Academic journal article International Journal of Child Health and Human Development

Creating "The Rural Pathway": Australia's University Departments of Rural Health and Rural Clinical Schools

Academic journal article International Journal of Child Health and Human Development

Creating "The Rural Pathway": Australia's University Departments of Rural Health and Rural Clinical Schools

Article excerpt

Introduction

The recent Report on the Audit of Health Workforce in Rural and Regional Australia suggested long standing major shortages of medical and health professionals in rural and Regional Australia, with the exception of nurses (1). University Departments of Rural Health (UDRHs) and Rural Clinical Schools (RCSs) are federal government-funded programs that are designed to make a difference to the number of willing (motivated) and able (well-trained and prepared) health and allied health practitioners in rural and remote communities. As such, they are key Australian initiatives in rural and remote health workforce policy and practice.

There are 11 UDRHs and 14 RCSs across rural Australia which have been operating for about a decade. They have been central to the Australian government's efforts to develop medical education and research in ways that accommodate the needs of rural and remote communities. In keeping with the broad aim of this collection of papers-to focus on working models of rural medical education-this paper aims to offer practical description of UDRHs and RCSs in a way that is helpful for lesson-drawing by rural medical educators and rural workforce policy-makers in this and other countries. It does so by first seeking to unpack the evidence base for what makes a willing and able medical practitioner. Second, it considers how well UDRHs and RCSs may have succeeded creating the conditions for willing and able practitioners. The paper is underpinned by the assumption that part of the challenge of developing rural medical education is about examining our assumptions about the nature of the health workforce challenge involved.

Methods

This paper draws on a small number, but wide variety of applied and scholarly sources:

· a search of PUBMED database using the terms ?University Department of Rural Health' and ?Rural Clinical School' in abstracts, title or keywords, from 2005 to 2010, limited to articles and reviews, which revealed (respectively) 11 and 19 possibly relevant publications

· a search of PUBMED using variations of the terms ?rural health education' and ?rural medical education' which revealed 73 possibly relevant papers

· an examination of sources listed in the reference lists of key applied publications, such as the recent 2008 national evaluation of UDRHs and RCSs (2) and the previously mentioned Australian government audit of rural and remote workforce (1)

· website searches of relevant applied material such as performance reports from the UDRHS and RCS available on the Department of Health and Ageing website at

· http://www.health.gov.au/internet/main/publi shing.nsf/Content/work-st-udrh

The material referenced here has been selected for its value for understanding first, the nature of the rural medical workforce challenge UDRHs and RCSs were designed to meet and second, how well they have met that challenge. It is acknowledged that much of the work of the UDRHs cannot be included in such an analysis. That is, while UDRHs in particular focus on a wide range of rural health initiatives, these have received less emphasis in this paper so that the role of UDRHs in relation to medical education can be highlighted.

A major difficulty in developing this paper has been the limits to the evidence base. While some recent evaluation data are available, outcomes of more complex efforts of the UDRHs and RCSs (for example, in relation to reinforcing students' intentions to practice rurally) are difficult to measure and presently there is little data to support how well they have been met. There is also very little evidence that can help evaluate how well the two programs- UDRHs and RCss-work together to achieve their shared workforce development aims.

Results

What makes willing and able medical practitioners?

What does this evidence say about how to create willing and able rural medical practitioners? Beliefs and research evidence that rural origin, in particular, as well as exposure to rural theory and practice in programs of study, is critical to graduate choices, have shaped rural medical (3) and nursing education practice (4,5), as well as allied health to a lesser extent (6, 7). …

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