Rural longitudinal integrated clerkships and medical workforce outcomes: A scoping review

Internationally the medical workforce is suffering from a persistent geographic and specialist maldistribution. Longitudinal models of rural medical education such as longitudinal integrated clerkships (LIC) have been one of the strategies employed to redress this issue. To map and synthesise the evidence on the medical workforce outcomes of rural LIC graduates, identifying gaps in the literature to inform future research. This review followed Arksey and O’Malley’s methodological steps. Databases searched included Medline, CINAHL Complete (EBSCOhost), Scopus, Embase (Elsevier), and ISI Web of Science. A total of 9045 non-duplicate articles were located, 112 underwent a full review, with 25 articles meeting the inclusion criteria. Studies were commonly cohort-based (84%), with data collected by database tracking and data linkage (52%). Five themes were identified to summarise the studies: (i) Overall geographic workforce outcomes (ii) influence of non-LIC medical training, (iii) remaining in region and level of rurality, (iv) medical speciality choice and rurality, and (v) selection and preferences. Synthesis of the evidence related to workforce outcomes of rural LIC graduates provides directions for future rural medical workforce planning and research. While rural LIC graduates were found to be more likely to work rurally and in primary care specialities compared to graduates from other training pathways there is evidence to suggest this can be enhanced by strategically aligning selection and training factors.

全球范围内，医疗人力始终面临地理分布与专科分布失衡的困境。诸如纵向整合临床实习（Longitudinal Integrated Clerkships, LIC）这类乡村医学教育纵向模式，正是用于纠正该问题的策略之一。本研究旨在梳理并综合乡村LIC毕业生的医疗人力从业产出相关证据，明确现有文献的研究空白以指导未来研究方向。

本综述遵循Arksey与O'Malley提出的方法学步骤开展。检索的数据库包括Medline、CINAHL Complete（EBSCOhost平台）、Scopus、Embase（Elsevier旗下）以及ISI Web of Science。最终共检索到9045篇非重复文献，其中112篇接受全文审阅，最终25篇符合纳入标准。

研究类型以队列研究为主（占比84%），数据收集方式多采用数据库追踪与数据关联法（占比52%）。最终归纳出5个研究主题：（1）医疗人力的整体地理分布从业结果；（2）非LIC医学培训的影响；（3）留在原地区的情况与乡村地域层级；（4）医学专科选择与乡村地域属性；（5）招募选拔与从业偏好。

对乡村LIC毕业生医疗人力从业产出相关证据的综合分析，可为未来乡村医疗人力规划与研究提供方向。研究发现，相较于其他培训路径毕业的医学生，乡村LIC毕业生更倾向于在乡村地区及基层医疗专科领域从业；另有证据表明，通过战略性匹配招募选拔与培训相关因素，可进一步强化这一效果。