Growing rural doctors as teachers: a rural community of medical education practice.

This reflective work considered the journey of rural doctors from diverse backgrounds as teachers and academics during the establishment and rapid expansion of an Australian rural clinical school. The observed social and academic processes are analysed in the context of social learning theory. The extent to which the theoretical social processes match observations during a period of transformational change indicates how social learning processes contributed to the outcome. Ten areas of thematic teacher concerns were identified during teachers' professional development and the strategies used to address these declared. Despite the concurrent evolution of both the overall organisation (teacher environment) and teachers' task (curriculum approach), a community of rural educational practice (CREP) formed and thrived. It adopted a culture of sharing experiences which enabled ongoing knowledge brokering, engaged experts and transformed members. Critical reflection resulting from engagement in mutual activity and a supporting culture of enablement driven by senior leadership was central to success. A generic framework for building a successful CREP includes, leadership that 'enables' its members to flourish, a rural academic identity with a 'Community of Practice' governance, internal benchmarking by members to measure and refine practice, critical reflection 'in' and 'on' academic practice, vertical and horizontal mentoring.

Tuning medical education for rural-ready practice: designing and resourcing optimally.

In an effort to bring doctors back to the bush the Australian government has resourced a number of rural clinical schools (RCS). At the RCS in the University of Western Australia students were allocated in small groups to rural sites for the entire fifth year of a six-year course, sitting the same final examinations as city students. Key factors guiding the successful outcome were the resourcing and implementation of the infrastructure and teaching and learning pedagogy. In designing support, the disconnection of students from their city colleagues was anticipated as an issue, as was the pedagogical indoctrination of the teachers. The curriculum implementation was adapted in this light. The role of the Web in teaching and learning, and their status as 'student colleagues' and independent learners were pivotal aspects. As students settled at their site, their confidence grew and their anxiety over urban disconnection dissipated. By benchmarking themselves using Web-based formative assessments and in formative 'objective structured clinical examinations' staged for them by the RCS, the students received ongoing feedback on their progress. This model of embedding students in rural centres for an extended period with rural practitioners as teachers was successfully implemented at multiple sites geographically vastly separate.