Rural Remote Health
-
Rural Remote Health · Mar 2020
Prevocational Integrated Extended Rural Clinical Experience (PIERCE): cutting through the barriers to prevocational rural medical education.
Despite an increase in the number of undergraduate training positions, Australia faces a critical shortage of medical practitioners in regional, rural and remote communities. Extended rural clinical placements have shown great utility in undergraduate medical curricula, increasing training capacity and providing comparable educational outcomes while promoting rural medicine as a career. The Prevocational Integrated Extended Rural Clinical Experience (PIERCE) was developed to increase the training capacity of the Queensland Rural Generalist Pathway (QRGP) and strengthen trainee commitment to rural practice by offering an authentic, extended 15-week rural term that provided an integrated experience in anaesthetics, obstetrics and gynaecology, and paediatrics, while meeting the requirements for satisfactory completion of prevocational rural generalist training. This study sought to evaluate whether trainees believed PIERCE and/or traditional regional hospital specialty placements achieved their learning objectives and to identify elements of the placements that contributed to, or were a barrier to, their realisation. ⋯ Both PIERCE and regional hospital placements provided opportunities and threats to the attainment of the curriculum objectives of the Australian Curriculum Framework for Junior Doctors, the Australian College of Rural and Remote Medicine and the Royal Australian College of General Practitioners Fellowship in Advanced Rural General Practice curricula. PIERCE trainees enjoyed the opportunity to experience rural medicine in a community setting, a broad caseload, hands-on proficiency, continuity of care and an authentic role as a valued member of the clinical team. This was reinforced by closer and more consistent clinical and educational interactions with their supervisors, and learning experiences that address key weaknesses identified in current hospital-based prevocational training. Successful achievement of prevocational curriculum objectives is contingent on strategic alignment of the curricula with supportive learning mechanisms focused by the learning context on the desired outcome, rural practice. This study adds weight to the growing consensus that rural community-based placements such as PIERCE are desirable components of prevocational training.
-
Rural Remote Health · Jan 2020
Establishing a mentorship program in rural workplaces: connection, communication, and support required.
Recruitment and retention of healthcare providers to rural workplaces is often challenging due to many factors, such as complex work environments requiring a broad skill set, minimal staffing, and limited community support and resources. Mentorship has been proposed as a strategy to encourage recruitment and retention of staff in rural workplaces. This article describes a rural-specific pilot mentorship program that was implemented and evaluated in terms of supporting rural mentorships, easing workplace transition, strengthening community connections, and encouraging recruitment and retention in rural communities. ⋯ Participants in this study believed that mentorship was beneficial to support healthcare providers working in rural environments. However, greater strides need to be made in terms of creating and supporting such relationships. The responsibility for mentorship resides with not only the mentor and mentee but also health organizations and rural communities. Members from all groups need to be committed and contribute to mentorship for rural mentorship programs to be successful and sustainable. Rural residents are often underserved due to insufficient numbers of healthcare professionals working in rural areas along with a limited number of services offered. The greater the numbers of healthcare professionals that can be recruited and retained within rural communities, the greater the likelihood the community residents will have timely and appropriate access to quality health services. These services can result in positive patient outcomes and greater community health.
-
Rural Remote Health · Nov 2019
Passing on wisdom: exploring the end-of-life wishes of Aboriginal people from the Midwest of Western Australia.
Indigenous patients with life-limiting conditions have complex needs, experience reduced access to and uptake of treatment, and have lower utilisation of palliative care services than the general population. Lack of understanding of the role of palliative care and poor availability of culturally safe specialist palliative care services impact on Indigenous people's end-of-life decision-making. ⋯ Within a safe space, Aboriginal people were happy to talk about end-of-life wishes, although certain aspects of death remain contentious. Sorting cards, ceremonies, education and care roles involving Aboriginal people offer potential means for effectively engaging Aboriginal people in preparing for death and dealing with grief.
-
Rural Remote Health · Nov 2019
General practitioner knowledge and practice in relation to unintended pregnancy in the Grampians region of Victoria, Australia.
Abortion has been legal in the Australian state of Victoria since 2008 and medical termination of pregnancy (MTOP) available since 2012. While these developments were expected to improve Victorian rural women's access to abortion, this has not been borne out in practice. General practitioners (GPs), particularly in rural areas, are women's first point of contact when faced with an unintended pregnancy. The objective of this study was to understand rural GPs' knowledge and practice in relation to unintended pregnancy and referral for abortion, using the Grampians region of Victoria as a case study. Parts of this region, like other rural and regional areas, experience teenage pregnancy rates double the national average and more than four times that of major cities, and access to abortion services is known to be limited. Findings from the study will inform rural health service development to improve rural women's access to abortion. ⋯ The results indicate high levels of conscientious objection and wide variation in knowledge of services. In addition, the provision of tele-abortion and medical abortion is extremely limited in this region, even while these are considered ideal ways to address rural access to abortion. It is likely the promise of tele-abortion is far from fulfilled in the Grampians region and possibly in other rural areas in Victoria. There is a need to improve GPs' knowledge of available services and adherence to legal and professional obligations, and there are clear opportunities to achieve this, with all interview participants expressing strong support for the prevention of unintended pregnancy, and many highlighting the need for good support for women up until the point of termination.
-
Rural Remote Health · Oct 2019
Overcoming the challenges of caring for a child with foetal alcohol spectrum disorder: a Pilbara community perspective.
Introduction Foetal alcohol spectrum disorder (FASD) is a neurodevelopmental impairment that may result in individuals experiencing poor development, cognitive issues and disruptive behaviours. In Australia, the prevalence of FASD is unknown; however, two studies have revealed the prevalence of FASD in high risk populations in Western Australia. Individuals with FASD may experience higher rates of negative outcomes including poor school performance, involvement with the justice system and incarceration, substance use and are at risk of being placed in out-of-home care. ⋯ Whilst experiences of caregivers raising children with FASD have been documented globally, little is known about the experiences of caregivers in a remote Australian context, particularly from an Australian Aboriginal perspective. This study aimed to investigate the experiences of caregivers in a remote Australian context. The findings will be valuable to inform programs at the family, community and broader policy levels that can help enhance children's development and wellbeing.