To the Editor: In the 4 February issue of the Journal, Playford and colleagues highlighted that clinical schools are encouraging interns and postgraduate year 2 (PGY2) trainees to complete some training in rural locations,1 a good strategy considering the link between living in a rural area and working there later.2

Prevocational training in New South Wales and the Australian Capital Territory is undertaken in 15 training networks administered by the NSW Institute of Medical Education and Training (IMET). Networks typically include a city tertiary referral hospital, a metropolitan district hospital and a rural hospital. Until now, all trainees were allocated to a network by an “optimised-preference” algorithm that maximises trainees’ preference for a particular network but does not guarantee their first choice. Intern and PGY2 rotations occur in the hospitals throughout the network, including rural sites.

Over the past few years, IMET has received requests to expand the number of rural sites accredited to provide trainees with all or most of their prevocational training in a rural site because:

• graduates with an interest in rural medicine want more opportunities for rural-based training;

• rural hospitals associated with a rural clinical school want to “retain” their rural students after graduation; and

• investment in rural clinical schools and the expanding service roles of rural hospitals has increased the attractiveness and viability of rural postgraduate training.

In 2006, as part of its review into the delivery of prevocational training in NSW, IMET piloted the Rural Preferential Recruitment (RPR) process:

• Accredited rural hospitals advertise positions under RPR.

• Interested trainees apply directly to these hospitals while applying for network optimised-preference allocation.

• These hospitals run a merit-based selection process before the main allocation process.

• Trainees who receive and accept an offer from a rural hospital are removed from the main allocation list.

• Trainees who do not gain a position from the RPR process remain in the main allocation process.

In 2006, four rural hospitals were involved in RPR and recruited 15 interns for the 2007 clinical year. In 2007, 11 rural hospitals attracted 122 applications from 58 applicants, and 35 doctors began a rural internship in January 2008.

IMET recently evaluated the RPR scheme, and there is clear demand for quality prevocational training in rural areas, particularly when applicants can choose their hospitals. We hope this increase in rural exposure during the prevocational years will result in more doctors spending all or part of their careers in rural practice.