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Pathman DE, de Saxe Zerden L, Gingras M, Seel J, Fannell J, Lombardi BM. Preparing behavioral health clinicians for success and retention in rural safety net practices. J Rural Health 2024; 40:509-519. [PMID: 38316680 DOI: 10.1111/jrh.12824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/22/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE This study assesses how, among behavioral health clinicians working in rural safety net practices, the amount of exposure to care in rural underserved communities received during training relates to confidence in skills important in their work settings, successes in jobs and communities, and anticipated retention. METHODS This study uses survey data from Licensed Clinical Social Workers, Licensed Professional Counselors, and Psychologists working in rural safety net practices in 21 states while receiving educational loan repayment support from the National Health Service Corps, from 2015 to April 2022. FINDINGS Of the 778 survey respondents working in rural counties, 486 (62.5%) reported they had formal education experiences with medically underserved populations during their professional training, for a median of 47 weeks. In analyses adjusting for potential confounders, the estimated amount of rural training exposure was positively associated with a variety of indicators of clinicians' integration and fit with their communities as well as with longer anticipated retention within their rural safety net practices. The amount of training in care for rural underserved populations was not associated with clinicians' confidence levels in various professional skills or successes in their work, including connection with patients and work satisfaction. CONCLUSIONS Formal training in care for underserved populations is a large part of the education of behavioral health clinicians who later work in rural safety net practices. More training in rural underserved care for these clinicians is associated with greater integration and fit in their communities and longer anticipated retention in their practices, but not with skills confidence or practice outcomes.
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Affiliation(s)
- Donald E Pathman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lisa de Saxe Zerden
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
- School of Social Work, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Mandi Gingras
- Rural Recruitment and Retention Network (3RNET), Jefferson City, Missouri, USA
| | - Jessica Seel
- South Carolina Office of Rural Health, Lexington, South Carolina, USA
| | - Jackie Fannell
- Rural Recruitment and Retention Network (3RNET), Jefferson City, Missouri, USA
| | - Brianna M Lombardi
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- School of Social Work, University of North Carolina, Chapel Hill, North Carolina, USA
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Hazelton L, da Luz Dias R, Esliger M, Tibbo P, Sinha N, Njoku A, Satyanarayana S, Siddhartha S, Alexiadis-Brown P, Rahman F, Maguire H, Gray G, Bosma M, Parker D, Connolly O, Raji A, Manning A, Bagnell A, Israel Opoku Agyapong V. Exploring Current Practices, Needs, and Barriers for Expanding Distributed Medical Education and Scholarship in Psychiatry: Protocol for an Environmental Scan Using a Formal Information Search Approach and Explanatory Design. JMIR Res Protoc 2023; 12:e46835. [PMID: 38010790 DOI: 10.2196/46835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/25/2023] [Accepted: 09/23/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Distributed medical education (DME) offers manifold benefits, such as increased training capacity, enhanced clinical learning, and enhanced rural physician recruitment. Engaged faculty are pivotal to DME's success, necessitating efforts from the academic department to promote integration into scholarly and research activities. Environmental scanning has been used to gather, analyze, and apply information for strategic planning purposes. It helps organizations identify current practices, assess needs and barriers, and respond to emerging risks and opportunities. There are process models and conceptual frameworks developed for environmental scanning in the business and educational sectors. However, the literature lacks methodological direction on how to go about designing and implementing this strategy to guide research and practice in DME, especially in the psychiatry field. OBJECTIVE This paper presents a protocol for an environmental scanning that aims to understand current practices and identify needs and barriers that must be addressed to facilitate the integration of psychiatrists from the Dalhousie University Faculty of Medicine's distributed education sites in Nova Scotia and New Brunswick into the Department of Psychiatry, contributing for the expansion of DME in both provinces and informing strategic planning and decision-making within the organization. METHODS This protocol adopts an innovative approach combining a formal information search and an explanatory design that includes quantitative and qualitative data. About 120 psychiatrists from 8 administrative health zones of both provinces will be invited to complete an anonymous web-based survey with questions about demographics, participants' experience and interest in undergraduate, postgraduate, and continuing medical education, research and scholarly activities, quality improvement, and knowledge translation. Focus group sessions will be conducted with a purposive sample of psychiatrists to collect qualitative data on their perspectives on the expansion of DME. RESULTS Results are expected within 6 months of data collection and will inform policy options for expanding Dalhousie University's psychiatry residency and fellowship programs using the infrastructure and human resources at distributed learning sites, leveraging opportunities regionally, especially in rural areas. CONCLUSIONS This paper proposes a comprehensive environmental scan procedure adapted from existing approaches. It does this by collecting important characteristics that affect psychiatrists' desire to be involved with research and scholarly activities, which is crucial for the DME expansion. Furthermore, its concordance with the literature facilitates interpretation and comparison. The protocol's new method also fills DME information gaps, allowing one to identify insights and patterns that may shape psychiatric education. This environmental scan's results will answer essential questions about how training programs could involve therapists outside the academic core and make the most of training experiences in semiurban and rural areas. This could help other psychiatry and medical units outside tertiary care establish residency and fellowship programs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46835.
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Affiliation(s)
- Lara Hazelton
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Raquel da Luz Dias
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Mandy Esliger
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Philip Tibbo
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Nachiketa Sinha
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Saint John, NB, Canada
| | - Anthony Njoku
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Saint John, NB, Canada
| | | | - Sanjay Siddhartha
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Saint John, NB, Canada
| | - Peggy Alexiadis-Brown
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Saint John, NB, Canada
| | - Faisal Rahman
- Mental Health and Addictions Program, Nova Scotia Health, Antigonish, NS, Canada
| | - Hugh Maguire
- Mental Health and Addictions Program, Nova Scotia Health, Truro, NS, Canada
| | - Gerald Gray
- Mental Health and Addictions Program, Nova Scotia Health, Kentville, NS, Canada
| | - Mark Bosma
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Deborah Parker
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Owen Connolly
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Adewale Raji
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Alexandra Manning
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Child and Adolescent Psychiatry, IWK Health, Halifax, NS, Canada
| | - Alexa Bagnell
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Child and Adolescent Psychiatry, IWK Health, Halifax, NS, Canada
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Killough C, Ortegon ER, Vasireddy R, Kincaid T, Silverblatt H, Crisanti A, Page K. Training Psychiatrists in New Mexico: Reflections from Psychiatry Residents Who Participated in a Rural Track Versus a Traditional Program Alone over the Past Decade. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:470-474. [PMID: 34988922 PMCID: PMC8731206 DOI: 10.1007/s40596-021-01572-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE With over 60% of rural Americans living in mental health professional shortage areas, there is a need for providing psychiatry residents training experiences in rural communities with the goal of increasing the likelihood that they will end up practicing in those same communities following graduation. The purpose of this study was to survey previous and current psychiatry residents, with the goal of describing the impact of the program on rural track residents compared to those in the traditional residency track. METHODS Psychiatry residents 2010-2020 completed an online survey. For those who participated in the rural residency track, the survey asked additional questions regarding barriers experienced practicing in rural areas (e.g., professional isolation) and whether the goals of the rural track were met. RESULTS Seventy-four residents completed surveys, with 26% in the "Rural Track Group" (RTG) and 74% in the "Non-rural Track Group" (NTG). More RTG reported they were more likely to practice in rural, frontier, or underserved areas after residency compared to NTG (74% versus 60%). Most RTG (72%) strongly agreed the rural program helped meet goals. Distance from family was a top barrier for current RTG (63%), followed by concerns about local schools, social isolation, and reduced career opportunities for partners (45%). CONCLUSIONS Residents of the RTG were more likely to consider a career in a rural area than those of the traditional program alone. Psychiatry residency requirements should be reviewed to address top rural training barriers to promote retention in rural areas.
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Vincenti M, Albanese A, Bope E, Watts BV. The Regional Distribution of Psychiatric Residency Positions Funded by the Department of Veterans Affairs and Its Relationship to Rural Veteran Populations. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:435-440. [PMID: 34787824 PMCID: PMC9349103 DOI: 10.1007/s40596-021-01565-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The authors evaluated the distribution of psychiatry residency positions funded by the Department of Veterans Affairs between 2014 and 2020 with respect to geographic location and hospital patient population rurality. METHODS The authors collected data on psychiatry residency positions from the Veterans Affairs' Office of Academic Affiliations Support Center and data on hospital-level patient rurality from the Veterans Health Administration Support Service Center. They examined the chronological and geospatial relationships between the number of residency positions deployed and the size of the rural patient populations served. RESULTS Between 2014 and 2020, the Department of Veterans Affairs has substantially increased the number of rural hospitals hosting psychiatry residency programs, as well as the number of residency positions at those hospitals. However, several geographic regions serve high numbers of rural veterans with few or no psychiatry resident positions. CONCLUSIONS While the VA efforts to increase psychiatry residency positions in rural areas have been partially successful, additional progress can be made increasing support for psychiatry trainees at Veterans Affairs hospitals and community-based outpatient clinics that serve large portions of the rural veteran population.
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Affiliation(s)
- Matthew Vincenti
- Veterans Rural Health Resource Center, White River Junction, VT, USA.
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - Anthony Albanese
- U.S. Department of Veterans Affairs' Office of Academic Affiliations, Washington, DC, USA
| | - Edward Bope
- U.S. Department of Veterans Affairs' Office of Academic Affiliations, Washington, DC, USA
| | - Bradley V Watts
- Veterans Rural Health Resource Center, White River Junction, VT, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Danilewitz M, Docherty C, Bahji A. How to Serve the Underserved: Making the Case for Rural and Remote Mental Health Training for Psychiatry Residents. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:642-643. [PMID: 32592008 DOI: 10.1007/s40596-020-01274-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/17/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Marlon Danilewitz
- University of British Columbia, Vancouver, British Columbia, Canada.
| | - Claire Docherty
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Anees Bahji
- Queen's University, Kingston, Ontario, Canada
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Guerrero APS, Balon R, Beresin EV, Louie AK, Coverdale JH, Brenner A, Roberts LW. Rural Mental Health Training: an Emerging Imperative to Address Health Disparities. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:1-5. [PMID: 30535843 DOI: 10.1007/s40596-018-1012-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Affiliation(s)
| | | | | | | | | | - Adam Brenner
- University of Texas Southwestern Medical Center, Dallas, USA
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Nash L, Hickie C, Clark S, Karageorge A, Kelly PJ, Earle M. The experience of psychiatry training in rural NSW. Australas Psychiatry 2014; 22:492-9. [PMID: 25073659 DOI: 10.1177/1039856214543086] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the experience of psychiatry training in rural New South Wales. METHOD All rural trainees in New South Wales and key psychiatrists involved in their training were invited to complete a survey in May-July 2013. RESULTS Responses were received from 26 out of 44 rurally placed psychiatry trainees (57% response rate) and 37 out of 55 psychiatrists involved in training in a rural area (67% response rate). Positive and negative aspects of rural training were reported. In general, trainees reported positive experiences regarding supervision, consultant input and their Site Coordinator of training. Their experience of other aspects of training and education in rural areas was often negative with 52% of trainees feeling at a disadvantage due to fewer registrar peers and 60% feeling educationally isolated. Difficulty progressing through training, workforce shortages, difficulty accessing formal aspects of training and limited options for advanced training were reported. Metropolitan trainees on rotation to rural terms receive accommodation, travel and an increase in wage from the rural Local Health District. Rural trainees on rotation to the city for their mandatory subspecialty training receive no such support. CONCLUSIONS There are many challenges for rural trainees. Support from the Royal Australian and New Zealand College of Psychiatrists and state and federal governments to enhance the rural training experience is vital.
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Affiliation(s)
- Louise Nash
- NSW Rural Coordinator of Training of the Rural Psychiatry Project, NSW Branch RANZCP, Rozelle, NSW; Clinical Chair in Psychiatry, Health Education and Training Institute, Sydney, NSW; Associate Director of Teaching and Learning, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Catherine Hickie
- Director of Clinical Training, Mental Health and Drug and Alcohol, Bloomfield Hospital, Western NSW Local Health District, Orange, NSW; Psychiatrist, HNET Psychiatry, Hunter New England Local Health District, NSW; Conjoint Senior Lecturer, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW; Steering Committee Member of the Rural Psychiatry Project of NSW Branch RANZCP, Sydney, NSW, Australia
| | - Scott Clark
- Clinical Director, Mental Health Drug and Alcohol Service, Western NSW Local Health District, Dubbo, NSW; Associate Professor, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW; Chair, Rural Psychiatry Project of NSW Branch RANZCP, Sydney, NSW, Australia
| | - Aspasia Karageorge
- Research Project Coordinator, Clinical Rehabilitation Sciences, Faculty of Health Science, University of Sydney, Sydney, NSW, Australia
| | - Patrick J Kelly
- Senior Lecturer, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Maree Earle
- Immediate Past Manager, Royal Australian and New Zealand College of Psychiatrists NSW Branch and Manger of Projects (NSW), Rozelle, NSW, Australia
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Bonham C, Salvador M, Altschul D, Silverblatt H. Training psychiatrists for rural practice: a 20-year follow-up. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2014; 38:623-626. [PMID: 24705826 DOI: 10.1007/s40596-014-0080-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 12/06/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE This report describes the Rural Psychiatry Residency Program at the University of New Mexico (UNM RPRP) and presents findings from a survey of program graduates. METHODS Current practice location of residency graduates was identified to learn whether graduates of the UNM RPRP continued to practice in rural communities compared to the graduates of the traditional residency program. Additionally, a web-based survey was completed by 37 of the 60 graduates who participated in the UNM RPRP since its inception in 1991 through 2010. Questions addressed current practice, perceived barriers, and perceptions of experiences. RESULTS Thirty-seven percent of the graduates from the UNM RPRP currently practice in rural communities compared to 10 % of the graduates from the traditional residency track. Of the survey respondents, 95 % continue to work with underserved individuals. Reported barriers to practice in rural areas include professional isolation, lack of referral resources, and travel distances. Respondents reported valuing education about systems based practice and telepsychiatry. CONCLUSION Purposeful and well-coordinated educational opportunities situated in rural community health clinics can address some of the barriers for recruiting and retaining practicing psychiatrists in rural areas. Practical skill building at the individual, agency, and system level is integral in training psychiatrists for work in these communities. In particular, the use of telepsychiatry emerged as an important practical application for the provision of rural mental health care.
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Affiliation(s)
- Caroline Bonham
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA,
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Gowans MC, Wright BJ, Brenneis FR, Scott IM. Which students will choose a career in psychiatry? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:605-13. [PMID: 22014693 DOI: 10.1177/070674371105601006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In Canada, availability of and access to mental health professionals is limited. Only 6.6% of practising physicians are psychiatrists, a situation unlikely to improve in the foreseeable future. Identifying student characteristics present at medical school entry that predict a subsequent psychiatry residency choice could allow targeted recruiting or support to students early on in their careers, in turn creating a supply of psychiatry-oriented residency applicants. METHOD Between 2002 and 2004, data were collected from students in 15 Canadian medical school classes within 2 weeks of commencement of their medical studies. Surveys included questions on career preferences, attitudes, and demographics. Students were followed through to graduation and entry data linked anonymously with residency choice data. Logistic regression was used to identify early predictors of a psychiatry residency choice. RESULTS Students (n = 1502) (77.4% of those eligible) contributed to the final analysis, with 5.3% naming psychiatry as their preferred residency career. When stated career interest in psychiatry at medical school entry was not included in a regression model, an exit career choice in psychiatry was predicted by a student's desire for prestige, lesser interest in medical compared with social problems, low hospital orientation, and not volunteering in sports. When an entry career interest in psychiatry was included in the model, this variable became the only predictor of an exit career choice in psychiatry. CONCLUSION While experience and attitudes at medical school entry can predict whether students will chose a psychiatry career, the strongest predictor is an early career interest in psychiatry.
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Affiliation(s)
- Margot C Gowans
- Department of Family Practice, University of British Columbia, Vancouver
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Robinson T, Hills D, Kelly B. The evaluation of an online orientation to rural mental health practice in Australia. J Psychiatr Ment Health Nurs 2011; 18:629-36. [PMID: 21848598 DOI: 10.1111/j.1365-2850.2011.01712.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The aim of this study was to develop and evaluate an online, interprofessional education programme for clinicians commencing work in rural mental health services in New South Wales, Australia. Twenty-eight participants, including nurses, psychologists, social workers and occupational therapists, completed a 24-week education programme (Introduction to Rural Mental Health Practice programme) that orientated clinicians to working in rural settings. The online programme included an orientation to online learning and clinical skills such as risk assessment, therapeutic communication and de-escalation skills applied in rural settings. Twenty-four participants provided pre- and post-evaluation responses that were matched and analysed using paired t-tests to identify any significant differences in mean scores across the domains of interest. Fifty per cent (n= 13) of participants had a background in nursing and 49% were allied health clinicians (psychologists, social workers and occupational therapists). Statistically significant improvements (P < 0.05) were detected in participant confidence in responding to common mental health problems, knowledge about the role of different services in rural mental health care, perceived safety of work and perceived self-efficacy in dealing with challenging or aggressive behaviours. The Introduction to Rural Mental Health Practice programme was successful in orienting clinicians to rural mental health but the small sample size highlights the need to evaluate the programme with a larger cohort of rural clinicians. The attrition at the early stages of the study highlights significant challenges in the retention of rural clinicians in online education programmes. Factors that promoted participation and retention included the provision of study leave and orientation to the online environment.
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Affiliation(s)
- T Robinson
- Centre for Rural & Remote Mental Health, University of Newcastle, Callaghan, NSW, Australia.
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Fleming DA, Riley SL, Boren S, Hoffman KG, Edison KE, Brooks CS. Incorporating telehealth into primary care resident outpatient training. Telemed J E Health 2009; 15:277-82. [PMID: 19382866 DOI: 10.1089/tmj.2008.0113] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Research is yet to fully examine the utility and effectiveness of telehealth in primary care resident ambulatory training. This study examined the attitudes of preceptors, residents, and nurses on (1) the impact of telehealth on healthcare; (2) the impact of telehealth on the work activity of resident clinics; (3) the impact of telehealth on resident training in the outpatient setting; and (4) the impact of telehealth on relationships. There were three focus groups, one each of preceptors (N = 5), residents (N = 10), nurses (N = 7). Eight focus group themes evolved regarding the use of telehealth in the resident clinic: (1) impact on patient/provider relationships; (2) consistent with the values of those using telehealth; (3) logistics; (4) reduces patient transfers; (5) appropriate level of care; (6) reimbursement concerns; (7) psychological risk; and (8) impact on resident/attending relationships. Though as yet not generalizable, results of this pilot study suggest that there is general acceptability of telehealth in ambulatory resident training settings, but there is concern about the impact that telehealth may have on relationships, logistics, finances, and the need to see patients face-to-face when there is greater complexity.
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Affiliation(s)
- David A Fleming
- MU Center for Health Ethics, University of Missouri School of Medicine, Columbia, Missouri 65212, USA.
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