Rural Remote Health
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Rural Remote Health · Jul 2015
Multicenter StudyRecruitment of doctors to work in 'our hinterland': first results from the Swansea Graduate Entry Programme in Medicine.
Recruitment and retention of doctors to rural and remote areas is a well-known problem to which very few countries are immune. Planning effective interventions to enable appropriate recruitment to rural areas requires an understanding of the specificities of each country and region, understanding 'what works' and 'why' in each specific context and then consideration of what that might mean in the context of neighbouring countries. In order to inform local policy makers and stakeholders, this study aimed to investigate 'how and why students elect to study in Wales, UK' and, more importantly, 'what influences students' choices about either staying, or leaving Wales, after graduation'. 'Our hinterland', in the title of this article, refers to the more rural parts of the country. ⋯ Despite the many positive aspects of studying in Wales and of having placements in rural areas emphasised by study participants, the prospect of entering postgraduate training in those regions is, for some, inhibited by feelings of social isolation and lack of opportunities. Some students still perceive rural locations as a backward step in the natural progression of their work and career. Graduates are concerned about discontinuity with family ties (for example stemming from the unpredictability of job allocation) and tend to gravitate to where family members, including life partners, reside. In line with international concerns and local efforts about these issues, the Swansea Graduate Entry Programme in Medicine will continue to monitor students' opinions and attitudes towards career pathways and training locations to maximise the likelihood of high-quality healthcare provision to rural communities.
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Rural Remote Health · Jul 2015
ReviewSuccesses, challenges and needs regarding rural health medical education in continental Central America: a literature review and narrative synthesis.
Central American countries, like many others, face a shortage of rural health physicians. Most medical schools in this region are located in urban areas and focus on tertiary care training rather than on community health or primary care, which are better suited for rural practice. However, many countries require young physicians to do community service in rural communities to address healthcare provider shortages. This study aimed to: (a) synthesize what is known about the current state of medical education preparing physicians for rural practice in this region, and (b) identify common needs, challenges and opportunities for improving medical education in this area. ⋯ Expertise in rural medicine and training exists in continental Central America. However, there are numerous challenges to improving medical education to meet the needs of rural communities. Overcoming these challenges will require creative solutions, new partnerships, and evaluation and dissemination of successful educational programs. There is a great need for further research on this topic.
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Rural Remote Health · Jul 2015
Using a participatory action research framework to listen to Aboriginal and Torres Strait Islander people in Australia about pandemic influenza.
This article describes the use and effectiveness of the participatory action research (PAR) framework to better understand community members' perceptions and risks of pandemic influenza. In 2009, the H1N1 influenza pandemic affected Indigenous populations more than non-Indigenous populations in Oceania and the Americas. Higher prevalence of comorbidities (diabetes, obesity, asthma and chronic obstructive pulmonary disease) as well as pregnancy in Indigenous communities may have contributed to the higher risks of severe disease. Social disparity, institutionalised racism within health services and differences in access to culturally safe health services have also been reported as contributors to disadvantage and delayed appropriate treatment. ⋯ The most effective responses of this project were embedded in pre-existing relationships with individuals within organisations that had been established over a long period of time between Aboriginal medical services and investigators; however, research relationships established specifically for the purposes of the project were less successful because of changes in personnel and organisational support. The participatory approach used in this study has the potential to be applied to vulnerable populations in other countries.
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Rural Remote Health · Jul 2015
ReviewThe Fly-in Fly-out and Drive-in Drive-out model of health care service provision for rural and remote Australia: benefits and disadvantages.
Rural Australians experience poorer health and poorer access to health care services than their urban counterparts, and there is a chronic shortage of health professionals in rural and remote Australia. Strategies designed to reduce this rural-urban divide include fly-in fly-out (FIFO) and drive-in drive-out (DIDO) services. The aim of this article is to examine the opportunities and challenges involved in these forms of service delivery. This article reviews recent literature relating to FIFO and DIDO healthcare services and discusses their benefits and potential disadvantages for rural Australia, and for health practitioners. ⋯ Given the potential negative consequences for both health professionals and rural Australians, the authors caution against the increasing use of FIFO and DIDO services, without the concurrent development of well-resourced, funded and staffed primary healthcare services in rural and remote communities.
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Rural Remote Health · Jul 2015
Multicenter StudyOutcomes of Australian rural clinical schools: a decade of success building the rural medical workforce through the education and training continuum.
The establishment of the rural clinical schools funded through the Commonwealth Department of Health and Ageing (now Department of Health) Rural Clinical Training and Support program over a decade ago has been a significant policy initiative in Australian rural health. This article explores the impacts of this policy initiative and presents the wide range of educational innovations contextualised to each rural community they serve. ⋯ The RCS policy initiative has vastly increased opportunities for medical students to have long-term clinical placements in rural health services. Over a decade since the policy has been implemented, graduates are being attracted to rural practice because they have positive learning experiences, good infrastructure and support within rural areas. The study shows the RCS initiative sets the stage for a sustainable future Australian rural medical workforce now requiring the development of a seamless rural clinical training pipeline linking undergraduate and postgraduate medical education.