Pharmacy students' intention to practise in a rural setting: Measuring the impact of a rural curriculum,rural campus and rural placement on a predominantly metropolitan student cohort

Objective: To compare pharmacy students' intention to practise in a rural setting expressed in their first year of university with that expressed during their final year. Design: Longitudinal survey of students in their first and final years. Setting: Tertiary educational institution. Participants: Predominantly metropolitan pharmacy students. Interventions: Students were exposed to a rural curriculum, rural campus and rural placement or rural placement alone during their degree. Main outcome measure: Change in proportion of students expressing an intention to practise in a rural setting following registration. Results: The proportion of respondents who indicated an intention to practise in a rural setting was 21.6% (27/125) in 2006 compared with 11.2% (14/125) in 2003. This was a statistically significant increase of 10.4% (P = 0.001) over the four years. Positive influences on students' intention to practise in a rural setting were: rural background (P = 0.012); rural placement (either two weeks or 12 weeks) (P = 0.002); having been enrolled in the BPharm (Rural) (P = 0.001). Conclusions: This study confirmed the work of others in that the students most likely to express an intention to practise in a rural setting were those from a rural background who elected to undertake and complete a rural degree involving a rural placement. A follow‐up survey will be conducted to establish whether their stated intention as students has translated to rural practice in reality.     

The Orange Declaration on rural and remote mental health

Rural mental health outcomes have been persistently poorer than those in larger cities suggesting that the prevailing investments to improve matters are not working. Mental health researchers and service providers from New South Wales, Victoria, Western Australia and the Australian Capital Territory met in Orange in October 2018 to explore issues pertaining to rural mental health and well‐being. The group recognised and acknowledged that rural residents experience a series of interconnected geographical, demographic, social, economic and environmental challenges which are not addressed adequately by the current mix of services. This declaration has been endorsed by those listed below and we welcome further support. We list ten interrelated problems and ten solutions. As a group, we take this declaration as an opportunity to invite discussion about how we can collectively improve the mental health of rural residents through research, service design and delivery. We invite the reader to consider endorsing this declaration. A short summary of supporting evidence is available online at https://www.crrmh.com.au/ .     

Teaching and learning resilience: building adaptive capacity for rural practice. A report and subsequent analysis of a workshop conducted at the Rural Medical Educators Conference, Savannah, Georgia, May 18, 2010

Abstract Purpose: Resilience, the capacity to endure and overcome hardship, has been suggested as a basic competency for rural medical practice. Unfortunately for physician educators, the medical education literature offers only limited guidance for nurturing this adaptive capacity. We describe the process and subsequent analysis of a daylong curriculum development workshop conducted at the annual meeting of Rural Medical Educators in 2010. Methods: Fifty administrator, faculty and student attendees reflected individually and worked in groups to construct key curricular components and modalities for teaching this competency. Prior to the meeting, participants were asked to submit a personal story about resilience. The 22 narratives received were distributed across 8 groups and provided the grist for the small group discussions, in which each group identified key concepts for teaching and learning about resilience, constructed a concept map, and developed a curriculum that was presented to all session participants. Concept maps, curriculum outlines and notes taken during the presentations were analyzed using content analysis techniques. Findings: Data highlight the importance of (1) embracing hardship as an opportunity for growth, (2) viewing resilience as both an individual and community property, (3) pursuing adaptability more than hardiness, and (4) setting a lifelong pattern of learning this competency in practice. Specific teaching modalities are suggested including individual reflective time and group activities. Conclusions: To our knowledge this represents a first effort to define and develop a medical curriculum for teaching resiliency in rural predoctoral and residency education.     

Going country: rural student placement factors associated with future rural employment in nursing and allied health

OBJECTIVE: To measure the rate and predictors of health science graduates joining the rural health workforce following a rural placement. DESIGN: Longitudinal survey including the years immediately prior to and post graduation. SETTING: Western Australian health sciences graduates contacted by email and/or phone. Participants: Allied health and nursing students from urban campuses of three Western Australian universities who had taken a rural placement in their final year of study between 2000 and 2003. MAIN OUTCOME MEASURES: Location of employment six months or more after graduation. RESULTS: Of 429 participating allied health and nursing graduates, 25% had entered the rural workforce. Factors with a positive bivariate association with rural employment were: rural background, health discipline, self-reported value of placement, non-compulsory rural placement, and placements of four weeks or less. After controlling for rural background, the value and duration of the placement were significantly associated with rural employment. CONCLUSIONS: This study augments previous work showing that any prior rural background is a significant predictor of rural work. Rural practitioners of both urban and rural origin who undertake voluntary rural placements are more likely to enter rural practice and consequently mandatory placements may not be helpful to increasing the rural workforce. The quality of a placement is a highly significant factor associated with future workplace choice, the details of which need to be further investigated.     

我国农村医疗卫生体制分析

近几年来，随着农民收入的增长相对缓慢，政府对农村卫生资金投入不足，造成农村卫生人才缺乏，基础设施落后，某些地方传染病、地方病有所抬头，医疗费用居高不下，农民因病致贫、因病返贫现象突出，农村合作医疗举步艰难等等。建议：(1)继续深化卫生服务体系改革。(2)增强政府筹资的作用.     

Creating a database to facilitate multilevel analyses of mental health determinants and outcomes in rural and remote areas

Objective:  The lack of consistent findings regarding comparisons of mental health between rural and urban areas has been attributed in part to methodological shortcomings, including poor conceptualisation of 'rurality'. To address the diversity of rural and remote communities, an interdisciplinary collaboration sought to establish a database incorporating a range of domains hypothesised to be major influences on the mental health of individuals, families and communities.
Design:  The database domains included health (physical and mental), health service utilisation, sociodemographic characteristics, climate patterns, agricultural activity and primary industry. Important steps in the development of the database were addressing issues related to ethics, ownership, accessing data sources, sustainability of the database and integration of differing outcomes sought by the collaborators.
Results:  The paper describes the database while an illustrative example of analysis demonstrates its application. The potential for multilevel analyses between the database and other datasets is discussed as well as challenges for the future development of this valuable resource for rural mental health research.
Conclusion:  The Centre for Rural and Remote Mental Health database will be a valuable resource for rural mental health research.     

Junior medical officer recruitment: challenges and lessons from the Northern Territory

OBJECTIVE: To examine the influence of newspaper and Internet advertising, word-of-mouth endorsement and student experience in attracting applicants for junior medical officer positions in the Northern Territory. DESIGN: A retrospective study. PARTICIPANTS: Fifty-four applicants for junior medical officer positions. MAIN OUTCOME MEASURE: Proportion of applicants who reported newspaper advertising, Internet advertising, word of mouth or personal experience in attracting their application for an intern or resident medical officer position. RESULTS: Nineteen per cent of applicants saw the newspaper advertisement and 52% of the Internet advertisement. Eighty-seven per cent of applicants were influenced by word-of-mouth endorsement and 52% by student experience in the Northern Territory or Indigenous health. CONCLUSION: These results suggest that word-of-mouth endorsement has the greatest influence in attracting applicants for junior medical officer positions in Northern Territory hospitals.     

A comparison of a hospital outpatients department and general practice in remote Queensland

A survey of all ambulant patients attending the hospital outpatients' department and the private general practice in a remote town in Queensland sought information on patients' reasons for attending. Patients handed the completed questionnaires to their practitioner, who indicated the type of visit and the focus of the encounter. There was little difference between the facilities in terms of patient demographics, except that males accounted for a higher proportion of encounters at the Outpatients' Department (OPD), mainly as emergency encounters. Excluding emergency encounters, patients appeared to perceive the facilities as alternative practices. The practitioners' reports suggested some differences in practice and/or experience between the two facilities, which were in line with commonly held perceptions about OPD and private general practice. The data suggest that the similarities between the two facilities may outweigh the differences. Moreover, the differences between rural hospital practice and rural general practice should be seen as providing the opportunity for more rounded training, rather than mutually exclusive forms of practice.     

Rural temperament and character: a new perspective on retention of rural doctors

OBJECTIVE: This exploratory study serves as a starting point to establish a psychobiological profile for rural GPs. The overall aim is to describe how individual levels and combinations of temperament (mildly heritable) and character (influenced by sociocultural learning) traits allow GPs to flourish or fail in rural medicine. DESIGN: In a mixed-method study, 13 rural GPs (rural and remote metropolitan areas 5-7, minimum 7 years of experience) from Central/Southern Queensland, Australia completed the Temperament and Character Inventory-R140 to identify the intensity of the seven basic dimensions of temperament and character. These are novelty seeking, harm avoidance, reward dependence, persistence, self-directedness, cooperativenes and self-transcendence. Semistructured interviews provided in-depth information on what brought them to and kept them in rural practice. RESULTS: Preliminary results show that our sample of rural GPs are highly self directed, caring, cooperative, objective and persistent. Individual variations occur in the temperament dimensions of harm avoidance, novelty seeking and reward dependence. In particular, GPs who intended to leave rural practice due to dissatisfaction had significantly higher harm avoidance (F = 23.74; P < 0.01) than those GPs intent on staying. CONCLUSION: Although preliminary, triangulation of the data sources provides insight into individual GP profiles regarding which particular combination of traits is most conducive to maintaining a rural career, and might provide a greater understanding of rural doctors. This information could provide a basis for counselling of students with an interest in rural medicine and for informing policy on appropriate initiatives for rural GPs and the communities they serve.     

开展农村健康促进提高农民健康水平

占我国人口70%以上农村居民的健康状况一直以来都与城市居民存在较大差距,全国第3次卫生服务总调查的数据也反映了这一问题。在我国农村开展健康促进对提高农民的健康水平有着十分重要的现实意义。在阐述了农民健康水平现状的基础上,对如何在我国农村因地制宜地开展健康促进的具体对策进行了一些探讨。     

Rural physicians' skills enrichment program: A cohort control study of retention in Alberta

Objective: The Rural Physician Action Plan of Alberta introduced an enrichment program in 2001 to improve physician access to skills training. The objective of this study was to evaluate this program and measure retention compared with matched controls over 5 years. Design: Longitudinal, matched, case control study and program evaluation. Setting: Rural communities in Alberta, Canada. Participants: Rural physicians. Interventions: Thirty‐one rural physicians self‐selected their personal skills training program and listed three goals they wished to attain. They were matched by age, specialty, years in practice and size of community with rural physicians who did not participate in a skills training or upgrading program. Main outcome measures: Goal attainment for subject physicians, use of skills at 5 years and comparison of rural retention of physicians at 5 years. Results: Thirty‐two of thirty‐five physicians classified their goal attainment to be as expected or greater, and all were using their new skills at 5 years. Of the matched physicians, 29 training participants remained in rural practice at 5 years compared with only 22 of 29 matched control: relative risk 1.31, confidence interval 1.06–1.62 P < 0.05. Conclusions: The enrichment program provides focused, valued skills training for rural physicians and long‐term benefits to rural communities.     

Issues in the Development of HIV-Preventive Interventions for Men Who Have Sex with Men (MSM) in Rural Areas

Interventions aimed at reducing HIV-related sexual risk behaviors among men who have sex with men (MSM) have been highly successful in urban areas in reducing the incidence of new cases of HIV infection. In rural areas, where the rates of infection are increasing, issues of culture, population density, isolation, and lack of access to health care services present different challenges for the design and dissemination of preventive interventions. In this paper, we will discuss the issues related to the development of preventive interventions for rural MSM, and propose a model of intervention based on preliminary findings from a recent study of rural MSM.     

Preparing professionals from a wide range of disciplines for life and work in rural and small communities

A new inter-professional subject has been offered at a Canadian university, which examines issues related to professionals' integrating into rural practice; understanding the history and geography of rural communities and important issues affecting life in rural settings.