Critically reviewing the policies used by colleges to select doctors for specialty training: A kink in the rural pathway

Objective: To review the selection policies and models used by speciality colleges to select candidates for entry to vocational training, exploring whether these processes are rural-focused. Design: A systematic desktop audit of college selection processes and criteria was done via college websites (Australian Medical Council (AMC) requires selection information to be publicly available). Setting and main outcomes: Material was extracted into a structured template, in 2020. Information extracted related to (i) training entry and selection steps; (ii) selection criteria and elements; (iii) rural-focused components; and (iv) rural outcomes. Findings were critically reviewed to explore their degree of rural focus. Results: Of 14 specialist colleges included, rural-focused selection mostly related to college-led selection models rather than employer-led. Six colleges had rural-focused selection criteria (four college-led), with the Australian College of Rural and Remote Medicine strongest, utilising a ‘suitability assessment’ for rural practice. Of the remaining five, childhood background or rural work experience contributed between 5% and 20% of the curriculum vitae assessment. Of eight specialist colleges without rural-focused selection, six used employer-led selection models. Conclusions: The majority of specialty colleges have no rural-focused selection criteria and colleges using employer-led models are weakest. Given that the colleges are required to adhere to the AMC's accreditation standards, it follows that the best way to mobilise change is by including rural selection policies within the AMC standards and requiring reporting of selection outcomes, regardless of the selection models used. This will substantially strengthen ongoing rural pathways in medicine.