Rural Remote Health
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Rural Remote Health · Jan 2012
A decade of Australian Rural Clinical School graduates--where are they and why?
The Australian Rural Clinical School (RCS) initiative has been addressing the rural medical workforce shortage at the medical education level for over a decade. A major expectation of this initiative is that it will improve rural medical workforce recruitment and subsequent retention through a rurally based undergraduate clinical training experience. The longitudinal nature of these workforce initiatives means that definitive evidence of its impact on the shortage of rural doctors is yet to be provided; however, to date cross-sectional studies are accumulating a measure of efficacy for these initiatives by monitoring early career factors such as internship location choice and speciality choice of RCS graduates. This article reports on a study in one RCS that is monitoring the impact of rural undergraduate clinical training on trends in workforce participation patterns of its graduates as long as 9 years in the workforce. Career location and speciality choice are reported as well as perspectives on early career intentions and the reality of making career and life decisions as a doctor in the medical workforce. ⋯ The study highlighted what is obvious but often overlooked in recruitment strategies for medical students and prevocational doctors: the significance of the inevitable life decisions that frequently take precedence over career intentions. A decade on there is strong endorsement for the positive influence that rural undergraduate clinical training has on promoting rural career intentions. However the fulfilment of these intentions is at risk when competing with concurrent personal/life choices and while based in an urban training environment. Provision of a continuum of postgraduate training opportunities in rural and regional settings that include a rural focus for specialties such as surgery, anaesthetics and obstetrics could: (1) satisfy speciality training requirements; (2) focus life decisions in a rural environment; and (3) keep rural career intentions viable and congruent with other life goals. The overriding message is: the longer the exposure to training in the rural context, the greater the impact on interest in future rural practice and, particularly, the greater the likelihood that important life decisions will also be made in the rural context.
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Rural Remote Health · Jan 2012
Extending the paramedic role in rural Australia: a story of flexibility and innovation.
This article identifies trends in the evolving practice of rural paramedics and describes key characteristics, roles and expected outcomes for a Rural Expanded Scope of Practice (RESP) model. ⋯ Adoption of the RESP model would mean that paramedics undertake four broad activities as core components of their new role: (1) rural community engagement; (2) emergency response; (3) situated practice; and (4) primary health care. The model's key feature is a capacity to integrate existing paramedic models with other health agencies and health professionals to ensure that paramedic care is part of a seamless system that provides patients with well-organized and high quality care. This expansion of paramedics' scope of practice offers the potential to improve patient care and the general health of rural communities.
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Rural Remote Health · Jan 2012
Recruiting and retaining rural students: evidence from a faculty of dentistry in South Africa.
There is a shortage internationally of adequately trained health professionals to service rural areas. Health professionals are more likely to practice in communities that are like the one in which they grew up. The WHO therefore suggests targeted university admission policies to facilitate the enrolment of students from rural areas. In South Africa, rural students have special needs with regard to university access and throughput because they come from the most economically disadvantaged communities and often are the first in their families to attend university. This descriptive study, the first in South Africa with a cohort of dentistry students, draws on data from undergraduates at a single faculty of dentistry in South Africa. It investigates the factors affecting rural students' access to university, their academic success, as well as their employment intentions. ⋯ Only a minority of dentistry students came from rural areas, and rural schools did not adequately prepare these students academically for university. Rural students also lacked immediate access to people with insight into the academic and socio-cultural aspects of higher education, including the process of independent learning. Despite financial and academic challenges, rural students had a significantly stronger commitment to rural employment than students from cities and towns. It is recommended that rural students should receive academic, financial, and mentoring support both before and during their studies.
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Rural Remote Health · Jan 2012
Qualitative needs assessment: healthcare experiences of underserved populations in Montgomery County, Virginia, USA.
Portions of Montgomery County, Virginia, are designated a Medically Underserved Area with a large portion of this population experiencing limited access to healthcare services. In September 2008, the Federal Bureau of Primary Care awarded the authors a planning grant to assess community need in Montgomery County and to develop a strategic plan to establish a Federally Qualified Health Center (FQHC) to best meet these needs. An FQHC is a federally funded clinic mandated to provide medical, dental and mental health services to underserved communities. As part of the planning process, the decision was made to include qualitative data to better understand the needs of underserved residents in the community. Descriptive studies of target populations can provide further insight into community priorities for effective health improvement and planning. The objective of the study was to investigate and describe the perceptions, beliefs and practices that impact healthcare utilization among underserved populations in Montgomery County, Virginia. This study was conducted as part of a comprehensive community assessment to determine the feasibility of developing a FQHC. ⋯ Establishing care that is culturally relevant, targets perceived barriers and incorporates and enhances coping strategies is needed to increase accessibility and utilization of preventative and comprehensive healthcare services. The findings from this study will assist in creating a strategic plan for a FQHC that capitalizes on community strengths while addressing the challenges and complex needs of the community.
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Rural Remote Health · Jan 2012
Is Fly in/Fly out (FIFO) a viable interim solution to address remote medical workforce shortages?
Geographically remote regions of Australia experience a higher degree of socioeconomic inequality and health inequity, amid poor resourcing and extreme climatic conditions, when compared with their more urban counterparts. Doctors with the knowledge, skills and interest in remote work remain a scarce resource, with only 58 practitioners per 100,000 people versus 196/100,000 in metropolitan areas. Pending the arrival of the full complement of long-term remote medical workforce, an alternative solution that has so far received little attention but could provide near equivalence to resident doctors is the 'fly in/fly out' (FIFO) model. ⋯ Although FIFO presents challenges and is not for everyone, it may be time for organisations providing medical care to remote Australia to further consider this option. Allowing mid-career doctors experienced in remote medicine to continue remote clinical practice when they move to the city for family reasons would provide an immediate benefit to remote communities. Notwithstanding the challenges, perhaps it is time to consider the option of FIFO to address ongoing workforce shortages?