Academic journal article Australian Health Review

Using Evaluation to Improve Medical Student Rural Experience

Academic journal article Australian Health Review

Using Evaluation to Improve Medical Student Rural Experience

Article excerpt


The limited number of rural medical practitioners in Australia and the effects of this are well documented.1,2 To encourage medical students to consider a career in rural medicine, the Department of Health and Ageing3 funded the Rural Undergraduate Support and Co-ordination (RUSC) program whereby all domesticmedicalstudentsmust complete a minimum ofa4-week structured rural placement.3 The rationale was that exposure in the clinical years can be influential in choosing a rural medicine career.4-6 The University of Queensland incorporated an 8-week Rural Medicine Rotation (RMR) into the Year 3, Bachelor Medicine Bachelor Surgery program. Evaluating the RMR was deemed important because the quality of medical education is a known prerequisite for high-quality medicine7 and having a positive rural experience has the capacity to encourage medical students to adopt a career in rural practice.8,9 This paper addresses the question, did the outcome measures for interventions over a 2-year period of an ongoing evaluation program demonstrate a more effective rotation and placement?

The RMR provides a rural-focused curriculum and exposure to working and living in a rural environment. Week 1 includes lectures and procedural workshops so students are 'work ready'. Preparation isimportant8,10,11becauseit isthefirst clinicalyear.A 6-week placement is then undertaken within Rural, Remote and Metropolitan Areas 4-7.12 Week 8 involves a debriefing session and exam. Approximately 80 students are in each of the five rotations per year. Preceptors are supported through two teleconferences per year and a site visit.

Published best practice models for the rural clinical learning environment are comparatively sparse.13 Evaluation of the RMR embedded in the rotation for a decade resembles the recently published Clinical Learning Environments Evaluation (CLEEF) model, which is recommended for all Australian health students undertaking clinical placements in rural or remote primary care settings.14 Evaluation involved using the Plan-Do-Check-Act approach,15 with interventions planned and actioned, then compared with the results using outcome measures.16 Information was derived from student questionnaires, preceptor interviews, two face-to-face discipline-level meetings and five teleconferences per year (Fig. 1). Student involvement addressed the common student perception that nothing changes as a result of their feedback.15 A team approach enabled varied perspectives and a shared responsibility.17

Having students living and training rurally required a broad range of outcome measures14,18 to ensure a safe, high-quality learning and rural experience as opposed to measuring just teaching effectiveness,19 or the traditional hospital clinical placement on which the Best Practice Clinical Learning Environments was based.13 These outcome measures were based on RUSC requirements:3 (1) teaching effectiveness; (2) ensuring a safe clinical placement environment; (3) provision of an environment supportive of learning; (4) opportunities for professional growth; (5) opportunities for procedural skills experience and development; and (6) provision of clinical supervision.

Teaching effectiveness was used despite criticism20 because it has numerous strengths and has been found consistently to be an effective measure.21 The interventions were: (1) professional development workshops for the academic teachers focused on dealing with difficult learners; (2) how to engage audiences and Gen Y learners; (3) student feedback on lecturer performance; (4) professional development for preceptors to provide an understanding of the concepts of clinical supervision and how to provide feedback; and (5) increased preceptor site visits (Table 1).

Ensuring a safe clinical placement environment involved having the students well prepared and work ready before the placement. Often physical safety can be problematical in remote locations;22 students can be exposed to accidents, infectious diseases, personal violence and even political threats. …

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