Introduction: In their first clinical year 25% of Western Australia's medical students undertake a clinical longitudinal integrated clerkship in rural and remote Western Australia. Annual evaluations are undertaken.

Method: All students, academic and administrative staff employed by the university were interviewed. Qualitative analysis of interview data was taken, fed back to the coordinators and modifications for the next annual cycle were then discussed and decided upon.

Results: The predominant themes were elation at the excellence of much of their rural experience and frustration at some individual sites because of issues which were not being resolved. Students were overwhelmingly positive in their interpretation of problems seeing them as systems issue to be improved. Staff at some sites, however, had a strong tendency to blame the student and not respond to the actual problem. All students passed their end of year examinations.

Discussion: Most academic evaluation of courses has focussed on comparative academic results with less, if any, attention paid to the qualitative experience of students. Not all clinical clerkship experiences are positive and it is useful to identify what works and what does not work in any medical school. Staff defensiveness is a well-recognised response to challenges and an evaluation system which encourages staff development is an essential component to any School's ongoing improvement.