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Noya F, Carr S, Thompson S. Social accountability in a medical school: is it sufficient? A regional medical school curriculum and approaches to equip graduates for rural and remote medical services. BMC MEDICAL EDUCATION 2024; 24:526. [PMID: 38734593 PMCID: PMC11088763 DOI: 10.1186/s12909-024-05522-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Social accountability is increasingly integral to medical education, aligning health systems with community needs. Universitas Pattimura's Faculty of Medicine (FMUP) enhances this through a curriculum that prepares graduates for rural and remote (RR) medical practice, exceeding national standards. The impact of this curriculum on graduate readiness in actual work settings remains unassessed. OBJECTIVE This study was conducted to capture the perspectives of FMUP medical graduates in a rural-centric curriculum, focusing on the teaching and learning opportunities afforded to them during their medical education. These insights are crucial for evaluating the accountability of regional medical schools in delivering quality service, particularly in underserved areas. METHODS Semistructured interviews were conducted with nine FMUP graduates employed in the RR areas of Maluku Province. A qualitative analysis was employed to examine graduates' views on the curriculum concerning medical school accountability. RESULTS The FMUP curriculum, informed by social accountability principles, partially prepares graduates to work under Maluku's RR conditions. However, it was reported by participants that their skills and preparedness often fall short in the face of substandard working environments. CONCLUSIONS The FMUP curriculum supports the government's aim to develop an RR medical workforce. However, the curriculum's social accountability and rural emphasis fall short of addressing community health needs amid inadequate practice conditions. Political investment in standardizing medical facilities and equipment is essential for enhancing graduates' effectiveness and health outcomes in RR communities.
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Affiliation(s)
- Farah Noya
- Department of Medical Education, Faculty of Medicine Universitas Pattimura, Jl. Ir. M. Putuhena Poka, Ambon, Maluku, 97233, Indonesia.
| | - Sandra Carr
- Division of Health Professions Education, School of Allied Health, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, WA, 6530, Australia
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Blattner K, Rogers-Koroheke M, Clay L. Te Paatu o Te Ao Hurihuri - pandemic-related virtual adaptation of an established marae-based workshop for rural doctors: a qualitative study. J Prim Health Care 2023; 15:343-349. [PMID: 38112704 DOI: 10.1071/hc23089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/20/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Due to COVID-19 pandemic restrictions in Aotearoa New Zealand, an established remote community marae-based workshop (a component of a postgraduate rural medical programme) was converted into a virtual platform. Aim The aim of this study was to explore student and teacher experiences of this virtual adaptation with focus on cultural aspects. Methods A qualitative exploratory study was undertaken that involved document review and qualitative interviews. Students and teachers were invited to participate. Semi-structured interviews were conducted. Thematic analysis was undertaken using a framework-guided rapid analysis method. The two participant groups' data were analysed concurrently but separately. Results Students found the virtual workshop valuable in furthering their knowledge of Māori culture, cross-cultural communication skills and health inequities in rural clinical practice. Through the innovative efforts of their teachers, they felt some sense of connection with the remote locality and its people. Teachers were able to impart knowledge, connect and keep everyone culturally safe through their commitment and adaptability. However, moving to a virtual platform meant compromise to the cultural experience for students and loss of sharing the learning and experience with their place and their people. Discussion In the event of a further pandemic or other emergency situation, where strong established relationships exist, replacing an in-person remote marae-based workshop with a virtual workshop, while limited, is achievable and has value. When urban tertiary institutions partner with remote Māori communities to deliver virtual teaching, caution is needed in ensuring sustained transparency in priorities and expectations to avoid further exacerbations of power imbalance and resulting loss of value.
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Affiliation(s)
- Katharina Blattner
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand; and Hokianga Health Enterprise Trust, Rawene, New Zealand
| | | | - Lynne Clay
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
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You Y, Xie A, Cleland J. Medical students' rural practice intention: Academic performance matters. MEDICAL EDUCATION 2022; 56:1203-1213. [PMID: 35953464 DOI: 10.1111/medu.14918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/20/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Many countries are driving forward policies and practices to train medical students for later rural practice. Previous research has investigated individual (e.g., rural upbringing) and structural factors (e.g., curricular exposure) associated with rural practice intention. However, the relationship between academic performance in medical school and rural practice intention has been neglected, although optimisation theory suggests there may be a relationship. To address this gap, our aim was to identify the relationship between academic performance and rural practice intention. METHODS Data were collected via a cross-sectional (self-report) survey in 2021. Participants were students from 60 of the 96 rural order directed (RODs) medical programmes across China. We asked students their rural practice intention. We conducted univariate analyses to test for associations between rural practice intention and independent variables, including socio-demographics, ROD location, grade year and academic performance measures. We used multilevel logistic regression models to test whether students' academic performance in medical school could be used to predict rural practice intention, holding the other factors constant. RESULTS There were 13 123 respondents, representing roughly 77.6% of the student population from the 60 schools. There was a statistically significant relationship between student (self)-reported academic performance in medical school and rural practice intention. Higher performers had a lower likelihood (ORs: 0.65-0.78) of rural practice intention. This held across all performance measures (GPA rank, academic awards and student leadership) and for the sub-group with rural upbringing (ORs: 0.68-0.78). DISCUSSION This is the first study to identify a relationship between medical school performance and rural practice intention. The findings suggest that students maximise their utility when choosing career options, with higher performers having lower rural practice intention. These data provide insight into the complexity of medical career decision making and can be used by medical school and workforce planners to inform rural training, recruitment and retention strategies.
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Affiliation(s)
- You You
- Institute of Medical Education/National Center for Health Professions Education Development, Peking University, Beijing, China
- Institute of Economics of Education, Peking University, Beijing, China
| | - Ana Xie
- Institute of Medical Education/National Center for Health Professions Education Development, Peking University, Beijing, China
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
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Kiuru SP, Webster CS. How might access to postgraduate medical education in regional and rural locations be best improved? A scoping review. Aust J Rural Health 2021; 29:236-244. [PMID: 33848396 DOI: 10.1111/ajr.12725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 11/30/2022] Open
Abstract
Rural medical education is known as one of the most effective strategies in improving rural recruitment and retention. The aim was to identify modes of delivery to improve access to rural postgraduate medical education. Arksey and O'Malley's methodological framework was used for conducting scoping reviews. CINAHL, Google Scholar, ERIC, PsycINFO, Medline and PubMed were searched to identify peer-reviewed English-language literature published between 2000 and 2019 focusing on postgraduate rural and regional medical education. A total of 102 articles were identified, with 51 included in the final analysis after applying inclusion and exclusion criteria. Outcome measures included: article type; research methodology; date of publication; country of origin; and study population. Through iterative reading, common themes were identified. A typology of 6 content themes emerged as follows: rural curriculum; procedural skills; rurally based learning; service delivery; workforce; and distance learning. The majority of articles focused on rural curriculum, and rurally based learning, with half originating from Australia or New Zealand. Although results strongly emphasised context and curriculum in rural environments, lack of specific and pragmatic approaches was noted. Surprisingly, few articles focused on rural distance learning utilising information and communication technology. Pathways to improve rural education access include recognition of the unique rural context in curriculums; development of rural educational faculty; and creation of opportunities for rural specialist training. Emphasis should be given for education provided through rural centres rather than urban facilities. Use of information technology could be increased, for example in remote trainee supervision programs.
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Affiliation(s)
- Sampsa P Kiuru
- Rural Health Academic Centre, Ashburton, New Zealand.,Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Craig S Webster
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand.,Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Roberts P, Cosgrave C, Gillespie J, Malatzky C, Hyde S, Hu WCY, Bailey J, Yassine T, Downes N. ‘Re‐placing’ professional practice. Aust J Rural Health 2021; 29:301-305. [DOI: 10.1111/ajr.12717] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/04/2020] [Accepted: 12/13/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Catherine Cosgrave
- Department of Rural Health University of Melbourne Melbourne Vic Australia
| | | | | | - Sarah Hyde
- School of Rural Medicine Charles Sturt University Orange NSW Australia
| | - Wendy CY Hu
- Western Sydney University Sydney NSW Australia
| | - Jannine Bailey
- Bathurst Rural Clinical School Western Sydney University Bathurst NSW Australia
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Ohta R, Ryu Y, Sano C. The Contribution of Citizens to Community-Based Medical Education in Japan: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1575. [PMID: 33562329 PMCID: PMC7915629 DOI: 10.3390/ijerph18041575] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 02/07/2023]
Abstract
Community-based medical education (CBME) offers vital support to healthcare professionals in aging societies, which need medical trainees who understand comprehensive care. In teaching comprehensive care practices, CBME can involve citizens from the relevant community. This research synthesizes the impact of the involvement of communities on the learning of medical trainees in CBME. We conducted a systematic review, in which we searched ten databases from April 1990 to August 2020 for original articles in Japan regarding CBME involving citizens and descriptively analyzed them. The Kirkpatrick model was used to categorize the outcomes. Our search for studies following the protocol returned 1240 results; 21 articles were included in this systematic review. Medical trainees reported satisfaction with the content, teaching processes, and teachers' qualities. Medical trainees' attitudes toward community and rural medicine improved; they were motivated to become family physicians and work in communities and remote areas. This review clarified that citizen involvement in CBME had an effective impact on medical trainees, positively affecting perceptions of this type of education, as well as improving trainees' knowledge about and attitude toward community and rural medicine.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan 699-1221, Shimane, Japan;
| | - Yoshinori Ryu
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan 699-1221, Shimane, Japan;
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, Izumo 693-8501, Shimane, Japan;
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Kawamoto R, Ninomiya D, Akase T, Kikuchi A, Kumagi T. The effect of short-term exposure to rural interprofessional work on medical students. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2020; 11:136-137. [PMID: 32581144 PMCID: PMC7870448 DOI: 10.5116/ijme.5eb6.81cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/09/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Ryuichi Kawamoto
- Department of Community Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Daisuke Ninomiya
- Department of Community Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Taichi Akase
- Department of Community Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Asuka Kikuchi
- Department of Community Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Teru Kumagi
- Department of Community Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
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Saikal A, Pit SW, McCarthy L. Medical student well-being during rural clinical placement: A cross-sectional national survey. MEDICAL EDUCATION 2020; 54:547-558. [PMID: 32012331 DOI: 10.1111/medu.14078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/24/2020] [Accepted: 01/31/2020] [Indexed: 06/10/2023]
Abstract
CONTEXT Understanding rural student well-being is essential to inform the development and training of the future rural medical workforce so as to ensure a pipeline of rural doctors to meet rural communities' needs. However, little is known about the well-being of students who are on rural placement. This study aims to identify the predictors of well-being amongst a national sample of medical students on rural clinical placement. METHODS The Federation of Rural Australian Medical Educators (FRAME) 2015 national exit survey of medical students, completed at the end of rural terms, was used (n = 644) to test the associations between well-being and demographic, financial, academic, supervisor, placement and clinical skills factors, and attitude to future rural work. Univariate and logistic regression were used. RESULTS Students aged 18-24 years (odds ratio [OR], 8.07 [95% confidence interval {CI}, 2.07-31.46]) and 25-34 years (OR, 4.06 [95% CI, 1.35-12.18]) reported higher levels of well-being compared to students aged over 35 years. Academic support from the rural clinical school (OR, 5.74 [95% CI, 2.59-12.73]), perceived respect from supervisors (OR, 3.13 [95% CI, 1.23-7.99]), not feeling socially isolated (OR, 2.7 [95% CI, 1.40-5.20]), access to counselling services (OR, 2.05 [95% CI, 1.10-3.83]), rural placement being a first choice (OR, 3.04 [95% CI, 1.58-5.86]) and positive attitudes to being part of a rural workforce in the future (OR, 4.0 [95% CI, 2.0-8.3]) were associated with higher odds of well-being compared to students who felt the opposite. Gender, rural background, financial support, clinical skills and role clarity were not found to be associated with well-being (P > .5). CONCLUSIONS This study may provide guidance to rural clinical schools, policymakers and medical educators in developing rural placement programmes that enhance student well-being so we can address workforce shortages in rural areas.
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Affiliation(s)
- Aiasha Saikal
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongon, New South Wales, Australia
| | - Sabrina Winona Pit
- Western Sydney University, School of Medicine, University Centre for Rural Health, Lismore, New South Wales, Australia
- The University of Sydney, University Centre for Rural Health, Lismore, New South Wales, Australia
| | - Louella McCarthy
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongon, New South Wales, Australia
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van Schalkwyk S, Couper I, Blitz J, Kent A, de Villiers M. Twelve tips for distributed health professions training. MEDICAL TEACHER 2020; 42:30-35. [PMID: 30696315 DOI: 10.1080/0142159x.2018.1542121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Increasing numbers of health professions students are being trained in healthcare facilities that are geographically removed from central academic hospitals. Consequently, studies have evaluated this distributed training, assessed the impact that it has on student learning as well as on the facilities where the training occurs, and explored factors that enable and constrain successful clinical training at such sites. The 12 tips presented in this article have been developed from a longitudinal project that has focused on developing a framework for effective distributed health professions training through an extensive review of the literature and a national consultative process. These 12 tips should, therefore, have applicability across multiple contexts. The purpose of this article is to assist people in implementing, adapting, upscaling, maintaining, and evaluating the distributed training of students in the health professions.
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Affiliation(s)
- Susan van Schalkwyk
- Centre for Health Professions Education, Stellenbosch University, Cape Town, South Africa
| | - Ian Couper
- Ukwanda Centre for Rural Health, Stellenbosch University, Cape Town, South Africa
| | - Julia Blitz
- Centre for Health Professions Education, Stellenbosch University, Cape Town, South Africa
| | - Athol Kent
- Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
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Playford D, Bailey S, Fisher C, Stasinska A, Marshall L, Gawlinski M, Young S. Twelve tips for implementing effective service learning. MEDICAL TEACHER 2019; 41:24-27. [PMID: 29171333 DOI: 10.1080/0142159x.2017.1401217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Service learning is an educational methodology that facilitates transformation of students' knowledge, attitudes and attitudes around holistic care through work with community organizations. To implement academically, defensible service learning requires faculty endorsement, consideration of course credit, an enthusiastic champion able to negotiate agreements with organizations, organizations' identification of their own projects so they are willing to both fund and supervise them, curricular underpinning that imparts the project skills necessary for success, embedding at a time when students' clinical identity is being formed, small packets of curriculum elements delivered "just in time" as students engage with their project, flexible online platform/s, assessment that is organically related to the project, providing cross cultural up-skilling, and focused on the students' responsibility for their own product. The result is a learning experience that is engaging for medical students, links the university to the community, and encourages altruism which is otherwise reported to decline through medical school.
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Affiliation(s)
- Denese Playford
- a The Rural Clinical School of Western Australia , The University of Western Australia , Crawley , Australia
| | - Susan Bailey
- b Social Work, School of Population Health , The University of Western Australia , Crawley , Australia
| | - Colleen Fisher
- c School of Population Health , The University of Western Australia , Crawley , Australia
| | - Ania Stasinska
- c School of Population Health , The University of Western Australia , Crawley , Australia
| | - Lewis Marshall
- d The School of Medicine , The University of Western Australia , Crawley , Australia
| | - Michele Gawlinski
- a The Rural Clinical School of Western Australia , The University of Western Australia , Crawley , Australia
| | - Susan Young
- b Social Work, School of Population Health , The University of Western Australia , Crawley , Australia
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Lyle D, Greenhill J. Two decades of building capacity in rural health education, training and research in Australia: University Departments of Rural Health and Rural Clinical Schools. Aust J Rural Health 2018; 26:314-322. [PMID: 30303287 DOI: 10.1111/ajr.12470] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2018] [Indexed: 11/27/2022] Open
Abstract
This review article reports on the contribution of university Departments of Rural Health and Rural Clinical Schools to the development of rural health and the rural health workforce and is set at the Australian Government's university Departments of Rural Health and Rural Clinical Training and Support Programs. The main outcome measures include educational infrastructure, clinical academic workforce, student numbers, community engagement, research outputs, rural health and workforce outcomes. As a result, university Departments of Rural Health and Rural Clinical Schools have established a substantial geographical footprint covering most of the rural and remote populations and regions across Australia. They have a large distributed rural clinical academic workforce that exceeds 1300. Medical student numbers on long-term placements have increased threefold from inception to 1200 annually. Allied health and nursing numbers doubled over 10 years to 4000 in 2013 and are projected to double again by 2018. In 2013, they published 363 peer-reviewed papers - half of which specifically addressed rural and/or remote health issues. High levels of intention to practise rurally and uptake of rural and remote practice following exposure to rural training have been reported, especially for medicine. Thus, university Departments of Rural Health and Rural Clinical Schools constitute a national network of academic units that deliver academically enriched clinical education and training for medical, nursing and allied health students and fulfil an essential academic role for the health system in rural and remote Australia. Community engagement and accountability to region are hallmarks of the program. Early evidence of the uptake of rural and remote practice following exposure to rural training has set expectations for the Rural Health Multidisciplinary Training Program.
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Affiliation(s)
- David Lyle
- Broken Hill University Department of Rural Health, University of Sydney, Broken Hill, New South Wales, Australia
| | - Jennene Greenhill
- Rural Clinical School, Flinders University, Renmark, South Australia, Australia
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Brooker R, Hu W, Reath J, Abbott P. Medical student experiences in prison health services and social cognitive career choice: a qualitative study. BMC MEDICAL EDUCATION 2018; 18:3. [PMID: 29291725 PMCID: PMC5748951 DOI: 10.1186/s12909-017-1109-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 12/17/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND One of the purposes of undergraduate medical education is to assist students to consider their future career paths in medicine, alongside the needs of the societies in which they will serve. Amongst the most medically underserved groups of society are people in prison and those with a history of incarceration. In this study we examined the experiences of medical students undertaking General Practice placements in a prison health service. We used the theoretical framework of the Social Cognitive Career Theory (SCCT) to explore the potential of these placements to influence the career choices of medical students. METHODS Questionnaire and interview data were collected from final year students, comprising pre and post placement questionnaire free text responses and post placement semi-structured interviews. Data were analysed using inductive thematic analysis, with reference to concepts from the SCCT Interest Model to further develop the findings. RESULTS Clinical education delivered in a prison setting can provide learning that includes exposure to a wide variety of physical and mental health conditions and also has the potential to stimulate career interest in an under-served area. While students identified many challenges in the work of a prison doctor, increased confidence (SCCT- Self-Efficacy) occurred through performance success within challenging consultations and growth in a professional approach to prisoners and people with a history of incarceration. Positive expectations (SCCT- Outcome Expectations) of fulfilling personal values and social justice aims and of achieving public health outcomes, and a greater awareness of work as a prison doctor, including stereotype rejection, promoted student interest in working with people in contact with the criminal justice system. CONCLUSION Placements in prison health services can stimulate student interest in working with prisoners and ex-prisoners by either consolidating pre-existing interest or expanding interest into a field they had not previously considered. An important aspect of such learning is the opportunity to overcome negative preconceptions of consultations with prisoners.
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Affiliation(s)
- Ron Brooker
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Wendy Hu
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Jennifer Reath
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Penelope Abbott
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
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Green-Thompson LP, McInerney P, Woollard B. The social accountability of doctors: a relationship based framework for understanding emergent community concepts of caring. BMC Health Serv Res 2017; 17:269. [PMID: 28403860 PMCID: PMC5389126 DOI: 10.1186/s12913-017-2239-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 04/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social accountability is defined as the responsibility of institutions to respond to the health priorities of a community. There is an international movement towards the education of health professionals who are accountable to communities. There is little evidence of how communities experience or articulate this accountability. METHODS In this grounded theory study eight community based focus group discussions were conducted in rural and urban South Africa to explore community members' perceptions of the social accountability of doctors. The discussions were conducted across one urban and two rural provinces. Group discussions were recorded and transcribed verbatim. RESULTS Initial coding was done and three main themes emerged following data analysis: the consultation as a place of love and respect (participants have an expectation of care yet are often engaged with disregard); relationships of people and systems (participants reflect on their health priorities and the links with the social determinants of health) and Ubuntu as engagement of the community (reflected in their expectation of Ubuntu based relationships as well as part of the education system). These themes were related through a framework which integrates three levels of relationship: a central community of reciprocal relationships with the doctor-patient relationship as core; a level in which the systems of health and education interact and together with social determinants of health mediate the insertion of communities into a broader discourse. An ubuntu framing in which the tensions between vulnerability and power interact and reflect rights and responsibility. The space between these concepts is important for social accountability. CONCLUSION Social accountability has been a concept better articulated by academics and centralized agencies. Communities bring a richer dimension to social accountability through their understanding of being human and caring. This study also creates the connection between ubuntu and social accountability and their mutual transformative capacity as agents for social justice.
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Affiliation(s)
- Lionel P Green-Thompson
- Faculty of Health Sciences, University of the Witwatersrand, PV Tobias Health Sciences Building, 5 York Road, Parktown, 2193, Johannesburg, South Africa.
| | - Patricia McInerney
- Faculty of Health Sciences, University of the Witwatersrand, PV Tobias Health Sciences Building, 5 York Road, Parktown, 2193, Johannesburg, South Africa
| | - Bob Woollard
- Department of Family Practice, University of British Columbia, Vancouver, Canada
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Exposure of undergraduates to authentic GP teaching and subsequent entry to GP training: a quantitative study of UK medical schools. Br J Gen Pract 2017; 67:e248-e252. [PMID: 28246097 DOI: 10.3399/bjgp17x689881] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/17/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND It has been suggested that the quantity of exposure to general practice teaching at medical school is associated with future choice of a career as a GP. AIM To examine the relationship between general practice exposure at medical school and the percentage of each school's graduates appointed to a general practice training programme after foundation training (postgraduate years 1 and 2). DESIGN AND SETTING A quantitative study of 29 UK medical schools. METHOD The UK Foundation Programme Office (UKFPO) destination surveys of 2014 and 2015 were used to determine the percentage of graduates of each UK medical school who were appointed to a GP training programme after foundation year 2. The Spearman rank correlation was used to examine the correlation between these data and the number of sessions spent in placements in general practice at each medical school. RESULTS A statistically significant association was demonstrated between the quantity of authentic general practice teaching at each medical school and the percentage of its graduates who entered GP training after foundation programme year 2 in both 2014 (correlation coefficient [r] 0.41, P = 0.027) and 2015 (r 0.3, P = 0.044). Authentic general practice teaching here is described as teaching in a practice with patient contact, in contrast to non-clinical sessions such as group tutorials in the medical school. DISCUSSION The authors have demonstrated, for the first time in the UK, an association between the quantity of clinical GP teaching at medical school and entry to general practice training. This study suggests that an increased use of, and investment in, undergraduate general practice placements would help to ensure that the UK meets its target of 50% of medical graduates entering general practice.
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Influences on students' career decisions concerning general practice: a focus group study. Br J Gen Pract 2016; 66:e768-75. [PMID: 27578812 DOI: 10.3399/bjgp16x687049] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/09/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Despite concerns about recruitment to UK general practice, there has been no concerted educational intervention to address them. AIM To better understand how medical students' perceptions of their experiences of their undergraduate curriculum may affect choosing general practice as a career. DESIGN AND SETTING Qualitative study comprising focus groups of a total of 58 students from a range of medical schools across the UK. METHOD A range of UK medical schools students were invited by email to participate in focus groups and return a questionnaire detailing their current career choice to facilitate sampling students with varied career preferences. Students late in their studies were sampled as they were likely to be considering future careers. Focus group discussions were audiotaped, transcribed, and anonymised for both school and participant, then thematically analysed. Perceived differences in medical school culture, curriculum philosophy, design, and intent were explored. RESULTS Six focus groups (58 students) were convened. Some student participants' career aspirations were strongly shaped by family and home, but clinical placements remained important in confirming or refuting these choices. High-quality general practice attachments are a powerful attractor to general practice and, when they reflect authentic clinical practice, promote general practice careers. GP tutors can be powerful, positive role models. Students' comments revealed conflicting understandings about general practice. CONCLUSION Attracting rather than coercing students to general practice is likely to be more effective at changing their career choices. Early, high-quality, ongoing and, authentic clinical exposure promotes general practice and combats negative stereotyping. It is recommended that increasing opportunities to help students understand what it means to be a 'good GP' and how this can be achieved are created.
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Schrewe B, Pratt DD, McKellin WH. Adapting the forms of yesterday to the functions of today and the needs of tomorrow: a genealogical case study of clinical teaching units in Canada. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2016; 21:475-499. [PMID: 25925722 DOI: 10.1007/s10459-015-9608-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 04/20/2015] [Indexed: 06/04/2023]
Abstract
Emergent discourses of social responsibility and accountability have in part fuelled the expansion of distributed medical education (DME). In addition to its potential for redressing physician maldistribution, DME has conferred multiple unexpected educational benefits. In several countries, its recent rise has occurred around the boundaries of traditional medical education practices. Canada has been no exception, with DME proliferating against a backdrop of its longstanding central node, the clinical teaching unit (CTU). The CTU first appeared just over 50 years ago with its position in Canadian health care largely taken-for-granted. Given the increasing prominence of DME, however, it is timely to reconsider what the place of tertiary centre-based practices such as the CTU might be in shifting medical education systems. From a genealogical perspective, it becomes clear that the CTU did not just "happen". Rather, its creation was made possible by multiple interrelated cultural, social, and political changes in Canadian society that, while subtle, are powerfully influential. Making them visible offers a better opportunity to harmonize the benefits of longstanding entities such as the CTU with novel practices such as DME. In so doing, the medical education field may sidestep the pitfalls of investing significant resources that may only produce superficial changes while unwittingly obstructing deeper transformations and improvements. Although this work is refracted through a Canadian prism, reconceptualizing the overall design of medical education systems to take advantage of both tradition and innovation is a persistent challenge across the international spectrum, resistant to tests of time and constraints of context.
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Affiliation(s)
- Brett Schrewe
- Department of Pediatrics, Centre for Health Education Scholarship, The University of British Columbia, JPPN 3300, 910 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
| | - Daniel D Pratt
- Faculty of Education, The University of British Columbia, Vancouver, BC, Canada
| | - William H McKellin
- Department of Anthropology, The University of British Columbia, Vancouver, BC, Canada
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Kitchener S, Day R, Faux D, Hughes M, Koppen B, Manahan D, Lennox D, Harrison C, Broadley SA. Longlook: initial outcomes of a longitudinal integrated rural clinical placement program. Aust J Rural Health 2015; 23:169-75. [DOI: 10.1111/ajr.12164] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- Scott Kitchener
- School of Medicine; Griffith University; Gold Coast Queensland Australia
- Queensland Rural Medical Education; Toowoomba Queensland Australia
| | - Renee Day
- School of Medicine; Griffith University; Gold Coast Queensland Australia
- Queensland Rural Medical Education; Toowoomba Queensland Australia
| | - Daniel Faux
- School of Medicine; Griffith University; Gold Coast Queensland Australia
| | - Maxine Hughes
- School of Medicine; Griffith University; Gold Coast Queensland Australia
| | - Blair Koppen
- Rural Generalist Pathway; Queensland Health; Brisbane Queensland Australia
| | - Dan Manahan
- Rural Generalist Pathway; Queensland Health; Brisbane Queensland Australia
| | - Denis Lennox
- Rural Generalist Pathway; Queensland Health; Brisbane Queensland Australia
| | - Claire Harrison
- School of Medicine; Griffith University; Gold Coast Queensland Australia
| | - Simon A. Broadley
- School of Medicine; Griffith University; Gold Coast Queensland Australia
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Playford DE, Nicholson A, Riley GJ, Puddey IB. Longitudinal rural clerkships: increased likelihood of more remote rural medical practice following graduation. BMC MEDICAL EDUCATION 2015; 15:55. [PMID: 25879715 PMCID: PMC4372318 DOI: 10.1186/s12909-015-0332-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 02/27/2015] [Indexed: 05/16/2023]
Abstract
BACKGROUND Extended rural clerkships clearly increase the likelihood of rural practice post-graduation. What has not been determined is whether such rural interventions increase the likelihood of graduates practicing in more remote, versus inner regional, locations. METHODS The Australian Health Practitioner Regulation Agency database was used to identify the current workplace of every graduate of the Medical School of Western Australia, 1980 to 2011. There were 324 graduates working in a primary practice location defined by the Australian Standard Geographical Classification as inner regional to very remote. They were divided into 3 groups - 200 graduates who entered medical school before commencement of the Rural Clinical School of Western Australia (RCSWA), 63 who entered after the RCSWA had started, but not participated in RCSWA, and 61 who participated in the RCSWA. The RCSWA offers a longitudinal rural clinical clerkship throughout level 5 of the MBBS course. RESULTS The two groups not participating in the RCSWA had 45.5% and 52.4% of subjects in outer regional/very remote locations, respectively. In comparison, 78.7% of those who had participated in the RCSWA were currently practicing in outer regional/very remote locations. When the 3 groups were compared, the significant predictors of working in a more remote practice compared to working in an inner regional area were being female (OR 1.75 95% CI 1.13, 2.72, P = 0.013) and participating in the RCSWA (OR 4.42, 95% CI 2.26, 8.67, P < 0.001). In multivariate logistic regression that corrected for gender and remoteness of rural address before entry to medical school, participation in the RCSWA still predicted a more than 4-fold increase in the odds of practicing in a more remote area (OR 4.11, 95% CI 2.04, 8.30, P < 0.001). CONCLUSION Extended rural clinical clerkship during an undergraduate MBBS course is related to a much greater likelihood of practicing in more remote, under-serviced rural locations.
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Affiliation(s)
- Denese E Playford
- School of Primary, Aboriginal and Rural Health Care, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Asha Nicholson
- School of Primary, Aboriginal and Rural Health Care, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Geoffrey J Riley
- School of Primary, Aboriginal and Rural Health Care, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Ian B Puddey
- Faculty Office, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
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Wright JR, Bourke L, Waite CJ, Holden TA, Goodwin JM, Marmo AL, Wilson ML, Malcolm HE, Pierce D. A short-term rural placement can change metropolitan medical students' knowledge of, and attitudes to, rural practice. Med J Aust 2014; 201:103-5. [PMID: 25045990 DOI: 10.5694/mja13.11329] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 01/28/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether a short-term placement of metropolitan medical students in a rural environment can improve their knowledge of, and change their attitudes to, rural health issues. DESIGN AND PARTICIPANTS Medical students taking part in the March and May 2013 3-week Rural Health Modules (RHMs) were invited to participate in focus groups and complete questionnaires before undertaking the RHM, after a 2-day rural orientation and at the end of the RHM. Students were asked to comment on a range of issues affecting rural health care including their attitude to pursuing a rural career. Focus group transcripts were thematically analysed and questionnaire data were statistically analysed. SETTING The RHM is a 3-week program designed and run by the University of Melbourne's Rural Health Academic Centre. MAIN OUTCOME MEASURES Responses to questionnaire items from before and after completing the RHM, scored on a seven-point Likert scale. RESULTS 69 of the 101 RHM students took part in this study. The focus groups identified five main themes in rural health care: access; teamwork, models of care and generalist practice; overlapping relationships; indigenous health; and working in a rural career. In all five areas, a change was seen in the depth of knowledge students had about these issues and in the students' attitudes towards rural health care. The questionnaires also showed a significant shift in the students' appreciation of, and positivity towards, rural health issues. CONCLUSION Undertaking a 3-week RHM changed students' perceptions of rural health and significantly improved their knowledge of issues facing rural health practitioners and patients.
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Affiliation(s)
- Julian R Wright
- Rural Health Academic Centre, University of Melbourne, Melbourne, VIC, Australia.
| | - Lisa Bourke
- Rural Health Academic Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Catherine J Waite
- Rural Health Academic Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Thom A Holden
- Rural Health Academic Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Jenni M Goodwin
- Rural Health Academic Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Anne L Marmo
- Rural Health Academic Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Maxine L Wilson
- Rural Health Academic Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Helen E Malcolm
- Rural Health Academic Centre, University of Melbourne, Melbourne, VIC, Australia
| | - David Pierce
- Rural Health Academic Centre, University of Melbourne, Melbourne, VIC, Australia
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Friedman SR, Loh LC, Burdick WP. Educator perceptions of the relationship between education innovations and improved health. MEDICAL TEACHER 2013; 35:e1060-e1067. [PMID: 23110354 DOI: 10.3109/0142159x.2012.733450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Education innovations by health professions faculty are shaped by faculty conceptualizations of the pathway between their innovations and changes in health of communities. AIMS We aimed to explore how existing theories about the relationship between education and health are attended to, interpreted, and applied by faculty in different national contexts. METHODS We compared existing theoretical frameworks to perceptions of "front line" faculty. Fellows in Brazil- and India-based FAIMER faculty development programs were asked via questionnaires about the contribution of their education innovation projects to health improvements. RESULTS Faculty identified pathways to improved societal health via increased quality, and to a lesser extent relevance, of education. Relationships between increased quantity of education and improved health were focused on faculty development. Faculty from both countries noted the value for health outcomes of innovations that affect networks and partnerships with other institutions. Faculty from India identified pathways to improved societal health via changes to instructional more than institutional processes. CONCLUSIONS Results indicate where there are gaps in existing theories, a need to raise awareness about potential pathways to improving health via education changes, and opportunities for more detailed understanding of mechanisms of change via in-depth research.
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Affiliation(s)
- Stacey R Friedman
- Foundation for Advancement of Medical Education and Research (FAIMER), Philadelphia, PA 19104, USA.
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Cleland J, Johnston PW, Walker L, Needham G. Attracting healthcare professionals to remote and rural medicine: learning from doctors in training in the north of Scotland. MEDICAL TEACHER 2012; 34:e476-e482. [PMID: 22746965 DOI: 10.3109/0142159x.2012.668635] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Research exploring the experiences of trainee doctors in remote and rural locations is scarce. Our aim was to gain an understanding of the experiences and perceptions of Foundation Programme (FP) doctors training in placements in remote and rural areas of the north of Scotland. METHODS FP doctors training in remote and rural areas in Scotland took part in a qualitative study (focus groups and individual interviews) exploring their training experiences and career plans. To make sense of a potential multitude of factors, we selected social cognitive careers theory (SCCT) to underpin data collection and analysis. RESULTS A total of 20 trainees participated. Using data-driven analysis, three themes relevant to the SCCT emerged. These are the educational experience (e.g., opportunities to develop skills, greater responsibility), geographical isolation factors (e.g., the impact of staff shortages, poor accommodation, travel) and personal factors (e.g., social isolation, attitudes towards the experience). CONCLUSION Many factors impact on trainees' experience of learning and living in remote and rural medicine (R&R) environments. These experiences can be very positive for some individuals but factors external to the educational environment influence the perception of the overall experience. SCCT helps clarify the interaction between individual and contextual factors in career decision making.
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Affiliation(s)
- J Cleland
- Center for Academic Primary Care, University of Aberdeen, Aberdeen, UK.
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Larkins S, Sen Gupta T, Evans R, Murray R, Preston R. Addressing inequities in access to primary health care: lessons for the training of health care professionals from a regional medical school. Aust J Prim Health 2011; 17:362-8. [DOI: 10.1071/py11040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 08/30/2011] [Indexed: 11/23/2022]
Abstract
Attention to the inequitable distribution and limited access to primary health care resources is key to addressing the priority health needs of underserved populations in rural, remote and outer metropolitan areas. There is little high-quality evidence about improving access to quality primary health care services for underserved groups, particularly in relation to geographic barriers, and limited discussion about the training implications of reforms to improve access. To progress equity in access to primary health care services, health professional education institutions need to work with both the health sector and policy makers to address issues of workforce mix, recruitment and retention, and new models of primary health care delivery. This requires a fundamental shift in focus from these institutions and the health sector, to each view themselves as partners in an integrated teaching, research and service-oriented health system. This paper discusses the challenges and opportunities for primary health care professionals, educators and the health sector in providing quality teaching and clinical experiences for increasing numbers of health professionals as a result of the reform agenda. It then outlines some practical strategies based on theory and evolving experience for dealing with some of these challenges and capitalising on opportunities.
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