Rural surgery: the Australian experience.

A significant proportion of the Australian population resides nonmetropolitan regions. For the majority of these smaller regional centers, the surgical service delivery has been traditionally provided by either solo or two-person surgical practices. As medical students' interest in rural practice declined, new models were created to ensure medical care in these areas. This article outlines the past and current state of medical care in rural areas, highlighting models used in Port Augusta, Mount Gambier, and Port Lincoln. It concludes that these models are successful and should be further developed.

Who will do general surgery?

Advantages to patients of a single anaesthetic for more than one operation are obvious; attracting generalist surgeons, training them and ensuring they have adequate credentials remain hurdles.

Is laparoscopic intraoperative cholangiogram a matter of routine?

BACKGROUND: Intraoperative cholangiography during laparoscopic cholecystectomy reveals the anatomy of the biliary tree and any stones contained within it. The use of intraoperative cholangiography may be routine for all laparoscopic cholecystectomy. An alternative approach is a selective policy, performing intraoperative cholangiography only for those cases in which choledocholithiasis is suspected on clinical grounds, or those for which the anatomy appears unclear at operation. The literature pertaining to both approaches is reviewed, to delineate their respective merits. METHODS: Relevant articles in English were identified from the Medline database, and reviewed. RESULTS: The literature reviewed consisted of retrospective analyses. Overall the incidence of unsuspected retained stones was 4%, but only 15% of these would go on to cause clinical problems. The incidence of complete transection of the common bile duct was rare for both routine and selective intraoperative cholangiography policies, and did not differ between them. Rates of minor bile duct injury did not differ between groups, but was more likely to be recognized in the routine group than the selective (P = 0.01). CONCLUSIONS: Routine intraoperative cholangiography yields very little useful clinical information over and above that which is obtained with selective policies. Large numbers of unnecessary intraoperative cholangiography are performed under routine intraoperative cholangiography policy, and therefore a selective policy is advocated.

Student attitudes to surgical teaching in provincial hospitals.

OBJECTIVE: The ever-increasing pressure on metropolitan teaching hospitals to rationalise budgets and increase productivity has resulted in a dwindling amount of teaching opportunity for the medical student population. One solution to the problem was to utilise a largely untapped resource in South Australia, namely the provincial hospitals, however, student opinion regarding such a radical change had yet to be determined. DESIGN: A questionnaire was circulated among an entire year group of medical students who would be undertaking the revised surgical curriculum with rural attachments. SETTING: In October 1997, a decision was made by the Department of Surgery at the University of Adelaide to proceed with optional rural surgical attachments in 1998. SUBJECTS: The survey was distributed to the 125 members of the 1997 fifth year medical student group. RESULTS: A total of 92 questionnaires were returned giving a response rate of 75%. Thirty-nine students ranked a rural term in their top half of preferences, while a further 18 indicated that they would go to a rural centre if they had to. CONCLUSION: Despite having little warning of the impending changes to their surgical curriculum, the majority of students who responded to the questionnaire stated that they would be willing to venture to the country locations. Before planning significant changes to an established curriculum, the student group should be consulted to gauge their opinion.

Surgical rotations in provincial South Australia: the trainees' perspective.

BACKGROUND: Rural general surgery is faced with a shortage of resident surgeons in many parts of Australia. Although it is accepted that an undergraduate rural exposure favourably influences graduates to undertake rural practice, it is not known whether postgraduate terms exert a similar effect. METHOD: Advanced general surgical trainees in 2000 were rotated for 1-month terms to Whyalla, a major provincial centre in South Australia. The trainees were asked to complete a questionnaire before and after the rotation. RESULTS: A total of nine trainees completed a rural term in Whyalla. Eight questionnaires were returned prior to the rotation and seven following the time in Whyalla. The overall experience, and the teaching standards and pathology experienced were rated highly but the term had little effect in changing trainee's attitudes towards eventual practice location. CONCLUSION: Postgraduate surgical terms in South Australia are a relatively new phenomenon compared to other states in Australia. Without a foundation in rural surgery at an undergraduate level, surgical terms for trainees, despite being of high quality, might not be very successful in influencing graduates to practise surgery in rural locations.

Surgical undergraduate education in rural Australia.

HYPOTHESIS: Surgical undergraduate education in a rural setting is feasible and sound in terms of educational outcomes. DESIGN: The final-year surgical curriculum at the University of Adelaide, Adelaide, South Australia, was restructured to include the option of a rural surgical term. SETTING: Five provincial center hospitals in rural South Australia. INTERVENTIONS: Forty-three final-year medical students undertook rural surgical clerkships in 1998. MAIN OUTCOME MEASURES: End-of-year results and subjective ward assessments were compared between the group of students who completed rural surgical terms and the remainder of the student group who participated in tertiary hospital-based electives. Subjective student feedback was obtained in a survey conducted by the Clinical Education Development Unit at the University of Adelaide. RESULTS: No significant (P =.45) differences in examination results were noted between the rural and city groups. A significant (P<.01) finding was observed in the subjective assessments, indicating that it was more difficult for the rural group to obtain an A grade compared with the city group. The rural students ranked the level of teaching and supervision highly and enjoyed the overall rural experience. CONCLUSION: Surgical undergraduate education is practical in a rural setting and, for educational outcome, seems to be at least as effective as city-based surgical clerkships in preparing students for final examinations.