Geoffrey Clive Solarsh

New approaches to spatially analyse primary health care usage patterns in rural South Africa

OBJECTIVE To develop indices to quantitatively assess and understand the spatial usage patterns of health facilities in the Hlabisa district of South Africa.

Populations at Special Health Risk: Rural Populations

Substantial rural–urban health differentials characterize both developing and developed countries. In general, rural populations are characterized by poorer health status and limited availability of, or access to, appropriate health-care services compared with urban dwellers. These rural–urban disparities reflect both the impact of specific environmental and geographical factors on health needs and access to health care, and, more importantly, broader structural and social and economic determinants of health. Rural health disadvantage is in the end the expression of a complex array of underlying risk factors requiring quite complex social interventions rather than solely health-related programs.

Identifying the aspects of rural exposure that influence medical students to take up rural practice

Editor – Identifying the factors that influence students to take up rural practice is crucial to ensuring the success and continuing funding of strategies designed to address rural medical workforce shortages. In Australia, strategies to encourage the uptake of rural practice include increasing the intake of students from rural backgrounds, providing students with greater exposure to rural medicine through rural placements, and an increased rural focus in medical curricula. Although evidence testifies to the success of programmes that selectively admit students from rural backgrounds and those who intend to practise as family practitioners (both independent predictors of practice location), the specific contribution of rural exposure to increasing uptake of rural practice is less clear, largely as a result of the lack of empirical evidence controlling for such confounding variables.

Governance and assessment in a widely distributed medical education program in Australia

The learning objectives, curriculum content, and assessment standards for distributed medical education programs must be aligned across the health care systems and community contexts in which their students train. In this article, the authors describe their experiences at Monash University implementing a distributed medical education program at metropolitan, regional, and rural Australian sites and an offshore Malaysian site, using four different implementation models. Standardizing learning objectives, curriculum content, and assessment standards across all sites while allowing for site-specific implementation models created challenges for educational alignment. At the same time, this diversity created opportunities to customize the curriculum to fit a variety of settings and for innovations that have enriched the educational system as a whole. Developing these distributed medical education programs required a detailed review of Monash’s learning objectives and curriculum content and their relevance to the four different sites. It also required a review of assessment methods to ensure an identical and equitable system of assessment for students at all sites. It additionally demanded changes to the systems of governance and the management of the educational program away from a centrally constructed and mandated curriculum to more collaborative approaches to curriculum design and implementation involving discipline leaders at multiple sites. Distributed medical education programs, like that at Monash, in which cohorts of students undertake the same curriculum in different contexts, provide potentially powerful research platforms to compare different pedagogical approaches to medical education and the impact of context on learning outcomes.