A return-on-investment analysis of impacts on James Cook University medical students and rural workforce resulting from participation in extended rural placements

Introduction: Although all medical students at James Cook University (JCU), Queensland, Australia, undertake rural placements throughout their course, a proportion (currently about 20 per year out of 170-190 final-year students) undertake extended rural placements in rural and remote towns - 5-month Integrated Rural Placement (IRP) or 10-month Longitudinal Integrated Clerkship (LIC) programs. This study uses a return-on-investment (ROI) approach to quantify student and rural medical workforce benefits arising from these 'extended placements' between 2012 and 2018. Methods: Seventy-two JCU MBBS graduates participated in extended rural placements between 2012 and 2018. In 2019, 46 of these graduates who had reached at least postgraduate year 2 and provided consent to be contacted for health workforce research were emailed a link to an online survey. Questions explored the key benefits to students' development of competencies and to rural medical workforce as a direct result of student participation in the IRP/LIC activities, as well as estimations of costs to students, deadweight (how much change would have occurred without participating in an extended placement), and attribution (how much change was due to other programs or experiences). The key student and rural medical workforce benefits were each assigned a 'financial proxy' to allow calculation of ROI from 2013 to 2019 as a dollar value, compared with the costs to students and to the JCU medical school from implementing the IRP/LIC programs between 2012 and 2018. Results: Twenty-five of the 46 JCU medical graduates who undertook an extended placement responded (response rate 54%), reporting that the most common (96%) and most important benefit (56%) from their extended placement was 'greater depth and breadth of clinical skills'. Seventy-five percent (18/24; one missing response for this question) of the respondents also reported intending to have a full-time career in rural and remote practice. The overall cost of undertaking an IRP or LIC program for students between 2012 and 2018 was calculated to be $60,264, while the cost to the JCU medical school for sending 72 students out on extended rural placements was calculated as$32,560, giving total costs of $92,824. Given the total value of benefits ($705,827) calculated for the key student benefit of increased clinical skills and confidence in the internship year from participating in an extended placement ($32,197) and for the key rural medical workforce benefit of willingness to work in a rural or remote town ($673,630), the ROI from the extended rural programs between 2013 and 2019 (after students graduated and entered the workforce) is calculated at $7.60 for every dollar spent. Conclusion: This study confirms that undertaking an extended placement has significant positive impacts on final-year medical students' clinical confidence, clinical skills and communication skills into their internship year. In addition, the extended placements have longer-term impacts on the non-metropolitan health workforce by inspiring more JCU medical graduates to take up rural generalist, rural general practitioner or generalist specialist positions in rural and remote towns. This positive ROI from extended rural placements is important evidence for shifting the conversation around supporting these programs from one of cost to one of value

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

What do I say?

This article, by Dr Aaron Hollins, is the winn ing entry in the Australian Doctor/GPET GP Registrar Writer of the Year award. [Extract] "I didn't know what to say. She opened up to me, revealed herself, and I didn't know what to say." "I'll paint you the picture and you tell me, what would you say?

Supporting GP advanced rural skills training

Objective: The aim of this study was to: investigate doctors' experiences of support during GP advanced rural skills training, and identify strategies to improve support.\ud \ud Design: The qualitative responses from a cross-sectional, postal survey are reported.\ud \ud Setting: Rural vocational training sector.\ud \ud Participants: Sixty-one doctors who had completed GP advanced rural skills training (procedural or non-procedural) in Queensland between 1995 and June 2009 participated in the study.\ud \ud Main outcome measure: Advanced trained doctors' experiences of support and their strategy recommendations to improve support.\ud \ud Results: Experiences and strategies to improve support were developed into a framework of support, consisting of three theme areas. Strategies included: provision of training and career advice to allow immediate use of advanced skills; introduction of rural attachments and rural case studies during training to ensure rural orientation; development of GP mentor and peer networks for clinical and non-clinical support; advocacy to improve understanding and recognition of advanced rural skills training.\ud \ud Conclusions: Expanded support is required across the pre-enrolment, training, early practice continuum. A holistic approach to support is required. Training providers, professional bodies, health departments, universities and workforce agencies need to work together to address and resource the support needs of advanced, rural GP trainees before, during and after training

Factors impacting the solo remote placement experiences of undergraduate James Cook University medical students: a mixed‐methods pilot study

Objective To determine the factors impacting the experiences of James Cook University medical students on solo placements in remote towns. Design This 2018 pilot study used an exploratory sequential mixed‐methods approach to explore the recent solo remote placement experiences of James Cook University medical students. Qualitative interviews were performed initially to elicit context sensitive themes for the self administered survey. The survey went on to use Likert‐scale questions in addition to pre‐validated survey instruments. Setting Focus groups and interviews took place at James Cook University Medical School in Townsville in late 2018 after students returned from their rural rotation. Two telephone interviews were conducted for Year 6 students unable to attend the focus groups. Participants James Cook University medical students in years 2, 4 and 6 students who experienced a solo placement in a remote (MMM 6 or 7) town during 2017 or 2018 were invited to be part of the study. Only Townsville‐based students were involved. A total of 14 students participated in the focus groups (n = 14) and a further 31 students completed the survey (n = 31). Main outcome measure(s) Interviews identified themes negatively or positively impacting solo remote placement experience, while bivariate analysis identified factors associated with having an ‘excellent’ overall experience. Results Student interviews identified five main themes impacting student experience in remote communities: culture of the medical facility; quality and quantity of clinical experiences; quality of accommodation; placement length; and community infrastructure and services. Negative impacts could result in students experiencing social isolation. Students reporting an ‘excellent’ solo remote placement experience in the survey were more likely to have: felt very welcome in the community; felt the health staff supported them; heavily involved themselves in clinical activities; enjoyed the experiences remote communities can offer; positive rural career intentions; reported they ‘bounce back during and after life's most stressful events’; and come from a rural or remote hometown. Conclusions Solo remote placements provide medical students with opportunities to further knowledge, clinical capabilities, social experiences and careers, but can have negative aspects. However, negative aspects are often modifiable management issues or can potentially be avoided if prospective students are better informed of the challenges associated with remote communities

A comparative evaluation of quality and depth of learning by trainee doctors in regional, rural, and remote locations

Abstract Background An equitable supply and distribution of medical practitioners for all the population is an important issue, especially in Australia where 28% of the population live in rural and remote areas. Research identified that training in rural/remote locations is a predictor for the uptake of rural practice, but training must provide comparable learning and clinical experiences, irrespective of location. Evidence shows GPs in rural and remote areas are more likely to be engaged in complex care. However, the quality of GP registrar education has not been systematically evaluated. This timely study evaluates GP registrar learning and clinical training experiences in regional, rural, and remote locations in Australia using assessment items and independent evaluation. Methods The research team retrospectively analysed GP trainee formative clinical assessment reports compiled by experienced medical educators during real-time patient consultations. Written reports were assessed using Bloom’s taxonomy classified into low and high cognitive level thinking. Regional, rural, and remotely located trainees were compared using Pearson chi-squared test and Fisher’s exact test (for 2 × 2 comparisons) to calculate associations between categorical proportions of learning setting and ‘complexity’. Results 1650 reports (57% regional, 15% rural and 29% remote) were analysed, revealing a statistically significant association between learner setting and complexity of clinical reasoning. Remote trainees were required to use a high level of clinical reasoning in managing a higher proportion of their patient visits. Remotely trained GPs managed significantly more cases with high clinical complexity and saw a higher proportion of chronic and complex cases and fewer simple cases. Conclusions This retrospective study showed GP trainees in all locations experienced comparable learning experiences and depth of training. However, learning in rural and remote locations had equal or more opportunities for seeing higher complexity patients and the necessity to apply greater levels of clinical reasoning to manage each case. This evidence supports learning in rural and remote locations is of a similar standard of learning as for regional trainees and in several areas required a superior level of thinking. Training needs to seriously consider utilising rural and remote clinical placements as exceptional locations for developing and honing medical expertise

Temporomandibular Disorder Modifies Cortical Response to Tactile Stimulation

Individuals with temporomandibular disorder (TMD) suffer from persistent facial pain and exhibit abnormal sensitivity to tactile stimulation. To better understand the pathophysiological mechanisms underlying TMD, we investigated cortical correlates of this abnormal sensitivity to touch. Using functional magnetic resonance imaging (fMRI), we recorded cortical responses evoked by low frequency vibration of the index finger in subjects with TMD and in healthy controls (HC). Distinct subregions of contralateral SI, SII, and insular cortex responded maximally for each group. Although the stimulus was inaudible, primary auditory cortex was activated in TMDs. TMDs also showed greater activation bilaterally in anterior cingulate cortex and contralaterally in the amygdala. Differences between TMDs and HCs in responses evoked by innocuous vibrotactile stimulation within SI, SII, and the insula paralleled previously reported differences in responses evoked by noxious and innocuous stimulation, respectively, in healthy individuals. This unexpected result may reflect a disruption of the normal balance between central resources dedicated to processing innocuous and noxious input, manifesting itself as increased readiness of the pain matrix for activation by even innocuous input. Activation of the amygdala in our TMD group could reflect the establishment of aversive associations with tactile stimulation due to the persistence of pain. PERSPECTIVE: This article presents evidence that central processing of innocuous tactile stimulation is abnormal in TMD. Understanding the complexity of sensory disruption in chronic pain could lead to improved methods for assessing cerebral cortical function in these patients

Reports of the 2018 AAAI fall symposium

The AAAI 2018 Fall Symposium Series was held Thursday through Saturday, October 18–20, at the Westin Arlington Gateway in Arlington, Virginia, adjacent to Washington, D.C. The titles of the eight symposia were Adversary-Aware Learning Techniques and Trends in Cybersecurity; Artificial Intelligence for Synthetic Biology; Artificial Intelligence in Government and Public Sector; A Common Model of Cognition; Gathering for Artificial Intelligence and Natural System; Integrating Planning, Diagnosis, and Causal Reasoning; Interactive Learning in Artificial Intelligence for HumanRobot Interaction; and Reasoning and Learning in Real-World Systems for Long-Term Autonomy. The highlights of each symposium (except the Gathering for Artificial Intelligence and Natural System symposium, whose organizers failed to submit a summary) are presented in this report