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Beattie J, Binder M, Fuller L. Rural longitudinal integrated clerkships and medical workforce outcomes: A scoping review. MEDICAL TEACHER 2024; 46:545-555. [PMID: 37769044 DOI: 10.1080/0142159x.2023.2260082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Internationally the medical workforce is suffering from a persistent geographic and specialist maldistribution. Longitudinal models of rural medical education such as longitudinal integrated clerkships (LIC) have been one of the strategies employed to redress this issue. AIM To map and synthesise the evidence on the medical workforce outcomes of rural LIC graduates, identifying gaps in the literature to inform future research. METHODS This review followed Arksey and O'Malley's methodological steps. Databases searched included Medline, CINAHL Complete (EBSCOhost), Scopus, Embase (Elsevier), and ISI Web of Science. RESULTS A total of 9045 non-duplicate articles were located, 112 underwent a full review, with 25 articles meeting the inclusion criteria. Studies were commonly cohort-based (84%), with data collected by database tracking and data linkage (52%). Five themes were identified to summarise the studies: (i) Overall geographic workforce outcomes (ii) influence of non-LIC medical training, (iii) remaining in region and level of rurality, (iv) medical speciality choice and rurality, and (v) selection and preferences. CONCLUSION Synthesis of the evidence related to workforce outcomes of rural LIC graduates provides directions for future rural medical workforce planning and research. While rural LIC graduates were found to be more likely to work rurally and in primary care specialities compared to graduates from other training pathways there is evidence to suggest this can be enhanced by strategically aligning selection and training factors.
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Affiliation(s)
- Jessica Beattie
- School of Medicine, Rural Community Clinical School, Deakin University, Colac, Australia
| | - Marley Binder
- School of Medicine, University Department of Rural Health, Deakin University, Warrnambool, Australia
| | - Lara Fuller
- School of Medicine, Rural Community Clinical School, Deakin University, Colac, Australia
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Somerville JG, Strang NC, Jonuscheit S. Topical review: Task shifting and the recruitment and retention of eye health workers in underserved areas. Optom Vis Sci 2024; 101:143-150. [PMID: 38546755 DOI: 10.1097/opx.0000000000002118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Many populations experience difficulty accessing eye care, especially in rural areas. Implementing workforce recruitment and retention strategies, as well as task shifting through widening scope of practice, can improve eye care accessibility. This article provides novel evidence on the compatibility of these strategies aimed at enhancing ophthalmic workforce recruitment, retention, and efficacy. PURPOSE The global burden of blindness is unequally distributed, affects rural areas more, and is frequently associated with limited access to eye care. The World Health Organization has specified both task shifting and increasing human resources for eye health as instruments to improve access to eye care in underserved areas. However, it is uncertain whether these two instruments are sufficiently compatible to provide positive synergic effects. To address this uncertainty, we conducted a structured literature review and synthesized relevant evidence relating to task shifting, workforce recruitment, retention, and eye care. Twenty-three studies from across the globe were analyzed and grouped into three categories: studies exploring recruitment and retention in human resources for eye health in general, studies discussing the relationship between task shifting and recruitment or retention of health workers in general, and studies specifically discussing task shifting and recruitment or retention in eye care workers. FINDINGS Our findings demonstrate that incentives are effective for initiating task shifting and improving recruitment and retention in rural areas with a stronger effect noted in midlevel eye care professionals and trainees. Incentives can take various forms, e.g., financial and nonfinancial. The consideration of context-specific motivational factors is essential when designing strategies to facilitate task shifting and to improve recruitment and retention.
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Cleland J, Zachariah A, David S, Pulimood A, Poobalan A. A qualitative study of social accountability translation: from mission to living it. BMC MEDICAL EDUCATION 2024; 24:145. [PMID: 38355545 PMCID: PMC10868042 DOI: 10.1186/s12909-024-05093-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: 05/08/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Medical schools are increasingly adopting socially accountable mission and curricula, the realisation of which are dependent on engaging individuals to embody the mission's principles in their everyday activities as doctors. However, little is known about how graduates perceive the efforts taken by their medical school to sensitise them to social accountability values, and how they translate this into their working lives. Our aim was to explore and understand graduate perceptions of how their medical school influenced them to embody a social accountability mission in their working lives. METHODS This was a qualitative interview study carried out with graduates/alumni [n = 51] of Christian Medical College, Vellore [CMCV], India, a school with a long-established and explicit social-accountability mission. Data coding and analysis were initially inductive and thematic using Braun and Clarke's six step framework. MacIntyre's virtue ethics theory framed secondary analysis, allowing us to consider the relationships between individual and contextual factors. RESULTS Our participants perceived that CMCV invested heavily in selecting personal qualities aligned with the CMCV mission. They saw that these qualities were reinforced through various practices: [e.g., placements in resource limited and/or remote and rural settings]; community engagement and expectations [e.g., student self-governance]; role modelling [staff and more senior students]. Much emphasis was placed on sustaining these traditions and practices over time, creating a strong sense of identity and belonging among participants, traditions which were fostered further by the alumni network and continued engagement with CMCV post-graduation. CONCLUSIONS Ensuring social accountable medical education depends on alignment and interactions over time between context and structures, systems and human agents. Further studies are needed to extend understanding of how students from diverse contexts experience socially accountable medical education and translate their educational experience into their thinking and practice after graduation.
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Affiliation(s)
- Jennifer Cleland
- Medical Education Research and Scholarship Unit, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore.
| | - Anand Zachariah
- Christian Medical College, M.G.R Medical University, Vellore, India
| | - Sarah David
- Christian Medical College, M.G.R Medical University, Vellore, India
| | - Anna Pulimood
- Christian Medical College, M.G.R Medical University, Vellore, India
| | - Amudha Poobalan
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Prentice S, Barrett A, Benson J, Elliott T. 'Being in a place where it matters': GPs who do and do not work in Aboriginal Health Services. Aust J Prim Health 2024; 30:NULL. [PMID: 37653685 DOI: 10.1071/py23105] [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: 05/29/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Few general practitioners (GPs) pursue a career in Aboriginal and Torres Strait Islander health. This research examined factors motivating Australian General Practice Training Program (AGPT) graduates to remain in, or leave, Aboriginal Medical Services (AMSs). METHODS AGPT graduates who remained (n =11) and left (n =9) AMSs after placements participated in semi-structured interviews across two studies. Thematic analysis informed by grounded theory was employed. RESULTS Both participant groups highlighted similar motivations for requesting an AMS placement, particularly their interest in Aboriginal health or culture. Participants enjoyed organisational structures and relationships, and faced similar barriers to working in AMSs. Those who left placed greater emphasis on the politics and bureaucracy, and unpredictability, and also faced the barrier of ties to their current practice. Those who remained in Aboriginal health more proactively addressed barriers and had a more external view of barriers. CONCLUSIONS Factors influencing career decisions of GPs in Aboriginal health overlap with those for GPs in rural and other under-served areas. Training providers can better prepare (e.g. more comprehensive orientations) and support registrars during their placements (e.g. greater mentoring). Registrars' perceptions of, and reactions to, barriers may be pivotal in determining whether they remain in Aboriginal health. This article provides guidance for training providers to better support AMS registrars and encourage more GPs to work in this sector.
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Affiliation(s)
- Shaun Prentice
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia; and General Practice Training Research Department, The Royal Australian College of General Practitioners, Melbourne, Vic., Australia
| | - Alexandra Barrett
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Jill Benson
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia; and The Royal Australian College of General Practitioners, Melbourne, Vic., Australia
| | - Taryn Elliott
- The Royal Australian College of General Practitioners, Melbourne, Vic., Australia
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Sabesan V, Young L, Carlisle K, Vangaveti V, Vu T, Van Erp A, Kapur N. Effects of candidates' demographics and evaluation of the virtual Multiple Mini Interview (vMMI) as a tool for selection into paediatric training in Queensland. MEDICAL TEACHER 2023; 45:1148-1154. [PMID: 37019115 DOI: 10.1080/0142159x.2023.2195969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
INTRODUCTION The Queensland Basic Paediatric Training Network (QBPTN) is responsible for the selection of candidates into paediatric training in Queensland. The COVID-19 pandemic necessitated interviews to be conducted 'virtually' as virtual Multiple-Mini-Interviews (vMMI). The study aimed to describe the demographic characteristics of candidates applying for selection into paediatric training in Queensland, and to explore their perspectives and experiences with the vMMI selection tool. METHODOLOGY The demographic characteristics of candidates and their vMMI outcomes were collected and analysed with a mixed methods approach. The qualitative component was comprised of seven semi-structured interviews with consenting candidates. RESULTS Seventy-one shortlisted candidates took part in vMMI and 41 were offered training positions. The demographic characteristics of candidates at various stages of selection were similar. The mean vMMI scores were not statistically different between candidates from the Modified Monash Model 1 (MMM1) location and others [mean (SD): 43.5 (5.1) versus 41.7 (6.7), respectively, p = 0.26]. However, there was a statistically significant difference (p value 0.03) between being offered and not offered a training position for candidates from MMM2 and above. The analysis of the semi-structured interviews suggested that candidate experiences of the vMMI were influenced by the quality of the management of the technology used. Flexibility, convenience, and reduced stress were the main factors that influenced candidates' acceptance of vMMI. Perceptions of the vMMI process focused on the need to build rapport and facilitate communication with the interviewers. DISCUSSION vMMI is a viable alternative to face-to-face (FTF) MMI. The vMMI experience can be improved by facilitating enhanced interviewer training, by making provision for adequate candidate preparation and by having contingency plans in place for unexpected technical challenges. Given government priorities in Australia, the impact of candidates' geographical location on the vMMI outcome for candidates from MMM >1 location needs to be further explored.
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Affiliation(s)
- Vanaja Sabesan
- Queensland Paediatric Training Network, Queensland Rural Medical Service (Darling Downs Health, Queensland Health), Brisbane, Queensland, Australia
| | - Louise Young
- College of Medicine and Dentistry at James Cook University, Townsville, Queensland, Australia
| | - Karen Carlisle
- College of Medicine and Dentistry at James Cook University, Townsville, Queensland, Australia
| | - Venkat Vangaveti
- College of Medicine and Dentistry at James Cook University, Townsville, Queensland, Australia
| | - Tung Vu
- Paediatric Education, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Ansmarie Van Erp
- Strategic Business Development, Queensland Rural Medical Services (Darling Downs Health, Queensland Health), Toowoomba, Queensland, Australia
| | - Nitin Kapur
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, and Faculty of Medicine, University of Queensland, South Brisbane, Queensland, Australia
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Flinterman LE, González-González AI, Seils L, Bes J, Ballester M, Bañeres J, Dan S, Domagala A, Dubas-Jakóbczyk K, Likic R, Kroezen M, Batenburg R. Characteristics of Medical Deserts and Approaches to Mitigate Their Health Workforce Issues: A Scoping Review of Empirical Studies in Western Countries. Int J Health Policy Manag 2023; 12:7454. [PMID: 38618823 PMCID: PMC10590222 DOI: 10.34172/ijhpm.2023.7454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 05/30/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Medical deserts are considered a problematic issue for many Western countries which try to employ multitude of policies and initiatives to achieve a better distribution of their health workforce (HWF). The aim of this study was to systematically map research and provide an overview of definitions, characteristics, contributing factors and approaches to mitigate medical deserts within the European Union (EU)-funded project "ROUTE-HWF" (a Roadmap OUT of mEdical deserts into supportive Health WorkForce initiatives and policies). METHODS We performed a scoping review to identify knowledge clusters/research gaps in the field of medical deserts focusing on HWF issues. Six databases were searched till June 2021. Studies reporting primary research from Western countries on definitions, characteristics, contributing factors, and approaches were included. Two independent reviewers assessed studies for eligibility, extracted data and clustered studies according to the four defined outcomes. RESULTS Two-hundred and forty studies were included (n=116, 48% Australia/New Zealand; n=105, 44% North America; n=20, 8% Europe). All used observational designs except for five quasi-experimental studies. Studies provided definitions (n=171, 71%), characteristics (n=95, 40%), contributing factors (n=112, 47%), and approaches to mitigate medical deserts (n=87, 36%). Most medical deserts were defined by the density of the population in an area. Contributing factors to HWF issues in medical deserts consisted in work-related (n=55, 23%) and lifestyle-related factors (n=33, 14%) of the HWF as well as sociodemographic characteristics (n=79, 33%). Approaches to mitigate them focused on training adapted to the scope of rural practice (n=67, 28%), HWF distribution (n=3, 1%), support/infrastructure (n=8, 3%) and innovative models of care (n=7, 3%). CONCLUSION Our study provides the first scoping review that presents and categorizes definitions, characteristics, contributing factors, and approaches to mitigate HWF issues in medical deserts. We identified gaps such as the scarcity of longitudinal studies to investigate the impact of factors contributing to medical deserts, and interventional studies to evaluate the effectiveness of approaches to mitigate HWF issues.
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Affiliation(s)
- Linda E. Flinterman
- Health Workforce and Organization Studies, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | | | - Laura Seils
- Avedis Donabedian Research Institute – UAB, Madrid, Spain
| | - Julia Bes
- Health Workforce and Organization Studies, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | | | | | - Sorin Dan
- Innovation and Entrepreneurship InnoLab, University of Vaasa, Vaasa, Finland
| | - Alicja Domagala
- Department of Health Policy and Management, Institute of Public Health, Jagiellonian University, Krakow, Poland
| | - Katarzyna Dubas-Jakóbczyk
- Department of Health Economics and Social Security, Institute of Public Health, Jagiellonian University, Krakow, Poland
| | - Robert Likic
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marieke Kroezen
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ronald Batenburg
- Health Workforce and Organization Studies, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of Sociology, Radboud University, Nijmegen, The Netherlands
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de Figueiredo AM, de Labry Lima AO, de Figueiredo DCMM, Neto AJDM, Rocha EMS, de Azevedo GD. Educational Strategies to Reduce Physician Shortages in Underserved Areas: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5983. [PMID: 37297587 PMCID: PMC10252282 DOI: 10.3390/ijerph20115983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
The shortage of physicians in rural and underserved areas is an obstacle to the implementation of Universal Health Coverage (UHC). We carried out a systematic review to analyze the effectiveness of initiatives in medical education aimed to increase the supply of physicians in rural or underserved areas. We searched for studies published between 1999 and 2019 in six databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Interventional or observational controlled studies were defined as inclusion criteria. A total of 955 relevant unique records were selected for inclusion, which resulted in the identification of 17 articles for analysis. The admission of students from rural areas associated with a rural curriculum represented 52.95% of the interventions. Medical practice after graduation in rural or underserved areas was the most evaluated outcome, representing 12 publications (70.59%). Participants of these educational initiatives were more likely to work in rural or underserved areas or to choose family medicine, with significant differences between the groups in 82.35% of the studies. Educational strategies in undergraduate and medical residencies are effective. However, it is necessary to expand these interventions to ensure the supply of physicians in rural or urban underserved areas.
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Affiliation(s)
- Alexandre Medeiros de Figueiredo
- Department of Health Promotion, Federal University of Paraíba, Campus I, Jardim Universitário, S/N, Castelo Branco, João Pessoa 58051-900, Paraiba, Brazil
- Health Sciences Postgraduate Program, Federal University do Rio Grande do Norte, Campus Universitário Lagoa Nova, Natal 59078-900, Rio Grande do Norte, Brazil
| | - Antonio Olry de Labry Lima
- Andalusian School of Public Health, Cuesta del Observatorio 4, Campus Universitario de Cartuja, 18011 Granada, Andalusia, Spain
| | | | - Alexandre José de Melo Neto
- Department of Health Promotion, Federal University of Paraíba, Campus I, Jardim Universitário, S/N, Castelo Branco, João Pessoa 58051-900, Paraiba, Brazil
| | - Erika Maria Sampaio Rocha
- Health Science Training Center, Federal University of Espírito Santo, Av. Fernando Ferrari, 514, Goiabeiras, Vitória 29075-910, Espirito Santo, Brazil
| | - George Dantas de Azevedo
- Multicampi School of Medical Sciences, Federal University of Rio Grande do Norte, Av. Cel Martiniano, 541, Caico 59300-000, Rio Grande do Norte, Brazil
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Playford D, Ngo H, Puddey I. Intention mutability and translation of rural intention into actual rural medical practice. MEDICAL EDUCATION 2021; 55:496-504. [PMID: 33141924 DOI: 10.1111/medu.14404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Rural intention and experience during medical school have been related to subsequent rural work. However, their relative contributions and the timing of their effects are not known. These data are critical to effective educational interventions able to improve rural medical workforce numbers, an international priority. METHODS Participants were graduates of an Australian MBBS degree between 2006 and 2016, who completed both entry and exit surveys approved by the Medical Deans of Australia, including workplace intention data. Rural/urban workplace intention changes from entry to exit were analysed using multinomial logistic regression. Binary logistic regression was used to assess actual rural versus urban work, obtained from a public practitioner registration website. RESULTS Of 547 eligible undergraduates, 169 completed a year-long rural clinical school (RCS). A subset of 93 of the 547 graduates practiced rurally, of whom 42 had completed RCS. Both rural background and RCS predicted rural practice intention; both were also significantly related to actual rural work. Enduring rural intention was associated with nearly sevenfold odds of actually practicing rurally, compared with an enduring urban intention. Those who changed practice intention from entry to exit were more likely to practice in the region of their exit intention. Of special note: Rural Clinical School of Western Australia (RCSWA) exposure particularly affects urban origin students such that the odds of changing from an urban to a rural orientation immediately after their rural experience were more than fourfold higher than those not so participating. DISCUSSION Both intention and RCSWA experience are associated with subsequent rural work. The impacts of RCSWA were able to be localised after the rural educational experience. Amongst those with mutable intention, exit intention was that most strongly related to actual work, suggesting this as the most reliable point to select for further rural training.
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Affiliation(s)
- Denese Playford
- Rural Clinical School of Western Australia, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Hanh Ngo
- Rural Clinical School of Western Australia, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Ian Puddey
- School of Medicine, University of Western Australia, Crawley, WA, Australia
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O'Doherty J, Hyde S, O'Connor R, Brown MEL, Hayes P, Niranjan V, Culhane A, O'Dwyer P, O'Donnell P, Glynn L, O'Regan A. Development and sustainment of professional relationships within longitudinal integrated clerkships in general practice (LICs): a narrative review. Ir J Med Sci 2021; 191:447-459. [PMID: 33641086 DOI: 10.1007/s11845-021-02525-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Longitudinal integrated clerkships (LICs) are a relatively new model of clinical medical education, whereby students participate in patient care over time and develop relationships with those patients', their clinicians, and other health care staff involved in the care of those patients. It has been called 'relationship-based education' but, to date, no review has investigated the development and impact of these central relationships within this curricula model. AIMS The aim of this study is to review the literature pertaining to relationships in LICs, specifically to understand how they come about and how they affect learning. METHODS The search strategy systematically explored PubMed, ERIC (EBSCO) and Academic Search Complete, using key words and MESH terms. Original research published in peer-reviewed journals between January 2007 and August 2020 that were written in the English language were included in the review. RESULTS After applying set inclusion and exclusion criteria, 43 studies were included in this review. A qualitative thematic analysis was undertaken, and results were synthesised narratively. Four distinct categories were identified: defining relationships in LICs, developing relationships in LICs, relationship maintenance and multi-stakeholder impact. CONCLUSIONS The longitudinal integrated clerkship model of clinical education facilitates the development of meaningful triangular relationships between student, clinical teacher and patient, which are the central drivers of successful learning within the context of an LIC. These relationships are nested in a set of important supporting relationships involving other supervisors, the medical school and university, the practice clinical and administrative team and peers.
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Affiliation(s)
- Jane O'Doherty
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland.
| | - Sarah Hyde
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
| | - Raymond O'Connor
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
- Mid-West Specialist Training Programme in General Practice, University of Limerick, Plassey, Limerick, Ireland
| | - Megan E L Brown
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Peter Hayes
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
| | - Vikram Niranjan
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
| | - Aidan Culhane
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
| | - Pat O'Dwyer
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
| | - Patrick O'Donnell
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
| | - Liam Glynn
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
| | - Andrew O'Regan
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
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Yahata S, Takeshima T, Kenzaka T, Okayama M. Long-term impact of undergraduate community-based clinical training on community healthcare practice in Japan: a cross-sectional study. BMC MEDICAL EDUCATION 2020; 20:337. [PMID: 33004049 PMCID: PMC7528470 DOI: 10.1186/s12909-020-02258-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Community-based medical education (CBME) has been evolving globally. However, the long-term impacts of CBME programs on career intention are ambiguous. Therefore, this study aimed to reveal the long-term impact of community-based clinical training (CBCT) such as CBME programs in Japan on current community healthcare (CH) practice. METHODS This cross-sectional study targeted physicians who had graduated from Kobe University School of Medicine between 1998 and 2004 and had over 15 years' experience after graduation. Self-administered questionnaires were mailed to participants between September and November 2019. Of the 793 potential subjects, 325 questionnaires were undeliverable. A total of 468 questionnaires substantially sent to the subjects. The exposure was the undergraduate CBCT defined as clinical training about CH in a community. The primary outcome was the provision of current CH practice. The secondary outcome was rural retention. The odds ratios (ORs) and confidence intervals (CIs) were calculated, and the confounders (age, gender, and attitude toward CH at admission; primary outcome, and age, gender, attitude toward rural healthcare at admission, own and spouse's hometown, and emphasis on child education; secondary outcomes) were adjusted using multivariate logistic regression analysis. RESULTS A total of 195 (41.7%) questionnaires were analyzed. The mean (standard deviation [SD]) age of study participants was 43.8 (3.5) years and 76.4% were men. A total of 48 physicians (24.6%) experienced CBCT, of which the mean (SD) training period was 26.3 (27.3) days. As many as 148 (76.3%) physicians provided CH at the time of the study, and 12 (6.5%) worked in rural areas. There was no notable impact of undergraduate CBCT on current CH practice (OR, 1.24; 95% CI, 0.53-3.08; adjusted OR [aOR], 1.00; 95% CI, 0.43-2.30) and rural retention (OR, 0.59; 95% CI, 0.06-2.94; aOR, 0.59; 95% CI, 0.11-3.04). CONCLUSIONS It may be insufficient to use conventional CBCT in Japan to develop CH professionals effectively. Japanese CBME programs should be standardized through a review of their content and quality. They should continue to be evaluated for their medium- to long-term effects.
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Affiliation(s)
- Shinsuke Yahata
- Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Kobe, Hyogo, 652-0032, Japan
| | - Taro Takeshima
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1, Toyochikamiyajiro, Shirakawa, Fukushima, 961-0005, Japan
- Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, 1, Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Tsuneaki Kenzaka
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Kobe, Hyogo, 652-0032, Japan
| | - Masanobu Okayama
- Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Kobe, Hyogo, 652-0032, Japan.
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Holst J. Increasing Rural Recruitment and Retention through Rural Exposure during Undergraduate Training: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176423. [PMID: 32899356 PMCID: PMC7503328 DOI: 10.3390/ijerph17176423] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 11/17/2022]
Abstract
Objectives: Ensuring nationwide access to medical care challenges health systems worldwide. Rural exposure during undergraduate medical training is promising as a means for overcoming the shortage of physicians outside urban areas, but the effectiveness is widely unknown. This integrative review assesses the effects of rural placements during undergraduate medical training on graduates’ likelihood to take up rural practice. Methods: The paper presents the results of a longitudinal review of the literature published in PubMed, Embase, Google Scholar and elsewhere on the measurable effects of rural placements and internships during medical training on the number of graduates in rural practice. Results: The combined database and hand search identified 38 suitable primary studies with rather heterogeneous interventions, endpoints and results, mostly cross-sectional and control studies. The analysis of the existing evidence exhibited predominantly positive but rather weak correlations between rural placements during undergraduate medical training and later rural practice. Beyond the initial scope, the review underpinned rural upbringing to be the strongest predictor for rural practice. Conclusions: This review confirms that rural exposure during undergraduate medical training to contributes to recruitment and retention in nonurban settings. It can play a role within a broader strategy for overcoming the shortage of rural practitioners. Rural placements during medical education turned out to be particularly effective for rural-entry students. Given the increasing funding being directed towards medical schools to produce graduates that will work rurally, more robust high-quality research is needed.
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Affiliation(s)
- Jens Holst
- Department of Nursing and Health Sciences, Fulda University of Applied Sciences, Leipziger Strasse 123, D-36037 Fulda, Germany
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Walters L, Worley P. Call to expand teaching opportunities in rural family medicine. MEDICAL EDUCATION 2020; 54:97-99. [PMID: 31800115 DOI: 10.1111/medu.14042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Lucie Walters
- Adelaide Rural Clinical School, University of Adelaide, Mount Gambier, Australia
| | - Paul Worley
- Prideaux Centre for Health Professions Education, Flinders University, Adelaide, Australia
- Centre for Health Professions Education, Stellenbosch University, Cape Town, South Africa
- National Rural Health Commissioner, Australian Government, Canberra, Australia
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Johnson G, Foster K, Blinkhorn A, Wright FC. Exploration of the factors that influence new Australian dental graduates to work rurally and their perspectives of rural versus metropolitan employment. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2019; 23:437-447. [PMID: 31206944 DOI: 10.1111/eje.12450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 06/10/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The challenges in the recruitment and retention of dentists in rural Australia have contributed to a lack of dental service provision to rural communities. This paper explores the workforce factors involved in the employment location decisions of dentists' post-graduation. MATERIALS AND METHODS Graduates between 2009 and 2013 from the University of Sydney, Dental School, were asked to complete a telephone interview related to their employment history. A total of 135 interviews were conducted, with 63% (135/214) of contactable graduates, or 33.4% (135/404) of all the graduates (2009-2013). Interviews followed a semi-structured script. RESULTS Key factors which positively impacted on rural employment included the following: job competition in metropolitan areas, good rural salaries, financial incentives, clinical experience, rural lifestyle and professional mentorship. Barriers were as follows: proximity to friends and family, building a social and professional network, isolation, less professional support and reduced access to education. CONCLUSION Recommendations to increase rural employment include: competitive rural salaries, financial incentives and formal mentorship during both recruitment and integration into a rural community. Dental schools should consider advertising identified drivers of rural employment, namely good salaries, full-time employment, clinical experience and rural lifestyle. This study provides important information related to rural employment and rural retention.
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Affiliation(s)
- George Johnson
- Sydney Institute for Women, Children and their Families, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Kirsty Foster
- Office of Medical Education, Mayne Medical School, University of Queensland, Herston, Queensland, Australia
| | - Anthony Blinkhorn
- Population Oral Health, University of Sydney, Sydney, New South Wales, Australia
| | - Fredrick Clive Wright
- Centre for Education and Research on Ageing, Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Playford D, Ngo H, Atkinson D, Puddey IB. Graduate doctors' rural work increases over time. MEDICAL TEACHER 2019; 41:1073-1080. [PMID: 31177927 DOI: 10.1080/0142159x.2019.1621278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background: The contribution of rural clinical school (RCS) and rural origin to developing a long-term rural medical workforce was examined. Methods: Longitudinal cohort study, after undergraduate location in either rural or urban setting, for all medical graduates 2004-2010, identified in the Australian Health Practitioner Regulation Agency, in the following groups: Urban origin/no RCS; Rural origin/no RCS; Urban origin/RCS; and Rural origin/RCS. Results: Proportions of all graduates working rurally increased from 2013 to 2018, including amongst urban origin/nonRCS graduates. Rural origin/RCS participants worked rurally at the highest rates across all time points, with an endpoint of 47%, and an odds ratio of 9.70 (5.41, 17.40) relative to the urban reference group. They had a cumulative duration of rural practice over 5 times higher than the urban reference group. RCS graduates were more likely to be working in remote areas than nonRCS graduates. Conclusion: All graduates' contribution to rural and remote workforce is dynamic and increasing. Both RCS participation and rural student recruitment make synergistic and increasing contributions to rural work. RCS effects workforce distribution to more remote areas. Single cross-sectional studies do not capture this dynamic growth in the rural workforce.
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Affiliation(s)
- Denese Playford
- The Rural Clinical School of Western Australia, The School of Medicine, The Faculty of Health and Medical Sciences, The University of Western Australia , Crawley , WA , USA
| | - Hanh Ngo
- The Rural Clinical School of Western Australia, The School of Medicine, The Faculty of Health and Medical Sciences, The University of Western Australia , Crawley , WA , USA
| | - David Atkinson
- The Rural Clinical School of Western Australia, The School of Medicine, The Faculty of Health and Medical Sciences, The University of Western Australia , Crawley , WA , USA
| | - Ian B Puddey
- School of Medicine and Pharmacology, The School of Medicine, The Faculty of Health and Medical Sciences, The University of Western Australia , Crawley , WA , USA
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Playford DE, Burkitt T, Atkinson D. Social network analysis of rural medical networks after medical school immersion in a rural clinical school. BMC Health Serv Res 2019; 19:305. [PMID: 31088454 PMCID: PMC6515657 DOI: 10.1186/s12913-019-4132-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/29/2019] [Indexed: 11/26/2022] Open
Abstract
Background The impact of new medical graduates on the social dimensions of the rural medical workforce is yet to be examined. Social Network Analysis (SNA) is able to visualize and measure these dimensions. We apply this method to examine the workforce characteristics of graduates from a representative Australian Rural Clinical School. Methods Participants were medical graduates of the Rural Clinical School of Western Australia (RCSWA) from the 2001–2014 cohorts, identified as being in rural work in 2017 by the Australian Health Practitioner Regulation Agency. SNA was used to examine the relationships between site of origin and of work destination. Data were entered into UCInet 6 as tied pairs, and visualized using Netdraw. UCINet statistics relating to node centrality were obtained from the node editor. Results SNA measures showed that the 124 of 709 graduates in rural practice were distributed around Australia, and that their practice was strongly focused on the North, with a clear centre in the remote Western Australian town of Broome. Women were strongly recruited, and were widely distributed. Conclusions RCSWA appears to be a “weak tie” according to SNA theory: the School attracts graduates to rural nodes where they had only passing prior contact. The multiple activities that comprise the social capital of the most attractive, remote, node demonstrate the clear workforce effects of being a “bridge, broker and boundary spanner” in SNA terms, and add new understanding about recruiting to the rural workforce.
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Affiliation(s)
- Denese E Playford
- The Rural Clinical School of Western Australia, RCSWA, M706, The School of Medicine, The University of Western Australia, Crawley, WA, 6009, Australia. .,The University of Notre Dame Australia, Fremantle Campus, Western Australia, Australia, 32 Mouat St, Fremantle, WA, 6160, Australia.
| | - Tessa Burkitt
- The Rural Clinical School of Western Australia, RCSWA, M706, The School of Medicine, The University of Western Australia, Crawley, WA, 6009, Australia.,The University of Notre Dame Australia, Fremantle Campus, Western Australia, Australia, 32 Mouat St, Fremantle, WA, 6160, Australia
| | - David Atkinson
- The Rural Clinical School of Western Australia, RCSWA, M706, The School of Medicine, The University of Western Australia, Crawley, WA, 6009, Australia.,The University of Notre Dame Australia, Fremantle Campus, Western Australia, Australia, 32 Mouat St, Fremantle, WA, 6160, Australia
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Bentley M, Dummond N, Isaac V, Hodge H, Walters L. Doctors' rural practice self-efficacy is associated with current and intended small rural locations of practice. Aust J Rural Health 2019; 27:146-152. [PMID: 30957340 PMCID: PMC7328767 DOI: 10.1111/ajr.12486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 09/10/2018] [Accepted: 10/08/2018] [Indexed: 11/28/2022] Open
Abstract
Objective Key factors which positively influence recruitment and retention of doctors to rural practice include rural background and positive rural training experience. Despite this knowledge, there is no well‐established conceptual framework to explain how these factors influence intention. The aim of this study was to consider rural practice self‐efficacy and its influence on rural career choice by doctors. Questions relating to self‐efficacy were formulated using Bandura's four proposed sources of self‐efficacy, which include mastery experiences, vicarious experience, social persuasion and emotional and physical response to experiences. Design Cross‐sectional study. Setting and participants Medical school graduates from Flinders University, who completed a rural year as a part of the clinical component of the course between 1997 and 2015. Main outcome measures Rural self‐efficacy; current and intended location of practice in small rural communities (<25 000 people). Result It was found that 28.5% of participants were currently working in communities of <25 000 people. Levels of intent for future small town rural practice were consistent across career stages after internship. Higher rural practice self‐efficacy scores were found in doctors working in smaller towns (<25 000) and small communities (<10 000). Higher self‐efficacy was also associated with rural background, more senior career status, earlier speciality decision time and smaller expectation‐experience gap. Conclusion An independent association exists between rural self‐efficacy and intention to remain or return to small rural practice. The article offers rural clinical schools the opportunity to consider how they can influence future rural career outcomes.
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Affiliation(s)
- Megan Bentley
- Flinders University Rural Health South Australia, Flinders University, Mount Gambier, South Australia, Australia
| | - Nadine Dummond
- Flinders University Rural Health South Australia, Flinders University, Renmark, South Australia, Australia
| | - Vivian Isaac
- Flinders University Rural Health South Australia, Flinders University, Renmark, South Australia, Australia
| | - Heidi Hodge
- Mid North Knowledge Partnership, Flinders University Rural Health South Australia, Flinders University, Burra, South Australia, Australia
| | - Lucie Walters
- Flinders University Rural Health South Australia, Flinders University, Mount Gambier, South Australia, Australia
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Woolley T, Ray RA. Effectiveness of regional medical schools in attracting and retaining students for early‐career practice in the local area: The James Cook University experience. Aust J Rural Health 2019; 27:125-131. [DOI: 10.1111/ajr.12498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 10/21/2018] [Accepted: 01/02/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Torres Woolley
- College of Medicine and Dentistry James Cook University Townsville Queensland Australia
| | - Robin Adelle Ray
- College of Medicine and Dentistry James Cook University Townsville Queensland Australia
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Kirkman JM, Bentley SA, Armitage JA, Woods CA. Could adoption of the rural pipeline concept redress Australian optometry workforce issues? Clin Exp Optom 2019; 102:566-570. [PMID: 30801801 DOI: 10.1111/cxo.12873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/07/2018] [Accepted: 12/30/2018] [Indexed: 11/26/2022] Open
Abstract
People living in rural and remote areas have poorer ocular health outcomes compared with those living in metropolitan areas. Reasons for this are multiple and complex but access to care is consistently reported as a defining factor. The geographic maldistribution of eye-care professionals is a major obstacle for regional, rural and remote Australians seeking care. Research from the medical profession suggests adopting the 'rural pipeline' concept to address the issue of maldistribution. This approach appears to have had some success in medicine, and involves recruiting students from a rural background, exposing students to rural practice through placements and offering graduates incentives and support to practice rurally. Lessons could be learnt from the medical field as there is a dearth of literature describing the utilisation of the rural pipeline in allied health. However, given the differences between professions it cannot be assumed factors and results will be the same. A greater understanding is required to determine whether optometry is a profession which may benefit from the rural pipeline concept.
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Affiliation(s)
- Jacqueline M Kirkman
- Deakin Optometry, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Sharon A Bentley
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Craig A Woods
- Deakin Optometry, School of Medicine, Deakin University, Geelong, Victoria, Australia
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Johnson G, Wright FAC, Foster K. A longitudinal evaluation of the Rural Clinical Placement Program at the University of Sydney Dental School. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2019; 23:e59-e70. [PMID: 30358039 DOI: 10.1111/eje.12401] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/15/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Australia has a lack of dental practitioners in rural and remote regions. This study evaluates the impact of a Rural Clinical Placement Program (RCPP) offered to final year students at the University of Sydney (USYD) Dental School on the graduates working locations. MATERIALS AND METHODS University of Sydney students who graduated between 2009 and 2013 (n = 404) were invited to complete a telephone interview. One hundred and thirty-five graduates were interviewed, 90 RCPP participants and 45 non-participants. RESULTS The majority of graduates interviewed were from a metropolitan background (87%), 47% were female, 77% worked full time, and 70% were employed in private practice. A higher proportion (33%) of the RCPP participants were working in rural Australia compared with 18% of the non-participants. The graduates reported that the RCPP was a high-quality program with excellent rural clinical supervisors, provided broad clinical dentistry; they met appreciative patients and enjoyed the rural lifestyle. CONCLUSIONS The RCPP was a valuable and positive experience with many considering it as a highlight of their dental education. A large proportion reported the program positively influenced their employment location choices, and a higher proportion of the RCPP participants were identified as working rurally, compared to the non-participants.
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Affiliation(s)
- George Johnson
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Fredrick A C Wright
- Concord Clinical School, University of Sydney, Australia, Centre for Education and Research on Ageing, Sydney, New South Wales, Australia
| | - Kirsty Foster
- Northern Clinical School, University of Sydney, & Office for Global Health, Sydney Medical School, Sydney, New South Wales, Australia
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Prideaux D. The global-local tension in medical education: turning 'think global, act local' on its head? MEDICAL EDUCATION 2019; 53:25-31. [PMID: 29974492 DOI: 10.1111/medu.13630] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/19/2018] [Accepted: 04/27/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT Medical education has not been immune from forces for globalisation in the contemporary world. At the same time the social accountability of medical schools in addressing local health priorities has been emphasised. This paper explores the global-local tension in medical education through a careful selection of key overview papers. GLOBALISATION Globalisation in medical education has taken two main forms: economic and altruistic. The former includes licensing curricula, recruiting internationally and establishing 'offshore' schools or campuses. Altruistic collaborations focus on the spread of learning and educational innovations. Both forms bring benefits but have been subject to critique for their differential impact and focus on educational inputs rather than outputs. SOCIAL ACCOUNTABILITY Social accountability requires medical schools to direct their activities to local priorities and to serving local health systems. Adoption of the principles of social accountability compels all medical schools to ask questions of their educational programmes and graduate outcomes. However, these are globally interdependent questions and are the intent of some well-known social accountability collaborations. It is naïve to think that adoption of a social accountability agenda by all medical schools would necessarily reduce global health inequity. A recent Australian example shows that workforce maldistribution, for example, is resistant to even high-level intervention. CONCLUSIONS It is yet too early to fully accept that 'think global, act local can be turned on its head'. There is much research to be carried out, particularly on the outcomes and impacts of medical education. Establishing cause and effect is a challenge, as is determining whether globalisation or localisation can contribute to greater global health equity. If we are ever to resolve the global-local tension in medical education, we need more evidence on the outcomes of what we do, whether globally or locally inspired.
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Affiliation(s)
- David Prideaux
- Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, South Australia, Australia
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21
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Cleland JA, Patterson F, Hanson MD. Thinking of selection and widening access as complex and wicked problems. MEDICAL EDUCATION 2018; 52:1228-1239. [PMID: 30192021 DOI: 10.1111/medu.13670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/30/2018] [Accepted: 06/13/2018] [Indexed: 05/24/2023]
Abstract
OBJECTIVES 'Wicked problems' are complex in nature, have innumerable causes associated with multiple social environments and actors with unpredictable behaviour and outcomes, and are difficult to define or even resolve. This paper considers why and how the frameworks of complexity theory and wicked problems can help medical educators consider selection and widening access (WA) to medicine through fresh eyes to guide future policy and practice. We illustrate how 'wickedity' can frame the key issues in this area, and then address steps that education stakeholders might take to respond to and act on these issues. METHODS We used the 10 properties of a wicked problem to frame common issues in the broad field of selection and WA in medicine. We drew heavily on literature from different disciplines, particularly education, and, through debate and reflection, agreed on the applicability of the theory for illuminating and potentially addressing outstanding issues in selection and WA. RESULTS Framing medical school selection using the 10 properties of wicked problems is a means of shifting thinking from erroneous 'simple' solutions to thinking more contextually and receptively. The wicked problem framework positions selection as a multi-causal, complex, dynamic, social problem and foregrounds stakeholders' views and context as being highly relevant in medical school selection. CONCLUSIONS The wicked problem lens shifts thinking and action from seeking one elusive, objective truth to recognising the complexity of medical school selection, managing uncertainty, questioning and considering 'issues' associated with medical school selection more productively. Although there are criticisms of this framework, labelling medical selection as 'wicked' provides original insights and genuine reframing of the challenges of this important, and high profile, aspect of medical education. Doing so, in turn, opens the door to different responses than would be the case if selection and WA were simple and readily tamed.
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Affiliation(s)
- Jennifer A Cleland
- Centre for Healthcare Education Research and Innovation (CHERI), Institute of Education for Medical and Dental Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Mark D Hanson
- Department of Psychiatry, Faculty of Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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22
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Johnson GE, Wright FC, Foster K. The impact of rural outreach programs on medical students' future rural intentions and working locations: a systematic review. BMC MEDICAL EDUCATION 2018; 18:196. [PMID: 30107795 PMCID: PMC6092777 DOI: 10.1186/s12909-018-1287-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 07/19/2018] [Indexed: 05/07/2023]
Abstract
BACKGROUND Significant investment has been undertaken by many countries into 'Rural Clinical Training Placement Schemes' for medical students in order to deal with shortages of trained health care professionals in rural and remote locations. This systematic review examines the evidence base of rural educational programs within medical education and focusses on workforce intentions and employment outcomes. The study provides a detailed description of the methodological characteristics of the literature, thematic workforce outcomes and key related factors are identified, study quality is assessed, and the findings are compared within an international context. METHODS A systematic review looking at international literature of rural placement programs within medical education between January 2005 to January 2017 from databases including; Medline, Embase, NursingOVID, PubMed and Cochrane. The study adopted the PRISMA protocol. A quality assessment of the literature was conducted based on the Health Gains Notation Framework. RESULTS Sixty two papers met the inclusion criteria. The review identified three program classifications; Rural Clinical Placement Programs, Rural Clinical Placement Programs combined with a rural health educational curriculum component and Rural Clinical School Programs. The studies included were from Australia, United States, Canada, New Zealand, Thailand and Africa. Questionnaires and tracking or medical registry databases were the most commonly reported research tools and the majority were volunteer programs. Most studies identified potential rural predictors/confounders, however a number did not apply control groups and most programs were based on a single site. There was a clear discrepancy in the ideal rural clinical placement length. Outcomes themes were identified related to rural workforce outcomes. Most studies reported that an organised, well-funded, rural placement or rural clinical school program produced positive associations with increased rural intentions and actual graduate rural employment. CONCLUSIONS Future research should focus on large scale methodologically rigorous multi-site rural program studies, with longitudinal follow up of graduates working locations. Studies should apply pre-and post-intervention surveys to measure change in attitudes and control for predictive confounders, control groups should be applied; and in-depth qualitative research should be considered to explore the specific factors of programs that are associated with encouraging rural employment.
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Affiliation(s)
- George E. Johnson
- Sydney Medical School, University of Sydney, Sydney, NSW 2050 Australia
| | - Fredrick Clive Wright
- Concord Clinical School, University of Sydney, Sydney, Australia
- Centre for Education and Research on Ageing, Sydney, NSW 2139 Australia
| | - Kirsty Foster
- Sydney Medical School, Northern & Kolling Institute, University of Sydney, Sydney, NSW Australia
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O'Sullivan B, McGrail M, Russell D, Walker J, Chambers H, Major L, Langham R. Duration and setting of rural immersion during the medical degree relates to rural work outcomes. MEDICAL EDUCATION 2018; 52:803-815. [PMID: 29676022 DOI: 10.1111/medu.13578] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/18/2017] [Accepted: 02/05/2018] [Indexed: 05/13/2023]
Abstract
CONTEXT Providing year-long rural immersion as part of the medical degree is commonly used to increase the number of doctors with an interest in rural practice. However, the optimal duration and setting of immersion has not been fully established. This paper explores associations between various durations and settings of rural immersion during the medical degree and whether doctors work in rural areas after graduation. METHODS Eligible participants were medical graduates of Monash University between 2008 and 2016 in postgraduate years 1-9, whose characteristics, rural immersion information and work location had been prospectively collected. Separate multiple logistic regression and multinomial logit regression models tested associations between the duration and setting of any rural immersion they did during the medical degree and (i) working in a rural area and (ii) working in large or smaller rural towns, in 2017. RESULTS The adjusted odds of working in a rural area were significantly increased if students were immersed for one full year (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.15-2.79), for between 1 and 2 years (OR, 2.26; 95% CI, 1.54-3.32) and for 2 or more years (OR, 4.43; 95% CI, 3.03-6.47) relative to no rural immersion. The strongest association was for immersion in a mix of both regional hospitals and rural general practice (OR, 3.26; 95% CI, 2.31-4.61), followed by immersion in regional hospitals only (OR, 1.94; 95% CI, 1.39-2.70) and rural general practice only (OR, 1.91; 95% CI, 1.06-3.45). More than 1 year's immersion in a mix of regional hospitals and rural general practices was associated with working in smaller regional or rural towns (<50 000 population) (relative risk ratios [RRR] 2.97; 95% CI, 1.82-4.83). CONCLUSION These findings inform medical schools about effective rural immersion programmes. Longer rural immersion and immersion in both regional hospitals and rural general practices are likely to increase rural work and rural distribution of early career doctors.
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Affiliation(s)
| | - Matthew McGrail
- Monash University School of Rural Health, Bendigo, Victoria, Australia
| | - Deborah Russell
- Monash University School of Rural Health, Bendigo, Victoria, Australia
| | - Judi Walker
- Monash University School of Rural Health, Bendigo, Victoria, Australia
| | - Helen Chambers
- Monash University School of Rural Health, Bendigo, Victoria, Australia
| | - Laura Major
- Monash University School of Rural Health, Bendigo, Victoria, Australia
| | - Robyn Langham
- Monash University School of Rural Health, Bendigo, Victoria, Australia
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O’Sullivan BG, McGrail MR, Russell D, Chambers H, Major L. A review of characteristics and outcomes of Australia's undergraduate medical education rural immersion programs. HUMAN RESOURCES FOR HEALTH 2018; 16:8. [PMID: 29386024 PMCID: PMC5793366 DOI: 10.1186/s12960-018-0271-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 01/19/2018] [Indexed: 05/16/2023]
Abstract
BACKGROUND A key strategy for increasing the supply of rural doctors is rurally located medical education. In 2000, Australia introduced a national policy to increase rural immersion for undergraduate medical students. This study aims to describe the characteristics and outcomes of the rural immersion programs that were implemented in Australian medical schools. METHODS Information about 19 immersion programs was sourced in 2016 via the grey and published literature. A scoping review of the published peer-reviewed studies via Ovid MEDLINE and Informit (2000-2016) and direct journal searching included studies that focused on outcomes of undergraduate rural immersion in Australian medical schools from 2000 to 2016. RESULTS Programs varied widely by selection criteria and program design, offering between 1- and 6-year immersion. Based on 26 studies from 10 medical schools, rural immersion was positively associated with rural practice in the first postgraduate year (internship) and early career (first 10 years post-qualifying). Having a rural background increased the effects of rural immersion. Evidence suggested that longer duration of immersion also increases the uptake of rural work, including by metropolitan-background students, though overall there was limited evidence about the influence of different program designs. Most evidence was based on relatively weak, predominantly cross-sectional research designs and single-institution studies. Many had flaws including small sample sizes, studying internship outcomes only, inadequately controlling for confounding variables, not using metropolitan-trained controls and providing limited justification as to the postgraduate stage at which rural practice outcomes were measured. CONCLUSIONS Australia's immersion programs are moderately associated with an increased rural supply of early career doctors although metropolitan-trained students contribute equal numbers to overall rural workforce capacity. More research is needed about the influence of student interest in rural practice and the duration and setting of immersion on rural work uptake and working more remotely. Research needs to be more nationally balanced and scaled-up to inform national policy development. Critically, the quality of research could be strengthened through longer-term follow-up studies, adjusting for known confounders, accounting for postgraduate stages and using appropriate controls to test the relative effects of student characteristics and program designs.
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Affiliation(s)
- Belinda G. O’Sullivan
- Monash University School of Rural Health, Office of Research, Level 3, 26 Mercy St, PO Box 666, Bendigo, VIC 3550 Australia
| | - Matthew R. McGrail
- Monash University School of Rural Health, Northways Road, Churchill, VIC 3842 Australia
| | - Deborah Russell
- Monash University School of Rural Health, Office of Research, Level 3, 26 Mercy St, PO Box 666, Bendigo, VIC 3550 Australia
| | - Helen Chambers
- Monash University School of Rural Health, 3 Ollerton Ave, Newborough, VIC 3825 Australia
| | - Laura Major
- Monash University School of Rural Health, Clayton, Australia
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Gorman D. Matching the production of doctors with national needs. MEDICAL EDUCATION 2018; 52:103-113. [PMID: 28722157 DOI: 10.1111/medu.13369] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/02/2017] [Accepted: 05/04/2017] [Indexed: 05/14/2023]
Abstract
CONTEXT Matching the supply of health workers to need is necessary if a health system is to be sustainable, affordable and fit for purpose. On the 30th anniversary of the 1988 Edinburgh Declaration of the World Federation for Medical Education, levels of compliance with the 10th recommendation, 'Ensure admission policies that match the numbers of students trained with national needs for doctors', warrant review. There are two domains to such a review, concerning, respectively, how well these health needs are known, and whether workforce supply is well matched. METHODS This is a literature review-based analysis of extant health system planning, which underpins current understanding of national health needs and of the consequent alignment of student selection processes. RESULTS The core finding is that national need for doctors, and any other health workers, is not confidently known for any jurisdiction. Consequently, validation of student selection processes is impossible against this endpoint and data to validate these processes against the alternative endpoint of a positive impact on health outcomes do not exist. Data do exist to suggest some student selection processes result in desirable career and career location uptakes.
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Affiliation(s)
- Des Gorman
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Health Workforce New Zealand, New Zealand Ministry of Health, Auckland, New Zealand
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Gorman D. Seven steps to redistributing doctors to meet health needs better. Intern Med J 2017; 47:845-847. [DOI: 10.1111/imj.13499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Des Gorman
- Department of Medicine; University of Auckland; Auckland New Zealand
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Mapukata NO, Dube R, Couper I, Mlambo M. Factors influencing choice of site for rural clinical placements by final year medical students in a South African university. Afr J Prim Health Care Fam Med 2017; 9:e1-e6. [PMID: 28470075 PMCID: PMC5417170 DOI: 10.4102/phcfm.v9i1.1226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 03/08/2017] [Accepted: 12/08/2016] [Indexed: 12/05/2022] Open
Abstract
Background Most of South Africa’s citizens who live in rural or underserved communities rely on the public health care sector to access quality health care. The value of rural exposure through clinical placements is well documented. Medical schools in South Africa have a responsibility to provide solutions that address the prevailing human resources challenges. Despite this commitment, medical students do not necessarily appreciate their role in resolving South Africa’s human resources challenges. This study aimed to assess the factors that influenced the choice of clinical learning sites in a self-selection process undertaken by Wits final year medical students for the compulsory 6-week integrated primary care block rotation. Methods Qualitative data related to reasons for choice of service learning site were gathered from 524 pre-placement questionnaires completed by final year medical students entering the rotation over a 3-year period (2012–2014). Thematic analysis was performed using the MAXQDA software. Results Eight themes emerged from the study indicating that the majority of participants were in favour of local urban underserved placement. Contextual factors, such as work commitments or family responsibilities, being compromised socially and losing academic standing were the main reasons for seeking urban placement. Good supervision, opportunistic learning, skills development and moral support were reasons for seeking rural placements. Previous voluntary exposure to rural practice or being of rural origin was a strong indicator for uptake of rural placement. Conclusion This study has demonstrated the challenges faced by coordinators in balancing personal and institutional needs with country needs and the contextual factors that must be considered when implementing medical education programmes that respond to social challenges.
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Puddey IB, Playford DE, Mercer A. Impact of medical student origins on the likelihood of ultimately practicing in areas of low vs high socio-economic status. BMC MEDICAL EDUCATION 2017; 17:1. [PMID: 28056975 PMCID: PMC5215143 DOI: 10.1186/s12909-016-0842-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 12/14/2016] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Medical schools are in general over-represented by students from high socio-economic status backgrounds. The University of Western Australia Medical School has been progressively widening the participation of students from a broader spectrum of the community both through expanded selection criteria and quota-based approaches for students of rural, indigenous and other socio-educationally disadvantaged backgrounds. We proposed that medical students entering medical school from such backgrounds would ultimately be more likely to practice in areas of increased socio-economic disadvantage. METHODS The current practice address of 2829 medical students who commenced practice from 1980 to 2011 was ascertained from the Australian Health Practitioner Regulation Agency (AHPRA) Database. Logistic regression was utilised to determine the predictors of the likelihood of the current practice address being in the lower 8 socio-economic deciles versus the top 2 socio-economic deciles. RESULTS Those who were categorised in the lower 8 socio-economic deciles at entry to medical school had increased odds of a current practice address in the lower 8 socio-economic deciles 5 or more years after graduation (OR 2.05, 95% CI 1.72, 2.45, P < 0.001). Other positive univariate predictors included age at medical degree completion (for those 25 years or older vs those 24 years or younger OR 1.53, 95% CI 1.27, 1.84, P < 0.001), being female (OR 1.26, 95% CI 1.07, 1.48, P = 0.005) and having a general practice versus specialist qualification (OR 4.16, 95% CI 3.33, 5.19, P < 0.001). Negative predictors included having attended an independent school vs a government school (OR 0.77, 95% CI 0.64, 0.92, P < 0.001) or being originally from overseas vs being born in Oceania (OR 0.80, 95% CI 0.67, 0.96, P = 0.017). After adjustment for potential confounders in multivariate logistic regression, those in the lower 8 socio-economic deciles at entry to medical school still had increased odds of having a current practice address in the lower 8 socio-economic deciles (OR 1.63, 95% CI 1.34, 1.99, P < 0.001). CONCLUSION Widening participation in medical school to students from more diverse socio-educational backgrounds is likely to increase the distribution of the medical workforce to ultimate service across areas representative of a broader socio-economic spectrum.
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Affiliation(s)
- Ian B. Puddey
- School of Medicine and Pharmacology, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Level 4 RPH MRF Building, Rear 50 Murray St, Perth, WA 6000 Australia
| | - 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
| | - Annette Mercer
- Faculty Office, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009 Australia
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Castelo-Branco L, Finucane P, Marvão P, McCrorie P, Ponte J, Worley P. Global sharing, local innovation: Four schools, four countries, one curriculum. MEDICAL TEACHER 2016; 38:1204-1208. [PMID: 27248161 DOI: 10.1080/0142159x.2016.1181731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Many internal and external obstacles, must be overcome when establishing a new medical school, or when radically revising an existing medical curriculum. AIMS Twenty-five years after the Flinders University curriculum was introduced as the first graduate-entry medical programme (GEMP) in Australia, we aim at describing how it has been adopted and adapted by several other schools, in Australia and in Europe (UK, Ireland, and Portugal). METHOD/RESULTS This paper reports on the experience of four schools establishing a new medical school or new curriculum at different times and in different settings. CONCLUSIONS We believe that these experiences might be of interest to others contemplating a similar development.
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Affiliation(s)
| | - Paul Finucane
- b Graduate-Entry Medical School, University of Limerick , Limerick , Ireland
| | - Pedro Marvão
- c Graduate Entry Medical School, University of Algarve , Faro , Portugal
- g Manchester Medical School, The University of Manchester , Manchester , UK
| | | | - José Ponte
- c Graduate Entry Medical School, University of Algarve , Faro , Portugal
| | - Paul Worley
- e Prideaux Centre for Research in Health Professions Education, Flinders University , Adelaide , Australia
- f South Australian Health and Medical Research Institute , Adelaide , Australia
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Playford D, Puddey IB. Interest in rural clinical school is not enough: Participation is necessary to predict an ultimate rural practice location. Aust J Rural Health 2016; 25:210-218. [DOI: 10.1111/ajr.12324] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2016] [Indexed: 12/01/2022] Open
Affiliation(s)
- Denese Playford
- The Rural Clinical School of Western Australia; SPARHC; Crawley Western Australia Australia
| | - Ian B. Puddey
- School of Medicine and Pharmacology; The Faculty of Medicine, Dentistry and Health Sciences; The University of Western Australia; Crawley Western Australia Australia
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Worley P, Couper I, Strasser R, Graves L, Cummings BA, Woodman R, Stagg P, Hirsh D. A typology of longitudinal integrated clerkships. MEDICAL EDUCATION 2016; 50:922-32. [PMID: 27562892 DOI: 10.1111/medu.13084] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/14/2015] [Accepted: 03/14/2016] [Indexed: 05/13/2023]
Abstract
CONTEXT Longitudinal integrated clerkships (LICs) represent a model of the structural redesign of clinical education that is growing in the USA, Canada, Australia and South Africa. By contrast with time-limited traditional block rotations, medical students in LICs provide comprehensive care of patients and populations in continuing learning relationships over time and across disciplines and venues. The evidence base for LICs reveals transformational professional and workforce outcomes derived from a number of small institution-specific studies. OBJECTIVES This study is the first from an international collaborative formed to study the processes and outcomes of LICs across multiple institutions in different countries. It aims to establish a baseline reference typology to inform further research in this field. METHODS Data on all LIC and LIC-like programmes known to the members of the international Consortium of Longitudinal Integrated Clerkships were collected using a survey tool developed through a Delphi process and subsequently analysed. Data were collected from 54 programmes, 44 medical schools, seven countries and over 15 000 student-years of LIC-like curricula. RESULTS Wide variation in programme length, student numbers, health care settings and principal supervision was found. Three distinct typological programme clusters were identified and named according to programme length and discipline coverage: Comprehensive LICs; Blended LICs, and LIC-like Amalgamative Clerkships. Two major approaches emerged in terms of the sizes of communities and types of clinical supervision. These referred to programmes based in smaller communities with mainly family physicians or general practitioners as clinical supervisors, and those in more urban settings in which subspecialists were more prevalent. CONCLUSIONS Three distinct LIC clusters are classified. These provide a foundational reference point for future studies on the processes and outcomes of LICs. The study also exemplifies a collaborative approach to medical education research that focuses on typology rather than on individual programme or context.
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Affiliation(s)
- Paul Worley
- Prideaux Centre for Research in Health Professions Education, School of Medicine, Flinders University, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Ian Couper
- Ukwanda Centre for Rural Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Lisa Graves
- Department of Family and Community Medicine, School of Medicine, Western Michigan University, Kalamazoo, Michigan, USA
| | - Beth-Ann Cummings
- Centre for Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatics, Flinders University, Adelaide, South Australia, Australia
| | - Pamela Stagg
- Centre for Remote Health, School of Medicine, Flinders University, Darwin, Australia
| | - David Hirsh
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts, USA
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Pálsdóttir B, Barry J, Bruno A, Barr H, Clithero A, Cobb N, De Maeseneer J, Kiguli-Malwadde E, Neusy AJ, Reeves S, Strasser R, Worley P. Training for impact: the socio-economic impact of a fit for purpose health workforce on communities. HUMAN RESOURCES FOR HEALTH 2016; 14:49. [PMID: 27523088 PMCID: PMC4983779 DOI: 10.1186/s12960-016-0143-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 07/28/2016] [Indexed: 05/04/2023]
Abstract
Across the globe, a "fit for purpose" health professional workforce is needed to meet health needs and challenges while capitalizing on existing resources and strengths of communities. However, the socio-economic impact of educating and deploying a fit for purpose health workforce can be challenging to evaluate. In this paper, we provide a brief overview of six promising strategies and interventions that provide context-relevant health professional education within the health system. The strategies focused on in the paper are:1. Distributed community-engaged learning: Education occurs in or near underserved communities using a variety of educational modalities including distance learning. Communities served provide input into and actively participate in the education process.2. Curriculum aligned with health needs: The health and social needs of targeted communities guide education, research and service programmes.3. Fit for purpose workers: Education and career tracks are designed to meet the needs of the communities served. This includes cadres such as community health workers, accelerated medically trained clinicians and extended generalists.4. Gender and social empowerment: Ensuring a diverse workforce that includes women having equal opportunity in education and are supported in their delivery of health services.5. Interprofessional training: Teaching the knowledge, skills and attitudes for working in effective teams across professions.6. South-south and north-south partnerships: Sharing of best practices and resources within and between countries.In sum, the sharing of resources, the development of a diverse and interprofessional workforce, the advancement of primary care and a strong community focus all contribute to a world where transformational education improves community health and maximizes the social and economic return on investment.
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Affiliation(s)
- Björg Pálsdóttir
- Training for Health Equity Network, New York, United States of America
| | - Jean Barry
- Consultant Nursing and Health Policy, International Council of Nurses, Geneva, Switzerland
| | - Andreia Bruno
- International Pharmaceutical Federation, The Hague, Netherlands
| | - Hugh Barr
- Centre for the Advancement of Interprofessional Education (CAIPE), London, United Kingdom
| | - Amy Clithero
- Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico United States of America
| | - Nadia Cobb
- Office for the Promotion of Global Healthcare Equity, Division of Physician Assistant Studies, University of Utah School of Medicine, Salt Lake City, Utah United States of America
| | - Jan De Maeseneer
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
- The Network: Towards Unity for Health, Ghent, Belgium
| | - Elsie Kiguli-Malwadde
- African Center for Global Health and Social Transformation (ACHEST), Kampala, Uganda
| | | | - Scott Reeves
- Interprofessional Research, Centre for Health and Social Care Research, Kingston University and St George’s, University of London, London, United Kingdom
| | - Roger Strasser
- Northern Ontario School of Medicine, Lakehead and Laurentian Universities, Sudbury and Thunder Bay, Canada
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Playford DE, Ng WQ, Burkitt T. Creation of a mobile rural workforce following undergraduate longitudinal rural immersion. MEDICAL TEACHER 2016. [PMID: 26204255 DOI: 10.3109/0142159x.2015.1060304] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND This study followed the workforce choices of 10-years of graduates from a longitudinal rural immersion programme, which involved living for one academic year in a rural location as a medical student. The Rural Clinical School of Western Australia is a whole-of-state Rural Clinical School partnership involving two medical schools and fourteen rural/remote towns. METHOD For this longitudinal cohort study, all consenting graduates were contacted annually after graduation, with the outcome measure being rural work location (defined by the Australian Standard Geographical Classification -Remoteness Area) of any duration. RESULTS There were 417 consenting graduates. Between 16 and 50% of contacted alumni worked rurally for a period of each post-graduate year. Aggregated over time, the majority took up to 30% of their postgraduate training rurally. There was considerable movement in and out of rural work. About 17% of contacted and practicing graduates were working full time rurally at the 2013 contact point. The majority remained in their state of training. The majority identified with GP and other rural-related colleges, and College-affiliation predicted amount of rural training time. Entry into rural work was equivalent for urban-origin and rural origin alumni, suggesting one year of RCS is sufficient to convert commitment to rural work. CONCLUSION Undergraduate rural immersion is sufficient to create a graduate rural workforce that is far more mobile that was previously appreciated.
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Affiliation(s)
- Denese E Playford
- a The Rural Clinical School of Western Australia, The University of Western Australia , Australia
| | - Wen Qi Ng
- a The Rural Clinical School of Western Australia, The University of Western Australia , Australia
| | - Tessa Burkitt
- a The Rural Clinical School of Western Australia, The University of Western Australia , Australia
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Amalba A, van Mook WNKA, Mogre V, Scherpbier AJJA. The effect of Community Based Education and Service (COBES) on medical graduates' choice of specialty and willingness to work in rural communities in Ghana. BMC MEDICAL EDUCATION 2016; 16:79. [PMID: 26931412 PMCID: PMC4774102 DOI: 10.1186/s12909-016-0602-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/17/2016] [Indexed: 05/22/2023]
Abstract
BACKGROUND Career choices and placements of healthcare professionals in rural areas are a major problem worldwide, and their recruitment and retention to these areas have become a challenge to the health sector. The purpose of this study was to investigate the effect of Community Based Education and Service (COBES) on medical graduates' choice of specialty and willingness to work in a rural area. METHOD This cross sectional survey was conducted among 56 pioneering graduates that followed a Problem Based Learning/Community Based Education and Service (PBL/COBES) curriculum. Using a mixed methods approach, open-and closed-ended questionnaire was administered to 56 graduates. Cross tabulation using Chi-square test were used to compare findings of the quantitative data. All qualitative data analysis was performed using the principles of primary, secondary and tertiary coding. RESULTS All 56 graduates answered and returned the questionnaire giving a 100 % response rate. 57.1 % (32) of them were male. Majority of them lived in towns (41.1 %) and cities (50 %) prior to medical school. A significant number of graduates (53.6 %,) from the cities, without any female or male predominance said COBES had influenced their choice of specialty. Again, a significant proportion of graduates from the towns (60.9 %,) and cities (67.8 %,), indicated that COBES had influenced them to work in the rural area. However, there was no significant difference between males and females from the towns and cities regarding the influence of COBES to work in the rural area. Qualitative data supported the finding that COBES will influence graduates willingness to work in the rural area CONCLUSION The majority of graduates from the towns and cities in Ghana, with a male predominance, indicated that COBES may have influenced their choice of specialty and willingness to practice in the rural areas despite their town or city based upbringing.
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Affiliation(s)
- Anthony Amalba
- University for Development Studies (UDS), School of Medicine and Health Sciences (SMHS), Tamale, Ghana.
- Department of Health Professions Education and Innovative Learning, School of Medicine and Health Sciences, University for Development Studies, P. O. Box 1883, Tamale, Ghana.
| | | | - Victor Mogre
- University for Development Studies (UDS), School of Medicine and Health Sciences (SMHS), Tamale, Ghana.
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Strasser R, Worley P, Cristobal F, Marsh DC, Berry S, Strasser S, Ellaway R. Putting communities in the driver's seat: the realities of community-engaged medical education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:1466-70. [PMID: 26017354 DOI: 10.1097/acm.0000000000000765] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
"Community" has featured in the discourse about medical education for over half a century. This discourse has explored relationships between medical education programs and communities in community-oriented medical education and community-based medical education and, in recent years, has extended to community-engaged medical education (CEME). This Perspective explores the developing focus on "community" in medical education, describes CEME as a concept, and presents examples of CEME in action at Flinders University School of Medicine (Australia), the Northern Ontario School of Medicine (Canada), and Ateneo de Zamboanga University School of Medicine (Philippines).The authors describe the ways in which CEME, which features active community participation, can improve medical education while meeting community needs and advancing national and international health equity agendas. They suggest that CEME can redefine student learning as taking place at the center of the partnership between communities and medical schools. They also consider the challenges of CEME and caution that criteria for community engagement must be sensitive to cultural variations and to the nature of the social contract in different sociocultural settings.The authors argue that CEME is effective in producing physicians who choose to practice in rural and underserved areas. Further research is required to demonstrate that CEME contributes to improved health, and ultimately health equity, for the populations served by the medical school.
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Affiliation(s)
- Roger Strasser
- R. Strasser is dean, Northern Ontario School of Medicine, Sudbury and Thunder Bay, Ontario, Canada. P. Worley is dean, Flinders University School of Medicine, Adelaide, Australia. F. Cristobal is dean, Ateneo de Zamboanga University School of Medicine, Zamboanga, the Philippines. D.C. Marsh is deputy dean, Northern Ontario School of Medicine, Sudbury, Ontario, Canada. S. Berry is associate professor, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada. S. Strasser is former associate dean, Flinders University, Northern Territory, Darwin, Australia. R. Ellaway is assistant dean, Curriculum and Planning, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
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Student Continuity with Patients: A System Delivery Innovation to Benefit Patient Care and Learning (Continuity Patient Benefit). Healthcare (Basel) 2015; 3:607-18. [PMID: 27417783 PMCID: PMC4939555 DOI: 10.3390/healthcare3030607] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/02/2015] [Accepted: 07/15/2015] [Indexed: 11/16/2022] Open
Abstract
Medical education is continuing to evolve to meet the healthcare needs of the future. The longitudinal integrated clerkship (LIC) model is an important innovation in medical education. It has in its vision and structure “patient- and learner-centered education”, using longitudinal relationships between patients and students as a foundational element in its design. LIC students have shown more patient-centered attitudes and behaviors that persist after medical school. They remain connected with the patient experience of care, which supports empathy and student moral development. The time that LIC students spend acting independently with patients also supports the development of higher order clinical and cognitive skills and professional identity formation. Student participation in a more meaningful way in the care of their patients promotes patient wellbeing, and helps patients with transitions of care, communication and preventative care. Patients report feeling empowered to be more active agents in their own care and feel an accountability and pleasure in the training of new physicians. Focusing on the patient/student relationship as a foundational element of clinical education has meaningful benefits to the patient and student with the potential to improve patient care directly and in the future, as these students become physicians.
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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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Latessa R, Beaty N, Royal K, Colvin G, Pathman DE, Heck J. Academic outcomes of a community-based longitudinal integrated clerkships program. MEDICAL TEACHER 2015; 37:862-7. [PMID: 25693796 DOI: 10.3109/0142159x.2015.1009020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Longitudinal integrated clerkships (LICs) receive recognition internationally as effective, innovative alternatives to traditional block rotations (TBRs) in undergraduate medical education. No studies of LICs in the USA have assessed how students perform on all the standardized exams. AIM To compare performance on standardized tests of students in the first four years of LICs at the University of North Carolina School of Medicine-Asheville (UNC SOM-Asheville) with students from UNC SOM's Chapel Hill main campus in TBRs. METHODS LIC and TBR students' previous academic performance was considered using Medical College Admissions Test (MCAT) and United States Medical Licensing Examination (USMLE) Step 1 scores. Step 1 exam tests students' pre-clinical, basic science knowledge. Outcome measures included all eight standardized National Board of Medical Examiners (NBME) Subject Shelf Examinations and USMLE Step 2 Clinical Knowledge (CK) examinations, which are used widely in the US to assess students' progress and as prerequisites to eventual licensure. TBR students were selected using propensity scores to match LIC students. Groups were also compared on the required core clinical conditions documented, and on residency specialty choice. RESULTS Asheville LIC students earned higher scores on the Step 2 CK examination and the six shelf examinations linked to longitudinal clerkships than the matched TBR students (Step 2 CK exam, Family Medicine and Ambulatory Medicine shelf exams reached statistical significance). LIC students logged greater percentages of core conditions than TBR students and more often chose primary care residencies. CONCLUSIONS UNC School of Medicine medical students participating in a longitudinal integrated curriculum in a community setting outperformed fellow students who completed a more TBR curriculum within the school's academic medical center. Differences were found in performance on standard tests of clinical knowledge (six NBME exams and Step 2 CK exam), documented breadth of clinical experiences, and likelihood of choosing primary care residency programs.
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Affiliation(s)
- Robyn Latessa
- a University of North Carolina School of Medicine , USA
- b Mountain Area Health Education Center (MAHEC) , USA
| | - Norma Beaty
- a University of North Carolina School of Medicine , USA
| | | | - Gaye Colvin
- a University of North Carolina School of Medicine , USA
- b Mountain Area Health Education Center (MAHEC) , USA
| | | | - Jeffery Heck
- a University of North Carolina School of Medicine , USA
- b Mountain Area Health Education Center (MAHEC) , USA
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Playford D, Power P, Boothroyd A, Manickavasagar U, Ng WQ, Riley G. Is the National Registration website (Australian Health Practitioner Regulation Agency) effective in tracking Australian medical graduates' rural work? Aust J Rural Health 2014; 21:249-53. [PMID: 24118146 DOI: 10.1111/ajr.12055] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study compared rural location identified through the National Registration (AHPRA) registry with location obtained through labour-intensive personal contact. DESIGN Longitudinal cohort study with two methods to identify the work locations of medical graduates from The Rural Clinical School of Western Australia (RCSWA). PARTICIPANTS Consenting alumni from the University of Western Australia and the University of Notre Dame Fremantle participating in RCSWA between 2002 and 2009 inclusive and available to contact in 2011. MAIN OUTCOME MEASURE Percentage location matches between two contact methods. RESULTS There was 80% agreement for principal suburb, 92% agreement for principal city and 94% agreement for principal state between RCSWA personal contact and the AHPRA registry. AHPRA identified nearly two times as many graduate locations. However, there was only 31% agreement for a rural placement location (of any length). In more detail, for year-long rural placement, personal contact was 88% concordant with AHPRA; work six months or more were less concordant (44% agreement); work less than six months were not concordant (4% agreement). CONCLUSIONS AHPRA data matched RCSWA alumni data only for graduates in full-time rural work. Since medical alumni spend up to 10 years in pre-vocational and vocational training, which includes many rural options, personal contact was able to pick up the myriad of rural choices, whereas the AHPRA database was not sensitive enough to identify them. Until graduates have stably finished training, the optimal method to identify rural work is through personal contact but statistical correction for missing data needs to be considered.
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Affiliation(s)
- Denese Playford
- The Rural Clinical School of Western Australia, M706, The Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Crawley, Western Australia, Australia
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Gaufberg E, Hirsh D, Krupat E, Ogur B, Pelletier S, Reiff D, Bor D. Into the future: patient-centredness endures in longitudinal integrated clerkship graduates. MEDICAL EDUCATION 2014; 48:572-82. [PMID: 24713035 DOI: 10.1111/medu.12413] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 11/05/2013] [Accepted: 11/29/2013] [Indexed: 05/13/2023]
Abstract
OBJECTIVES This study was intended to determine if previously identified educational benefits of the Harvard Medical School (HMS) Cambridge Integrated Clerkship (CIC) endure over time. METHODS The authors' earlier work compared the 27 graduates in the first three cohorts of students undertaking the CIC with a comparison group of 45 traditionally trained HMS students; CIC graduates emerged from their clerkship year with a higher degree of patient-centredness and felt more prepared to deal with numerous domains of patient care. Between April and July 2011, at 4-6 years post-clerkship, the authors asked these original study cohorts to complete an electronic survey which included measures used in the original study. The authors also reviewed data from the National Residency Match Program to compare career paths in the two groups. RESULTS The response rate was 62% (42/68). The immediate post-clerkship finding that CIC students held more patient-centred attitudes was sustained over time (p < 0.035). Reflecting retrospectively on their clerkship experiences, CIC graduates continued to report that their clerkship year had better prepared them in a wide variety of domains. Graduates of the CIC attained awards and published papers at the same rates as peers, and were more likely to engage in health advocacy work. Both groups chose a wide range of residency programmes. Among those expressing a preference, no CIC graduates said they would choose a traditional clerkship, but 6 (27%) of the traditionally trained graduates said they would choose a longitudinal integrated clerkship. CONCLUSIONS This paper indicates that benefits of longitudinal integrated clerkship training are sustained over time across multiple domains.
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Affiliation(s)
- Elizabeth Gaufberg
- Harvard Medical School, Boston, Massachusetts, USA; Cambridge Health Alliance, Cambridge, Massachusetts, USA
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Playford DE, Evans SF, Atkinson DN, Auret KA, Riley GJ. Impact of the Rural Clinical School of Western Australia on work location of medical graduates. Med J Aust 2014; 200:104-7. [PMID: 24484114 DOI: 10.5694/mja13.11082] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 11/26/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether completing a year of the Rural Clinical School of Western Australia (RCSWA) program is associated with entering the rural medical workforce. DESIGN AND SETTING Cohort study of graduates from the University of Western Australia who completed Year 5 of medical school between 2002 and 2009, comparing work location (identified from the Australian Health Practitioner Regulation Agency database in March-June 2013) between those who participated in the RCSWA (RCSWA graduates) and those who did not (controls). MAIN OUTCOME MEASURE Rural or urban work location of graduates. RESULTS Of 1116 eligible graduates, 1017 (91.1%) could be traced and were included in the study. Of 258 RCSWA graduates, 42 (16.3%) were working rurally compared with 36 of 759 controls (4.7%). Of 195 RCSWA graduates from urban backgrounds, 29 (14.9%) were working rurally compared with 26 of 691 urban-background controls (3.8%). Of 63 rural-background RCSWA graduates, 13 (20.6%) were working rurally, compared with 10 of 68 rural-background controls (14.7%). Using logistic regression, RCSWA participation had a strong relationship with working rurally (rural-background RCSWA graduates: odds ratio [OR], 7.5; 95% CI, 3.5-15.8; urban-background RCSWA graduates: OR, 5.1; 95% CI, 2.9-9.1). Rural background without RCSWA participation (OR, 4.2; 95% CI, 1.8-9.2) and older age (age in 2012, 30-39 years: OR, 2.2; 95% CI, 1.3-3.7 v ≥ 40 years: OR, 6.6; 95% CI, 2.8-15.0) were also significant factors for working rurally. CONCLUSIONS Participation in the RCSWA is strongly associated with greater likelihood of working rurally. Graduates from urban backgrounds who participated in the RCSWA were much more likely to work in rural areas than those who did not. These data substantiate the RCSWA as an effective rural workforce strategy.
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Affiliation(s)
- Denese E Playford
- Rural Clinical School of Western Australia, University of Western Australia, Perth, WA, Australia.
| | - Sharon F Evans
- Rural Clinical School of Western Australia, University of Western Australia, Perth, WA, Australia
| | - David N Atkinson
- Rural Clinical School of Western Australia, University of Western Australia, Broome, WA, Australia
| | - Kirsten A Auret
- Rural Clinical School of Western Australia, University of Western Australia, Albany, WA, Australia
| | - Geoffrey J Riley
- Rural Clinical School of Western Australia, University of Western Australia, Albany, WA, Australia
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Jones MP, Bushnell JA, Humphreys JS. Are rural placements positively associated with rural intentions in medical graduates? MEDICAL EDUCATION 2014; 48:405-16. [PMID: 24606624 DOI: 10.1111/medu.12399] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 06/11/2013] [Accepted: 10/17/2013] [Indexed: 05/23/2023]
Abstract
CONTEXT Medical school curricula remain one of the key levers in increasing the future supply of rural doctors. Data from Australia and overseas have suggested exposure to rural practice via rural placements during basic medical training is positively associated with graduates becoming rural doctors. However, previous studies have suffered from serious methodological limitations. OBJECTIVES This study sought to determine whether rural clinical placements are associated with a higher proportion of graduating students planning rural careers and to explore associations with timing, duration and location of placements. METHODS Data were obtained from the Medical Schools Outcomes Database and Longitudinal Tracking Project, which is a longitudinal study with a high response rate that prospectively collects data, including practice location intention, from all Australian medical schools. Using logistic regression analysis, the association between placements and rural career intention was assessed, controlling for a number of demographic and contextual variables. RESULTS The association between rural/remote placements later in the programme and rural practice intention was strongly positive whether viewed as simple occurrence or as duration, in contrast to later urban placements, which were strongly negative. A longer duration of placement enhanced the associations reported. Non-metropolitan medical schools were also associated with higher odds of intention to take up rural practice. However, the association with rural placements was overshadowed by the strong positive associations with rural background of students and their stated intention to become a rural doctor at the start of their studies. CONCLUSIONS Exposure to rural practice during basic medical training, and the location and curriculum focus of a medical school are confirmed as factors that are positively associated with students' intention to become rural doctors after graduation. However, rural origin and the early intentions at the start of their medical training are better predictors of expressed intention to take up rural practice than rural clinical placements.
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Affiliation(s)
- Michael P Jones
- Psychology Department, Macquarie University, North Ryde, New South Wales, Australia; Centre of Excellence in Rural and Remote Primary Health Care, School of Rural Health, Monash University, Bendigo, Victoria, Australia
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Myhre DL, Woloschuk W, Jackson W, McLaughlin K. Academic performance of longitudinal integrated clerkship versus rotation-based clerkship students: a matched-cohort study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:292-295. [PMID: 24362389 DOI: 10.1097/acm.0000000000000110] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Prior studies suggest that students on a longitudinal integrated clerkship (LIC) have comparable academic performance to those on a rotation-based clerkship (RBC); however, most of these studies did not adjust for preclerkship academic performance. The objective of this study was to compare the academic performance of LIC and RBC students matched on prior academic performance over a three-year period. METHOD Each LIC student in the University of Calgary classes of 2009, 2010, and 2011 (n = 34) was matched with four RBC students (n = 136) of similar prior academic performance. Knowledge and clinical skills performance between the streams was compared. Knowledge was evaluated by internal summative examinations and the Medical Council of Canada Part 1 licensing exam. Clinical skills were evaluated via in-training evaluation report (ITERs) and performance on the clerkship objective structured clinical examination (OSCE). Meta-analysis was used to compare knowledge evaluations and clinical performance for all core clerkship disciplines, and pooled effect sizes from the fixed-effect models were reported. RESULTS Meta-analyses showed no statistically significant heterogeneity. There were no differences between LIC and RBC students on knowledge evaluations (pooled effect size 0.019; 95% confidence interval [-0.155, 0.152], P = .8), ITERs (pooled effect size -0.015 [-0.157, 0.127], P = .8), or mean OSCE ratings (67.9 [SD = 4.6] versus 68.6 [SD = 5.8], P = .5). CONCLUSIONS After matching on prior academic performance, LIC and RBC students at one school had comparable performance on summative evaluations of knowledge, clinical performance, and clinical skills over three years.
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Affiliation(s)
- Douglas L Myhre
- Dr. Myhre is associate dean for distributed learning and rural initiatives, University of Calgary, Calgary, Alberta, Canada. Dr. Woloschuk is director of program evaluation, Office of Undergraduate Medical Education, University of Calgary, Calgary, Alberta, Canada. Dr. Jackson is director, Rural Integrated Community Clerkship, University of Calgary, Calgary, Alberta, Canada. Dr. McLaughlin is assistant dean of undergraduate medical education, University of Calgary, Calgary, Alberta, Canada
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Young L, Larkins SL, Sen Gupta TK, McKenzie SH, Evans RJ, Crowe MJ, Ware EJ. Rural general practice placements: alignment with the Australian Curriculum Framework for Junior Doctors. Med J Aust 2013; 199:787-91. [PMID: 24329659 DOI: 10.5694/mja13.10563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 09/01/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To review the available literature regarding skills and competencies gained by junior doctors in rural and regional general practice placements and their alignment with the Australian Curriculum Framework for Junior Doctors (ACFJD). STUDY DESIGN A comprehensive literature review using a three-phase process. Articles were initially identified from database searches in OvidSP and Scopus. Additional information was obtained after a hand search of contents pages from relevant journals and from reports, conference abstracts and grey literature. Documented skills and procedures were mapped against the competencies from the ACFJD. DATA SOURCES We analysed 36 relevant articles written in English and published during 1997-2011. Articles referring to learning outcomes for junior doctors training with rural general practitioners were included. DATA SYNTHESIS Evidence was available of the advantages of junior doctor rural general practice placements in gaining advanced skills in the areas of communication and professionalism, as well as developing autonomy in clinical management and decision making. Less evidence was available regarding exposure to particular clinical conditions and development of specific clinical skills. CONCLUSION Rural and regional general practice placements for junior doctors are likely to comply with the ACFJD requirements and, further, provide excellent learning opportunities in several domains of the curriculum. However, there was little research published confirming learning outcomes for junior doctors in rural general practice settings.
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Affiliation(s)
- Louise Young
- School of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
| | - Sarah L Larkins
- School of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Tarun K Sen Gupta
- School of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Suzanne H McKenzie
- School of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Rebecca J Evans
- School of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Michael J Crowe
- School of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Elizabeth J Ware
- Queensland Medical Education and Training, ClinEdQ, QLD Health, Mackay, QLD, Australia
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Wakerman J, Humphreys JS. Sustainable workforce and sustainable health systems for rural and remote Australia. Med J Aust 2013; 199:S14-7. [DOI: 10.5694/mja11.11639] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 05/16/2012] [Indexed: 11/17/2022]
Affiliation(s)
- John Wakerman
- Centre for Remote Health, Flinders University and Charles Darwin University, Alice Springs, NT
- Centre of Research Excellence in Rural and Remote Primary Health Care
| | - John S Humphreys
- School of Rural Health, Monash University, Melbourne, VIC
- Centre of Research Excellence in Rural and Remote Primary Health Care
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Hirsh D, Worley P. Better learning, better doctors, better community: how transforming clinical education can help repair society. MEDICAL EDUCATION 2013; 47:942-9. [PMID: 23931543 DOI: 10.1111/medu.12278] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- David Hirsh
- Department of Internal Medicine, Cambridge Health Alliance, Harvard Medical School, 1493 CambridgeStreet, Cambridge, MA 02139, USA.
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Eley DS, Brooks KD, Zink T, Cloninger CR. Toward a global understanding of students who participate in rural primary care longitudinal integrated clerkships: considering personality across 2 continents. J Rural Health 2013; 30:164-74. [PMID: 24689541 DOI: 10.1111/jrh.12039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Medical schools worldwide have developed rural primary care immersive experiences to nurture students' interest in future rural careers and address workforce shortages. Few studies have looked at the students who participate in these programs. This study explores personality traits in US and Australian students who undertake rural-focused medical training. METHODS A cross-sectional cohort design used the Temperament and Character Inventory to identify levels of the 7 basic dimensions of personality. Data were collected in successive cohorts over 2007-2011. Multivariate analysis compared trait levels between groups and by demographic variables. FINDINGS The majority of the 302 students (US-167; Australia-135) were female, aged 20-29 years and single. A greater proportion of US students reported being partnered, living longest in a small rural/remote community and having a rural background. Significant differences between groups were detected in several traits but effect sizes were small. The personality pattern of the combined sample indicates students with a mature and stable personality high in Self-Directedness, Persistence, and Cooperativeness. Rural background and marital status enhanced this pattern. CONCLUSIONS Despite coming from different educational and societal backgrounds, similar personality patterns are evident in US and Australian students who pursue rural medical education. Data provide support for a pattern of traits associated with a rural background and its predictive influence on interest in rural practice. Considering the international expansion of rural longitudinal integrated clerkships, understanding student attributes may assist in identifying strategies to enhance the rural workforce that are relevant across cultures and continents.
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Affiliation(s)
- Diann S Eley
- School of Medicine, The University of Queensland, Brisbane, Australia
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Jones MP, Eley D, Lampe L, Coulston CM, Malhi GS, Wilson I, Kelly B, Talley NJ, Owen C, Corrigan G, Griffin B, Humphreys J, Alba B, Stagg P. Role of personality in medical students' initial intention to become rural doctors. Aust J Rural Health 2013; 21:80-9. [DOI: 10.1111/ajr.12013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2012] [Indexed: 11/27/2022] Open
Affiliation(s)
- Michael P. Jones
- Psychology Department; Macquarie University; Sydney New South Wales Australia
| | - Diann Eley
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Lisa Lampe
- Discipline of Psychiatry; Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - Carissa M. Coulston
- Discipline of Psychiatry; Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - Gin S. Malhi
- Discipline of Psychiatry; Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - Ian Wilson
- School of Medicine; University of Western Sydney; Sydney New South Wales Australia
| | - Brian Kelly
- Centre for Brain and Mental Health Research; School of Medicine and Public Health; University Drive; Newcastle New South Wales Australia
| | - Nicholas J. Talley
- Faculty of Health University of Newcastle; University Drive; Newcastle New South Wales Australia
| | - Cathy Owen
- Rural Clinical School, Medical School; Australian National University; Canberra Australian Capital Territory Australia
| | - Gerry Corrigan
- ANU Medical School; Australian National University; Canberra Australian Capital Territory Australia
| | - Barbara Griffin
- Psychology Department; Macquarie University; Sydney New South Wales Australia
| | - John Humphreys
- Monash University School of Rural Health; Bendigo Victoria Australia
| | - Beatrice Alba
- Psychology Department; Macquarie University; Sydney New South Wales Australia
| | - Pamela Stagg
- Flinders University Rural Clinical School; Adelaide South Australia Australia
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Forster L, Assareh H, Watts LD, McLachlan CS. Additional years of Australian Rural Clinical School undergraduate training is associated with rural practice. BMC MEDICAL EDUCATION 2013; 13:37. [PMID: 23607311 PMCID: PMC3599975 DOI: 10.1186/1472-6920-13-37] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 02/27/2013] [Indexed: 05/23/2023]
Abstract
BACKGROUND To understand the influence of the number of years spent at an Australian rural clinical school (RCS) on graduate current, preferred current and intended location for rural workforce practice. METHODS Retrospective online survey of medical graduates who spent 1-3 years of their undergraduate training in the University of New South Wales (UNSW) Rural Clinical School. Associations with factors (gender, rural versus non-rural entry, conscription versus non-conscript and number of years of RCS attendance) influencing current, preferred current and intended locations were assessed using X2 test. Factors that were considered significant at P 0.1 were entered into a logistic regression model for further analysis. RESULTS 214 graduates responded to the online survey. Graduates with three years of previous RCS training were more likely to indicate rural areas as their preferred current work location, than their colleagues who spent one year at an RCS campus (OR = 3.0, 95% CI = 1.2-7.4, P = 0.015). Also RCS graduates that spent three years at an RCS were more likely to intend to take up rural medical practice after completion of training compared to the graduates with one year of rural placement (OR = 5.1, 95% CI = 1.8-14.2, P = 0.002). Non-rural medicine entry graduates who spent three years at rural campuses were more likely to take up rural practice compared to those who spent just one year at a rural campus (OR = 8.4, 95% CI = 2.1-33.5, P = 0.002). CONCLUSIONS Increasing the length of time beyond a year at an Australian RCS campus for undergraduate medical students is associated with current work location, preferred current work location and intended work location in a rural area. Spending three years in a RCS significantly increases the likelihood of rural career intentions of non-rural students.
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Affiliation(s)
- Lesley Forster
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Hassan Assareh
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Simpson Centre for Health Services Research, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Lisa D Watts
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Craig S McLachlan
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
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O'Regan A, Culhane A, Dunne C, Griffin M, Meagher D, McGrath D, O'Dwyer P, Cullen W. Towards vertical integration in general practice education: literature review and discussion paper. Ir J Med Sci 2012; 182:319-24. [PMID: 23266908 DOI: 10.1007/s11845-012-0893-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Medical education policy in Ireland has enabled an increase in undergraduate and postgraduate education activity in general practice. Internationally, 'vertical integration in general practice education' is suggested as a key strategy to support the implementation of this policy development. AIMS To review the emerging literature on vertical integration in GP education, specifically to define the concept of 'vertical integration' with regard to education in general practice and to describe its benefits and challenges. METHODS We searched 'Pubmed', 'Academic Search Complete', 'Google', and 'MEDLINE' databases using multiple terms related to 'vertical integration' and 'general practice education' for relevant articles published since 2001. Discussion papers, reports, policy documents and position statements were identified from reference lists and retrieved through internet searches. RESULTS The key components of 'vertical integration' in GP education include continuous educational pathway, all stages in GP education, supporting the continuing educational/professional development needs of learners at each stage and effective curriculum planning and delivery. Many benefits (for GPs, learners and the community) and many challenges (for GPs/practices, learners and GPs in training) have been described. Characteristics of successful implementation include role sharing and collaborative organisational structures. CONCLUSIONS Recent developments in medical education in Ireland, such as the increase in medical school clinical placements in general practice and postgraduate GP training and the introduction of new competence assurance requirements offer an important opportunity to further inform how vertical integration can support increased educational activity in general practice. Describing this model, recognising its benefits and challenges and supporting its implementation in practice are priorities for medical education in Ireland.
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Affiliation(s)
- A O'Regan
- Graduate Entry Medical School, University of Limerick, Castletroy, Limerick, Ireland
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