Snapshot of Australian primary health care research

Snapshot of Australian primary health care research is a collaborative venture involving representatives from PHCRIS, the Australian Government Department of Health and Ageing, Australian Primary Health Care Research Institute, National Health and Medical Research Council, Australian Association for Academic General Practice, Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine

Developing the accredited postgraduate assessment program for Fellowship of the Australian College of Rural and Remote Medicine

Introduction: Accreditation of the Australian College of Rural and Remote Medicine (ACRRM) as a standards and training provider, by the Australian Medical Council (AMC) in 2007, is the first time in the world that a peak professional organisation for rural and remote medical education has been formally recognised. As a consequence, the Australian Government provided rural and remote medicine with formal recognition under Medicare as a generalist discipline. This accreditation was based on the ability of ACRRM to meet the AMC's guidelines for its training and assessment program.\ud \ud Methods: The methodology was a six-step process that included: developing an assessment blueprint and a classification scheme; identifying an assessment model; choosing innovative summative and formative assessment methods that met the needs of rural and remote located medical practitioner candidates; 21 rural doctors and academics developing the assessment items as part of a week-long writing workshop; investigating the feasibility of purchasing assessment items; and 48 rural candidates piloting three of the assessment items to ensure they would meet the guidelines for national accreditation.\ud \ud Results: The project resulted in an innovative formative and summative assessment program that occurs throughout 4 years of vocational training, using innovative, reliable, valid and acceptable methods with educational impact. The piloting process occurred for 3 of the 6 assessment tools. Structured Assessment Using Multiple Patient Scenarios (StAMPS) is a new assessment method developed as part of this project. The StAMPS pilot found that it was reliable, with a generalisability coefficient of >0.76 and was a valid, acceptable and feasible assessment tool with desired educational impact. The multiple choice question (MCQ) examination pilot found that the applied clinical nature of the questions and their wide range of scenarios proved a very acceptable examination to the profession. The web based in-training assessment examination pilot revealed that it would serve well as a formative process until ACRRM can further develop their MCQ database.\ud \ud Conclusions: The ACRRM assessment program breaks new ground for assessing rural and remote doctors in Australia, and provides new evidence regarding how a comprehensive and contemporary assessment system can work within a postgraduate medical setting

What influences trainee decisions to practise in rural and regional Australia?

Although international medical graduates (IMGs) make up a substantial part of the Australian rural general practice workforce, most research on factors associated with rural practice has focused on Australian medical graduates (AMGs). This study aimed to determine whether there were differences between IMGs and AMGs in terms of these factors. Registrars in training and recent fellows (Fellowship of the Royal Australian College of General Practitioners/ Fellowship of the Australian College of Rural and Remote Medicine) who participated in training in rural and regional Australia were surveyed about practice models and rural practice. Almost two-thirds of participants were practicing or intending to practice in rural areas, with no difference between AMGs and IMGs. None of the variables associated with rural practice for AMGs was found to be associated with rural practice in IMGs in univariate binary regression analysis. Two key variables that are strongly associated with rural medical practice in the current literature, namely rural background and rural exposure, were not significant predictors of rural practice among IMGs. Due to the significant number of IMGs in regional training programs, any future incentives designed to improve rural recruitment and retention need to address factors relevant to IMGs

Training, status and migration of general practitioners / family physicians within Europe

The survey intended to explore and identify the training background and status of general practitioners/ family physicians (GPs) in member countries within EURACT (European Academy of Teachers in General Practice/Family Medicine), and to gain an overview of processes involved when GP-trained doctors migrate to work in another member country. A questionnaire, with closed and open-ended questions, was sent to representatives of all 39 EURACT-member countries in 2009. The main outcome measures were the training background and status of GPs in public/private settings in each country and the requirements of additional training and testing when migrating to another country. Forty-one completed questionnaires were received from 31 (79%) of the EURACT countries. The data indicate that specialist training for General Practice/ Family Medicine (GP/FM) is well established throughout and generally required for appointment to public career posts. The data also indicate that European Uniontrained GPs can move freely to most countries with usually no tests of medical knowledge or language proficiency. Orientation to the healthcare system in the destination country is usually not provided. work in public/private GP/FM posts in many European countries, although new appointments to public posts RESEARCH ARTICLE Training, status and migration of General Practitioners/Family Physicians within Europe in nearly all countries require specialist GP training. It was not possible to identify a uniform or agreed approach applied by employing agencies to confirm the medical competence and language skills of migrant doctors and to provide them with orientation to healthcare systems. In the high-context dependent discipline of GP/FM this is of concern.peer-reviewe

Development of the Rural Generalist Program Japan: meeting the needs of Japanese rural communities

Context: There is a worldwide shortage of physicians, which is worse in rural areas, with a large underserved rural and remote population. Most jurisdictions in countries of all income levels report shortages of rural doctors, often exacerbated where primary care is not strong. Japan is not an exception: Japanese specialist-driven approaches in medical education and public health have resulted in disproportionate distribution of medical services in the country. Issue: Rural generalism, or rural generalist medicine, is emerging in many jurisdictions as one approach to training and provision of care for rural communities. While there is considerable variation in titles, the format of the training and models of care, the emphasis is on training a generalist doctor capable of meeting community needs. This usually includes development of appropriate skills in primary care, inpatient care, emergency medicine, public health and one or more extended skills. These models are well established in Australia, particularly in Queensland, which has offered a rural generalist program for over a decade. The Rural Generalist Program Japan (RGPJ) has been developed to meet the needs of Japanese rural communities. Lessons learned: This article outlines development of the RGPJ using the World Federation for Medical Education standards. While early evaluations are positive, there is much more to do to develop a mature program capable of meeting the needs of Japan's rural and remote communities

General practice registrars’ intentions for future practice: Implications for rural medical workforce planning

The models of practice that general practice registrars (GPRs) envisage undertaking will affect workforce supply. The aim of this research was to determine practice intentions of current GPRs in a regional general practice training program (Coast City Country General Practice Training). Questionnaires were circulated to 220 GPRs undertaking general practice placements to determine characteristics of ideal practice models and intentions for future practice. Responses were received for 99 participants (45%). Current GPRs intend to work an average of less than eight half-day sessions/week, with male participants intending to work more hours (t(91) = 3.528, P = 0.001). More than one-third of this regional cohort intends to practice in metropolitan centres. Proximity to family and friends was the most important factor influencing the choice of practice location. Men ranked remuneration for work as more important (t (88) = –4.280, P \u3c 0.001) and women ranked the ability to work part-time higher (t(94) = 3.697, P \u3c 0.001). Fee-for-service payment alone, or in combination with capitation, was the preferred payment system. Only 22% of Australian medical graduates intend to own their own practice compared with 52% of international medical graduates (χ2(1) = 8.498, P = 0.004). Future general practitioners (GPs) intend to work fewer hours than current GPs. Assumptions about lifestyle factors, practice models and possible professional roles should be carefully evaluated when developing strategies to recruit GPs and GPRs into rural practice

e-Mental health for mood and anxiety disorders in general practice

Familiarises general practitioners (GPs) with the range of online programs in Australia that have demonstrated efficacy and are currently available for use by patients with mental health problems. Background Australia is a world leader in the development of internetdelivered programs for the prevention and management of mood and anxiety disorders. Despite a strong evidence base of time- and cost-effectiveness, as well as clinical efficacy, the uptake of these programs in general practice remains low. Objective To familiarise general practitioners (GPs) with the range of online programs in Australia that have demonstrated efficacy and are currently available for use by patients with mental health problems. Discussion E-mental health programs provide an efficacious and accessible form of mental healthcare and have the potential to fill the gap for those for whom such care is inaccessible, unaffordable or unacceptable. Clinicians can also use it in a stepped-care manner to augment existing healthcare services. There are a number of online resources currently available to Australians who have mood or anxiety disorders. These resources have strong evidence to support their effectiveness. Online portals facilitate access to these programs. Recently the Australian Federal Government has funded an education program (eMHPrac) for GPs and mental health professionals, to outline what is available, indicate situations where recommending such resources is appropriate, and suggest ways in which they can be incorporated into general practice

International approaches to rural generalist medicine: a scoping review

Background: Contemporary approaches to rural generalist medicine training and models of care are developing internationally as part of an integrated response to common challenges faced by rural and remote health services and policymakers (addressing health inequities, workforce shortages, service sustainability concerns). The aim of this study was to review the literature relevant to rural generalist medicine. Methods: A scoping review was undertaken to answer the broad question 'What is documented on rural generalist medicine?' Literature from January 1988 to April 2017 was searched and, after final eligibility filtering (according to established inclusion and exclusion criteria), 102 articles in English language were included for final analysis. Results: Included papers were analysed and categorised by geographic region, study design and subject themes. The majority of articles (80%) came from Australia/New Zealand and North America, reflecting the relative maturity of programmes supporting rural generalist medicine in those countries. The most common publication type was descriptive opinion pieces (37%), highlighting both a need and an opportunity to undertake and publish more systematic research in this area. Important themes emerging from the review were: - Definition - Existing pathways and programmes - Scope of practice and service models - Enablers and barriers to recruitment and retention - Reform recommendations There were some variations to, or criticisms of, the definition of rural generalist medicine as applied to this review, although this was only true of a small number of included articles. Across remaining themes, there were many similarities and consistent approaches to rural generalist medicine between countries, with some variations reflecting environmental context and programme maturity. This review identified recent literature from countries with emerging interest in rural generalist medicine in response to problematic rural health service delivery. Conclusions: Supported, coordinated rural generalist medicine programmes are being established or developed in a number of countries as part of an integrated response to rural health and workforce concerns. Findings of this review highlight an opportunity to better share the development and evaluation of best practice models in rural generalist medicine

The Queensland Health Rural Generalist Pathway: providing a medical workforce for the bush

Introduction: Queensland Health's Rural Generalist Pathway is a supported career pathway for junior doctors to train in rural and remote medicine. The pathway joins evidence with policy to achieve professional recognition, credentialing, and industrial recognition. Methods: This article describes the principles underpinning the notion of rural generalism, the background to the establishment of the Rural Generalist Pathway in Queensland, Australia, how the pathway has been developed to meet the needs of Queensland's rural and remote communities, the implementation of the pathway, and the implications for other jurisdictions. Results: In 2007, 30 trainees commenced on the pathway, with total enrolment now of 182 in 2012. Trainees commence at the start of internship, completing their prevocational training component in postgraduate years 1 to 2. After prevocational certification they undertake advanced specialised training in a range of specialties, and then complete vocational training in a rural location, usually in their 4th to 5th postgraduate years. Trainees complete their general practice training through a Regional Training Provider, and achieve vocational registration by completion of appropriate fellowship assessment requirements. The pathway is managed by a geographically dispersed team of educators, clinicians and managers. The Rural Generalist team provide training and career advice, advocate for trainees and assist with negotiating posts. They map progress of trainees through the Vocational Indicative Planning process and arrange other educational activities including Rural Generalist workshops. Applications are often oversubscribed, with the intake growing to 41 in 2012, located at 10 intern training hospitals. In total 90 trainees have completed advanced specialised training as at the end of 2012. Conclusion: The Rural Generalist Pathway includes a challenging prevocational start to the career, the opportunity to specialise in a procedural skill or skills of interest and obtain general practice vocational training in a rural setting and appears to be proving an attractive choice for medical graduates seeking a challenging and varied career. Early evidence suggests that by recognizing and rewarding the worth of rural and remote practice, this strategy is creating its own supply line. From its initial roll-out in Queensland, rural generalist training continues to generate increased interest and enthusiasm across all Australian states and territories wishing to join this new wave of generalist practice. This new generation of health professionals for a new generation of services has the potential to provide the rural medical workforce the bush needs