"They liked it if you said you cried": how medical students perceive the teaching of professionalism.

OBJECTIVE: To discover what Australian medical students think about the way professionalism is taught in their medical curriculum. DESIGN, PARTICIPANTS AND SETTING: Qualitative study including five focus groups between 2 June 2010 and 30 September 2010, comprised of medical students from both undergraduate and postgraduate entry programs who were in the last 1-2 years of the medical program and had undertaken rural longitudinal integrated clinical placements. RESULTS: The five focus groups ran for a total of 5.5 hours. Participants (16 women and 24 men; mean age, 26 years [range 23-32 years]) expressed a low regard for the ways in which professionalism had been taught and assessed in their learning programs. They "gamed the system", giving assessors the results on reflective writing assignments that they believed would gain them a pass. They considered experiential learning - observing good professional practice - to be the best way (some view it as the only way) to learn professionalism and consolidate what they learned, and formed their individual mental model of professionalism through group reflection with their peers in medical school. CONCLUSIONS: While students will always be critical of their curriculum, the universal negative views we captured indicate that current teaching would benefit from review. We suggest a less didactic approach in early years, with more evaluation and feedback from students to assure relevance; an emphasis on true reflection, as opposed to guided reflections linked to overformalised requirements; and more attention devoted to role-modelling and mentoring in the clinical years of training.

Rural placements are effective for teaching medicine in Australia: evaluation of a cohort of students studying in rural placements.

INTRODUCTION: Medical education in Australia is increasingly delivered through longitudinal placements in general practice and other community settings. Early meaningful exposure to patients has been shown to improve the transition from medical student to junior doctor. This study examines the experience of the first year cohort of the University of Western Sydney (UWS) Medical School long-term rural placement students. Results have been placed in the context of other published results for rural training schemes, comparing and contrasting the present results to those of others. METHODS: Students undertaking a rural placement in their final year of the UWS medical program (n = 21) participated in a mixed methods evaluation. Students filled out a quantitative survey, modified from a validated instrument, and also participated in a focus group. Class ranking of students, and changes over the time of their placement, were also examined. RESULTS: Overall, students were very pleased with their rural experience, both clinically and socially. Students found the rural experience more comprehensive than they had expected. They considered that they had a stronger learning experience in most aspects than they expect they would have received in a metropolitan area. The smaller realm of the medical world in a rural area was considered an advantage in providing more hands-on experience and more interprofessional team approaches to healthcare provision. It was also considered a drawback by some that more advanced cases of all kinds were sent out of the area to metropolitan hospitals. Between their ranking in the end of Year 3 examination and the examination in the middle of Year 5, during which period students undertook their year-long placement, 14 of 22 students increased their class rank while two experienced no change and six decreased their class rank. Overall, the rural cohort advanced 4.2 places compared to their urban-placed peers. CONCLUSIONS: The present results confirm that rural placements have come into their own in Australia. Curriculum content regarding Aboriginal health issues should emphasise the complexity of culture and range of living conditions that makes up Aboriginal Australia and avoid a 'deficit-based perspective' that emphasises extreme cases over routine presentations. Taken together, the results reported by Australian medical schools now offering long-term rural placements suggest that rural long-term placements are at least as effective, and may even be more effective, than metropolitan hospital placements as an effective means of providing clinical education to medical students in their senior years.

Doctors trading places: the Isolated Practitioner Peer Support Scheme.

We describe the outcomes of a practice exchange in which an isolated general practitioner from a remote region traded work and living arrangements with a rural group practice GP. An exchange can provide an opportunity for mid- and senior-career professionals to refresh their outlook on their careers. Involving the rural medical workforce in practice exchanges can enable the development of peer networks that can improve retention of isolated practitioners in Australia. A fresh experience in a new setting can provide opportunities for practitioners to improve practice management and sharpen their clinical skills. Uprooting families and preparing homes for unfamiliar visitors add stress to doctors and their families on exchange. Patients in isolated practices could feel concerned that they may lose their doctor as a result of an exchange. In this instance, the benefits far outweighed the difficulties.

Medical schools can cooperate: a new joint venture to provide medical education in the Northern Rivers region of New South Wales.

The medical schools at the University of Western Sydney, University of Wollongong and University of Sydney have developed a joint program for training medical students through placements of up to 40 weeks on the New South Wales North Coast. The new partnership agency - the North Coast Medical Education Collaboration - builds on the experience of regional doctors and their academic partners. A steering committee has identified the availability and support requirements of local practitioners to provide training, and has undertaken a comparative mapping of learning objectives and assessments from the courses of the three universities. The goals of the program include preparing doctors who can perform effectively in rural settings and multidisciplinary health care teams, and to advance research in medical education.

The researcher development program: how to extend the involvement of Australian general practitioners in research?

CONTEXT: This article reviews the Researcher Development Program (RDP) component of the Australian Government's Primary Health Care Research, Evaluation, and Development (PHC RED) strategy, examining critical aspects of program performance and suggesting strategies that might increase the involvement of rural GPs in research. ISSUE: Primary health care research capacity can only be built by providing sustainable, dedicated funding and a dedicated redistribution of workload from practice to research. The PHC RED funds and program supports only provide incentives to redirect existing capacity within primary health care from patient care to research for the time during which incentives are in place, generally as a part-time funded position for less than one-year's duration. The one-year time constraint is the most serious impediment to the success of the program. There is no formal provision for the continuing status of clinician/researchers. Continuation depends on the capacity of the mentor agencies, academic departments of general practice or university departments of rural health, to continue to support them, and on the time they can make available from their practice. Existing measures of program success, published research and new knowledge incorporated into practice settings, are too ambitious for researchers given a one-year time frame, working part time. Clinician/researchers have a demonstrated willingness to devote time to developing and answering a research question, but often lack the time and administrative support to get through the processes required, including ethics application and writing for publication. LESSONS LEARNED: A better way to capture success of the RDP program might be through a multi-objective composite set of measures of research performance that captures different types of outputs, with weighting factors assigned to different measures of research output. Development of peer-review panels to replace or augment annual reporting to assess the progress of PHC RED programs might also serve both to measure success and to promote collaborative ventures. Small scale research projects are more conducive to practising GPs than randomised controlled trials or large scale observational studies. Smaller projects can still lead to important discoveries and improvements to the healthcare system. Examples include guideline development, descriptive studies, and small-number analytical epidemiological studies. In order to engage the rural primary care community in redirecting clinical time to research, the needs of clinicians must be met, as well as those of funders, academic mentors and collaborators. Structures and systems that can be developed through PHC RED, including research networks, will determine whether efforts to increase research in primary-care settings succeed and are sustainable. Sustainable networks need sustainable funding.