Barriers to practicing General Practice in rural areas - Results of a qualitative pre-post-survey about medical students during their final clinical year.

Objective: At the end of the Practical Year (PY), medical students decide on a specialization. Individual motivational factors and barriers play a central role in the choice of the subsequent subject area and the place of establishment (city/country). The aim of this study was to document the barriers of PY students within the General Practice (GP) tertiary elective over time. Methodology: Two guided interviews were conducted with each participant (N=19) as part of qualitative process monitoring - a pre-interview at the start and a post-interview after completion of the PY. Evaluation of the interviews was based on Grounded Theory. Results: 13 barriers could be deduced from the 38 interviews. The most frequently cited barriers were "expected workload", "recreational opportunities", "work-life balance" and "compatibility with family". 13 of the participants were firmly committed to continuing GP training, 12 of whom aspired to opening a practice in a rural area. Another three were considering GP training, three had decided against it after the PY. After the PY, some of the previously anticipated individual barriers were now perceived in a more differentiated manner as a result of practical experience. The barriers "work-life-balance", "compatibility with family", "recreational opportunities" and "infrastructure" had been largely eliminated. Conclusion: The PY General Practice Tertiary itself appears to have a positive impact on the individual barriers expressed before the PY. Targeted experience with a PY in General Practice at the end of study seems to be a solution to increase the attractiveness of the subject.