Telemedicine in remote Australia: The Royal Flying Doctor Service (RFDS) Medical Chest Program as a marker of remote health.

INTRODUCTION: Remote communities across Australia lack the ready access to medical care generally afforded to metropolitan populations. The Royal Flying Doctor Service (RFDS) medical chest program provides medical resources to these communities allowing medications to be dispensed in conjunction with a telehealth consulting service. More than 3000 medical chests are located throughout Australia and each year the Queensland RFDS conducts approximately 20 000 telehealth consultations. The aim of this study was to review the use of the medical chest model within the state of Queensland and to analyse changes in the medical chest program from 10 years earlier to evaluate the changing healthcare needs of remote Australian populations. METHODS: All telehealth consultations and items dispensed from the medical chests were reviewed over a 1-year period from 1 July 2013 and 30 June 2014. Items dispensed were categorised and compared to those in 2005-06 in absolute terms by one-way ANOVA and proportionately by χ2 with Fisher's exact test. Consultations using the medical chest were categorised and compared to those in 2005-06 by χ2 with Fisher's exact test. RESULTS: The number of telehealth consultations conducted in 2013-14 (N=20 707) was not different to the number conducted in 2005-06 (N=21 470). Fewer items were dispensed from the medical chests in 2013-14 (3936 total items) than in 2005-06 (8607 total items; p<0.0001). In the specific categories of 'burns and other dressings' and 'antihistamines', the number of individual items dispensed increased. Resources from the medical chest were used more for genitourinary system consultations and less for consultations involving specific infectious diseases; the circulation, respiratory and abdominal systems; skin diseases; injury; symptoms without a diagnosis; and following other contact with a health service. CONCLUSIONS: The medical chests remain a vital tool for medical care of remote populations and the need for telehealth medical advice remains unchanged, although fewer items are being dispensed. The use of the medical chest for each diagnostic category of consultation has shown some variation over the past 10 years, reflective of changing patterns of accident, injury and disease.

Investigating the impact of a research-based integrated curriculum on self-perceived research experiences of medical students in community placements: a pre- and post-test analysis of three student cohorts.

BACKGROUND: To build research capacity among graduating medical students, the teaching of research and critical analysis was integrated into the University of Wollongong (UoW) new, graduate-entry medical curriculum. This study examined whether the self-perceived research experiences of medical students, and consequent research capability, were influenced by exposure to this innovative research and critical analysis curriculum, which incorporated a 12-month community-based research project, and associated assessment tasks. METHODS: The first three medical students cohorts (N = 221) completed a self-assessment of their research experiences in ten areas of research activity. Their responses were collected: before and after they undertook an individual community-based research project within a 12-month regional/rural clinical placement. The research areas investigated by the self-assessment tool were: (i) defining a research question/idea; (ii) writing a research protocol; (iii) finding relevant literature; (iv) critically reviewing the literature; (v) using quantitative research methods; (vi) using qualitative research methods; (vii) analysing and interpreting results; (viii) writing and presenting a research report; (ix) publishing results; and (x) applying for research funding. RESULTS: Participation rates of 94% (207/221) pre-placement and 99% (219/221) post-placement were achieved from the three student cohorts. Following the successful completion of the research projects and their assessment tasks, the median responses were significantly higher (p < 0.05) in nine of the ten research areas. The only area of research for which there was no increase recorded for any one of the three cohorts, or overall, was (x) applying for research funding. This activity was not a component of the UoW research and critical analysis curriculum and the item was included as a test of internal validity. Significant gains were also seen between cohorts in some key research areas. CONCLUSIONS: Improved research capability among medical students was evidenced by increased scores in various areas of research experience in the context of successful completion of relevant assessment tasks. The results suggest that research capability of medical students can be positively influenced by the provision of a research-based integrated medical curriculum and further consolidated by authentic learning experiences, gained through conducting 'hands-on' research projects, under the supervision and mentoring of research-qualified academics.