increasing for medical student, intern and registrar training placements in rural general practices. This demand is being driven by two imperatives. The first is a need for training placements for the growing number of medical students, interns and registrars. Medical student numbers have increased by 81% between 2005 and 201215 with the majority of these students undertaking their placements in rural clinical schools. Following this increase in medical student numbers is a steep increase in the number of medical interns, many of whom are being accommodated in general practice placements. General practice training program entrants doubled, from 600 to 1200 nationally, between 2010 and 201416,17.
The second imperative seeks to address shortages in the rural medical workforce by placing higher numbers of learners in rural settings both to provide an immediate workforce and to build a rural medical workforce. The 'rural pipeline' is considered to be a means of graduating doctors who are likely to practice rurally: preferentially selecting students from rural backgrounds into medical school and providing them with undergraduate, postgraduate, vocational and post-vocational training in the rural context18-21. Education in rural general practices is core to the 'rural pipeline'22. It has been well established that medical students who are exposed to rural settings during their training are more likely to engage in rural practice after graduating20. Also, placing GP registrars in rural practices provides a rural workforce and is a way of attracting more experienced practitioners to rural communities23. The 'rural pipeline' also supports practising rural doctors by enriching their experience, addressing isolation and helping to develop skills18.
While increasing the number of learners in rural general practice may be a way of attracting and retaining rural GPs, the capacity for rural practices to host more learners is limited. Laurence and Black's 2007 survey of urban and rural training practices found that although GPs were usually willing to increase teaching loads, the ability to do so depended on adequate additional resources and support, particularly in areas such as funding for teaching, practice subsidies and consulting space3.
There is capacity for rural general practices to increase engagement in education. For example, practices that do not host learners could be recruited as teaching practices, while practices that host one learner may have capacity to host several learners at different levels of training. To achieve this, educational and funding models that are attractive and sustainable for both practices and learners must be developed. For education to be considered as a core activity, the approach to funding, educational support and learner placement must be an integrated one22. Further, issues such as effective teacher orientation and professional development, physical space, infrastructure and internal organisational structures need to be considered22,24.
Elsewhere the authors have reported the advantages and challenges for rural general practices to host several learners at varying levels25. In that report, the perspective of the practice, the learners and the practice patient community was examined. This article addresses the research question, 'What considerations contribute to the development of a rural academic general practice?'
The rural academic general practice
To inform the development of a rural academic general practice, the model of the academic health sciences centre (AHSC) was explored for use in the context of a rural academic general practice. AHSCs are well established in the USA and the UK and are beginning to be acknowledged in Australia26. The AHCS model describes three complementary pillars of service, education and research. A principle of the AHCS model is fostering the 'discovery-care' continuum by bringing clinical services, education and research together in the one institution. AHSCs are characterised by their large scale, resulting in improved patient outcomes and cost efficiencies26