Worley P

Language: English
References: 28
Page: 30-34
PDF size: 179.39 Kb.

ABSTRACT

Introduction Medical schools today are being challenged to educate doctors who are willing and able to practice in areas of poverty and workforce need. In many countries, there is a shortage of doctors practicing in rural and remote communities. There is evidence that locating undergraduate medical education in rural areas increases the likelihood that graduates will choose to practice in underserved areas. Through its Parallel Rural Community Curriculum (PRCC), Flinders University School of Medicine (FUSM) now enables over 25% of its students to undertake an entire clinical year based in small rural communities supervised principally by rural family physicians.
Objective The PRCC was conceived to provide a high quality educational intervention that would result in an increased number of students choosing to practice in rural and remote Australia. It was also designed to test the hypothesis that small rural and remote practices were capable of facilitating a full year of medical training at a standard comparable to that provided at a major tertiary hospital.
Intervention Starting with eight students in four towns in 1997, the PRCC now places 30 students across 18 towns in rural Australia. The students simultaneously learn the disciplines of medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry, and family medicine. At the end of the year, all Flinders students, regardless of training location, take the same comprehensive exam.
Outcomes PRCC students improved their academic performance in comparison to their tertiary trained peers. This improvement has been consistent over the ten years studied. Seventy percent of the PRCC students have chosen to practice in rural locations, compared to 18 percent of tertiary-trained students. Over twelve years, the program has proved to be sustainable in a private practice environment with a workforce shortage.
Conclusions Evaluation of the PRCC indicates that a rural community-based clinical education can provide a high quality academic experience for students as well as a sustainable solution to rural medical workforce maldistribution.

REFERENCES

1. Australian Institute of Health and Welfare. Australia’s Health 2006. Canberra: AIHW; 2006.

2. Australian Institute of Health and Welfare. Medical Labour Force 2004. National Health Labour Force Series No. 38. Canberra: AIHW;2006.

3. Kamien M, Boelen C, Heck JE. Measuring the social responsiveness of medical schools. Education for Health (Abingdon) 1999;(12):9-19.

4. Wilkinson D, Laven G, Pratt N, Beilby J. Impact of undergraduate and postgraduate rural training, and medical school entry criteria on rural practice among Australian general practitioners: national study of 2414 doctors. Med Educ. 2003;(37):809-14.

5. Rabinowitz HK, Diamond JJ, Markham FW, Paynter NP. Critical factors in designing programs to increase the supply and retention of rural primary care physicians. JAMA. 2001;(286):1041-8.

6. Denz-Penhey H, Shannon S, Murdoch JC, Newbury JW. Do benefits accrue from longer rotations for students in Rural Clinical Schools? Rural and Remote Health 5 [serial on the Internet]. 2005:414. Available from: http://rrh.deakin.edu.au.

7. General Medical Council Education Committee Tomorrow’s Doctors: Recommendations on undergraduate medical education. London, UK: General Medical Council;1993.

8. Hamad B. Community-oriented medical education: what is it? Med Educ. 1991;(25):16-22.

9. Komesaroff PA. What is the future of the hospital system? Is the hospital obsolete? Med J Australia. 1997;(166):17-9.

10. White KL, Williams TF, Greenberg BG. The ecology of medical care. N Engl J Med. 1961;(265):885-92.

11. Boaden N, Bligh J. Community-Based Medical Education. London: Arnold; 1999.

12. Worley PS, Prideaux DJ, Strasser RP, Silagy CA, Magarey JA. Why we should teach undergraduate medical students in rural communities. Med J Australia. 2000;(172):615-17.

13. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. Br Med J. 1996;(312):71-2[3].

14. Humphreys JS, Lyle D, Wakerman J, Chalmers E, Wilkinson D, Walker J, et al. Roles and activities of the Commonwealth government university departments of rural health. Australian Journal of Rural Health. 2000;(8):120-33.

15. 15 DeWitt DE, McLean R, Newbury J, et al. Development of a common national questionnaire to evaluate student perceptions about the Australian Rural Clinical Schools Program. Rural and Remote Health 5 [serial on the Internet]. 2005 [cited 2008 Jul];486. Available from: http://www. rrh.org.au

16. McDonnel Smedts A, Lowe M. Clinical Training in the Top End: Impact of the Northern Territory Clinical School on the Territory’s Health Workforce. Rural and Remote Health [serial on the Internet]. 2007 [cited 2008 July];723. Available from http://www.rrh.org.au

17. Worley P, Silagy C, Prideaux D, Newble D, Jones A. The Parallel Rural Community Curriculum: an integrated clinical curriculum based in rural general practice. Med Educ. 2000;(34):558-65.

18. Hirsh DA, Ogur B, Thibault GE, Cox M. “Continuity” as an organizing principle for clinical education reform. New Engl J Med. 2007;356(8):858-66.

19. Disisto N. Success through partnerships: a learning environment. Commonwealth Department of Health and Aging National Networks. 2000;(24):6,7,16.

20. Worley P, Esterman A, Prideaux D. Cohort study of examination performance of undergraduate medical students learning in community settings. Br Med J. 2004;(328):207-9.

21. Worley P, Prideaux D, Strasser R, March R, Worley E. What do medical students actually do on clinical rotations? Med Teach. 2004; 26(7):594-8.

22. Worley P, Strasser R, Prideaux D. Can medical students learn specialist disciplines based in rural practice: lessons from students’ self reported experience and competence. Rural and Remote Health 4 [serial on the Internet]. 2004 [cited 2008 Jul 21];338. Available from: http://www.rrh.org.au

23. Worley P, Prideaux D, Strasser R, Magarey A, March R. Empirical evidence for symbiosis medical education: a comparative analysis of community and tertiary-based programs. Med Educ. 2006;(40):109-16.

24. Worley P, Prideaux D, Woodman R, Worley E. Vocational Medical Career Paths of Graduate Entry Medical Students at Flinders University: a comparison of rural, remote and tertiary tracks. Med J Aust. 2008;188(3):177-8.

25. Walters L, Worley P, Prideaux D, Lange K. Do consultations in rural general practice take more time when precepting medical students? Med Educ. 2008;42(1):69-73.

26. Tesson G, Curran V, Pong RW, Strasser R. Advances in rural medical education in three countries: Canada, The United States and Australia. Rural and Remote Health 5 [serial on the Internet]. 2005 [cited 2008 Jul 21];397. Available from: http://www.rrh.org.au

27. Nelson J. Rural general practice: a community perspective. National Networks. 2000;(25):9.

28. Stagg P. Future doctors of the Riverland. Chosen by the community, in the community, for the community. National Networks. 2000;(22):8-10.