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Objectives To determine whether moving clinical medical education out of the tertiary hospital into a community setting compromises academic standards.

Design Cohort study.

Setting Flinders University four year graduate entry medical course. In their third year, students are able to choose to study at the tertiary teaching hospital in Adelaide, in rural general practices, or at Royal Darwin Hospital, a regional secondary referral hospital.

Participants All 371 medical students who did their year 3 study from 1998-2002.

Main outcome measures Mean student examination score (%) at the end of year 3.

Results The unadjusted mean year 3 scores at each location differed significantly (P < 0.001); the mean score was 65.2 (SE = 0.43) for Adelaide students, 68.2 (0.83) for Darwin students, and 69.3 (0.97) for students on the rural programme. Mean year 2 scores were similar for each location. Post hoc tests of means …