David Campbell

Cost of best-practice primary care management of chronic disease in a remote Aboriginal community

Objective: To estimate the cost of completing all chronic care tasks recommended by the Central Australian Rural Practitioners Association Standard Treatment Manual (CARPA STM) for patients with type 2 diabetes and chronic kidney disease (CKD).

Vocational training of general practitioners in rural locations is critical for the Australian rural medical workforce

Objective: To investigate associations between general practitioner vocational training location and subsequent practice location, including the effect of rural origin.

Procedural skills practice and training needs of doctors, nurses, midwives and paramedics in rural Victoria

Introduction Procedural skills are a significant component of clinical practice. Doctors, nurses, midwives and paramedics are trained to use a variety of procedural skills. Rural clinicians in particular are often required to maintain competence in some procedural skills that are used infrequently, and which may require regular and repeated rehearsal. This paper reports on a research project conducted in Gippsland, Victoria, to ascertain the frequency of use, and relevance to clinical practice, of a range of skills in the fields of medicine, nursing, midwifery, and paramedic practice. The project also gathered data on the attitudes of clinicians regarding how frequently and by what means they thought they needed to practice these skills with a particular focus on the use of simulation as an educational method. Methods The research was conducted following identification of a specific set of procedural skills for each professional group. Skills were identified by an expert steering committee. We developed online questionnaires that consisted of two parts: 1) demographic and professional characteristics, and 2) experience of procedural skills and perceived training needs. We sought to invite all practicing clinicians (doctors, nurses, midwives, paramedics) working in Gippsland. Online surveys were distributed between November 2011 and April 2012 with three follow-up attempts. The Monash University Human Research Ethics Committee approved the study. Results Valid responses were received from 58 doctors, 94 nurses, 46 midwives, and 30 paramedics, whom we estimate to represent not more than 20% of current clinicians within these professions. This response rate reflected some of the difficulties experienced in the conduct of the research. Results were tabulated for each professional group across the range of skills. There was significant correlation between the frequency of certain skills and confidence with maintenance of these skills. This did not necessarily correlate with perceptions of respondents as to how often they need to practice each skill to maintain mastery. The more complex the skill, the more likely the respondents were to report a need for frequent rehearsal of the skill. There was variation between the professional groups as to how to retain mastery; for some skills, professional groups reported skill maintenance through clinical observation and clinical practice; for other skills, simulation was seen to be more appropriate. Conclusion This project provided insight into the clinical application of procedural skills for clinicians comprising a relatively large professional population within a defined geographical region in rural Victoria, as well as attitudes to skills maintenance and competency. Although not the focus of the study, an unexpected outcome was the design of questionnaires on procedural skills. We believe that the questionnaires may have value in other rural settings. We acknowledge the limitations of the study in the text. The project provides some information on which to base planning for procedural skills education, including simulation-based training, and directions for further research.

What is the impact of longitudinal rural medical student clerkships on clinical supervisors and hospitals

OBJECTIVEnStudies have investigated the impact of medical students undertaking longitudinal clerkships in General Practices; however, little is known about the impact of students longitudinal clerkships on clinical supervisors in the hospital environment. This research aimed to explore the educational impacts and benefits gained from supervisory responsibilities in a rural hospital context.nnnDESIGNnWe assessed the impact of longitudinal clerkships using individual and group-structured interviews. The responses were thematically analysed by the researchers.nnnSETTINGnTwo rural hospitals in Victoria, Australia.nnnPARTICIPANTSnFifteen senior medical and nursing staff at two rural hospitals who supervised year four medical students in a longitudinal clinical program.nnnRESULTSnThematic analysis identified three major themes: changes to the supervisor, change in the hospital learning culture and student usefulness. Doctors and nurses who undertook student supervisory responsibilities reported a sense of personal change, including increased reflective practice, improved value of professional identity and increased enthusiasm for interprofessional learning. Supervisors updated their clinical skills and became proactive in seeking out learning opportunities for students. Hospitals became more vibrant learning environments and interprofessional education enhanced teamwork. Patient care increased, knowledge gaps filled and hospital governance, policy and procedures challenged.nnnCONCLUSIONnThe benefits of longitudinal clerkship in the rural hospital setting provided symbiotic relationships between hospitals, students, patients and educations provider. The interprofessional approach towards clinical supervision enhanced supervisor learning and generated an understanding among professional groups of each others clinical skills, roles and values, and raised an awareness of the importance of working collaboratively for better patient outcomes and addressing future workforce shortages.