Is small beautiful? Student performance and perceptions of their experience at larger and smaller sites in rural and remote longitudinal integrated clerkships in the Rural Clinical School of Western Australia.

INTRODUCTION The Rural Clinical School of Western Australia (RCSWA) provides 25% of Western Australia's medical students in their first full clinical year with a longitudinal integrated clerkship in rural and remote areas. They live and work in 10 different sites in groups of 3 to 10 members. This study aimed to discover if students at the smaller sites were disadvantaged by the reduced number of student colleagues, and also by a smaller population catchment area potentially providing a smaller number of clinical presentations. METHOD Data were collected from 2003 until 2007 from a variety of sources including annual comparisons of end of year results, annual mid-year interviews of all students and staff, and the Dundee Ready Education Environment Measure (DREEM) Survey. RESULTS There was no difference in end of year results between smaller sites and larger sites and both had slightly higher marks (and statistically significantly better) than their metropolitan colleagues. Mid-year interviews were shown to correlate significantly with the findings from the DREEM questionnaire in terms of student perceptions. Students at small sites were more satisfied with their educational experience than those at the larger sites. CONCLUSION With good infrastructure, clarity about learning objectives and a structured academic approach to the complexities of the first full clinical year's curriculum, students need not be disadvantaged by being sent in small numbers to small and/or remote sites for their clinical education. This was established both academically in terms of end of year marks, and also by their subjective experiences.