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Rural temperament and character: A new perspective on retention of rural doctors

Rural temperament and character: A new perspective on retention of rural doctors. Diann Eley The University of Queensland, Rural Clinical School, School of Medicine Louise Young The University of Queensland, School of Medicine

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Rural temperament and character: A new perspective on retention of rural doctors

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  1. Rural temperament and character: A new perspective on retention of rural doctors Diann Eley The University of Queensland,Rural Clinical School, School of Medicine Louise YoungThe University of Queensland, School of Medicine Thomas R PrzybeckWashington University, Department of Psychiatry, School of Medicine, St. Louis, MO USA

  2. The rural doctor is an entity in itself but not well defined • Mostly anecdotal & narrative descriptions • Rural practice requires different skills & traits from urban counterparts • Temperament and Character Inventory (TCI) • Psychobiological model of personality • Cloninger, Svrakic, Przbeck. Archives of General Psychiatry 1993; 50: 975-990. Study Aim To describe how individual profiles (levels & combinations) of temperament & character traits influence GPs who flourish or fail in rural medicine

  3. Temperament Traits • mildly heritable, • developmentally stable, • emotion based & • not influenced by socio-cultural learning Four dimensions of Temperament • Novelty Seeking: NS (exploratory, impulsive, curious vs stoicism, frugality, regimented) • Harm Avoidance: HA (anxious, worrying, doubtful vs outgoing, confidence, vigour, risk taking) • Reward Dependence: RD (sentimental, warm, attached vs aloof, withdrawn, independent) • Persistence: PS (industrious, ambitious perfectionist vs indolent, modest)

  4. Character Traits • a reflection of personal goals & values • are moderately influenced by socio-cultural learning • mature progressively throughout life Three dimensions of Character • Self Directedness: SDi.e. self-concept (responsible, reliable, long term goals vs blaming, ineffective, short term goals) • Cooperativeness: COi.e. concept of relationships (empathic, constructive, vs critical, opportunistic) • Self-Transcendence: STi.e. global concept (idealistic, humble vs practical, arrogant)

  5. Methods • Two successive studies • Mixed method, cross sectional design - qualitative & quantitative methods • Study 1: Exploratory/Pilot - Purposive sampling, Rural GPs (n=13), 7- 40 years (mean = 23.1) experience in RRMA 5-7 practice in Central & Southern Queensland • All completed demographic questionnaire and TCI-R140 plus a semi- structured interview • Triangulation of data sources described the findings Study 2: Comparison of rural & urban GPs - Postal distribution of research materials to 286 rural GPs & 258 urban GPs Multivariate statistics compared the two groups & logistic regression predicted rural or urban practice from TCI dimensions

  6. RESULTS Study 1: Pilot study of 13 rural GPs • Interview findings concur with the literature • CHARACTER: ALL docs highly self-directed (SD), cooperative (CO), & objective (ST) • TEMPERAMENT: ALL very caring & reward dependent (RD) & persistent (PS). But more variation in Harm Avoidance (HA) & Novelty Seeking (NS) • Longer serving GPs, intent on staying rural = lower HA & higher NS compared to shorter serving GPs intending to leave (p<.01) Study 2: Comparison of rural versus urban GP cohorts • Response rates: 42% (n=120) for rural & 36% (n=94) for urban GPs • Rural GPs = significantly lower HA & higher NS compared to urban GPs • NS & HA independently predictive of rural or urban membership (p<.01)

  7. Implications for Recruitment • Differences detected were Novelty Seeking (NS) and Harm Avoidance (HA) – both temperament traits – more innate & not likely to change • These traits could be identifiable in persons regardless of prior life experience or educational exposure • Character traits are developmental & identification in established rural doctors may suggest areas for special training or counselling of students with an interest in rural practice • The higher curiosity level of a person high in NS might suggest that this is the impetus responsible for students/graduates to engage with rural medicine • The majority of medical students are not of rural origin with little or no knowledge of rural life. High levels of NS could be a contributingfactor to ‘testing the unknown’ i.e. going bush!

  8. Implications for Retention • Harm Avoidance (HA) has many adaptive advantages. A measure of anticipatory anxiety & the ability to tolerate uncertainty • Persons low in HA portray greater confidence when faced with uncertainty & optimism in situations that would worry most people • Rural GPs with low HA may be innately more suited to their environment & more likely to be retained for longer periods • Consider the rural GP as a unique entity - a mixture of both a primary care specialist who is also a proceduralist • Data imply that temperament levels of Reward Dependence (RD) [warm, dedicated, sociable] may vary • Levels of Novelty Seeking (NS) & Harm Avoidance (HA) may be most descriptive of individuals who cope in rural medicine

  9. SUMMARY A starting point to establish a psychobiological profile for rural doctors This preliminary work may be the precursor to a new approach to the recruitment and retention of rural health professionals • Predicting students who may be best suited to a rural career • Provide medical schools with more information regarding counselling students for (or against) rural medicine • Inform policy associated with incentives & retention strategies for existing rural doctors, nurses & allied health professionals

  10. Study Limitations • Cross sectional study – measuring variables at one point in time • Small sample size, from one state • Acknowledge the myriad of demographic, developmental & environmental factors that influence an individual’s life choices & psychological profile • Response rate – long questionnaire, rural focus, busy doctors • This paper was compiled from the following citations: • Eley D, Young L, Prysbeck T. Exploring the temperament and character traits of rural and urban doctors; implications for retention of the rural workforce. Journal of Rural Health (USA) In Press:Accepted 07 March 2008. • Eley D, Young L, Shrapnel M. Rural temperament and character: A new perspective on recruitment and retention of rural doctors. Australian Journal of Rural Health 2008; 16, 12-22 • Acknowledgements • This research was supported by grants from the Australian Research Council and the Central and Southern Queensland Training Consortium

  11. Temperament Descriptors Taken from Cloninger et al, 1994

  12. Character Descriptors Taken from Cloninger et al, 1994

  13. Queensland AUSTRALIA (a BIG place & a LONG way away)

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