Educational needs of Australian rural and remote doctors for intermediate obstetric ultrasound and emergency medicine ultrasound

Introduction: The aim of this research was to determine the educational needs of Australian rural and remote doctors for intermediate obstetric ultrasound and emergency medicine ultrasound. The main research questions were: what educational topics would rural and remote doctors prefer to learn about in intermediate obstetric ultrasound and emergency medicine ultrasound, and what were those doctors' preferred methods of delivery for an ultrasound education program. Method: A self-administered postal questionnaire containing a pre-paid return envelope was mailed to 344 Australian rural and remote doctors in December 2003. Results: 107 completed questionnaires were returned, giving a response rate of 32.7%. This was after the denominator was adjusted for the 17 doctors whose letters were returned to sender. The respondents included 23 (21.5%) female and 84 (78.5%) male doctors. Eighty doctors (74.8%) stated that they used ultrasound, and 27 (25.2%) said they did not. Seventy-seven (72%) indicated they had previously participated in some ultrasound education and training. The respondents stated that their main areas of educational need in intermediate obstetric ultrasound were ectopic pregnancy (76.6%), miscarriage (72%), intrauterine growth restriction (65.4%), transvaginal scanning (47.7%), detecting fetal abnormalities (47.7%) and morphology scanning at 18-20 weeks (41.1%). The main areas of educational need in emergency medicine ultrasound were focused abdominal sonography in trauma (63.5%), detecting foreign bodies (40.2%), gynecological ultrasound (39.2%), gall bladder and biliary tract (37.4%), abdominal aortic aneurysm (32.7%) and trauma bleeding (31.7%). Conclusion: Australian rural and remote doctors are using ultrasound technology to improve the clinical investigation and diagnosis of a large variety of clinical conditions in their family medical practices. This paper describes the results of research into the educational needs of this target group of doctors

Prevocational integrated extended rural clinical experience (PIERCE): cutting through the barriers to prevocational rural medical education

Introduction: Despite an increase in the number of undergraduate training positions, Australia faces a critical shortage of medical practitioners in regional, rural and remote communities. Extended rural clinical placements have shown great utility in undergraduate medical curricula, increasing training capacity and providing comparable educational outcomes while promoting rural medicine as a career. The Prevocational Integrated Extended Rural Clinical Experience (PIERCE) was developed to increase the training capacity of the Queensland Rural Generalist Pathway (QRGP) and strengthen trainee commitment to rural practice by offering an authentic, extended 15-week rural term that provided an integrated experience in anaesthetics, obstetrics and gynaecology, and paediatrics, while meeting the requirements for satisfactory completion of prevocational rural generalist training. This study sought to evaluate whether trainees believed PIERCE and/or traditional regional hospital specialty placements achieved their learning objectives and to identify elements of the placements that contributed to, or were a barrier to, their realisation. Methods: This translational qualitative study explored the experiences and perceptions of QRGP trainees who undertook a PIERCE placement in three Queensland rural hospitals (Mareeba, Proserpine and Stanthorpe) in 2015, with a matched cohort of trainees who undertook regional hospital placements in anaesthetics, obstetrics and gynaecology, and paediatrics at a regional referral hospital (Cairns, Mackay and Toowoomba base hospitals). The study used a realist evaluation framework that investigates What works, for whom, in what circumstances, in what respects and why? Results: PIERCE provided an enjoyable and valued rural training experience that promoted trainee engagement with, and contribution to, a rural community of practice, reinforcing their commitment to a career in rural medicine. However, QRGP trainees did not accept that PIERCE could be a substitute for regional hospital experience in anaesthetics, obstetrics and gynaecology, and paediatrics. Rather, trainees thought PIERCE and regional hospital placements offered complementary experiences. PIERCE offered integrated, hands-on rural clinical experience in which trainees had more autonomy and responsibility. Regional hospital placements offered more traditional caseload learning experiences based on observation and the handing down of knowledge and skills by hospital-based supervisors. Conclusion: Both PIERCE and regional hospital placements provided opportunities and threats to the attainment of the curriculum objectives of the Australian Curriculum Framework for Junior Doctors, the Australian College of Rural and Remote Medicine and the Royal Australian College of General Practitioners Fellowship in Advanced Rural General Practice curricula. PIERCE trainees enjoyed the opportunity to experience rural medicine in a community setting, a broad caseload, hands-on proficiency, continuity of care and an authentic role as a valued member of the clinical team. This was reinforced by closer and more consistent clinical and educational interactions with their supervisors, and learning experiences that address key weaknesses identified in current hospital-based prevocational training. Successful achievement of prevocational curriculum objectives is contingent on strategic alignment of the curricula with supportive learning mechanisms focused by the learning context on the desired outcome, rural practice. This study adds weight to the growing consensus that rural community-based placements such as PIERCE are desirable components of prevocational training

Mekanika fluida, ed.2/ White

xii, 432 hal.; ill.;..

Mekanika fluida, ed.2/ White

xii, 432 hal.; ill.;..

Mekanika fluida, ed.2/ White

xii, 432 hal.; ill.;..

The Roma Agreement: changing the face of rural generalist training in Queensland

Aims and relevance: Queensland Health's Rural Generalist Pathway commenced as a new stream of rural training in 2007. This pathway, which has changed the face of rural medical recruitment and training across the jurisdiction, arose from a number of sentinel events relating to workforce recruitment and retention, work practices, and industrial processes, culminating in a forum in the rural town of Roma in 2005. \ud \ud This seminal meeting of Queensland Health, colleges, educational providers, rural doctors and other stakeholders led to the so-called Roma Agreement, which agreed to: 'develop and sustain an integrated service and training program to form a career pathway supplying the Rural Generalist workforce that the bush needs'.\ud \ud Methods and results: This agreement, which fulfilled the state government's promise of a specialist career pathway for rural generalists, developed a pathway for junior doctors (including government scholarship holders with return-of-service obligations), which was integrated with their training and linked to industrial recognition. The training program has a jurisdictional focus—supplying rural generalists to both public and private sectors. The nine principles articulated, which underpinned the pathway, are still relevant today, and are being adopted in other jurisdictions as the pathway is rolled out nationally.\ud \ud Conclusion: The principles enunciated in the Roma Agreement have served the Queensland Rural Generalist Pathway well. But does everyone need such an agreement? This paper will explore with the audience:\ud \ud • Would similar agreements be useful in their own context? How would they work?\ud • Who are their stakeholders and communities of interest?\ud • What are the key lessons from this experience?\ud \ud Target audience: This paper/workshop presentation will be relevant for anyone interested in rural medical/health professional education, including educators, policy makers and rural clinicians

Educational needs of rural and remote Australian non-specialist medical practitioners for obstetric ultrasound

Objective: To determine the educational needs of rural and remote non-specialist Australian doctors for obstetric ultrasound.\ud \ud Design: Survey design.\ud \ud Setting: The study surveyed rural and remote doctors practising in a variety of settings including general practice, rural hospitals, Aboriginal communities and flying doctor organisations throughout Australia.\ud \ud Subjects: Subjects included 314 solo and group practice rural general practitioners, rural hospital medical superintendents, senior medical officers, Aboriginal community controlled health service doctors, flying doctors, rural locums, registrars and two rural obstetricians. A total of 55% of the subjects were general practitioners in group practice. Respondents included 68 (22%) women and 246 (78%) men.\ud \ud Results: The response rate was 32%. The highest priority areas of need for education included detecting foetal abnormalities and anomalies (19.1%), basic routine ultrasonography (17.17%), placental position (17.17%), dating (17.17%), foetal viability (12.88%) and morphology scan (12.26%). The main areas where doctors stated they lacked confidence included detecting foetal abnormalities (29.09%), basic routine ultrasonography (including machine use), such as, carrying out and interpreting obstetric ultrasound scans (27.27%), morphology scans (16.36%) and placental position (14.54%).\ud \ud Conclusion: The study showed there was a large unmet need for education in obstetric ultrasound among rural and remote non-specialist doctors. Information from the needs assessment was used to develop the Australian College of Rural and Remote Medicine national obstetric ultrasound professional development program

The rural generalis: a new generation of health professionals providing the rural medical workforce the bush needs

Rural generalist medicine was recognised in Queensland as a medical discipline of specialist equivalence in\ud 2008. Since the introduction of the career pathway in 2007, approximately 140 trainees have commenced training on this education continuum to rural generalist status.\ud \ud The Rural Generalist Pathway—which includes a challenging prevocational start to the career, the opportunity\ud to specialise in a procedural skill or skills of interest and obtain general practice vocational training in a rural\ud setting—is certainly proving an attractive choice for those searching for a challenging and varied career.\ud \ud Although currently a Queensland phenomenon, this unique and exciting career pathway continues to generate increased interest and enthusiasm across all Australian states and territories now wishing to join this new wave of generalist practice. This new generation of health professionals for a new generation of services will, in turn, provide the rural medical workforce the bush needs.\ud \ud As the number of trainees increases, so in turn does the competition for advanced skills training posts. The\ud pursuit to identify, accredit and develop not only a range, but an appropriate number of advanced skills training posts is now a major focus and challenge to the ongoing expansion of the training pathway. A collaborative approach to identifying posts, selecting appropriate applicants via an open merit selection process and providing ongoing orientation and support throughout the advanced skills training year is currently a major state wide project of the pathway.\ud \ud A significant outcome of the pathway currently being researched concerns the advanced skill(s) being pursued\ud including identifying how many trainees go on to use the skills, in what location(s), and for how long.\ud \ud This paper will identify and report on the outcomes of the research into the advanced skills being pursued and used by rural generalists in Queensland and the new collaborative state wide approach to securing, selecting and supporting advanced skills trainees. It will also outline applicability of the concept of the rural generalist in other jurisdictions, and perhaps in other disciplines

Depression biased non-Hebbian spike-timing-dependent synaptic plasticity in the rat subiculum

The subiculum is a structure that forms a bridge between the hippocampus and the entorhinal cortex (EC), and plays a major role in the memory consolidation process. Here, we demonstrate spike-timing-dependent plasticity (STDP) at the proximal excitatory inputs on the subicular pyramidal neurons of juvenile rat. Causal (positive) pairing of a single EPSP with a single back-propagating action potential (bAP) after a time interval of 10 ms (+10 ms) failed to induce plasticity. However, increasing the number of bAPs in a burst to three, at two different frequencies of 50 Hz (bAP burst) and 150 Hz, induced long-term depression (LTD) after a time interval of +10 ms in both the regular-firing (RF), and the weak burst firing (WBF) neurons. The LTD amplitude decreased with increasing time interval between the EPSP and the bAP burst. Reversing the order of the pairing of the EPSP and the bAP burst induced LTP at a time interval of -10 ms. This finding is in contrast with reports at other synapses, wherein prebefore postsynaptic (causal) pairing induced LTP and vice versa. Our results reaffirm the earlier observations that the relative timing of the pre- and postsynaptic activities can lead to multiple types of plasticity profiles. The induction of timing-dependent LTD (t-LTD) was dependent on postsynaptic calcium change via NMDA receptors in the WBF neurons, while it was independent of postsynaptic calcium change, but required active L-type calcium channels in the RF neurons. Thus the mechanism of synaptic plasticity may vary within a hippocampal subfield depending on the postsynaptic neuron involved. This study also reports a novel mechanism of LTD induction, where L-type calcium channels are involved in a presynaptically induced synaptic plasticity. The findings may have strong implications in the memory consolidation process owing to the central role of the subiculum and LTD in this process