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Unexpected benefits of rural medical training

At the recent national rural health conference in Perth, Professor Max Kamien, Emeritus Professor of General Practice at the University of Western Australia, warned that rural clinical schools would eventually lose funding if they can’t prove that a significant proportion of graduates have ended up working in rural, remote or Indigenous health (you can watch his presentation here).

Rural health advocates need to ensure that the medical deans are tracking what is happening to the graduates from rural clinical schools, he said.

But another presentation at the conference suggests that perhaps any evaluation of rural clinical schools should also consider their broader impacts upon rural communities.

Thanks to Marge Overs, Editor of Australian Rural Doctor magazine, for sharing this report from the conference with Croakey readers.

***

Rural clinical schools have unexpected benefits

Marge Overs writes:

The enthusiasm of a small town for undergraduate medical training had led to unexpected benefits, Dr Peter Arvier told the National Rural Health Conference.

Dr Arvier, associate head of the University of Tasmania rural clinical school, said the success of undergraduate training in Smithton/Circular Head in north-west Tasmania showed universities could help sustain rural health services.

Smithton/Circular Head was a good choice for undergraduate education because it has a stable GP population and good health facilities. Economically the town isn’t faring so well, with local agriculture and industry battling loss of jobs.

Dr Arvier said medical education started in the community because of the need to place increased numbers of students.

After initially placing final-year students in rotations at the hospital and in general practice, students from earlier years are now training in Smithton.

A highlight of the medical education calendar is an annual emergency weekend, which involves more than 150 health workers, students and community volunteers.

Dr Arvier said there had been unexpected benefits. The influx of students had attracted funding to expand the general practice, to renovate the hospital and to build student accommodation, creating a raft of spin-off economic benefits.

“It has breathed new life into the hospital, turning a good facility into something much better,” he said.

Medical students had become role models for high-school students for whom health careers, or even tertiary education, was not really on their radar.  “Students run career camps and go into local high schools to talk to the students and this works much better than us older adults going into the schools, as the students can identify with them,” he said.

Dr Arvier said the links with the town had evolved to the extent that the community felt it owned the undergraduate education in town. “The community now very proudly sees themselves as a teaching community of health professionals. There is a pride that has gone with that because of the benefits that have flowed through.”

He said the model of a university driving sustainability of health services might apply to other parts of Australia.

“Instead of asking what these communities can do for our students, we need to look at it from the other side – what can we do for those communities?

“If the commitment to teaching and learning can be sustained, I think we will see a breaking away from that cycle of reliance on locum services, agency nurses and fluctuating levels of morale.”

The proof of that impact is shown with the first graduate from the rural clinical school returning to Smithton as a GP in training.

• This article is published in the current issue of Australian Rural Doctor.

***

PostScript from Croakey: Perhaps this is an example of how health services and organisations can influence the social determinants of health beyond the more obvious ways. They are major employers after all…

Comments 8

  1. SoulmanZ says:

    good article. Undoubtably a lot of good comes out of rural training, for students and communities

    I would question the ‘impact’ in the last line, as far as I am aware there is very little evidence that the current programs are attracting more doctors ‘back’ to the country, although perhaps it is too early to judge in the life cycle of training?

    But the benefits truly do outweigh the fact that so far it doesnt seem to do what it was intended to do. That and the fact that nothing really seems to work to get doctors to the country

  2. old epictetus says:

    I work part time as a specialist in a Victoria wide chronic rare disease service based in a small not-for-profit hospital in Melbourne. I do some medical student teaching at three rural medical schools in Victoria. The mature students strike me as generally very able & hard working. The courses so far as I can judge are sound, tho’ lacking in specialist exposure (I would say that of course.)
    But it is far too early to see what impact this is having on rural health. I just hope data is being collected.
    Our service could do far far more for our patients and their ‘home teams’ with telemedicine, but the department seems to me to be too slow to help us make it work. we have actually used skype at our own expense to see what can be done. It works!

  3. SoulmanZ says:

    The rural school in SA has been running for years now (I am a ‘rural streamed’ graduate – which means I spent at least 1 full time year in a rural setting), and while it was a very good experience for everyone, it has not yet boosted rural doctor numbers.

    It will still be a few years before we truly start getting specialists out of the program, but GPs are finishing already.

    Data is certainly being collected here though, I get a email every year saying “where are you now? are you going to the country?”

    In terms of telemedicine, it hasnt been publicised much, but SA health is going paperless over the next few years, and integrating a world leading (1st in Asia) statewide health IT service with bedside to GP video conferencing facilities and a huge range of other things.

    When the benefits of all this get noted (I suspect it will be a roaring success within 6 months!) it wont be long before it, or something similar, roll out nation wide. The NBN syngery will just be icing on the cake

  4. old epictetus says:

    telemedicine’s effectiveness is well published in EU. Finland & Germany have telemedicine stroke thrombolysis data showing it works, they have been doing it for years. What’s keeping Oz back? Not only do we not do that, some so-called teaching hospitals don’t even do stroke thrombolysis, eg Townsville. Evidence based medicine, world’s best practice, I hear this all the time, but it sure isn’t in stroke, except in some units.

    What I see is an Australian desire to re-invent the wheel for australia, not just take over and adapt what has been shown to work, or am I jaundiced in a narrow view? See Myki ticketing system compared to London or Hong Kong.

    Why can’t we just get on with it? Give us the equipment and set up a medicare number and we will start next week. It should have been nation wide years ago.

  5. SoulmanZ says:

    A little jaundiced! This is worlds best practice they are rolling out, it is in place in Canada (alberta I think) and instead of helping small sections of medicine the improvements across the board have been nothing but remarkable

    and it is happening now. They are already installing the touchscreens at every bedside (100 at LMHS already!)

    what the system will do is give you access to all SA health patient records in one place, including every ward round note, every nurse assessment, every BP reading, in an easy to access format (totally user controlled)

    it will give you the ability to video conference to 100 sites in SA

    it will give you the ability to set up automatic alerts, so you will get a text message when a patient you are concerned about drops BP and has a fever for example

    it will give you the ability to collate all patient information from every service in australia, with all records easily accessible, for research

    it will tell you when falls risk assessments and advance directives are not yet complete, and pester you to do them

    it will guide you as to what current best practice is in your hospital or clinical setting, but not restrict you to follow it

    all of that and heaps more. Considering how quiet Sa health has kept this, I am very surprised at the scale and scope, and really, this is the future of australian medicine

    it will wipe out 95% of medication errors on the spot. It will reduce falls risks and dvt risks (alberta evidence says it does). it will improve the evidence base within a few years, as it will be very easy to see which interventions work and which dont

    every surgeon will have access to their own operating statistics. every physician can get daily reports on their CRF patient’s up to date renal functions, and recall them if necessary

    ahh .. sorry, it does excite me. I will stop rambling on. Just to be clear though, this is not MyKi, this is something that is already working elsewhere and is very very popular with clinicians there

  6. old epictetus says:

    Why not OZ-wide then? The state & federal system in the way again, I guess. Sounds terrific! Hope the privacy and protection of personal info is sound. The UK attempt to have national health record is held up on this little difficulty. I want it now, in Victoria and the rest of Australia. Put SA in charge please. Immediately.

  7. SoulmanZ says:

    I know! It is amazing right?

    It sounds too good to be true, but we had a grand round on it the other week. They are partially paying for the new touchscreens by having them double as digital TVs, as they had to remove the patient analog TVs anyway

    The security will be no different from currently – you will need access to get onto the system. In fact, it will be better because (apparently) access will be proximity based (something you will wear on your nametag) instead of log in and accidently leave it logged it

    So every access of medical records will have a direct trail to who accessed it

    Lots of timesaving stuff too – like prepopulating past history, so you just have to check it all off (that it is right) rather than re-enter it

    I am sure if it works (and cant imagine it not working) it will be australia wide soon enough!

  8. callumweeks91 says:

    Hello SoulmanZ and old epictetus,
    How large an enflux of urban students are opting out of long term rural placements following their accreditation with a medical board?? I see some studies were mentioned, but is the MRBS scheme meeting it’s aims?

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