracy of the data analysis. In the future, the reasons for a lack of response by students should be explored. Despite these limitations, the study's strength lies in its representation of medical students from 17 Australian medical schools, allowing for a comprehensive national evaluation. The longitudinal nature of this study provides insights into trends over time. To our knowledge, it is the first study to analyse changes in medical students' well-being and social isolation over five years. The inclusion of rural-specific variables in the survey allows the study to evaluate social isolation and wellbeing among medical students at RCS more effectively. CONCLUSION AND RECOMMENDATION Overall, over one in two medical students in Australian RCS experienced social isolation whereas one in five felt that their RCS did not have a positive impact on their wellbeing. There was a decline in perceived well-being and an increase in social isolation among the students undertaking RCS placements over time and this was attributed to factors such as academic and financial support, academic isolation, rural background, active role-modelling of self-care and information regarding rural career options. Surprisingly, COVID-years had no significant impact on both outcome measures in the adjusted analysis. Addressing social isolation and well-being factors by implementing effective wellness strategies and support networks is crucial to foster empathetic, resilient healthcare professionals in the future. Improving students’ wellbeing could also contribute to greater retention of doctors in rural and remote areas to address the shortage of medical practitioners in these locations. To improve student well-being and minimise feelings of social isolation, we recommend that medical schools consider these findings, and in doing so, work towards identifying and implementing explicit measures of academic and financial support. Such support might encompass initiatives such as providing virtual study groups, formative examinations, accommodation, scholarships and commute subsidies. Continuing and/or expanding RCS student access to role-modelling of self-care and informal information regarding rural career options is likely to have a positive influence reducing social isolation and increasing wellbeing, as indicated by the results of this study. Improving medical students’ wellbeing during RCS placements may also increase their intentions to practice rurally, assisting with the recruitment and retention of future doctors in rural and remote areas. Declarations Ethics approval and consent to participate Written informed consent was obtained from all participants prior to completing the survey. Ethics approval was obtained from University of Notre Dame Australia (UNDA:2020-196S) and from each of the participating universities. The custodian of the FRAME data also gave approval the use of the data set for the purpose of this study. The study was conducted in accordance with the tenets of the Declaration of Helsinki. Consent for publication Not applicable Availability of data and materials The dataset supporting the conclusions of this article is included within the article (and its additional files). Data is also available on request from the corresponding author U.L.O. Competing interests The authors declare that they have no competing interests . Funding This research did not receive any funding. Authors' contributions U.L.O, M.L., P.S, T.M, and Z.D. were involved in the conceptualization of the study; U.L.O, M.L., P.S, T.M, S.D, and Z.D. performed the methodology; Software, Z.D., and U.L.O; Validation, U.L.O, M.L., J.B., P.S, T.M, S.D, and Z.D.; Formal Analysis, Z.D., M.L., and U.L.O.; Investigation, all authors; Resources, Z.D., M.L., and U.L.O; Data Curation, Z.D., M.L., P.S., T.M., and U.L.O.; Writing – Original Draft Preparation, Z.D., M.L., T.M., and U.L.O.; Writing – Review & Editing, U.L.O, M.L., J.B., P.S, T.M, S.D, and Z.D.; Visualization, U.L.O, M.L., J.B., P.S, T.M, S.D, and Z.D; Supervision, U.L.O., Z.D. and T.M. Project Administration, M.L., Z.D., and U.L.O. All authors reviewed the manuscript, read and agreed to the published version of the manuscript. Acknowledgement None References Welfare AI. .o.H.a. Social isolation loneliness. 2023 [cited 2023 22 November]. Organisation WH. 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Student opinions on a rural placement program in New South Wales, Australia. Rural Remote Health. 2011;11(2):1703. Seal AN, et al. Influence of rural clinical school experience and rural origin on practising in rural communities five and eight years after graduation. Med J Aust. 2022;216(11):572–7. Greenhill J, et al. Towards an understanding of medical student resilience in longitudinal integrated clerkships. BMC Med Educ. 2015;15:137. Ey C. Higher Education Loan Program (HELP) and other student loans: a quick guide . 2023 [cited 2024 February 8]; Available from: https://www.aph.gov.au/About_Parliament/Parliamentary_departments/Parliamentary_Library/pubs/rp/rp2223/Quick_ Guides/Higher_Education_Loan_Program#:~:text=For%202023%2 C%20the%20limit%20is,%24113%2C028%20for%20all%20other%20students. Cohen D, et al. Factors that impact on medical student wellbeing - Perspectives of risks. Cardiff University; 2013. 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-3958319","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":274641017,"identity":"5493a9ce-9e03-4434-b5dd-49d62c04c688","order_by":0,"name":"Minha Lee","email":"","orcid":"","institution":"Bathurst Rural Clinical School, Western Sydney University","correspondingAuthor":false,"prefix":"","firstName":"Minha","middleName":"","lastName":"Lee","suffix":""},{"id":274641018,"identity":"acaf0db6-0cd2-4edd-ae89-d3301169d73d","order_by":1,"name":"Zelda Doyle","email":"","orcid":"","institution":"The University of Notre Dame","correspondingAuthor":false,"prefix":"","firstName":"Zelda","middleName":"","lastName":"Doyle","suffix":""},{"id":274641019,"identity":"04cfa6c4-976e-4310-ba6f-e6b9c0a2b1d4","order_by":2,"name":"Tracy McFarlane","email":"","orcid":"","institution":"Bathurst Rural Clinical School, Western Sydney University","correspondingAuthor":false,"prefix":"","firstName":"Tracy","middleName":"","lastName":"McFarlane","suffix":""},{"id":274641020,"identity":"7a7473f0-d50f-4902-8b78-7f255e4fbbff","order_by":3,"name":"Jodie Bailie","email":"","orcid":"","institution":"The University of Sydney","correspondingAuthor":false,"prefix":"","firstName":"Jodie","middleName":"","lastName":"Bailie","suffix":""},{"id":274641021,"identity":"7410ce48-9410-40a8-9859-e66df3ce6e7b","order_by":4,"name":"Peter Simmons","email":"","orcid":"","institution":"Bathurst Rural Clinical School, Western Sydney University","correspondingAuthor":false,"prefix":"","firstName":"Peter","middleName":"","lastName":"Simmons","suffix":""},{"id":274641022,"identity":"8f1f04f9-c23f-4066-b510-e8e93e61dd04","order_by":5,"name":"Sari Dewi","email":"","orcid":"","institution":"The Australian National University","correspondingAuthor":false,"prefix":"","firstName":"Sari","middleName":"","lastName":"Dewi","suffix":""},{"id":274641023,"identity":"e9d68d22-20b8-4859-890f-92e8790d05a2","order_by":6,"name":"Uchechukwu Levi Osuagwu","email":"data:image/png;base64,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","orcid":"","institution":"Bathurst Rural Clinical School, Western Sydney University","correspondingAuthor":true,"prefix":"","firstName":"Uchechukwu","middleName":"Levi","lastName":"Osuagwu","suffix":""}],"badges":[],"createdAt":"2024-02-15 10:08:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3958319/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3958319/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51706282,"identity":"faa43986-36c6-45c7-9da2-43d3fd727bed","added_by":"auto","created_at":"2024-02-27 16:24:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":15080,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eSocial Isolation (derived from ‘I felt socially isolated during my RCS placement’) \u0026amp; Well-being (derived from ‘RCS placement impacted positively on my wellbeing’)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Onlinedrawingimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3958319/v1/06b4057b400dff8f60ff0dd2.png"},{"id":69596976,"identity":"25ece5e1-6beb-4a05-8cef-039ba93b032a","added_by":"auto","created_at":"2024-11-22 05:02:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1143221,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3958319/v1/9ac635b9-be07-42a0-8d72-3af189671ee9.pdf"},{"id":51706283,"identity":"73f84055-1b4d-4f17-963e-8e30adcca3e7","added_by":"auto","created_at":"2024-02-27 16:24:11","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":17149,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile.docx","url":"https://assets-eu.researchsquare.com/files/rs-3958319/v1/c3460de0a329bda238e5e97c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Longitudinal Assessment of Medical Students' Perceptions of Social Isolation and Wellbeing: A 5-Year Analysis of FRAME Surveys (2017-2022)","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMedical education is a demanding and rigorous process that can significantly impact the mental well-being of aspiring healthcare professionals. There are increasing concerns about the mental well-being of medical students given the unique challenges and stressors they face during their training [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Wellbeing is defined as a positive state\u0026hellip;[that] encompasses quality of life and the ability\u0026hellip;to contribute to the world with a sense of meaning and purpose [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. More specifically, mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eResearch has highlighted the high prevalence of mental health problems among medical students [\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], which is associated with poorer overall well-being [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A Beyondblue study [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] conducted in 2013 showed that more extreme levels of psychological distress were found among Australian medical students compared to the general population (9.2% vs 3.1%). Additionally, at the time of this study, 26.2% of medical students had been diagnosed with depression, and a further 20.2% with anxiety [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Another Australian study in 2016 found that 26.5% of medical students reported experiences of burnout during a rural clinical school (RCS) placement [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Suicidal ideation has been reported in a higher proportion of male (17.1%) and female (20.5%) medical students compared to the wider Australian population (1.9% of males and 2.7% of females) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSocial isolation is defined as \u0026lsquo;having objectively few social relationships or roles and infrequent social contact\u0026rsquo;. This is often conflated with but is distinct from loneliness, which is defined as \u0026lsquo;a subjective, unpleasant, or distressing feeling of a lack of connection to other people, along with a desire for more, or more satisfying, social relationships. The frequency of social contact has been declining across all age groups in Australia for decades, with a relative decline of 11% overall from 2001 to 2020. Although people aged 15 to 25 had the highest frequency of social contact, they also showed the greatest relative decline (17%) over this time period [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Medical students are at a higher risk of experiencing social isolation, especially those completing rural placements [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. As shown in a cross-sectional study, 37.1% of medical students undertaking a rural placement in Australia reported feeling socially isolated [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], which can be attributed to the insulated nature of the degree [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], academic stress [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], personality traits such as lower levels of self-efficacy and self-esteem [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], internet addiction [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and impact of the COVID-19 pandemic [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePast studies have documented the detrimental impact of the COVID-19 pandemic on individuals\u0026rsquo; wellbeing and social connectedness [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The Australian National University study showed a 6.3% increase in psychological distress among individuals aged 18 years or older between February 2017 and April 2020, which marked the start of the pandemic [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Medical students faced numerous challenges during the pandemic such as social distancing, disrupted student societies and lack of in-person lectures and clinical teaching. These restrictions made it difficult for medical students to build friendships and seek support, increasing the likelihood of social isolation and poorer wellbeing [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, other studies have highlighted some positive impacts of the pandemic on medical students such as improved family relationships [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIncreased exposure to a rural clinical environment during medical school has been reported to increase medical students\u0026rsquo; rural career interest and intent [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, those who felt socially isolated during their placements were less likely to be interested in a rural internship opportunity and a future career in rural medicine [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Thus, effective interventions that minimise medical students\u0026rsquo; social isolation during their rural clinical placements could influence their future career decision to going rural and alleviate the shortage of rural and remote doctors across Australia.\u003c/p\u003e \u003cp\u003eAlthough studies [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] have demonstrated a clear psychological burden on medical students, researchers are yet to understand the trends and changes in student wellbeing across time, especially those located in rural or remote locations. The present study aimed to assess the level of wellbeing and social isolation reported among medical students at rural clinical schools across 17 universities in Australia, and changes over five years (2017 to 2022). Additionally, the study sought to identify the factors that influence medical students\u0026rsquo; perceptions of wellbeing and social isolation during their rural clinical placements.\u003c/p\u003e \u003cp\u003eUnderstanding the trends and contributing factors to medical students\u0026rsquo; perceptions of social isolation and wellbeing can be used to identify areas of concern and develop interventions that will effectively alleviate the wellbeing challenges faced by medical students [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The findings of this study will inform medical institutions and policymakers about the efficacy of current support systems in rural clinical schools and help develop evidence-based strategies to improve future medical students\u0026rsquo; wellbeing.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eParticipants\u003c/p\u003e \u003cp\u003eThis was a self-administered cross-sectional survey of medical students who completed their RCS placements between 2017 and 2022 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The Federation of Rural Australian Medical Educators (FRAME), a peak body representing 19 universities with RCS funded by the Australian Government Rural Health Multidisciplinary Training (RHMT) Program, conducts annual rural placement evaluations. Invitations to complete the FRAME survey are distributed to all relevant students on exit from RCS at the end of their placement and in their year of graduation [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Data from approximately 600 medical students per year who completed an extended RCS training placement (\u0026ge;\u0026thinsp;12 months) across 17 Australian institutions and participated in the survey was extracted for this study. A completed copy of the 2017\u0026ndash;2022 survey instruments can be found on the FRAME website (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ausframe.org/publications-and-resources/\u003c/span\u003e\u003cspan address=\"https://ausframe.org/publications-and-resources/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003eOnly data from medical students who responded to the survey, completed their RCS placements within the study period and responded to the two questions identified as the dependent variables in this study were included in the analysis. Data from medical students who were not on RCS at the time of this study, and those who may have participated in the survey but failed to respond to the two items used as dependent variables in this study were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eEthical consideration\u003c/h2\u003e \u003cp\u003e Written informed consent was obtained from all participants prior to completing the survey. Ethics approval was obtained from the University of Notre Dame Australia (UNDA) (2020-196S) and from each of the participating universities. The custodian of the FRAME data also gave approval the use of the data set for the purpose of this study. The study was conducted in accordance with the tenets of the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSetting\u003c/h2\u003e \u003cp\u003eRural clinical school (RCS) placements are rural training programs delivered by Australian medical schools, which aim to improve medical students\u0026rsquo; intentions to practise rurally. These placements are funded by Australian Government\u0026rsquo;s Rural Clinical Training and Support (RCTS) program, which was established by the Department of Health in 2000. There are currently 17 Australian rural clinical/regional medical schools (RCS/RMS) delivering these placements, which are funded by the Australian Government\u0026rsquo;s Rural Clinical Training and Support (RCTS) program [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSurvey design\u003c/h2\u003e \u003cp\u003eA sample of the FRAME survey is included as Appendix 1. The survey included 28 broader questions, out of which 16 were chosen as relevant to the aims of this study. Of these 16 items, only the 12 questions that were consistent across the 5 years were used in this study. The chosen survey items comprised of 9 sociodemographic items including year of study (2017\u0026ndash;2022), gender (female, male or other), rural background on entry to the program (yes or no), lived outside a major city in Australia for 10 years cumulatively or 5 years consecutively (yes or no), was a member of their university\u0026rsquo;s rural health club (yes or no), year at the RCS (first year, second consecutive year, third consecutive year, fourth consecutive year or other), placement type (Commonwealth Supported HECS Place, Medical Rural Bonded Scholarship, Bonded Medical Place, Commonwealth Bonded Place, State Bonded Place, International Fee-paying Place, Australian Fee-paying place or other), type of location in Australia that they had lived the longest, and the geographical location in Australia they were most likely to practice after training (Capital city, Major urban centre, Regional city/large town, Smaller town, Small rural community or Remote centre/area). Due to the small number of respondents in the various categories, \u0026lsquo;Small rural community\u0026rsquo; and \u0026lsquo;Remote centre/area\u0026rsquo; were merged into a single category \u0026lsquo;Rural or remote community\u0026rsquo;, and those identifying as \u0026lsquo;Other\u0026rsquo; gender were excluded from the analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eDependent variables\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eSocial isolation\u003c/strong\u003e \u003cp\u003eThis was measured by students\u0026rsquo; responses to the statement, \u0026lsquo;\u003cem\u003eI felt socially isolated during my RCS placement\u0026rsquo;\u003c/em\u003e.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eWellbeing\u003c/strong\u003e \u003cp\u003eDue to the lack of a clear definition in the FRAME surveys, we assume that \u0026lsquo;wellbeing\u0026rsquo; encompasses both mental and physical sphere. Students self-reported on their sense of wellbeing was measured by their responses to the statement, \u003cem\u003e\u0026lsquo;Overall, my RCS placement impacted positively on my well-being\u0026rsquo;.\u003c/em\u003e\u003c/p\u003e \u003c/p\u003e \u003cp\u003eStudent responses to both dependent variables were assessed on a five-point Likert-scale, dichotomised from 1 = \u0026lsquo;Strongly disagree\u0026rsquo;, 2 = \u0026lsquo;Disagree\u0026rsquo;, 3 = \u0026lsquo;Neutral\u0026rsquo;, 4 = \u0026lsquo;Agree\u0026rsquo; to 5 = \u0026lsquo;Strongly agree\u0026rsquo;.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eIndependent variables\u003c/h2\u003e \u003cp\u003eIn addition to the sociodemographic variables, other independent variables included students\u0026rsquo; perceptions of academic, financial, and overall support. These were assessed by their responses to the statements \u0026lsquo;\u003cem\u003eI felt well supported academically by my RCS\u0026rsquo;, \u0026lsquo;I felt well supported financially by my RCS\u0026rsquo; and \u0026lsquo;Overall, I felt well supported by my RCS\u0026rsquo;\u003c/em\u003e. Their feelings of academic isolation were gauged from their responses to the statement \u0026lsquo;\u003cem\u003eI felt academically isolated during my RCS placement\u003c/em\u003e. The effect of COVID was evaluated through the variable \u0026lsquo;COVID-year\u0026rsquo;, which was defined as a year in which medical students experienced lockdowns (2020 and 2021), or restricted access to hospitals or hospital teaching (2020 to 2022).\u003c/p\u003e \u003cp\u003eAdditionally, the study considered factors related to the services and programs provided by the medical school. Students reported their opinions on whether their medical school provided a \u0026lsquo;mindfulness course\u0026rsquo;, \u0026lsquo;other formal wellbeing/resilience training\u0026rsquo;, \u0026lsquo;structured support activities\u0026rsquo;, \u0026lsquo;informal/optional wellbeing activities\u0026rsquo; or \u0026lsquo;active role modelling of self-care\u0026rsquo;. They also assessed whether they received \u0026lsquo;formal or informal tuition regarding career options for rural medical practice\u0026rsquo; during their placement or \u0026lsquo;had the opportunity to work with junior doctors undertaking training for rural practice\u0026rsquo;.\u003c/p\u003e \u003cp\u003eRural-specific interventions were evaluated by students\u0026rsquo; responses to the statements \u0026lsquo;\u003cem\u003eI have a rural-based clinician as a mentor\u003c/em\u003e\u0026rsquo; and \u0026lsquo;\u003cem\u003eRural health club activities increased my intentions of practising in a rural area compared to when entering medical school\u0026rsquo;\u003c/em\u003e (see Appendix 1). These items were assessed using a five-point Likert scale as described above.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData analyses\u003c/h2\u003e \u003cp\u003eFor ease of data analysis, student responses to wellbeing \u0026lsquo;Strongly agree\u0026rsquo; and \u0026lsquo;Agree\u0026rsquo; were merged into a single category \u0026lsquo;Agree\u0026rsquo;. Similarly, the responses \u0026lsquo;Strongly disagree\u0026rsquo;, \u0026lsquo;Disagree\u0026rsquo; and \u0026lsquo;Neutral\u0026rsquo; were merged into a single category \u0026lsquo;Neutral\u0026rsquo;. However, for the social isolation variable, the responses \u0026lsquo;Strongly agree\u0026rsquo;, \u0026lsquo;Agree\u0026rsquo; and \u0026lsquo;Neutral\u0026rsquo; were merged into a single category \u0026lsquo;Agree\u0026rsquo;, while \u0026lsquo;Strongly disagree\u0026rsquo; and \u0026lsquo;Disagree\u0026rsquo; was merged into a single category \u0026lsquo;Disagree\u0026rsquo;. This was done under the assumption that students who felt neutral about a statement were unsure about their response and thus more likely to disagree with the statement of being impacted positively on their wellbeing or agree with the statement that they felt some form of social isolation, than the opposite response. Combining \u0026lsquo;Neutral\u0026rsquo; responses into the \u0026lsquo;Disagree\u0026rsquo; or \u0026lsquo;Agree\u0026rsquo; category allows future interventions to focus on assisting those who felt socially isolated or that their RCS placement did not impact positively on their wellbeing.\u003c/p\u003e \u003cp\u003eStatistical analysis was performed using SPSS Version 29 (SPSS IBM, New York, USA). Data was combined in Microsoft Excel (Microsoft Corporation, USA), and there were some missing data due to students not completing all questions on the survey, which was coded with \u0026lsquo;96\u0026rsquo;. Data was presented using descriptive statistics showing frequencies, proportions, and graphs for the variables. Chi-square analysis was conducted to examine differences between variables. To determine the factors associated with each of the dependent variables, binomial logistic regression using a forward conditional (stepwise) approach was conducted. This was necessary to examine the contribution of each of the independent variable categories to the model. Odd ratios and their 95% confidence interval were determined. For the regression, categorical variables included those with \u0026gt;\u0026thinsp;2 categories in no significant order, disagree or agree and yes or no. The positives were set as baseline (0 in coding) to consider students who felt negatively. Level of statistical significance was set at 5%.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of respondents\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the socio-demographic characteristics of the 3556 medical students who completed the FRAME surveys between 2017\u0026ndash;2022 and had responses for the survey items used in this study. The table showed that the lowest student participation in the survey was in 2020 (464, 13.0%) and the highest in 2017 (696, 19.6%). More than half of students were females (57.7%), aged 19 years or older, mostly in their first year at the RCS (64.0%), came from a non-rural background (54.5%), but many of them (58.4%) had lived in a capital city for the longest. Majority of students had a Commonwealth Supported (HECS) Place with very few fee-paying students (45.5%) including international students (2.5%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of the students in the FRAME survey (n\u0026thinsp;=\u0026thinsp;3556, otherwise stated).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n,%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e696 (19.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e658 (18.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e668 (18.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e464 (13.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e557 (15.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e513 (14.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender, n\u0026thinsp;=\u0026thinsp;3556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1483 (42.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2025 (57.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eAge groups, n\u0026thinsp;=\u0026thinsp;3356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u0026ndash;22 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e505 (15.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e625 (18.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e633 (18.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;26 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e747 (22.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;27 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e846 (25.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003ePlacement type, n\u0026thinsp;=\u0026thinsp;3524\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommonwealth Supported (HECS) Place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2276 (64.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical Rural Bonded Scholarships (MRBS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74 (2.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBonded Medical Place (BMP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e933 (26.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommonwealth Bonded Place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (0.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eState Bonded Place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (0.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternational Fee-paying Place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89 (2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAustralian Fee-paying Place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107 (3.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (0.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRural background, n\u0026thinsp;=\u0026thinsp;3514\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1914 (54.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1600 (45.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eType of location in Australia lived longest, n\u0026thinsp;=\u0026thinsp;3541\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCapital or major urban city\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2068 (58.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegional city/large town\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e571 (16.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmaller town\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e397 (11.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural or remote community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e505 (14.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLived outside major city in Australia for 10 years cumulatively or 5 years consecutively, n\u0026thinsp;=\u0026thinsp;3540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1821 (51.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1719 (48.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eYear at RCS, n\u0026thinsp;=\u0026thinsp;3524\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2256 (64.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond consecutive year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e771 (21.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird consecutive year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e176 (5.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e321 (9.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eUpon entry to RCS, geographical location in Australia mostly likely to practise after training, n\u0026thinsp;=\u0026thinsp;3436\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCapital or major urban city\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2559 (74.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegional city/large town\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e495 (14.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmaller town\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e170 (4.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural or remote community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e212 (6.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMember of university\u0026rsquo;s student rural health club during preclinical years, n\u0026thinsp;=\u0026thinsp;3425\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1819 (53.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1606 (46.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003csup\u003eRCS=rural clinical school. FRAME=Federation of Rural Australian Medical Educators\u003c/sup\u003e.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInsert\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cb\u003ehere\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eChange in perceived social isolation and wellbeing of medical students over time\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the percentage of students who disagreed or agreed with the statements \u003cem\u003e\u0026lsquo;I felt socially isolated during my RCS placement\u0026rsquo;\u003c/em\u003e and \u003cem\u003e\u0026lsquo;My RCS placement impacted positively on my wellbeing\u0026rsquo;\u003c/em\u003e between 2017 and 2022. Solid lines represent the proportion who agree with the statement; otherwise, dotted lines were used.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSocial isolation\u003c/h2\u003e \u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e showed significant changes across years in the student perception of social isolation while in RCS placement (p\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.001). On average, more than 1 in 2 medical students reported feeling socially isolated during their RCS placement, with an increase of about 23.2% from 2017 to 2022. There was a dramatic increase of about 17.4% in the proportion who felt socially isolated between 2018 and 2019, before steadily increasing each year until 2022. From 2019 onwards, more than half of students consistently agreed that they felt socially isolated during their RCS placement.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eWellbeing\u003c/h2\u003e \u003cp\u003eAcross all years, significantly more students agreed that their RCS placement had a positive impact on their wellbeing (average of 80.9% over 5 years, p\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The proportion of students who felt their wellbeing was positively impacted during their RCS placement decreased by 11.0% between 2017 (84.3%) and 2019 (75.0%), before rising again in subsequent years. By contrast, the proportion that disagreed with this statement rose by about 19.7% over the study period (from 15.7% in 2017 to 18.8% in 2022).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eStudent perceptions of social isolation during their RCS placement\u003c/h2\u003e \u003cp\u003eOver the years, majority of students agreed that they felt well-supported financially (65.6%), and this was significantly associated with their lack of feelings of social isolation (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 as seen in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the percentage distribution of student responses regarding the statement \u003cem\u003e\u0026lsquo;I felt socially isolated during my RCS placement\u0026rsquo;\u003c/em\u003e by their sociodemographic variables.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudents responses on feeling of social isolation during RCS placement, derived from the statement \u0026lsquo;I felt socially isolated during my RCS placement\u0026rsquo; (n\u0026thinsp;=\u0026thinsp;3462, otherwise stated).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eOutcome, n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eDisagree\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eAgree\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e378 (54.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e318 (45.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e359 (54.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e296 (45.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e234 (37.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e392 (62.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e167 (37.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e280 (62.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e192 (35.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e348 (64.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e155 (31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e343 (68.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender, n\u0026thinsp;=\u0026thinsp;3416\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e604 (41.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e852 (58.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e857 (43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1103 (56.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eAge groups, n\u0026thinsp;=\u0026thinsp;3356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u0026ndash;22 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e212 (42.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e293 (58.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e247 (43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e351 (56.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e282 (44.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e351 (55.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;26 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e318 (42.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e429 (57.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;27 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e357 (42.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e489 (57.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003ePlacement type, n\u0026thinsp;=\u0026thinsp;3437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommonwealth Supported (HECS) Place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e958 (43.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1270 (57.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical Rural Bonded Scholarships (MRBS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (56.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (43.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBonded Medical Place (BMP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e385 (42.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e514 (57.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommonwealth Bonded Place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (61.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (38.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eState Bonded Place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (23.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (76.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternational Fee-paying Place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (62.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAustralian Fee-paying Place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (35.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68 (64.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRural background, n\u0026thinsp;=\u0026thinsp;3424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e823 (44.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1043 (55.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e645 (41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e913 (58.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eType of location in Australia lived longest, n\u0026thinsp;=\u0026thinsp;3452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCapital or major urban city\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e865 (43.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1145 (57.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegional city/large town\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e248 (44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e313 (55.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmaller town\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163 (41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e228 (58.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural or remote community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e205 (41.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e285 (58.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLived outside major city in Australia for 10 years cumulatively or 5 years consecutively, n\u0026thinsp;=\u0026thinsp;3452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e781 (44.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e994 (56.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e697 (41.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e980 (58.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eYear at RCS, n\u0026thinsp;=\u0026thinsp;3434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e934 (42.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1269 (57.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond consecutive year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e325 (43.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e425 (56.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird consecutive year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98 (56.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77 (44.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112 (36.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e194 (57.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eUpon entry to RCS, geographical location in Australia mostly likely to practise after training, n\u0026thinsp;=\u0026thinsp;3390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCapital or major urban city\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1109 (43.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1417 (56.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegional city/large town\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e219 (45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e268 (55.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmaller town\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96 (57.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural or remote community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (30.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e146 (69.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eI feel well supported academically by RCS, n\u0026thinsp;=\u0026thinsp;3454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e207 (14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e249 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1272 (86.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1726 (87.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eI feel well supported financially by RCS, n\u0026thinsp;=\u0026thinsp;3422\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e565 (38.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e671 (34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e908 (61.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1278 (65.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eI felt academically isolated during my rural placement, n\u0026thinsp;=\u0026thinsp;3455\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e458 (30.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1025 (69.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1858 (94.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRCS informed me of health and counselling services that I could access for support if needed, n\u0026thinsp;=\u0026thinsp;3434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e435 (29.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e622 (31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1040 (70.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1337 (68.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eI felt well supported by RCS, n\u0026thinsp;=\u0026thinsp;3455\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e211 (14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e248 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1271 (85.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1725 (87.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eI have rural-based clinician as mentor, n\u0026thinsp;=\u0026thinsp;3419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e588 (39.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e684 (35.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e887 (60.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1260 (64.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMedical school provided mindfulness course, n\u0026thinsp;=\u0026thinsp;3441\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e885 (59.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1148 (58.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e593 (40.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e815 (41.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMedical school provided other formal wellbeing/resilience training, n\u0026thinsp;=\u0026thinsp;3441\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e954 (64.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1210 (61.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e524 (35.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e753 (38.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMedical school provided structured support activities, n\u0026thinsp;=\u0026thinsp;3439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e798 (54.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1044 (53.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e678 (45.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e919 (46.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMedical school provided informal/optional wellbeing activities, n\u0026thinsp;=\u0026thinsp;3442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e621 (42.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e809 (41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e855 (57.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1157 (58.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMedical school provided active role modelling of self-care, n\u0026thinsp;=\u0026thinsp;3422\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e808 (55.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1030 (52.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e662 (45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e922 (47.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuring my placement, I received formal tuition regarding career options for rural medical practice, n\u0026thinsp;=\u0026thinsp;3375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e806 (55.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1023 (53.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e638 (44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e908 (47.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuring my placement, I received informal information regarding career options for rural medical practice, n\u0026thinsp;=\u0026thinsp;3369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e294 (20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e373 (19.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1146 (79.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1556 (80.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuring my placement, I had the opportunity to work with junior doctors undertaking training for rural practice, n\u0026thinsp;=\u0026thinsp;3363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e242 (1.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e312 (16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1196 (83.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1613 (83.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMember of university's student rural health club during preclinical years, n\u0026thinsp;=\u0026thinsp;3377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e738 (41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1057 (58.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e703 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e879 (55.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRural health club activities increased my intentions of practising in a rural area compared to when entering medical school, n\u0026thinsp;=\u0026thinsp;1686\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e426 (56.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e527 (56.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e334 (43.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e399 (43.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOVID-19 year. n\u0026thinsp;=\u0026thinsp;3462\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e971 (65.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1006 (50.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e514 (34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e971 (49.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003eRCS=rural clinical school. COVID\u0026minus;19 year was defined as 2020\u0026ndash;2022\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInsert\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cb\u003ehere.\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOver the years, majority of students agreed that they felt well-supported financially (65.6%), and few of these students felt socially isolated compared to their counterparts who felt not well-supported financially (p\u0026thinsp;=\u0026thinsp;0.02)). Almost 95% of students agreed that they felt academically isolated which in turn significantly increased their feeling of social isolation compared to the students who did not feel academically isolated also. Compared to other placement types, significantly more students with a State Bonded Place and fewer students with a Commonwealth Bonded Place reported feeling socially isolated, during their RCS placement.\u003c/p\u003e \u003cp\u003eInterestingly, majority of students (64.8%) who disagreed with the statement that they felt socially isolated during their RCS placement had a rural-based clinician as a mentor and did not belong to the university\u0026rsquo;s student rural health club during their preclinical years. This was also true for students who were part of the club but participated to a lesser extent (55.6%) in their activities. Compared to the students who completed their RCS placement during the non-COVID years, the proportion who reported feeling socially isolated was significantly higher during the COVID-years (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStudent responses on their feeling of wellbeing by their sociodemographic variables\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the percentage distribution of the student responses regarding the impact of RCS placement on their wellbeing sociodemographic variables. Across five years, a vast majority of students (75.0-84.3%) agreed that their RCS placement impacted positively on their wellbeing, especially those aged between 24 and 26 years, and more among females than males (82.3% vs 79.2%; p\u0026thinsp;=\u0026thinsp;0.02). There were significantly more students with Medical Rural Bonded Scholarships (MRBS) who reported a positive impact on their wellbeing compared to those who were not on this scholarship, while fewer students with an International Fee-paying Place reported a positive impact on their wellbeing during RCS placement.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudents responses on how the rural clinical school placement years impacted their wellbeing, derived from the statement \u0026lsquo;RCS placement impacted positively on my wellbeing\u0026rsquo; (n\u0026thinsp;=\u0026thinsp;3451, otherwise stated).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eOutcome (n, %)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eDisagree\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eAgree\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e587 (84.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e128 (19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e526 (80.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e156 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e467 (75.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e361 (80.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e445 (84.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94 (18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e407 (81.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender, n\u0026thinsp;=\u0026thinsp;3407\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e301 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1146 (79.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e346 (17.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1614 (82.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eAge groups, n\u0026thinsp;=\u0026thinsp;3348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u0026ndash;22 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e386 (76.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e524 (83.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e532 (85.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;26 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125 (16.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e620 (83.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;27 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e182 (21.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e663 (78.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003ePlacement type, n\u0026thinsp;=\u0026thinsp;3426\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommonwealth Supported (HECS) Place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e429 (19.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1798 (80.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical Rural Bonded Scholarships (MRBS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68 (91.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBonded Medical Place (BMP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e175 (19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e717 (80.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommonwealth Bonded Place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (88.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eState Bonded Place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (88.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternational Fee-paying Place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (71.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAustralian Fee-paying Place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93 (91.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (75.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRural background, n\u0026thinsp;=\u0026thinsp;3414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e350 (18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1510 (81.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e300 (19.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1254 (80.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eType of location in Australia lived longest, n\u0026thinsp;=\u0026thinsp;3443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCapital or major urban city\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e381 (19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1624 (81.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegional city/large town\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112 (20.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e446 (79.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmaller town\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e312 (80.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural or remote community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e407 (82.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLived outside major city in Australia for 10 years cumulatively or 5 years consecutively, n\u0026thinsp;=\u0026thinsp;3442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e333 (18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1436 (81.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e322 (19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1351 (80.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eYear at RCS, n\u0026thinsp;=\u0026thinsp;3424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e415 (18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1779 (81.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond consecutive year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e134 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e614 (82.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird consecutive year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e138 (78.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e238 (77.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eUpon entry to RCS, geographical location in Australia mostly likely to practise after training, n\u0026thinsp;=\u0026thinsp;3379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCapital or major urban city\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e517 (20.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2002 (79.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegional city/large town\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e407 (83.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmaller town\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e144 (85.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural or remote community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e176 85.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eI feel well supported academically by RCS, n\u0026thinsp;=\u0026thinsp;3444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e272 (41.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e187 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e382 (58.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2603 (93.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eI feel well supported financially by RCS, n\u0026thinsp;=\u0026thinsp;3415\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e369 (56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e868 (31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e286 (43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1892 (68.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eI felt academically isolated during my rural placement, n\u0026thinsp;=\u0026thinsp;3441\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 (14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e472 (16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e558 (85.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2314 (83.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRCS informed me of health and counselling services that I could access for support if needed, n\u0026thinsp;=\u0026thinsp;3426\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e327 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e730 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e327 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2042 (73.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eI felt well supported by RCS, n\u0026thinsp;=\u0026thinsp;3447\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e325 (49.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e140 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e333 (50.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2649 (95.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eI have rural-based clinician as mentor n\u0026thinsp;=\u0026thinsp;3408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e316 (48.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e955 (34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e335 (51.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1802 (65.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMedical school provided mindfulness course, n\u0026thinsp;=\u0026thinsp;3431\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e430 (66.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1596 (57.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e220 (33.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1185 (42.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMedical school provided other formal wellbeing/resilience training, n\u0026thinsp;=\u0026thinsp;3431\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e495 (75.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1665 (59.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e158 (24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1113 (40.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMedical school provided structured support activities, n\u0026thinsp;=\u0026thinsp;3431\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e468 (72.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1369 (49.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e180 (27.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1413 (50.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMedical school provided informal/optional wellbeing activities, n\u0026thinsp;=\u0026thinsp;3432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e399 (61.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1028 (37.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e253 (38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1752 (63.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMedical school provided active role modelling of self-care, n\u0026thinsp;=\u0026thinsp;3414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e499 (77.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1338 (48.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e145 (22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1431 (51.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuring my placement, I received formal tuition regarding career options for rural medical practice, n\u0026thinsp;=\u0026thinsp;3365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e394 (62.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1436 (52.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e240 (37.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1295 (47.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuring my placement, I received informal information regarding career options for rural medical practice, n\u0026thinsp;=\u0026thinsp;2908\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e164 (25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e502 (18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e471 (74.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2222 (81.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuring my placement, I had the opportunity to work with junior doctors undertaking training for rural practice, n\u0026thinsp;=\u0026thinsp;3353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e144 (22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e408 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e489 (77.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2312 (85.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMember of university\u0026rsquo;s student rural health club during preclinical years, n\u0026thinsp;=\u0026thinsp;3368\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e368 (20.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1419 (79.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e267 (267)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1314 (83.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRural health club activities increased my intentions of practising in a rural area compared to when entering medical school, n\u0026thinsp;=\u0026thinsp;1685\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e186 (65.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e769 (54.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 (34.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e633 (45.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOVID-19 year, n\u0026thinsp;=\u0026thinsp;3451\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e393 (59.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1580 (56.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e265 (40.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1213 (43.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003eRCS=rural clinical school. COVID\u0026minus;19 year was defined as 2020\u0026ndash;2022\u003c/sup\u003e.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInsert\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cb\u003ehere\u003c/b\u003e\u003c/p\u003e \u003cp\u003eStudents were less likely to report that their RCS placement impacted positively on their wellbeing, if they felt well supported academically or financially. More than half of students who reported that their RCS informed them of health and counselling services or those who had a rural-based clinician as a mentor, reported a positive impact on their wellbeing compared to their counterparts. Of the students whose medical school did not provide a mindfulness course, formal wellbeing/resilience training, structured support activities, informal/optional wellbeing activities, active role-modelling of self-care or formal tuition regarding career options for rural medical practice majority did not feel that the RCS had a positive impact on their wellbeing.\u003c/p\u003e \u003cp\u003eOver 80% of students who agreed their RCS placement impacted positively on their wellbeing received informal information regarding rural career options, had the opportunity to work with rurally-training junior doctors or were members of their university\u0026rsquo;s student rural health club during their preclinical years. Majority of students who felt that their rural health club activities did not increase their intentions of practising in a rural area compared to when entering medical school, disagreed with the statement that the RCS placement had a positive impact on their wellbeing.\u003c/p\u003e \u003cp\u003e \u003cb\u003eUnivariate analysis of factors associated with social isolation and wellbeing of rural medical students.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIn the univariate analysis, placement type, perceived financial support, mentorship by rural-based clinician(s) and membership of the university\u0026rsquo;s student rural health club during preclinical years were significantly associated with feeling socially isolated and positive impact on wellbeing during their RCS placement. There were significant associations between gender, age, perceived academic support, perceived support by RCS, location and the students report of positive impact on wellbeing during RCS placement. Students report of social isolation was also significantly associated with the year at RCS, feeling of academic isolation and was higher during the COVID-year.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMultivariable analysis of factors associated with social isolation and wellbeing of rural medical students.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e displays the variables that are significantly associated with students feeling of social isolation identified by a forward (conditional) binomial logistic regression with \u003cem\u003e\u0026lsquo;I felt socially isolated during my RCS placement\u0026rsquo;\u003c/em\u003e as the outcome variable and \u0026lsquo;Year\u0026rsquo; as the controlled variable. The non-significant variables in the model have been presented in Supplementary Table\u0026nbsp;1.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBinomial logistic regression of factors associated with self-reported social isolation during RCS placement with \u0026lsquo;Year\u0026rsquo; as control.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural background\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.77 (0.60, 0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpon entry to RCS, geographical location in Australia mostly likely to practise after training is capital or major urban city\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.12 (0.82, 1.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpon entry to RCS, geographical location in Australia mostly likely to practise after training is regional city/large town\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.78 (0.45, 1.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpon entry to RCS, geographical location in Australia mostly likely to practise after training is smaller town\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.46 (0.26, 0.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI felt academically isolated during my rural placement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.13 (8.07, 18.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003eRCS=rural clinical school; OR= Odd ratios; CI=Confidence intervals. Year of study was controlled for in the analysis\u003c/sup\u003e.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInsert\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e \u003cb\u003ehere\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAfter controlling for the year of survey, students who felt feel academically isolated were 12.1 times more likely to report social isolation while those who come from a non-rural background were 1.3 times more likely to report social isolation during placement. Other factors associated with feeling of social isolation in this study included preferring practising in a capital or major urban city upon entry to the RCS, while students that preferred practising in a smaller town and regional city/large town were 2.18 times and 1.28 times less likely to feel socially isolated, respectively. Surprisingly, the COVID-19 year had no significant influence on the students\u0026rsquo; feeling of social isolation in this study.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e presents the variables that were significantly associated with positive wellbeing after controlling for year of study in the regression analysis.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBinomial logistic regression of factors associated with positive impact on students\u0026rsquo; wellbeing during their RCS placement with \u0026lsquo;Year\u0026rsquo; as the control.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.64 (1.17, 2.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel well supported academically by RCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.57 (1.61, 4.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel well supported financially by RCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.94 (1.39, 2.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI felt well supported by RCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.63 (3.56, 8.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical school provided active role modelling of self-care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.15 (1.44, 3.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical school provided informal/optional wellbeing activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.48 (1.03, 2.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuring my placement, I had the opportunity to work with junior doctors undertaking training for rural practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.70 (1.12, 2.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003eRCS=rural clinical school; OR= odd ratio; CI= confidence interval. Year of study was controlled for in the analysis\u003c/sup\u003e.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInsert\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e \u003cb\u003ehere.\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFrom Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, students who felt well supported academically, financially or in general were significantly more likely to agreed that their RCS placement impacted positively on their wellbeing. Medical students were 2.40 times and 1.66 times more likely to report a positive impact on their wellbeing when the medical school actively role-modelled self-care and provided informal information regarding rural career options respectively during their RCS placement. Also, the COVID-year was not significantly associated with the students\u0026rsquo; report on their wellbeing in this study.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study examined medical students' perceptions regarding their well-being and social isolation during RCS placements over a five-year period using the FRAME dataset. The study found that for most medical students, their RCS placement had a positive impact on their well-being, but in a small proportion of them, their experience was not positive, and this perception increased over time. On average, more than half of the students felt socially isolated during the study period, and this proportion also increased over the five years. Studies have found that about one in four medical students had depression, and another 20.2% had anxiety [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In another study, 26.5% of medical students had experienced burnout during their RCS placement [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], with a significant proportion of male (17.1%) and female (20.5%) medical students across Australia self-reporting suicidal ideation [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. These findings agreed with the present study findings of a decrease over time with respect to the proportion of students who felt that RCS placement had a positive impact on their wellbeing. The findings attest to the rising mental health struggles faced by Australian medical students, signalling the need for effective wellbeing strategies.\u003c/p\u003e \u003cp\u003eA major finding from this study was the lack of impact of the COVID-years (2020 to 2022) on students feeling of social isolation and well-being, which was contrary to a previous study [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In that study, the proportion that reported psychological distress increased by 6.25% among people aged 18 years or older between 2017 and 2020, which marked the beginning of the COVID pandemic [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The present study did not assess psychological distress, which is considered a mental health problem [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], and it was beyond the scope of this study to interrogate the reasons for our findings. Other potential explanations for the lack of COVID-19 impact on wellbeing may include the shorter duration of the lockdowns in some rural and regional areas, some states and territories, and the difference in rural training programs between universities. Also, the riming of data collection differed between studies in relation to pandemic progression which may explain some of the differences in findings.\u003c/p\u003e \u003cp\u003eAnother major finding of this study was that a sustained high proportion of students (more than one in every two students) felt socially isolated during their RCS placement. These figures are higher than previous reports in 2015, which found that 37.1% of medical students in Australia felt socially isolated during their RCS placement [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Furthermore, this increases in perceived social isolation among medical students mirrors the declining frequency of social contact across all age groups in Australia which may explain the rise in social isolation noted in this study, suggesting the need to foster social contact among medical students.\u003c/p\u003e \u003cp\u003eMultivariable regression analysis revealed that students who felt academically isolated were more likely to report social isolation. Past research has reported that medical students often segregate themselves from non-medical students and may spend less time with friends and family due to the structure and time commitments required to excel academically and the high workload [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The smaller number of students in RCS may further contribute to students\u0026rsquo; experience of academic isolation. In addition, social isolation was higher among students who came from a non-rural background or preferred to practise in a capital or major urban city after training. These findings corroborate a 2011 Western Australian study, which reported that medical students\u0026rsquo; rural background was a strong motivation to go rural after graduation. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] A 2022 Australian study also found that, 8 years after graduation, medical students of rural origin with extended rural clinical school experience were more likely to practise in regional or rural communities than graduates of metropolitan origin without such training. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eStudents who felt academically supported were more likely to report a positive impact on their well-being during their RCS placement. This is consistent with a previous report linking academic studies and exams to stress among medical students [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In another study, authors found that stress from can undo team cohesion as students often prioritise their own needs [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Considering that medical school is academically demanding, it is possible that feeling well supported academically would impact positively on the student wellbeing, further highlighting the need to improve academic support provided by medical schools and reduce academic isolation to alleviate social isolation and poor wellbeing among students.\u003c/p\u003e \u003cp\u003ePositive wellbeing during the RCS placement was significantly associated with perceived financial support by the RCS. A past study found that two-thirds of medical students found financial concerns very or extremely stressful. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] In 2023, the maximum HECS-HELP debt for medical students was \u003cspan\u003e$\u003c/span\u003e162 336, which is nearly 1.5 times that of other students. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] In a 2013 study by Cardiff University, medical students revealed that the financial burden of medical school was a major stressor, stating that \u0026ldquo;the added cost of buying clothes for placement, as well as books and stethoscopes\u0026hellip;[and] travelling can cause extra debt\u0026rdquo;. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] The study went on to identify measures to alleviate the stress of finances for medical students such as teaching them how to manage finances effectively, travel reimbursements and subsidies or bulk discounts for medical equipment. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eActive role-modelling of self-care and informal information regarding rural career options was significantly associated with a report of positive well-being in this study. These findings underscore the importance of having active demonstration of effective self-care practices to equip medical students with healthy habits and techniques to improve their wellbeing. Medical schools should also ensure that information regarding rural medical practice is readily available to students.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eThis study had some limitations that should be considered when interpreting or comparing the findings with other studies. First, the voluntary nature of survey participation introduces potential selection bias, meaning that the sample population may not be representative of Australian medical students undertaking rural clinical placements at the time. Second, the assumption that students with 'Neutral' responses are more likely to agree or disagree with a particular statement may not hold true in all circumstances due to insufficient information about their perceptions.\u003c/p\u003e \u003cp\u003eThird, the lack of clear definitions for 'well-being' and 'social isolation' in the FRAME surveys may affect data interpretation. Students may have different interpretations of these terms, resulting in an inconsistent frame of reference through which to view the questions. For example, social isolation may be incorrectly interchanged with loneliness and wellbeing could encompass mental and/or physical spheres. Fourth, restrictions that accompany the data sharing agreement in this study prevents any comparison between participating universities. State-based comparisons are not always available due to the unequal distribution of RCS between states. Fifth, there is a potential for self-reporting bias of social isolation, wellbeing and support since these concepts are subjective and may be influenced by individual expectations [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Finally, missing data could affect the accuracy of the data analysis. In the future, the reasons for a lack of response by students should be explored.\u003c/p\u003e \u003cp\u003eDespite these limitations, the study's strength lies in its representation of medical students from 17 Australian medical schools, allowing for a comprehensive national evaluation. The longitudinal nature of this study provides insights into trends over time. To our knowledge, it is the first study to analyse changes in medical students' well-being and social isolation over five years. The inclusion of rural-specific variables in the survey allows the study to evaluate social isolation and wellbeing among medical students at RCS more effectively.\u003c/p\u003e \u003c/div\u003e "},{"header":"CONCLUSION AND RECOMMENDATION","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003cp\u003eOverall, over one in two medical students in Australian RCS experienced social isolation whereas one in five felt that their RCS did not have a positive impact on their wellbeing. There was a decline in perceived well-being and an increase in social isolation among the students undertaking RCS placements over time and this was attributed to factors such as academic and financial support, academic isolation, rural background, active role-modelling of self-care and information regarding rural career options. Surprisingly, COVID-years had no significant impact on both outcome measures in the adjusted analysis. Addressing social isolation and well-being factors by implementing effective wellness strategies and support networks is crucial to foster empathetic, resilient healthcare professionals in the future. Improving students\u0026rsquo; wellbeing could also contribute to greater retention of doctors in rural and remote areas to address the shortage of medical practitioners in these locations.\u003c/p\u003e \u003cp\u003eTo improve student well-being and minimise feelings of social isolation, we recommend that medical schools consider these findings, and in doing so, work towards identifying and implementing explicit measures of academic and financial support. Such support might encompass initiatives such as providing virtual study groups, formative examinations, accommodation, scholarships and commute subsidies. Continuing and/or expanding RCS student access to role-modelling of self-care and informal information regarding rural career options is likely to have a positive influence reducing social isolation and increasing wellbeing, as indicated by the results of this study. Improving medical students\u0026rsquo; wellbeing during RCS placements may also increase their intentions to practice rurally, assisting with the recruitment and retention of future doctors in rural and remote areas.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all participants prior to completing the survey. Ethics approval was obtained from University of Notre Dame Australia (UNDA:2020-196S) and from each of the participating universities. The custodian of the FRAME data also gave approval the use of the data set for the purpose of this study. The study was conducted in accordance with the tenets of the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset supporting the conclusions of this article is included within the article (and its additional files).\u0026nbsp;Data is also\u003cstrong\u003e\u0026nbsp;\u003cstrong\u003eavailable on request from the corresponding author U.L.O.\u003c/strong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eU.L.O, M.L., P.S, T.M, and Z.D. were involved in the conceptualization of the study; U.L.O, M.L., P.S, T.M, S.D, and Z.D. performed the methodology; Software, Z.D., and U.L.O; Validation, U.L.O, M.L., J.B., P.S, T.M, S.D, and Z.D.; Formal Analysis, Z.D., M.L., and U.L.O.; Investigation, all authors; Resources, Z.D., M.L., and U.L.O; Data Curation, Z.D., M.L., P.S., T.M., and U.L.O.; Writing \u0026ndash; Original Draft Preparation, Z.D., M.L., T.M., and U.L.O.; Writing \u0026ndash; Review \u0026amp; Editing, U.L.O, M.L., J.B., P.S, T.M, S.D, and Z.D.; Visualization, U.L.O, M.L., J.B., P.S, T.M, S.D, and Z.D; Supervision, U.L.O., Z.D. and T.M. Project Administration, M.L., Z.D., and U.L.O. All authors reviewed the manuscript, read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWelfare AI. .o.H.a. 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Front Public Health. 2021;9:679178.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJafari H, Aghaei A, Khatony A. The relationship between addiction to mobile phone and sense of loneliness among students of medical sciences in Kermanshah, Iran. BMC Res Notes. 2019;12(1):676.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVythilingam DI, et al. A scoping review of the literature on the impact of the COVID-19 quarantine on the psychological wellbeing of medical students. BMC Med Educ. 2022;22(1):770.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaz D et al. \u003cem\u003eCOVID-19 and mental health: A systematic review of international medical student surveys\u003c/em\u003e. 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Impact of COVID-19 on Medical Students around the Globe. J Community Hosp Intern Med Perspect. 2022;12(4):1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBingham A, et al. How rural immersion training influences rural work orientation of medical students: Theory building through realist evaluation. Med Teach. 2021;43(12):1398\u0026ndash;405.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsaac V, Pit S, Craig M. \u003cem\u003eSelf-efficacy reduces the impact of social isolation on medical student\u0026rsquo;s rural career intent\u003c/em\u003e. BMC Med Educ, 2018. 18(42).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartin P, et al. Impact of the COVID-19 pandemic on student experiences during rural placements in Australia: findings from a national multi-centre survey. BMC Medical Education; 2022. p. 22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFRAME. Publications \u0026amp; Resources. 2023 [cited 2023 December 14]; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ausframe.org/publications-and-resources/\u003c/span\u003e\u003cspan address=\"https://ausframe.org/publications-and-resources/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreenhill J, Walker J, Playford D. \u003cem\u003eOutcomes of Australian rural clinical schools: a decade of success building the rural medical workforce through the education and training continuum\u003c/em\u003e. Rural Remote Health, 2015. 15(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBiddle N, Gray M, Rehill P. Mental health and wellbeing during the COVID-19 period in Australia. 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BMC Med Educ. 2015;15:137.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEy C. \u003cem\u003eHigher Education Loan Program (HELP) and other student loans: a quick guide\u003c/em\u003e. 2023 [cited 2024 February 8]; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.aph.gov.au/About_Parliament/Parliamentary_departments/Parliamentary_Library/pubs/rp/rp2223/Quick_ Guides/Higher_Education_Loan_Program#:~:text=For%202023%2\u003c/span\u003e\u003cspan address=\"https://www.aph.gov.au/About_Parliament/Parliamentary_departments/Parliamentary_Library/pubs/rp/rp2223/Quick_Guides/Higher_Education_Loan_Program#:~:text=For%202023%2\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003eC%20the%20limit%20is,%24113%2C028%20for%20all%20other%20students.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCohen D, et al. Factors that impact on medical student wellbeing - Perspectives of risks. Cardiff University; 2013.\u003c/span\u003e\u003c/li\u003e\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":"Students, rural medical schools, medical education, loneliness, social connectedness, mental health, wellbeing, stress, COVID-19, rural health, rural population","lastPublishedDoi":"10.21203/rs.3.rs-3958319/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3958319/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe geographical remoteness of rural clinical school (RCS) placements presents unique challenges to medical students, detrimentally impacting their well-being and potentially leading to social isolation. Understanding these challenges is essential for medical institutions to implement effective support mechanisms.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study investigated the perceptions of rural medical students regarding well-being and social isolation during a five-year period (2017 to 2022) during their RCS placements.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eData from approximately 600 medical students (mostly females n\u0026thinsp;=\u0026thinsp;2025, 57.7%) collected annually across 17 Australian universities, through self-administered FRAME (Federation of Rural Australian Medical Educators) surveys were extracted. Sociodemographic variables, their feelings of academic isolation and support, and the effect of COVID during their RCS were assessed. The main outcomes were social isolation and well-being which were derived from students\u0026rsquo; responses to the statement, \u0026lsquo;\u003cem\u003eI felt socially isolated during my RCS placement\u0026rsquo;\u003c/em\u003e, and \u003cem\u003e\u0026lsquo;Overall, my RCS placement impacted positively on my well-being\u0026rsquo;, respectively.\u003c/em\u003e Data was analyzed using descriptive statistics and binomial logistic regressions to identify factors associated with their perception of social isolation and well-being during RCS placement.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOver half of Australian rural medical students reported experiencing social isolation, with one-fifth expressing that rural placement had no positive impact on their wellbeing. Although the majority perceived a positive impact, this proportion decreased by 11.0% from 2017 to 2019, before rising again in subsequent years. Factors contributing to social isolation and negative impacts on well-being included academic isolation, non-rural background, preference to practice in a capital or major urban city upon entry to the RCS, and lack of academic, financial, or general support from the RCS. Positive influences were associated with active self-care role modeling and informal information regarding rural career options Notably, the years affected by the COVID-19 pandemic did not significantly alter perceived social isolation and well-being.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAddressing the challenges faced by medical students in rural placements is imperative to foster positive well-being and combat social isolation. These findings underscore the importance of tailored support mechanisms and educational programs to enhance resilience among future healthcare professionals. Moreover, improving the experiences of medical students in RCS placements may contribute to increased retention of doctors in rural and remote areas, thereby alleviating the nationwide shortage in these regions.\u003c/p\u003e","manuscriptTitle":"Longitudinal Assessment of Medical Students' Perceptions of Social Isolation and Wellbeing: A 5-Year Analysis of FRAME Surveys (2017-2022)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-27 16:24:06","doi":"10.21203/rs.3.rs-3958319/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":"b43a4b58-3bba-44d4-81b0-4bd144141a9c","owner":[],"postedDate":"February 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-22T04:54:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-27 16:24:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3958319","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3958319","identity":"rs-3958319","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}