A compulsory experiential and inter-professional rural health subject for undergraduate students.

CONTEXT: The Australian University Departments of Rural Health (UDRH) program aims to improve the rural workforce through improving rural experiences of undergraduates, graduates and health professionals. The 10 UDRHs vary in the way they implement the UDRH Program. This article describes the development of a compulsory, experiential and inter-professional rural health subject in a medical curriculum by the UDRH at the University of Melbourne, Victoria, Australia. The key concepts, underpinning theory, processes, logistics and resources required to develop and implement the subject among a network of small towns and Indigenous communities are examined. METHODS: METHODS used included formative evaluation using a participatory research approach, including the examination of internal discussion papers, minutes of meetings and planning workshops, financial records and feedback from students, staff and preceptors. ISSUES: Students, staff and preceptors generally accept the value of the rural health module in professional training. However, they stress the need for explicit learning objectives, relevant content and engaging delivery. Students expressed some concern about the compulsory nature of the subject. Significant issues are capacity, quality, sustainability and managing expectations of government and communities. Capacity includes the availability of appropriate placements and preceptors who have the capacity and capability to teach or to be supported to teach. The availability of appropriate and affordable accommodation is important, as are the cost and safety of travel to and from placements. Sustainability of 'placements' and 'placement fatigue' must be managed with a combination of resources and preceptor training and support. Quality of placements is important and highlights a paradox in that, while academically rigorous teaching, research and clinical programs for students and preceptors are important for quality, they are mostly perceived as additional burdens by health service providers. Finally, the expectations and commitment of stakeholders, in particular governments and communities, for student placements must be realistic and backed with resources. LESSONS LEARNED: A compulsory experiential inter-professional subject for undergraduate students is possible but requires significant resources and commitment over the long term. The resources must include funding for: preceptor time, training and support; recruitment and retention of appropriately qualified academic clinicians; intersectoral strategies like improved public transport and safe roads; community and other stakeholder engagement to develop and maintain educational facilities. Last but not least, funding is essential to support the long-term evaluation and monitoring of the outcomes in terms of the quality and quantity of the rural workforce over time.

Developing a conceptual understanding of rural health practice.

OBJECTIVE: This study presents a set of concepts underpinning rural practice that could assist teaching health and medical students. OUTCOME: Five concepts, important in distinguishing rural health practice, are presented and discussed. These are rural-urban health differentials, access, confidentiality, cultural safety and team practice. Together these concepts impact the ways in which rural health professionals provide care, due to fewer services, greater distances, smaller populations, less choice of services and smaller workforce. CONCLUSION: These concepts introduce students to some of the positive and negative aspects of rural practice, as well as opportunities for rural practitioners to have a diverse practice, to become involved in all aspects of health and to initiate change. They provide an understanding of rurality from which health students can learn from their practical experiences during rural placements.

Removing the roadblocks to medical and health student training in rural hospitals in Victoria.

OBJECTIVE: To assess the extent of undergraduate health student placements in regional hospitals in northern Victoria in 1999, prior to substantial changes in rural undergraduate medical education in Australia. METHOD: Cross sectional postal survey with telephone follow-up in north-east Victoria. Subjects were all 17 regional and rural hospitals involved in health student teaching in North-east Victoria. Main outcome measures were the numbers, duration and discipline of health students placements and reported barriers to such placements. RESULTS: Large regional hospitals accounted for two-thirds of all undergraduate health student placements. Smaller sites placed few allied health students. Barriers to a larger, more sustainable system of rural placements and rotations included accommodation shortages and funding constraints, particularly in smaller rural hospitals. CONCLUSIONS: Adequate resourcing of placements of a meaningful duration, stronger institutional support, and improved resourcing of regional accommodation is required to facilitate a larger, more systematic and sustainable system of medical and health student placements in rural areas.