1
|
Peel R, Young L, Reeve C, Kanakis K, Malau-Aduli B, Sen Gupta T, Hays R. The impact of localised general practice training on Queensland's rural and remote general practice workforce. BMC MEDICAL EDUCATION 2020; 20:119. [PMID: 32306959 PMCID: PMC7169031 DOI: 10.1186/s12909-020-02025-4] [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: 08/27/2019] [Accepted: 03/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The diverse rural medical education initiatives that have been developed in Australia to address the medical workforce maldistribution have been less successful in many smaller and remote communities. This study explored the factors that attract and retain GP registrars and supervisors and the impact that localised training (i.e., rural and remote workplace-based training and support) has on both GP registrars and supervisors, and the GP workforce in rural and remote underserved areas. METHODS A purposive sample of 79 GP registrars, supervisors, practice managers, health services staff and community representatives living and working in areas of low GP workforce in rural and remote Australia were invited to participate in semi-structured interviews and one focus group divided over two phases. Thematic analysis was used to explore themes within the data. FINDINGS Attractors and barriers to rural and remote practice were identified as the main themes. Attractors include family and community lifestyle factors, individual intrinsic motivators, and remote medicine experiences. In contrast, barriers include work related, location, or family factors. Further, localised GP training was reported to specifically influence GP registrars and supervisors through education, social and financial factors. CONCLUSION The current study has provided a contemporary overview of the issues encountered in expanding GP training capacity in rural and remote communities to improve the alignment of training opportunities with community and workforce needs. Strategies including matching scope of practice to registrar interests have been implemented to promote the attractors and lessen the barriers associated with rural and remote practice.
Collapse
Affiliation(s)
- Raquel Peel
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
- School of Psychology and Counselling, University of Southern Queensland, Ipswich, Queensland, Australia.
| | - Louise Young
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Carole Reeve
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Katerina Kanakis
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Bunmi Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Tarun Sen Gupta
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Richard Hays
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| |
Collapse
|
2
|
Hays RB, McKinley RK, Sen Gupta TK. Twelve tips for expanding undergraduate clinical teaching capacity. MEDICAL TEACHER 2019; 41:271-274. [PMID: 29400107 DOI: 10.1080/0142159x.2018.1429587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Undergraduate medical education has expanded substantially in recent years, through both establishing new programs and increasing student numbers in existing programs. This expansion has placed pressure on the capacity for training students in clinical placements, raising concerns about the risk of dilution of experience, and reducing work readiness. The concerns have been greatest in more traditional environments, where clinical placements in large academic medical centers are often the "gold standard". However, there are ways of exposing medical students to patient interactions and clinical supervisors in many other contexts. In this paper, we share our experiences and observations of expanding clinical placements for both existing and new medical programs in several international locations. While this is not necessarily an easy task, a wide range of opportunities can be accessed by asking the right questions of the right people, often with only relatively modest changes in resource allocation.
Collapse
Affiliation(s)
- Richard B Hays
- a Remote and Rural Health , James Cook University , Townsville , Australia
| | | | - Tarun K Sen Gupta
- c Medical Education , James Cook University , Townsville , Australia
| |
Collapse
|
3
|
Martin P, Sen Gupta T, Douyere JM. Clinical supervision in rural Australia: challenges and opportunities. Med J Aust 2018; 209:382-383. [PMID: 30376657 DOI: 10.5694/mja18.00525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/15/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Priya Martin
- Darling Downs Hospital and Health Service, Toowoomba, QLD
| | | | | |
Collapse
|
4
|
Tarimo CN, Kapanda GE, Muiruri C, Kulanga AT, Lisasi E, Mteta KA, Kessi E, Mogella D, Venance M, Rogers T, Mimano L, Bartlett J. Building Clinical Clerkships Capacity in a Resource-limited Setting: The Case of the Kilimanjaro Christian Medical University College in Tanzania. Ann Glob Health 2018; 84:129-138. [PMID: 30873784 PMCID: PMC6748287 DOI: 10.29024/aogh.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The shortage of medical doctors in sub-Saharan Africa (SSA) has resulted in increased enrolment in medical schools, which has not been matched with increased faculty size or physical infrastructure. This process has led to overcrowding and possibly reduced quality of training. To reduce overcrowding at its teaching hospital, the Kilimanjaro Christian Medical University College introduced eight-week peripheral clerkship rotations in 2012. We explore students' perceptions and attitudes towards peripheral hospital placements. METHOD The clerkship rotations were conducted in eight hospitals operating in the northern Tanzania, after evaluating each hospitals' capabilities and establishing the optimum number of students per hospital. Paper-based surveys were conducted after student rotations from 2014 to 2016. RESULTS Overall student satisfaction was moderate (strength of consensus measure (sCns), 77%). The three cohorts exhibited improving trends over three years with respect to satisfaction with clinical skills and attitude towards placements. student-preceptor interaction was rated highly (sCns 81-84%). The first cohort students expressed concerns about limited laboratory support, and poor access to Internet and learning resources. Specific interventions were undertaken to address these concerns. CONCLUSIONS Student experiences in peripheral rotations were positive with adequate satisfaction levels. Opportunities exist for medical schools in SSA to enhance clinical training and relieve overcrowding through peripheral clerkship rotations.
Collapse
Affiliation(s)
| | | | - Charles Muiruri
- Kilimanjaro Christian Medical, Centre Medical Education Partnership Initiative, Durham, North Carolina, US
| | - Ahaz T Kulanga
- Kilimanjaro Christian Medical University College, Moshi, TZ
| | - Esther Lisasi
- Kilimanjaro Christian Medical University College, Moshi, TZ.,University of Cape Town, ZA
| | - Kien A Mteta
- Kilimanjaro Christian Medical University College, Moshi, TZ.,Kilimanjaro Christian Medical, Centre Medical Education Partnership Initiative, Moshi, TZ
| | - Egbert Kessi
- Kilimanjaro Christian Medical University College, Moshi, TZ.,Kilimanjaro Christian Medical Centre Medical, TZ
| | | | - Maro Venance
- Kilimanjaro Christian Medical University College, Moshi, TZ.,Kilimanjaro Christian Medical Centre Medical, TZ
| | - Temu Rogers
- Kilimanjaro Christian Medical University College, Moshi, TZ.,Kilimanjaro Christian Medical Centre Medical, TZ
| | - Lucy Mimano
- Kilimanjaro Christian Medical University College, Moshi, TZ
| | - John Bartlett
- Kilimanjaro Christian Medical, Centre Medical Education Partnership Initiative, Durham, North Carolina, US.,Medicine, Global Health, and Nursing, Duke University, US
| |
Collapse
|
5
|
de Villiers M, van Schalkwyk S, Blitz J, Couper I, Moodley K, Talib Z, Young T. Decentralised training for medical students: a scoping review. BMC MEDICAL EDUCATION 2017; 17:196. [PMID: 29121923 PMCID: PMC5680751 DOI: 10.1186/s12909-017-1050-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 11/02/2017] [Indexed: 05/10/2023]
Abstract
BACKGROUND Increasingly, medical students are trained at sites away from the tertiary academic health centre. A growing body of literature identifies the benefits of decentralised clinical training for students, the health services and the community. A scoping review was done to identify approaches to decentralised training, how these have been implemented and what the outcomes of these approaches have been in an effort to provide a knowledge base towards developing a model for decentralised training for undergraduate medical students in lower and middle-income countries (LMICs). METHODS Using a comprehensive search strategy, the following databases were searched, namely EBSCO Host, ERIC, HRH Global Resources, Index Medicus, MEDLINE and WHO Repository, generating 3383 references. The review team identified 288 key additional records from other sources. Using prespecified eligibility criteria, the publications were screened through several rounds. Variables for the data-charting process were developed, and the data were entered into a custom-made online Smartsheet database. The data were analysed qualitatively and quantitatively. RESULTS One hundred and five articles were included. Terminology most commonly used to describe decentralised training included 'rural', 'community based' and 'longitudinal rural'. The publications largely originated from Australia, the United States of America (USA), Canada and South Africa. Fifty-five percent described decentralised training rotations for periods of more than six months. Thematic analysis of the literature on practice in decentralised medical training identified four themes, each with a number of subthemes. These themes were student learning, the training environment, the role of the community, and leadership and governance. CONCLUSIONS Evident from our findings are the multiplicity and interconnectedness of factors that characterise approaches to decentralised training. The student experience is nested within a particular context that is framed by the leadership and governance that direct it, and the site and the community in which the training is happening. Each decentralised site is seen to have its own dynamic that may foreground certain elements, responding differently to enabling student learning and influencing the student experience. The insights that have been established through this review have relevance in informing the further expansion of decentralised clinical training, including in LMIC contexts.
Collapse
Affiliation(s)
- Marietjie de Villiers
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Susan van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Julia Blitz
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Ian Couper
- Ukwanda Centre for Rural Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Kalavani Moodley
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Zohray Talib
- Departments of Medicine and Health Policy, George Washington University, Washington DC, USA
| | - Taryn Young
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| |
Collapse
|
6
|
Kapanda GE, Muiruri C, Kulanga AT, Tarimo CN, Lisasi E, Mimano L, Mteta K, Bartlett JA. Enhancing future acceptance of rural placement in Tanzania through peripheral hospital rotations for medical students. BMC MEDICAL EDUCATION 2016; 16:51. [PMID: 26861915 PMCID: PMC4746898 DOI: 10.1186/s12909-016-0582-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 02/04/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND Mal-distribution of health care workers is a global health challenge that exacerbates health disparities, especially in resource-limited settings. Interventions to mitigate the problem have targeted qualified personnel with little focus on medical students. However, studies have demonstrated that rural rotations positively influence students to practice in rural settings upon graduation. To evaluate the influence of peripheral rotations in a resource-limited setting, the Kilimanjaro Christian Medical University College introduced a 12-week clerkship rotation in peripheral hospitals for third-year medical (MD3) students in 2012. We administered an end-of-rotation survey to assess student perceptions, and attitudes toward rural practice after graduation. METHODS Questionnaires were voluntarily and anonymously administered to MD3 students in April 2014. The questions assessed perceptions of the experience, and attitudes towards rural practice upon graduation. The perceptions were assessed using strength of consensus measures (sCns). The effect of the experience on likelihood for rural practice was assessed using Crude Odds Ratio (COR), and predictors using Adjusted Odds Ratio (AOR) with 95 % Confidence Intervals (CI) tested at a 5 % level of significance. Variation was assessed using Hosmer and Lemeshow test Chi-square. RESULTS 111 out of 148 MD3 students participated; 62 % were male; 62 % <25 years old; and 72 % matriculated directly from secondary school. Overall, 81 % of MD3 students were satisfied with rural rotations (sCns = 83 %). The likelihood of accepting rural practice deployment after graduation was predicted by satisfaction with the peripheral hospital rotation program (AOR, 4.32; 95 % CI, 1.44-12.96; p, 0.009) and being male (AOR, 2.73; 95 % CI, 1.09-6.84; p, 0.032). Students admitted in medical school after health-related practice trended toward a higher likelihood of accepting rural practice after graduation compared to those enrolled directly from secondary school, although the difference was not significant (AOR, 4.99; 95 % CI, 0.88-28.41; p, 0.070). The Hosmer and Lemeshow test p-value was 0.686, indicating a good fit of the model. No significant differences in satisfaction between these two groups were observed, and also no significant differences between students born in rural areas compared to those born in urban areas existed. CONCLUSION Results indicate that satisfaction with rural rotations is associated with increased likelihood of rural practice after graduation. We conclude that opportunities may exist to reduce mal-distribution of healthcare workers through interventions that target medical students.
Collapse
Affiliation(s)
| | | | - Ahaz T Kulanga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | | | - Esther Lisasi
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - Lucy Mimano
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - Kien Mteta
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - John A Bartlett
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
- Duke Global Health Institute, Durham, NC, USA.
- Duke University School of Medicine, Durham, NC, USA.
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Larkins SL, Preston R, Matte MC, Lindemann IC, Samson R, Tandinco FD, Buso D, Ross SJ, Pálsdóttir B, Neusy AJ. Measuring social accountability in health professional education: development and international pilot testing of an evaluation framework. MEDICAL TEACHER 2013; 35:32-45. [PMID: 23102162 DOI: 10.3109/0142159x.2012.731106] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Health professional schools are responsible for producing graduates with competencies and attitudes to address health inequities and respond to priority health needs. Health professional schools striving towards social accountability founded the Training for Health Equity Network (THEnet). AIM This article describes the development of THEnet evaluation framework for socially accountable health professional education, presents the framework to be used as a tool by other schools and discusses the findings of pilot implementation at five schools. METHODS The framework was designed collaboratively and built on Boelen and Woollard's conceptualization, production and usability model. It includes key components, linked to aspirational statements, indicators and suggested measurement tools. Five schools completed pilot implementation, involving workshops, document/data review and focus group discussions with faculty, students and community members. RESULTS Three sections of the framework consider: How does our school work?; What do we do? and What difference do we make? Pilot testing proved that the evaluation framework was acceptable and feasible across contexts and produced findings useful at school level and to compare schools. The framework is designed as a formative exercise to help schools take a critical look at their performance and progress towards social accountability. Initiatives to implement the framework more widely are underway. The framework effectively aids in identifying strengths, weaknesses and gaps, with a view to schools striving for continuous self-improvement. CONCLUSION THEnet evaluation framework is applicable and useful across contexts. It is possible and desirable to assess progress towards social accountability in health professional schools and this is an important step in producing health professionals with knowledge, attitudes, and skills to meet the challenges of priority health needs of underserved populations.
Collapse
Affiliation(s)
- Sarah L Larkins
- School of Medicine and Dentistry, James Cook University, Australia.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Barnett T, Walker LE, Jacob E, Missen K, Cross MD, Shahwan-Akl L. Expanding the clinical placement capacity of rural hospitals in Australia: displacing Peta to place Paul? NURSE EDUCATION TODAY 2012; 32:485-489. [PMID: 21920643 DOI: 10.1016/j.nedt.2011.08.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 08/09/2011] [Accepted: 08/16/2011] [Indexed: 05/31/2023]
Abstract
In order to identify opportunities to build capacity for clinical placements, we mapped and described the organisation of student placements at three hospitals, each with multiple education providers, in rural Victoria, Australia. Using a cross-sectional, mixed method design, data were collected by survey, interviews and discussion with student placement coordinators representing 16 clinical health disciplines. Teaching and supporting students was regarded as an important part of the service each hospital provided and a useful staff recruitment strategy. There were peaks and troughs in student load over the year, though this was less marked for medicine and dentistry than for nursing and allied health disciplines. Whilst placements were managed largely on a discipline basis, each hospital had taken steps to communicate information about student placements across disciplines and to identify opportunities for interprofessional education (IPE). Placement capacity could be increased by sharing placement data within hospitals, smoothing the utilisation patterns across the year, capitalising on opportunities for IPE when there is concurrent placement of students from different disciplines, and through better employment of underutilised clinical areas.
Collapse
Affiliation(s)
- Tony Barnett
- University Department of Rural Health, University of Tasmania, Launceston, Tas, Australia.
| | | | | | | | | | | |
Collapse
|
10
|
Larkins S, Sen Gupta T, Evans R, Murray R, Preston R. Addressing inequities in access to primary health care: lessons for the training of health care professionals from a regional medical school. Aust J Prim Health 2011; 17:362-8. [DOI: 10.1071/py11040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 08/30/2011] [Indexed: 11/23/2022]
Abstract
Attention to the inequitable distribution and limited access to primary health care resources is key to addressing the priority health needs of underserved populations in rural, remote and outer metropolitan areas. There is little high-quality evidence about improving access to quality primary health care services for underserved groups, particularly in relation to geographic barriers, and limited discussion about the training implications of reforms to improve access. To progress equity in access to primary health care services, health professional education institutions need to work with both the health sector and policy makers to address issues of workforce mix, recruitment and retention, and new models of primary health care delivery. This requires a fundamental shift in focus from these institutions and the health sector, to each view themselves as partners in an integrated teaching, research and service-oriented health system. This paper discusses the challenges and opportunities for primary health care professionals, educators and the health sector in providing quality teaching and clinical experiences for increasing numbers of health professionals as a result of the reform agenda. It then outlines some practical strategies based on theory and evolving experience for dealing with some of these challenges and capitalising on opportunities.
Collapse
|