Journal articles: 'Medicine, Rural Practice Australia'

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Seal, Alexa, Catherine Harding, and Joe McGirr. "What influences trainee decisions to practise in rural and regional Australia?" Australian Journal of Primary Health 26, no. 6 (2020): 520. http://dx.doi.org/10.1071/py19214.

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Although international medical graduates (IMGs) make up a substantial part of the Australian rural general practice workforce, most research on factors associated with rural practice has focused on Australian medical graduates (AMGs). This study aimed to determine whether there were differences between IMGs and AMGs in terms of these factors. Registrars in training and recent fellows (Fellowship of the Royal Australian College of General Practitioners/Fellowship of the Australian College of Rural and Remote Medicine) who participated in training in rural and regional Australia were surveyed about practice models and rural practice. Almost two-thirds of participants were practicing or intending to practice in rural areas, with no difference between AMGs and IMGs. None of the variables associated with rural practice for AMGs was found to be associated with rural practice in IMGs in univariate binary regression analysis. Two key variables that are strongly associated with rural medical practice in the current literature, namely rural background and rural exposure, were not significant predictors of rural practice among IMGs. Due to the significant number of IMGs in regional training programs, any future incentives designed to improve rural recruitment and retention need to address factors relevant to IMGs.

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Wardle, Jonathan Lee, David Sibbritt, and Jon Adams. "Acupuncture Referrals in Rural Primary Healthcare: A Survey of General Practitioners in Rural and Regional New South Wales, Australia." Acupuncture in Medicine 31, no. 4 (December 2013): 375–82. http://dx.doi.org/10.1136/acupmed-2013-010393.

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Background Acupuncture services form a significant part of the Australian healthcare setting, with national registration of acupuncture practitioners, public subsidies for acupuncture services and high use of acupuncture by the Australian public. Despite these circumstances, there has been little exploration of the interface between acupuncture providers and conventional primary healthcare practitioners in rural and regional Australia. Methods A 27-item questionnaire was sent by post in the second half of 2010 to all 1486 general practitioners (GPs) currently practising in rural and regional Divisions of General Practice in New South Wales, Australia to explore their practices and attitudes to a variety of complementary and alternative medicine (CAM) practices. Their responses on other therapies have been published previously; this report covers acupuncture. Results A total of 585 GPs completed the questionnaire; 49 were returned as ‘no longer at this address’, resulting in an adjusted response rate of 40.7%. Two-thirds of GPs (68.3%) referred patients to an acupuncturist at least a few times per year, while only 8.4% stated that they would not refer patients to an acupuncturist under any circumstances. GPs being older (OR=6.08), GPs being women (OR=2.94), GPs practising in a rural rather than remote area (OR=6.25), GPs having higher levels of self-reported knowledge of acupuncture (OR=5.54), the use of complementary medicine (CAM) by a GP for their personal health (OR=2.37), previous prescription of CAM to other patients (OR=2.99), lack of other treatment options (OR=4.31) and GPs using CAM practitioners as the major source of their CAM information (OR=3.05) were all predictive of increased referral to acupuncture among rural GPs. Conclusions There is a significant interface between acupuncture and Australian rural and regional general practice, with generally high levels of support for acupuncture.

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Hickner, John M. "Training for rural practice in Australia 1990." Medical Journal of Australia 154, no. 2 (January 1991): 111–18. http://dx.doi.org/10.5694/j.1326-5377.1991.tb120996.x.

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Hays, R. B., D. A. Wallace, and T. K. Sen Gupta. "Training for rural family practice in australia." Teaching and Learning in Medicine 9, no. 2 (January 1997): 80–83. http://dx.doi.org/10.1080/10401339709539819.

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Hayman, John. "The practice of pathology in rural australia." Pathology 21, no. 2 (1989): 146–49. http://dx.doi.org/10.3109/00313028909059553.

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MAXWELL, JAL, ND COSTA, LL LAYMAN, and ID ROBERTSON. "Rural veterinary services in Western Australia: Part B. Rural practice." Australian Veterinary Journal 86, no. 3 (March 2008): 74–80. http://dx.doi.org/10.1111/j.1751-0813.2008.00264.x.

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Kamien, Max. "The viability of general practice in rural Australia." Medical Journal of Australia 180, no. 7 (April 2004): 318–19. http://dx.doi.org/10.5694/j.1326-5377.2004.tb05964.x.

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Rourke, J. T., and R. Strasser. "Education for rural practice in Canada and Australia." Academic Medicine 71, no. 5 (May 1996): 464–9. http://dx.doi.org/10.1097/00001888-199605000-00015.

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Dooney, N. M., and K. D. Osborn. "Rural Anaesthesia Practice: Attitudes and Recruitment following a Period of Anaesthetic Training in Rural and Regional Hospitals. A Survey of New Consultants." Anaesthesia and Intensive Care 38, no. 2 (March 2010): 354–58. http://dx.doi.org/10.1177/0310057x1003800236.

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The provision of specialist anaesthetic services to rural and remote locations in Australia poses an ongoing challenge-Initiatives to improve delivery of specialist anaesthetic services include the provision of anaesthesia training opportunities at rural hospitals. Previous surveys of trainees demonstrated the positive effect of rural training on attitudes toward subsequent practice in rural areas. We aimed first to survey attitudes of specialist anaesthetists towards anaesthetic training at rural and regional hospitals. We then compared the current workplace of those who had experienced a period of training at rural/regional hospitals versus those who did not. A web-based survey was distributed to fellows of the Australian and New Zealand College of Anaesthetists who had commenced consultant practice in the preceeding five years. Six hundred and fifteen surveys were distributed with a response rate of 53%. Respondents held their rural training experience in high regard. Anaesthetic specialists with a period of training in rural/regional areas were more likely to subsequently practise in rural areas compared to those who did not.

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McGrail, Matthew R., and Belinda G. O’Sullivan. "Faculties to Support General Practitioners Working Rurally at Broader Scope: A National Cross-Sectional Study of Their Value." International Journal of Environmental Research and Public Health 17, no. 13 (June 28, 2020): 4652. http://dx.doi.org/10.3390/ijerph17134652.

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Strategies are urgently needed to foster rural general practitioners (GPs) with the skills and professional support required to adequately address healthcare needs in smaller, often isolated communities. Australia has uniquely developed two national-scale faculties that target rural practice: the Fellowship in Advanced Rural General Practice (FARGP) and the Fellowship of the Australian College of Rural and Remote Medicine (FACRRM). This study evaluates the benefit of rural faculties for supporting GPs practicing rurally and at a broader scope. Data came from an annual national survey of Australian doctors from 2008 and 2017, providing a cross-sectional design. Work location (rurality) and scope of practice were compared between FACRRM and FARGP members, as well as standard non-members. FACRRMs mostly worked rurally (75–84%, odds ratio (OR) 8.7, 5.8–13.1), including in smaller rural communities (<15,000 population) (41–54%, OR 3.5, 2.3–5.3). FARGPs also mostly worked in rural communities (56–67%, OR 4.2, 2.2–7.8), but fewer in smaller communities (25–41%, OR 1.1, 0.5–2.5). Both FACRRMs and FARGPs were more likely to use advanced skills, especially procedural skills. GPs with fellowship of a rural faculty were associated with significantly improved geographic distribution and expanded scope, compared with standard GPs. Given their strong outcomes, expanding rural faculties is likely to be a critical strategy to building and sustaining a general practice workforce that meets the needs of rural communities.

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Humphreys, John S., Shari Mathews‐Cowey, and Herbert C. Weinand. "Factors in accessibility of general practice in rural Australia." Medical Journal of Australia 166, no. 11 (June 1997): 577–80. http://dx.doi.org/10.5694/j.1326-5377.1997.tb123267.x.

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Alston, Margaret. "Gender Mainstreaming in Practice: A View from Rural Australia." NWSA Journal 18, no. 2 (July 2006): 123–47. http://dx.doi.org/10.2979/nws.2006.18.2.123.

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Isaac, Vivian, Craig S. McLachlan, Lucie Walters, and Jennene Greenhill. "Screening for burn-out in Australian medical students undertaking a rural clinical placement." BMJ Open 9, no. 7 (July 2019): e029029. http://dx.doi.org/10.1136/bmjopen-2019-029029.

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ObjectiveTo investigate Australian medical student burn-out during rural clinical placement. Second, to examine the association between perceived burn-out and rural career intent at the time of finishing their rural placement.Design, settings and participantsThe 2016 Federation of Rural Australian Medical Educators evaluation survey is a cross-sectional study of medical students from 17 Australian universities. Specifically, those medical students who completed a full academic year or more at a Rural Clinical School (RCS). Responses from 638 medical students from regional Australia were analysed in the study of all eligible 756 medical students (response rate 84.3%).Primary and secondary outcome measuresThe primary objective was to determine self-reported burn-out (emotional exhaustion) in rural placements for medical students. Secondary outcome measures were designed to explore interactions with rural practice self-efficacy and rural intentions. Logistic regression models explored factors associated with burn-out.Results26.5% of students reported experiencing burn-out during a rural placement. Factors associated with burn-out were female gender, rural origin, low preference for RCS, stress in the year prior to a rural clinical placement, perceived social isolation during rural placement and lower rural practice self-efficacy. Burn-out was not associated with rural career intentions. Social isolation and low rural self-efficacy were independently associated with burn-out during rural placement and together explained 10% of variance in burn-out (Model Nagelkerke R2=0.23).ConclusionBurn-out during rural placement may be a consequence of stress prior to a medical school placement. Social isolation and rural self-efficacy are amendable factors to mitigate medical student burn-out during rural placements.

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Fielding, Alison, Dominica Moad, Amanda Tapley, Andrew Davey, Elizabeth Holliday, Jean Ball, Michael Bentley, et al. "Prevalence and associations of rural practice location in early-career general practitioners in Australia: a cross-sectional analysis." BMJ Open 12, no. 4 (April 2022): e058892. http://dx.doi.org/10.1136/bmjopen-2021-058892.

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ObjectivesTo: (1) establish the prevalence of urban, regional, rural and remote practice location of early-career general practitioners (GPs); and (2) examine demographic and training-related characteristics associated with working in regional, rural or remote areas post attainment of vocational general practice qualifications.DesignCross-sectional, questionnaire-based study, combined with contemporaneously collected data from participants’ prior vocational training.SettingAustralian general practice.ParticipantsNewly vocationally qualified GPs (ie, within 6 months–2 years post fellowship) who had completed vocational training with regional training organisations in New South Wales, Australian Capital Territory, eastern Victoria, and Tasmania between January 2016 and July 2018.Primary outcome measureRurality of post-fellowship practice location, as defined by Modified Monash Model (MMM) geographical classifications, based on current practice postcode. Prevalence of regional/rural/remote (‘rural’) practice was described using frequencies, and associations of rural practice were established using multivariable logistic regression, considering a range of demographic factors and training characteristics as independent variables.ResultsA total of 354 participants completed the questionnaire (response rate 28%) with 319 providing information for their current practice location. Of these, 100 (31.4%) reported currently practising in a rural area (MMM2-7). Factors most strongly associated with practising in a rural area included having undertaken vocational GP training in a rural location OR 16.0 (95% CI 6.79 to 37.9); p<0.001; and undertaking schooling in rural area prior to university OR 4.21 (1.98, 8.94); p<0.001.ConclusionsThe findings suggest that vocational training experience may have a role in rural general practice location post fellowship, attenuating the previously demonstrated ‘leakage’ from the rural practice pipeline.

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BSc, Rosalind Welch, Grad Dip Env Sc, and Ray Power. "General Practitioner Obstetric Practice in Rural and Remote Western Australia." Australian and New Zealand Journal of Obstetrics and Gynaecology 35, no. 3 (August 1995): 241–44. http://dx.doi.org/10.1111/j.1479-828x.1995.tb01972.x.

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McGrail, Matthew R., John S. Humphreys, Catherine M. Joyce, Anthony Scott, and Guyonne Kalb. "How do rural GPs’ workloads and work activities differ with community size compared with metropolitan practice?" Australian Journal of Primary Health 18, no. 3 (2012): 228. http://dx.doi.org/10.1071/py11063.

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Rural communities continue to experience shortages of doctors, placing increased work demands on the existing rural medical workforce. This paper investigates patterns of geographical variation in the workload and work activities of GPs by community size. Our data comes from wave 1 of the Medicine in Australia: Balancing Employment and Life longitudinal study, a national study of Australian doctors. Self-reported hours worked per usual week across eight workplace settings and on-call/ after-hours workload per usual week were analysed against seven community size categories. Our results showed that a GP’s total hours worked per week consistently increases as community size decreases, ranging from 38.6 up to 45.6 h in small communities, with most differences attributable to work activities of rural GPs in public hospitals. Higher on-call workload is also significantly associated with smaller rural communities, with the likelihood of GPs attending more than one callout per week ranging from 9% for metropolitan GPs up to 48–58% in small rural communities. Our study is the first to separate hours worked into different work activities whilst adjusting for community size and demographics, providing significantly greater insight to the increased hours worked, more diverse activities and significant after-hours demands experienced by current rural GPs.

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Thach, Sarah B., Bryan Hodge, Misty Cox, Anna Beth Parlier-Ahmad, and Shelley L. Galvin. "Cultivating Country Doctors: Preparing Learners for Rural Life and Community Leadership." Family Medicine 50, no. 9 (October 2, 2018): 685–90. http://dx.doi.org/10.22454/fammed.2018.972692.

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Background and Objectives: Rural health disparities are growing, and medical schools and residency programs need new approaches to encourage learners to enter and stay in rural practice. Top correlates of rural practice are rural upbringing and rurally located training, yet preparation for rural practice plays a role. The authors sought to explore how selected programs develop learners’ competencies associated with rural placement and retention: rural life, community engagement, and community leadership. Methods: Qualitative, semistructured phone interviews (n=20) were conducted with faculty of medical schools or family medicine residencies across the United States, Canada, Australia, and South Africa in which success in training rural practitioners was identified in the literature or by leaders of the National Rural Health Association’s Rural Medical Educators Group. Participants included 18 physician program directors, one nonphysician program administrator, and one PhD researcher who had studied rural preparation. Interview transcripts were read twice using an inductive process: first to identify themes, and then to identify specific strategies and quotes to exemplify each theme. Results: Participants’ recommendations for rural preparation were: (1) Be intentional about strategies to prepare learners for rural practice; (2) Identify and cultivate rural interest; (3) Develop confidence and competence to meet rural community needs; (4) Teach skills in negotiating dual relationships, leading, and improving community health; and (5) Fully engage rural host communities throughout the training process. Conclusions: Medical schools and residencies may increase the likelihood of producing rural physicians by implementing these experts’ strategies. Educators may select strategies that mesh with the structure and location of their training program.

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Beks, Hannah, Sandra Walsh, Laura Alston, Martin Jones, Tony Smith, Darryl Maybery, Keith Sutton, and Vincent L. Versace. "Approaches Used to Describe, Measure, and Analyze Place of Practice in Dentistry, Medical, Nursing, and Allied Health Rural Graduate Workforce Research in Australia: A Systematic Scoping Review." International Journal of Environmental Research and Public Health 19, no. 3 (January 27, 2022): 1438. http://dx.doi.org/10.3390/ijerph19031438.

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Redressing the maldistribution of the health workforce in regional, rural, and remote geographical areas is a global issue and crucial to improving the accessibility of primary health care and specialist services. Geographical classification systems are important as they provide an objective and quantifiable measure of access and can have direct policy relevance, yet they are not always consistently applied in rural health research. It is unclear how research focusing on the graduate health workforce in Australia has described, measured, and analyzed place of practice. To examine approaches used, this review systematically scopes Australian rural studies focusing on dentistry, medicine, nursing, and allied health graduates that have included place of practice as an outcome measure. The Joanna Brigg’s Institute Scoping Review Methodology was used to guide the review. Database searches retrieved 1130 unique citations, which were screened, resulting in 62 studies for inclusion. Included studies were observational, with most focusing on the practice locations of medical graduates and predicators of rural practice. Variations in the use of geographical classification approaches to define rurality were identified and included the use of systems that no longer have policy relevance, as well as adaptations of existing systems that make future comparisons between studies challenging. It is recommended that research examining the geographical distribution of the rural health workforce use uniform definitions of rurality that are aligned with current government policy.

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Thomson, Peter. "Returning to Oz: regional, rural, remote and relevant!" Faculty Dental Journal 12, no. 4 (October 2021): 190–95. http://dx.doi.org/10.1308/rcsfdj.2021.44.

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As Peter Thomson returns to Australia to take up the position of head of dentistry at James Cook University in northern Queensland, he reflects on the unique rural and regional clinical educational base as well as the significant contributions that the College of Medicine and Dentistry is making to ensure relevance and effectiveness in the delivery of education and contemporary clinical practice in the tropics.

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Draper, Diane. "Preparing for New Health Privacy Legislation in Rural Australia." Health Information Management 31, no. 2 (June 2003): 15–17. http://dx.doi.org/10.1177/183335830303100210.

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This Rural Professional Practice item describes the benefits of a collaborative, regional approach to implementing new health privacy legislation. Videoconferencing has been adopted to surmount the problems of long-distance communication between the Privacy Officers of 11 regional health services spread throughout a large region of south-eastern Australia.

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Russell, Deborah J., Matthew R. McGrail, John S. Humphreys, and John Wakerman. "What factors contribute most to the retention of general practitioners in rural and remote areas?" Australian Journal of Primary Health 18, no. 4 (2012): 289. http://dx.doi.org/10.1071/py11049.

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The objectives of this study were to measure the relative strength, significance and contribution of factors associated with rural and remote medical workforce retention. Length of stay data from two Australian GP workforce datasets, the 2008 National Minimum Data Set (4223 GPs) and a subset of the 2008 Medicine in Australia: Balancing Employment and Life dataset (1189 GPs), were separately analysed using multiple linear regression models and the results compared. Length of employment in their current practice location was the outcome measure. Consistent results were obtained across both datasets. The most important factors associated with the retention of rural and remote GPs, after adjusting for GP age, were primary income source, registrar status, hospital work and restrictions on practice location (which are linked to geographic location). Practice ownership was associated with ~70% higher retention than average, whilst undertaking hospital work in addition to routine general practice was associated with at least 18% higher retention compared with if no hospital work was undertaken. Less important factors included geographic location, procedural skills, annual leave, workload and practice size. Our findings quantify a range of financial and economic, professional and organisational, and geographic factors contributing to the retention of rural GPs. These findings have important implications for future medical workforce policy, providing an empirical evidence base to support the targeting and ‘bundling’ of retention initiatives in order to optimise the retention of rural GPs.

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Kljakovic, Marjan, and Jo Risk. "The anatomical placement of body organs by Australian and New Zealand patients and health professionals in general practice." Journal of Primary Health Care 4, no. 3 (2012): 239. http://dx.doi.org/10.1071/hc12239.

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INTRODUCTION: Understanding patients awareness of the anatomical placement of their body organs is important for doctorpatient communication. AIM: To measure the correct anatomical placement of body organs by people from Australian and New Zealand general practices METHOD: A questionnaire survey containing drawings of 11 organs placed in different locations within each drawing. RESULTS: Among 1156 participants, there was no difference in the proportion of correct placement of 11 organs between Australian (51.7%) and New Zealand (49.6%) general practices. There was a positive correlation between the proportion of correctly placed organs and the age participants left school (p=0.012) and a negative correlation with the number of GP visits in the previous year (p=0.040). Participants from rural Australia were more likely to correctly place organs than urban participants (p=0.018). The mean proportion of organs correctly placed for doctors was 80.5%, nurses 66.5%, allied health 61.5%, health administrators 50.6% and the remaining consulting patients 51.3%. DISCUSSION: Patients from Australian and New Zealand general practice were poorly aware of the correct placement of organs. Health professionals were moderately better than patients at correct placement. KEYWORDS: Health knowledge; attitudes; practice; anatomy; general practice

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Lim, Adrian C., Adrian C. See, and Stephen P. Shumack. "Progress in Australian teledermatology." Journal of Telemedicine and Telecare 7, no. 2_suppl (December 2001): 55–58. http://dx.doi.org/10.1258/1357633011937146.

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Because of their remoteness, the majority of rural towns in Australia are disadvantaged in terms of access to dermatological services. Telemedicine offers one solution. Since the mid-1990s, Australian dermatologists have experimented with tele-medicine as an adjunct to clinical practice. The technical viability of teledermatology was first demonstrated in 1997. In 1999, the accuracy and reliability of teledermatology were demonstrated in a real-life urban setting. In 2001, Broken Hill (in western New South Wales), a location remote from dermatology services, served as a trial site for the institution of tele-dermatology as the primary method of accessing dermatological services. High patient and general practitioner acceptability and positive medical outcomes were demonstrated, but the study also revealed unexpected barriers and pitfalls in the effective operation of rural teledermatology.

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Tually, Peter, John Walker, and Simon Cowell. "The effect of nuclear medicine telediagnosis on diagnostic pathways and management in rural and remote regions of Western Australia." Journal of Telemedicine and Telecare 7, no. 2_suppl (December 2001): 50–53. http://dx.doi.org/10.1258/1357633011937119.

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Limited accessibility to certain medical imaging services in regional and rural centres has led to the use of alternative modalities, which may not be best practice or which require patients to travel considerable distances for diagnosis. Data collected over three years were examined to determine the clinical effect of nuclear medicine teleradiology (NMT) and its effect on diagnostic patterns for the investigation of cardiovascular disease, radio-occult musculoskeletal injury and oncology. In comparison with two other rural, non-NMT areas of similar demographic profile, there was a significant shift in the delivery of care in terms of diagnostic work-up. NMT input led to the detection of disease and a change to therapeutic management in 122 cases and eliminated the need to transfer patients to another facility for unnecessary and expensive examinations in 38 cases. While NMT is more costly than conventional nuclear medicine services, it permits faster access to specialist consultation, provides for better management and is likely to reduce overall health costs by reducing the volume of inappropriate tests and treatment practice.

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Fisher, Karin A., and John D. Fraser. "Rural health career pathways: research themes in recruitment and retention." Australian Health Review 34, no. 3 (2010): 292. http://dx.doi.org/10.1071/ah09751.

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Objective.This paper describes stages in the research literature related to recruitment and retention of health professionals to rural health careers. Data sources.Electronic databases accessed included Medline, CINAHL, Social Sciences and Humanities. Key search terms included ‘high school’, ‘career choices’, ‘rural’, ‘attachment’, ‘recruitment’ and ‘retention’. Data synthesis.We identified four stages: (1) making career choices; (2) being attached to place; (3) taking up rural practice; and (4) remaining in rural practice. This is termed the ‘rural pipeline’. However, as some stages of the ‘rural pipeline’ refer specifically to the medical profession, we propose an extension of the notion of the medical ‘rural pipeline’ to include other professions such as nursing, midwifery and allied health. Conclusions.Utilising the ‘rural pipeline’ as a template for medicine, nursing and allied health would strengthen current approaches to the recruitment and retention of professionals in rural areas and provide a consolidated evidence base that would assist in policy development to improve availability and service provision of the rural health workforce. Future research that utilises a multidisciplinary approach could explore how the role and relationship between place and identity shape needs of career choices and would provide important information to advance the practical aspects supporting rural health career pathways. What is known about the topic?A universal shortage of rural health professionals is a significant issue and is becoming critical in rural areas of Australia. Although there have been many studies, internationally and in Australia, there are several gaps in recruitment and retention of rural health professionals that require further attention. What does this paper add?This paper examines workforce studies related to recruitment and retention of health professionals to rural health careers. The pipeline, however, refers mainly to the medical profession. The stages in this paper extend the notion of the medical ‘rural pipeline’ to include other professions such as nursing and allied health. This paper focusses on literature concerning developed countries such as Australia, New Zealand, Europe, the USA and Canada and identifies several proposed areas of future research. What are the implications for practitioners?The literature clearly identifies important issues for the rural health workforce. Having an understanding of the key issues underpinning the recruitment and retention of health professionals in rural areas allows the development and enhancement of appropriate workforce strategies. Utilising the ‘rural pipeline’ as a template for medicine, nursing and allied health would strengthen current approaches to the recruitment and retention of professionals in rural areas and provide a consolidated evidence base.

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Wardle, J., J. Adams, and D. Sibbritt. "Homeopathy in rural Australian primary health care: a survey of general practitioner referral and practice in rural and regional New South Wales, Australia." Homeopathy 102, no. 3 (July 2013): 199–206. http://dx.doi.org/10.1016/j.homp.2013.03.002.

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O'Sullivan, Belinda G., Matthew R. McGrail, Catherine M. Joyce, and Johannes Stoelwinder. "Service distribution and models of rural outreach by specialist doctors in Australia: a national cross-sectional study." Australian Health Review 40, no. 3 (2016): 330. http://dx.doi.org/10.1071/ah15100.

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Objective This paper describes the service distribution and models of rural outreach by specialist doctors living in metropolitan or rural locations. Methods The present study was a national cross-sectional study of 902 specialist doctors providing 1401 rural outreach services in the Medicine in Australia: Balancing Employment and Life study, 2008. Five mutually exclusive models of rural outreach were studied. Results Nearly half of the outreach services (585/1401; 42%) were provided to outer regional or remote locations, most (58%) by metropolitan specialists. The most common model of outreach was drive-in, drive-out (379/902; 42%). In comparison, metropolitan-based specialists were less likely to provide hub-and-spoke models of service (odd ratio (OR) 0.31; 95% confidence interval (CI) 0.21–0.46) and more likely to provide fly-in, fly-out models of service (OR 4.15; 95% CI 2.32–7.42). The distance travelled by metropolitan specialists was not affected by working in the public or private sector. However, rural-based specialists were more likely to provide services to nearby towns if they worked privately. Conclusions Service distribution and models of outreach vary according to where specialists live as well as the practice sector of rural specialists. Multilevel policy and planning is needed to manage the risks and benefits of different service patterns by metropolitan and rural specialists so as to promote integrated and accessible services. What is known about this topic? There are numerous case studies describing outreach by specialist doctors. However, there is no systematic evidence describing the distribution of rural outreach services and models of outreach by specialists living in different locations and the broad-level factors that affect this. What does this paper add? The present study provides the first description of outreach service distribution and models of rural outreach by specialist doctors living in rural versus metropolitan areas. It shows that metropolitan and rural-based specialists have different levels of service reach and provide outreach through different models. Further, the paper highlights that practice sector has no effect on metropolitan specialists, but private rural specialists limit their travel distance. What are the implications for practitioners? The complexity of these patterns highlights the need for multilevel policy and planning approaches to promote integrated and accessible outreach in rural and remote Australia.

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Wardle, Jon, Jon Adams, Ricardo J. Soares Magalhães, and David Sibbritt. "Distribution of complementary and alternative medicine (CAM) providers in rural New South Wales, Australia: A step towards explaining high CAM use in rural health?" Australian Journal of Rural Health 19, no. 4 (July 20, 2011): 197–204. http://dx.doi.org/10.1111/j.1440-1584.2011.01200.x.

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Caldwell, T. M., T. M. Caldwell, A. F. Jorm, S. Knox, D. Braddock, K. B. G. Dear, and H. Britt. "General Practice Encounters for Psychological Problems in Rural, Remote and Metropolitan Areas in Australia." Australian & New Zealand Journal of Psychiatry 38, no. 10 (October 2004): 774–80. http://dx.doi.org/10.1080/j.1440-1614.2004.01461.x.

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Humphreys, John S., Judith A. Jones, Michael P. Jones, and Paul R. Mara. "Workforce retention in rural and remote Australia: determining the factors that influence length of practice." Medical Journal of Australia 176, no. 10 (May 2002): 472–76. http://dx.doi.org/10.5694/j.1326-5377.2002.tb04518.x.

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Emery, Ashleigh, Sarah Hurley, Jasmine Williams, Sue Pougnault, Annette Mercer, and Marc Tennant. "A seven-year retrospective analysis of students entering medicine via a Rural Student Recruitment program in Western Australia." Australian Journal of Rural Health 17, no. 6 (December 2009): 316–20. http://dx.doi.org/10.1111/j.1440-1584.2009.01105.x.

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Seehusen, Dean A., Meghan F. Raleigh, Julie P. Phillips, Jacob Prunuske, Christopher P. Morley, Molly E. Polverento, Iris Kovar-Gough, and Andrea L. Wendling. "Institutional Characteristics Influencing Medical Student Selection of Primary Care Careers: A Narrative Review and Synthesis." Family Medicine 54, no. 7 (July 5, 2022): 522–30. http://dx.doi.org/10.22454/fammed.2022.837424.

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Background and Objectives: There is an ongoing shortage of primary care physicians in the United States. Medical schools are under pressure to address this threat to the nation’s health by producing more primary care graduates, including family physicians. Our objective was to identify institutional characteristics associated with more medical students choosing primary care. Methods: We conducted a systematic literature review with narrative synthesis to identify medical school characteristics associated with increased numbers or proportions of primary care graduates. We included peer-reviewed, published research from the United States, Canada, Australia, and New Zealand. The existing literature on characteristics, including institutional geography, funding and governance, mission, and research emphasis, was analyzed and synthesized into summary statements. Results: Ensuring a strong standing of the specialty of family medicine and creating an atmosphere of acceptance of the pursuit of primary care as a career are likely to increase an institution’s percentage of medical students entering primary care. Training on regional campuses or providing primary care experiences in rural settings also correlates with a larger percentage of graduates entering primary care. A research-intensive culture is inversely correlated with primary care physician production among private, but not public, institutions. The literature on institutional financial incentives is not of high enough quality to make a firm statement about influence on specialty choice. Conclusions: To produce more primary care providers, medical schools must create an environment where primary care is supported as a career choice. Medical schools should also consider educational models that incorporate regional campuses or rural educational settings.

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Brodribb, Wendy, Maria Zadoroznyj, and Bill Martin. "How do rural placements affect urban-based Australian junior doctors’ perceptions of working in a rural area?" Australian Health Review 40, no. 6 (2016): 655. http://dx.doi.org/10.1071/ah15127.

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Objectives The aim of the present study was to provide qualitative insights from urban-based junior doctors (graduation to completion of speciality training) of the effect of rural placements and rotations on career aspirations for work in non-metropolitan practices. Methods A qualitative study was performed of junior doctors based in Adelaide, Brisbane and Melbourne. Individual face-to-face or telephone semistructured interviews were held between August and October 2014. Thematic analysis focusing on participants’ experience of placements and subsequent attitudes to rural practice was undertaken. Results Most participants undertook rural placements in the first 2 years after graduation. Although experiences varied, positive perceptions of placements were consistently linked with the degree of supervision and professional support provided. These experiences were linked to attitudes about working outside metropolitan areas. Participants expressed concerns about being ‘forced’ to work in non-metropolitan hospitals in their first postgraduate year; many received little warning of the location or clinical expectations of the placement, causing anxiety and concern. Conclusions Adequate professional support and supervision in rural placements is essential to encourage junior doctors’ interests in rural medicine. Having a degree of choice about placements and a positive and supported learning experience increases the likelihood of a positive experience. Doctors open to working outside a metropolitan area should be preferentially allocated an intern position in a non-metropolitan hospital and rotated to more rural locations. What is known about the topic? The maldistribution of the Australian medical workforce has led to the introduction of several initiatives to provide regional and rural experiences for medical students and junior doctors. Although there have been studies outlining the effects of rural background and rural exposure on rural career aspirations, little research has focused on what hinders urban-trained junior doctors from pursuing a rural career. What does this paper add? Exposure to medical practice in regional or rural areas modified and changed the longer-term career aspirations of some junior doctors. Positive experiences increased the openness to and the likelihood of regional or rural practice. However, junior doctors were unlikely to aspire to non-metropolitan practice if they felt they had little control over and were unprepared for a rural placement, had a negative experience or were poorly supported by other clinicians or health services. What are the implications for practitioners? Changes to the process of allocating junior doctors to rural placements so that the doctors felt they had some choice, and ensuring these placements are well supervised and supported, would have a positive impact on junior doctors’ attitudes to non-metropolitan practice.

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Lyndon, Robert W., and Janice D. Russell. "Benzodiazepine Use in a Rural General Practice Population." Australian & New Zealand Journal of Psychiatry 22, no. 3 (September 1988): 293–98. http://dx.doi.org/10.3109/00048678809161210.

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This study investigates the prevalence and pattern of benzodiazepine use in an isolated Australian rural general practice setting. Some clinical features of psychological dependence were also examined. Data were obtained from 771 patients attending each of two general practices over a five-day period. The results indicated that 11.3% of the sample had used a benzodiazepine in the preceding four weeks and that 82% of these had been regular users for over six months. Prevalence increased with age and 36.5% of patients over the age of 70 were using benzodiazepines. Features suggesting some degree of psychological dependence were found in over 50% of users. The findings illustrate the extensive and prolonged use of benzodiazepines and raise questions about overuse and dependence, particularly in the elderly.

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Lea, Jackie, and Mary Cruickshank. "The support needs of new graduate nurses making the transition to rural nursing practice in Australia." Journal of Clinical Nursing 24, no. 7-8 (October 24, 2014): 948–60. http://dx.doi.org/10.1111/jocn.12720.

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O'Sullivan, Belinda G., Matthew R. McGrail, and Johannes U. Stoelwinder. "Subsidies to target specialist outreach services into more remote locations: a national cross-sectional study." Australian Health Review 41, no. 3 (2017): 344. http://dx.doi.org/10.1071/ah16032.

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Objective Targeting rural outreach services to areas of highest relative need is challenging because of the higher costs it imposes on health workers to travel longer distances. This paper studied whether subsidies have the potential to support the provision of specialist outreach services into more remote locations. Methods National data about subsidies for medical specialist outreach providers as part of the Wave 7 Medicine in Australia: Balancing Employment and Life (MABEL) Survey in 2014. Results Nearly half received subsidies: 19% (n = 110) from a formal policy, namely the Australian Government Rural Health Outreach Fund (RHOF), and 27% (n = 154) from other sources. Subsidised specialists travelled for longer and visited more remote locations relative to the non-subsidised group. In addition, compared with non-subsidised specialists, RHOF-subsidised specialists worked in priority areas and provided equally regular services they intended to continue, despite visiting more remote locations. Conclusion This suggests the RHOF, although limited to one in five specialist outreach providers, is important to increase targeted and stable outreach services in areas of highest relative need. Other subsidies also play a role in facilitating remote service distribution, but may need to be more structured to promote regular, sustained outreach practice. What is known about this topic? There are no studies describing subsidies for specialist doctors to undertake rural outreach work and whether subsidies, including formal and structured subsidies via the Australian Government RHOF, support targeted outreach services compared with no financial support. What does this paper add? Using national data from Australia, we describe subsidisation among specialist outreach providers and show that specialists subsidised via the RHOF or another source are more likely to provide remote outreach services. What are the implications for practitioners? Subsidised specialist outreach providers are more likely to provide remote outreach services. The RHOF, as a formally structured comprehensive subsidy, further targets the provision of priority services into such locations on a regular, ongoing basis.

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Laven, Gillian A., Justin J. Beilby, Heather J. McElroy, and David Wilkinson. "Factors associated with rural practice among Australian‐trained general practitioners." Medical Journal of Australia 179, no. 2 (July 2003): 75–79. http://dx.doi.org/10.5694/j.1326-5377.2003.tb05439.x.

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Orchard, Jessica J., Lis Neubeck, Ben Freedman, Ruth Webster, Anushka Patel, Robyn Gallagher, Jialin Li, et al. "Atrial Fibrillation Screen, Management And Guideline Recommended Therapy (AF SMART II) in the rural primary care setting: an implementation study protocol." BMJ Open 8, no. 10 (October 2018): e023130. http://dx.doi.org/10.1136/bmjopen-2018-023130.

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IntroductionScreening for atrial fibrillation (AF) in people ≥65 years is now recommended by guidelines and expert consensus. While AF is often asymptomatic, it is the most common heart arrhythmia and is associated with increased risk of stroke. Early identification and treatment with oral anticoagulants can substantially reduce stroke risk. The general practice setting is ideal for opportunistic screening and provides a natural pathway for treatment for those identified.This study aims to investigate the feasibility of implementing screening for AF in rural general practice using novel electronic tools. It will assess whether screening will fit within an existing workflow to quickly and accurately identify AF, and will potentially inform a generalisable, scalable approach.Methods and analysisScreening with a smartphone ECG will be conducted by general practitioners and practice nurses in rural general practices in New South Wales, Australia for 3–4 months during 2018–2019. Up to 10 practices will be recruited, and we aim to screen 2000 patients aged ≥65 years. Practices will be given an electronic screening prompt and electronic decision support to guide evidence-based treatment for those with AF. De-identified data will be collected using a clinical audit tool and qualitative interviews will be conducted with selected practice staff. A process evaluation and cost-effectiveness analysis will also be undertaken. Outcomes include implementation success (proportion of eligible patients screened, fidelity to protocol), proportion of people screened identified with new AF and rates of treatment with anticoagulants and antiplatelets at baseline and completion. Results will be compared against an earlier metropolitan study and a ‘control’ dataset of practices.Ethics and disseminationEthics approval was received from the University of Sydney Human Research Ethics Committee on 27 February 2018 (Project no.: 2017/1017). Results will be disseminated through various forums, including peer-reviewed publication and conference presentations.Trial registration numberACTRN12618000004268; Pre-results.

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FRANCIS, Heather Marion, Kerrie A. CLARKE, Christopher B. STEER, Jillian J. FRANCIS, and Craig R. UNDERHILL. "Attitudes of advanced Australian medical oncology trainees to rural practice." Asia-Pacific Journal of Clinical Oncology 4, no. 1 (March 2008): 34–41. http://dx.doi.org/10.1111/j.1743-7563.2008.00146.x.

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Page, Amy Theresa, Rhonda Marise Clifford, Kathleen Potter, Liza Seubert, Andrew J. McLachlan, Xaysja Hill, Stephanie King, et al. "Exploring the enablers and barriers to implementing the Medication Appropriateness Tool for Comorbid Health conditions during Dementia (MATCH-D) criteria in Australia: a qualitative study." BMJ Open 7, no. 8 (August 2017): e017906. http://dx.doi.org/10.1136/bmjopen-2017-017906.

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ObjectivesThe Medication Appropriateness Tool for Comorbid Health conditions in Dementia (MATCH-D) criteria provide expert consensus guidance about medication use for people with dementia. This study aimed to identify enablers and barriers to implementing the criteria in practice.SettingParticipants came from both rural and metropolitan communities in two Australian states.ParticipantsFocus groups were held with consumers, general practitioners, nurses and pharmacists. Outcomes: data were analysed thematically.ResultsNine focus groups were conducted. Fifty-five participants validated the content of MATCH-D, appraising them as providing patient-centred principles of care. Participants identified potential applications (including the use of MATCH-D as a discussion aid or educational tool for consumers about medicines) and suggested supporting resources.ConclusionParticipants provided insights into applying MATCH-D in practice and suggested resources to be included in an accompanying toolkit. These data provide external validation of MATCH-D and an empiric basis for their translation to practice. Following resource development, we plan to evaluate the feasibility and efficacy of implementation in practice.

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Higgins, Niall S., Kersi Taraporewalla, Michael Steyn, Rajesh Brijball, and Marcus Watson. "Workforce education issues for international medical graduate specialists in anaesthesia." Australian Health Review 34, no. 2 (2010): 246. http://dx.doi.org/10.1071/ah09793.

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International medical graduate (IMG) specialists in anaesthesia need education to be part of the assessment process for pre-registration college fellowship. Fellowship of the anaesthetic college is required in Australia for registration as a specialist in this field. Marked differences exist between local trainees and IMG specialists in terms of training, stakes of the exam and isolation of practice. We have examined the reasons for the low pass rate for IMG specialists compared to the local trainees in the Australian and New Zealand College of Anaesthetists (ANZCA) final fellowship examinations. We also offer an IMG specialists’ view of this perceived problem. It highlights their difficulties in obtaining adequate supervision and education. What is known about the topic?There has been a worldwide shortage of doctors over the last decade. In Australia this shortage has been attributed to government policy in the 1990s limiting the number of medical school places. Other factors that may have contributed to this shortage are changes in the practice of medicine, increasing specialisation, growth in population and patterns of population settlement at the coastal fringes of Australia. The use of international medical graduates and reliance on them is associated with several problems and challenges. A key factor relates to their performance at a standard acceptable to the country. What does the paper add?This paper offers an examination of the issues that present to IMG specialists located at rural and remote areas of Australia. The global aim of this study is to understand the workforce education issues that present to IMG specialists as a basis for supporting this group, having migrated to Australia, to better prepare for assessment of their practice in this country. Results of a survey of IMG specialists in Anaesthesia are included to contribute to an overall view. It highlights their understanding of the issues that present when preparing for specialist assessments. What are the implications for practitioners?This information will be useful for policy practitioners who determine critical elements that influence workforce planning and education support. Decision makers will be able to make more informed decisions on the need to integrate education into planning for workforce efficiencies. There are currently no published data explaining why the pass rate for IMG specialist in anaesthesia is so different from local trainees and this paper also offers a viewpoint of present issues from those who are attempting these examinations.

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Khalil, H., A. Leversha, and J. Walker. "Evaluation of pharmacy students' rural placement program: preparation for interprofessional practice." Australian Health Review 39, no. 1 (2015): 85. http://dx.doi.org/10.1071/ah14121.

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Objective To date, there are few data on pharmacy-specific placement programs and their impact on students’ work after graduation. The present study evaluated an innovative rural pharmacy placement program targeted at influencing students to work and live in rural areas after graduation. A secondary aim of the study was to explore the students’ intentions to come back and practice in rural areas as a result of their involvement in the rural pharmacy program. Methods A questionnaire was distributed, by hand, to a total of 58 third and fourth (final) year pharmacy students undertaking their rural placement in the Gippsland region, in rural Victoria in 2011 and 2012. Results Fifty-seven responses were returned (response rate = 98%). Students stated that understanding pharmacy practice from a rural perspective, visits to rural health professionals and sites and the attitude of their preceptors were essential to their satisfaction with their rural placements. A significant number of students (72%) intend to seek employment in rural areas if opportunities arise as a result of their increased rural awareness. The key components for a successful rural placement program were described by the surveyed students as social awareness, recognising job opportunities and interprofessional learning. Conclusion The evaluation of the rural placement program revealed that students valued their visits to rural sites and their interaction with other rural health professionals the most. What is known about the topic? Rural undergraduate student programs have been initiated as a result of several Australian government strategies to address shortages in rural health workforce. Subsequently, various rural placement programs have been integral parts of several disciplines, including medicine, dentistry, nursing, occupational therapy and pharmacy among others. To date, there are few data on pharmacy-specific placement programs and their impact on students’ work after graduation What does this paper add? The rural pharmacy program is important in influencing students’ perceptions and interest in a career in rural areas. The key components for a successful rural placement program were described by the surveyed students as social awareness, recognising job opportunities and interprofessional learning. What are the implications for practitioners? Interprofessional learning and collaboration are inevitable due to the shortage of health professionals and the move towards holistic management of patients in healthcare settings. The development of an interprofessional rural education that combines rural medical and pharmacy students together highlights the importance of an interprofessional approach to preparing students to work in rural areas.

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Hays, Catherine, Melanie Sparrow, Selina Taylor, Daniel Lindsay, and Beverley Glass. "Pharmacists’ “Full Scope of Practice”: Knowledge, Attitudes and Practices of Rural and Remote Australian Pharmacists." Journal of Multidisciplinary Healthcare Volume 13 (December 2020): 1781–89. http://dx.doi.org/10.2147/jmdh.s279243.

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Gum, Lyn Frances, Linda Sweet, Jennene Greenhill, and David Prideaux. "Exploring interprofessional education and collaborative practice in Australian rural health services." Journal of Interprofessional Care 34, no. 2 (August 20, 2019): 173–83. http://dx.doi.org/10.1080/13561820.2019.1645648.

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Schofield, Deborah, Michelle M. Cunich, and Lucio Naccarella. "An evaluation of the quality of evidence underpinning diabetes management models: a review of the literature." Australian Health Review 38, no. 5 (2014): 495. http://dx.doi.org/10.1071/ah14018.

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Objective There is a paucity of research on the quality of evidence relating to primary care workforce models. Thus, the aim of the present study was to evaluate the quality of evidence on diabetes primary care workforce models in Australia. Methods The National Health and Medical Research Council of Australia’s (National Health and Medical Reseach Council; 2000, 2001) frameworks for evaluating scientific evidence and economic evaluations were used to assess the quality of studies involving primary care workforce models for diabetes care involving Australian adults. A search of medical databases (MEDLINE, AMED, RURAL, Australian Indigenous HealthInfoNet and The Cochrane Institute), journals for diabetes care (Diabetes Research and Clinical Practice, Diabetes Care, Diabetic Medicine, Population Health Management, Rural and Remote Health, Australian Journal of Primary Health, PLoS Medicine, Medical Journal of Australia, BMC Health Services Research, BMC Public Health, BMC Family Practice) and Commonwealth and state government health websites was undertaken to acquire Australian studies of diabetes workforce models published 2005–13. Various diabetes workforce models were examined, including ‘one-stop shops’, pharmacy care, Aboriginal services and telephone-delivered interventions. The quality of evidence was evaluated against several criteria, including relevance and replication, strength of evidence, effect size, transferability and representativeness, and value for money. Results Of the14 studies found, four were randomised controlled trials and one was a systematic review (i.e. Level II and I (best) evidence). Only three provided a replicable protocol or detailed intervention delivery. Eleven lacked a theoretical framework. Twelve reported significant improvements in clinical (patient) outcomes, commonly HbA1c, cholesterol and blood pressure; only four reported changes in short- and long-term outcomes (e.g. quality of life). Most studies used a small or targeted population. Only two studies assessed both benefits and costs of their intervention compared with usual care and cost effectiveness. Conclusions More rigorous studies of diabetes workforce models are needed to determine whether these interventions improve patient outcomes and, if they do, represent value for money. What is known about the topic? Although health systems with strong primary care orientations have been associated with enhanced access, equity and population health, the primary care workforce is facing several challenges. These include a mal-distribution of resources (supply side) and health outcomes (demand side), inconsistent support for teamwork care models, and a lack of enhanced clinical inter-professional education and/or training opportunities. These challenges are exacerbated by an ageing health workforce and general population, as well as a population that has increased prevalence of chronic conditions and multi-morbidity. Although several policy directions have been advocated to address these challenges, there is a lack of high-quality evidence about which primary care workforce models are best (and which models represent better value for money than current practice) and what the health effects are for patients. What does this paper add? This study demonstrated several strengths and weaknesses of Australian diabetes models of care studies. In particular, only five of the 14 studies assessed were designed in a way that enabled them to achieve a Level II or I rating (and hence the ‘best’ level of evidence), based on the NHMRC’s (2000, 2001) frameworks for assessing scientific evidence. The majority of studies risked the introduction of bias and thus may have incorrect conclusions. Only a few studies described clearly what the intervention and the comparator were and thus could be easily replicated. Only two studies included cost-effectiveness studies of their interventions compared with usual care. What are the implications for practitioners? Although there has been an increase in the number of primary care workforce models implemented in Australia, there is a need for more rigorous research to assess whether these interventions are effective in producing improved health outcomes and represent better value for money than current practice. Researchers and policymakers need to make decisions based on high-quality evidence; it is not obvious what effect the evidence is having on primary care workforce reform.

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Griffin, Cassandra, Ricardo Vilain, Simon King, Sandy Nixon, Alisha Gooley, Samara Bray, James Lynam, Marjorie M. Walker, Rodney J. Scott, and Christine Paul. "Mind Over Matter: Confronting Challenges in Post-Mortem Brain Biobanking for Glioblastoma Multiforme." Biomarker Insights 16 (January 2021): 117727192110133. http://dx.doi.org/10.1177/11772719211013359.

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Over the past 10 years, there has been limited progress for the treatment of brain cancer and outcomes for patients are not much improved. For brain cancer researchers, a major obstacle to biomarker driven research is limited access to brain cancer tissue for research purposes. The Mark Hughes Foundation Brain Biobank is one of the first post-mortem adult brain banks in Australia to operate with protocols specifically developed for brain cancer. Located within the Hunter New England Local Health District and operated by Hunter Cancer Biobank, the boundaries of service provided by the Brain Bank extend well into the surrounding regional and rural areas of the Local Health District and beyond. Brain cancer biobanking is challenging. There are conflicting international guidelines for best practice and unanswered questions relating to scientific, psychosocial and operational practices. To address this challenge, a best practice model was developed, informed by a consensus of existing data but with consideration of the difficulties associated with operating in regional or resource poor settings. The regional application of this model was challenged following the presentation of a donor located in a remote area, 380km away from the biobank. This required biobank staff to overcome numerous obstacles including long distance patient transport, lack of palliative care staff, death in the home and limited rural outreach services. Through the establishment of shared goals, contingency planning and the development of an informal infrastructure, the donation was facilitated within the required timeframe. This experience demonstrates the importance of collaboration and networking to overcome resource insufficiency and geographical challenges in rural cancer research programmes.

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Malau-Aduli, Bunmi S., Faith O. Alele, Paula Heggarty, Carole Reeve, and Peta-Ann Teague. "Key elements of effective postgraduate GP educational environments: a mixed methods study." BMJ Open 11, no. 2 (February 2021): e041110. http://dx.doi.org/10.1136/bmjopen-2020-041110.

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ObjectivesEvidence in the literature suggests that satisfaction with postgraduate general practice (GP) training is associated with the quality of the educational environment. This study aimed to examine GP registrars’ level of satisfaction with a distributed model of training in a regional educational environment and investigate the relationship between satisfaction and academic performance.Study designA longitudinal 3-year study was conducted among GP registrars at James Cook University using a sequential explanatory mixed methods research design. GP registrars’ satisfaction was obtained using the scan of postgraduate educational environment domains tool. A focus group discussion was conducted to explore GP registrars’ perceptions of satisfaction with the educational environment.SettingJames Cook University General Practice Training (JCU GPT) programme.ParticipantsSix hundred and fifty one (651) GP registrars enrolled between 2016 and 2018 at JCU GPT programme.Results651 registrars completed the satisfaction survey between 2016 and 2018. Overall, 92% of the registrars were satisfied with the educational training environment. Registrars who had become fellows reported higher satisfaction levels compared with those who were still in training (mean=4.39 vs 4.20, p=0.001). However, academic performance had no impact on level of satisfaction with the educational environment. Similarly, practice location did not influence registrars’ satisfaction rates. Four themes (rich rural/remote educational environment, supportive learning environment, readiness to continue with rural practice and practice culture) emerged from the thematic data analysis.ConclusionA clinical learning environment that focuses on and supports individual learning needs is vital for effective postgraduate medical training. This study suggests that JCU GPT programme’s distributed model fostered a satisfying and supportive training environment with rich educational experiences that enhance retention of GP registrars in rural/remote North Queensland, Australia. The findings of this study may be applicable to other settings with similar training models.

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Terry, Daniel, Blake Peck, Ed Baker, and David Schmitz. "The Rural Nursing Workforce Hierarchy of Needs: Decision-Making concerning Future Rural Healthcare Employment." Healthcare 9, no. 9 (September 18, 2021): 1232. http://dx.doi.org/10.3390/healthcare9091232.

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Addressing nursing shortages in rural areas remains essential, and attracting nursing graduates is one solution. However, understanding what factors are most important or prioritized among nursing students contemplating rural employment remains essential. The study sought to understand nursing student decision-making and what aspects of a rural career need to be satisfied before other factors are then considered. A cross-sectional study over three years at an Australian university was conducted. All nursing students were invited to complete a Nursing Community Apgar Questionnaire to examine their rural practice intentions. Data were analyzed using principal component analysis, and mean scores for each component were calculated and ranked. Overall, six components encompassed a total of 35 items that students felt were important to undertake rural practice after graduating. Clinical related factors were ranked the highest, followed by managerial, practical, fiscal, familial, and geographical factors. Maslow’s Hierarchy of Needs provided a lens to examine nursing student decision-making and guided the development of the Rural Nursing Workforce Hierarchy of Needs model. Each element of the model grouped key factors that students considered to be important in order to undertake rural employment. In culmination, these factors provide a conceptual model of the hierarchy of needs that must be met in order to contemplate a rural career.

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Shields, Linda, Julie Jomeen, Wendy Smyth, and David Stanley. "Matthew Flinders Senior (1751–1802): Surgeon and ‘man midwife’." Journal of Medical Biography 28, no. 2 (October 26, 2017): 115–20. http://dx.doi.org/10.1177/0967772017707713.

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Until the eighteenth century, midwifery was the sole domain of women, but changes in medical science saw it appropriated by medical men and the ‘man-midwife’ emerged. This paper demonstrates the work of a man-midwife in a small English village in one year, 1775, using his accounts and correspondence. The man was Matthew Flinders Senior, ‘surgeon and man-midwife’ at Donington, Lincolnshire. He was the father of Captain Matthew Flinders, the famous navigator who mapped the coast line of Australia and who coined that name. Primary sources, published as a collection by the Lincoln Record Society, were used. Flinders Senior made a good living from his midwifery, charging rates commensurate with those charged by obstetricians today (with reduced costs for the poor). His descriptions of his practice show how midwifery was conducted in rural England during the development of medicine as a high-status profession. The paper uses data from one year to provide a snap shot of the work of a rural surgeon and man-midwife, but much more is available in the published collection, providing ready access for researchers who may like to pursue such work further.

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Scholes-Robertson, Nicole. "The Norm Bourke Box: A Patient-Led Initiative to Improve Care for Rural Patients Requiring Peritoneal Dialysis." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 39, no. 4 (July 2019): 390–91. http://dx.doi.org/10.3747/pdi.2019.00011.

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Patients living in rural communities face many barriers and challenges in accessing peritoneal dialysis (PD) because it often requires travelling long distances, and accommodation away from home for training and follow-up. Patient perception is that there is a lack of financial support for out-of-pocket expenses, which makes home-based treatments less appealing. It can be difficult for patients to source equipment required to do PD safely and effectively at home, and more difficult for those who live in rural or remote settings. This article describes a patient-led initiative—the “Norm Bourke Box” (NBB) for patients requiring PD in rural New South Wales, Australia. The NBB provides necessary equipment including bathroom scales and a blood pressure machine, that are not supplied by the health service. For patients, this has enabled a “good start” to PD and has helped to alleviate the financial burden and stress of needing to source the equipment required for PD. This also gave patients and staff reassurance because patients could undertake training with the equipment that they would be using at home to support efficient and safe practice at home. Efforts are now underway to expand the distribution of the NBB to help improve access and care for rural patients on PD.

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Journal articles on the topic 'Medicine, Rural Practice Australia'

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