Exploring rural doctors' early experiences of coping with the emerging COVID-19 pandemic.

PURPOSE: To understand how rural doctors (physicians) responded to the emerging COVID-19 pandemic and their strategies for coping. METHODS: Early in the pandemic doctors (physicians) who practise rural and remote medicine were invited to participate through existing rural doctors' networks. Thirteen semi-structured interviews were conducted with rural doctors from 11 countries. Interviews were transcribed verbatim and coded using NVivo. A thematic analysis was used to identify common ideas and narratives. FINDINGS: Participants' accounts described highly adaptable and resourceful responses to address the crisis. Rapid changes to organizational and clinical practices were implemented, at a time of uncertainty, anxiety, and fear, and with limited information and resources. Strong relationships and commitment to their colleagues and communities were integral to shaping and sustaining these doctors' responses. We identified five common themes underpinning rural doctors' shared experiences: (1) caring for patients in a context of uncertainty, fear, and anxiety; (2) practical solutions through improvising and being resourceful; (3) gaining community trust and cooperation; (4) adapting to unrelenting pressures; and (5) reaffirming commitments. These themes are discussed in relation to the Lazarus and Folkman stress and coping model. CONCLUSIONS: With limited resources and support, these rural doctors' practical responses to the COVID-19 crisis underscore strong problem-focused coping strategies and shared commitments to their communities, patients, and colleagues. They drew support from sharing experiences with peers (emotion-focused coping) and finding positive meanings in their experiences (meaning-based coping). The psychosocial impact on rural doctors working at the limits of their adaptive resources is an ongoing concern.

Crisis and continuity: Rural health care students respond to the COVID-19 outbreak.

The COVID-19 outbreak in Winter (2020) has caused widespread disruption for health sciences students undergoing clinical placements-vital periods of experiential learning that cannot be substituted with distance alternatives. For students placed in rural areas, already coping with isolation, precarious supply chains and shortages of essential personnel, the effects of the COVID-19 outbreak may have far-reaching implications for psychosocial wellness, self-efficacy and clinical judgment. Four nursing and eight medical students (n = 12) supplied photographs and commentary documenting the experience of withdrawing suddenly from clinical sites in rural Alberta. Collaborative, thematic analysis revealed continuities between pre- and post-outbreak life, both for the students and their rural hosts. Social determinants of health such as seclusion, environmental hazards, and health-seeking behaviors carried over and compounded the effects of the outbreak on the placement communities and clinical sites. Other continuities included the reliance on technology for clinical and social connectivity, and capitalizing on natural settings to cope with isolation and confinement. Prolonged liminality, lack of closure, and the loss of team identity were the greatest stressors brought on by the suspension of clinical activities. However, the participants felt well equipped to deal with these circumstances through the resilience, adaptability, and community ethos acquired during their placements.