Influences on medical students' decisions to study at a rural clinical school

Objective: To identify factors that influenced medical students at Monash University to undertake their first year of clinical training (third year of the medical course) at a rural clinical school (RCS). Design: Third‐year Monash University medical students undertaking clinical placements at a RCS were surveyed in 2005. A semistructured questionnaire was used to ask students to rate the influence of a list of factors on their decision to undertake their year‐long placement at a RCS. Results: Under half (48%) of students studying at an RCS reported that they were of rural background. All surveyed items were identified as having had a positive influence. Greater clinical experience, learning opportunities and patient access were identified as having the greatest positive influence followed closely by free accommodation and other financial and supportive incentives. Future rural career intention was eight times more likely to be a positive influence in rural compared with urban background students. Conclusion: The most important positive influence on Monash third‐year medical students' decision to study at an RCS is the perception of high‐quality clinical experiences and education. This perception arises from rural exposure during pre‐clinical years.     

Farmers' concerns: a qualitative assessment to plan rural medical education

Abstract Context: Limited research suggests that translational approaches are needed to decrease the distance, physical and cultural, between farmers and health care. Purpose: This study seeks to identify special concerns of farmers in Alabama and explore the need for a medical education program tailored to prepare physicians to address those concerns. Methods: We conducted 2 focus groups with 20 farmers from diverse communities, backgrounds, and farming operations. The sessions were audio‐recorded, transcribed, coded, and analyzed for determined patterns. Findings: The following categories were developed as areas of importance to farmers: the need for physicians to understand the culture of farming, occupational exposures in farming, and recommendations for improving the health of farmers. Conclusion: Findings suggest that to adequately serve farmers, medical students interested in entering practice in rural areas should have or develop a relevant and adequate understanding of farming practices.     

'Swallowing the medicine': determining the present and desired modes for delivery of continuing medical education to rural doctors

ABSTRACT: A National Needs Assessment of the continuing professional educational needs of Australian rural medical practitioners was conducted on a model previously successfully used in Queensland. The objective was to describe and quantify the continuing education needs of rural medical practitioners in order that service providers might more expeditiously set educational curricula in continuing medical education (CME) provision. A major component of the study was to determine which modes of CME delivery rural doctors currently use and which they would prefer to use. Rural doctors were perceived to be slow to access new technologies and training may be required in order for the doctors to use them.     

One approach to improving indigenous health care through medical education

ABSTRACT: The present paper discusses some of the issues relating to the poorer health and shorter life expectancy of Australian Aboriginal and Torres Strait Islander peoples. The barriers to improvement include funding of the medical service, the nature of early contact between Indigenous peoples and the European settlers, and the complex nature of Indigenous cultures. The role of the new medical school at James Cook University is discussed in relation to its mission of meeting the health care needs of the population of tropical and rural North Queensland. Indigenous representation in the management of the Medical School, staff selection, student selection, and curriculum content are discussed, and recommendations are made for a partnership approach to achieving improvements in the functioning of the health system of the area.     

Removing the roadblocks to medical and health student training in rural hospitals in Victoria

Objective: To assess the extent of undergraduate health student placements in regional hospitals in northern Victoria in 1999, prior to substantial changes in rural undergraduate medical education in Australia. Method: Cross sectional postal survey with telephone follow‐up in north‐east Victoria. Subjects were all 17 regional and rural hospitals involved in health student teaching in North‐east Victoria. Main outcome measures were the numbers, duration and discipline of health students placements and reported barriers to such placements. Results: Large regional hospitals accounted for two‐thirds of all undergraduate health student placements. Smaller sites placed few allied health students. Barriers to a larger, more sustainable system of rural placements and rotations included accommodation shortages and funding constraints, particularly in smaller rural hospitals. Conclusions: Adequate resourcing of placements of a meaningful duration, stronger institutional support, and improved resourcing of regional accommodation is required to facilitate a larger, more systematic and sustainable system of medical and health student placements in rural areas. What is already known: The extent of training of health professionals in rural Australia is increasing rapidly. Fears have been expressed that the capacity to deliver quality experience in rural practice may be limited. What this study adds: This cross sectional survey of rural Victorian hospitals shows that there is a major untapped potential in rural hospitals of all sizes to assist with training in rural practice, but that a number of barriers to such training need to be removed to reach full capacity.     

Medical education: a student perspective

Discussions with a sample of final year students generated a questionnaire designed to elicit a phenomenological account of their experiences at medical school. Sources of dissatisfaction and stress were identified and the students also offered recommendations for improving the system.     

Patient-centred medicine through student-centred teaching: a student perspective on the key impacts of community- based learning in undergraduate medical education

CONTEXT: The UK General Medical Council has proposed that increased use of community settings is essential to enhancement of medical education. However, such curriculum developments have been directed by educationalists and clinical faculty; there is to date little to show whether student perspectives accord with such expectations. AIM: To examine student views on whether community-based learning during a UK undergraduate medical education course results in new learning in the areas expected, and to elucidate any process factors which enhance attainment of learning objectives. METHOD: Nominal group technique, to develop consensus on important learning outcomes and process factors, and questionnaire survey, developed from the views of the nominal groups. RESULTS: 89 students participated (response rate 70% for the nominal groups, and 88% for questionnaire). Students perceived increased learning in many of the areas expected. In particular, students reported significant learning from: witnessing the impact of a longer term and more personal relationship with patients; the visible impact of social environment on health; the importance of dealing with people rather than diseases, and the use of the whole team for care. In addition, they emphasized that tutor, staff and patient enthusiasm for student presence and learning greatly enhanced the student learning experience. CONCLUSIONS: Community settings appear to achieve the expected attitudinal adaptation of students. The role of the committed tutor and team is seen as pivotal to learning. The conclusions support an increased emphasis in contemporary medical education and related research activity on the key impact of relationships in the learning environment.     

Rural doctor recruitment: does medical education in rural districts recruit doctors to rural areas?

Summary. The impact of the University of Tromsø Medical School on the distribution of doctors in rural areas in northern Norway was evaluated by a postal questionnaire. The survey covered 11 graduation years (417 doctors), and the response rate was 84.2%. The establishment of a new medical school in northern Norway has clearly had beneficial effects: a total of 56.1% of the graduates stay in these remote areas. Of those who also spent their youth in northern Norway the proportion is 82.0%, compared to graduates who lived in the southern parts of the country while growing up (37.7%). The results clearly demonstrate that one of the main goals for the Medical School at the University in Tromsø, to educate doctors who prefer to work in these rural areas, has been accomplished.     

农村小学校健康教育传播模式研究

目的探讨高效、低耗的农村小学校健康教育传播方式。方法将长春市绿园区合心镇10所农村小学随机分成五组,每组分别采用设定的健康教育传播方式,对620名三、四年级小学生进行健康教育（内容相同）两年。结果健康教育后,实验组学生的卫生知识水平和口腔卫生状况明显好于对照组学生（P＜0．01）,卫生行为正确率也明显高于对照组学生（P＜0．01）。实验组学生的龋齿患病率和龋均明显低于对照组学生（P＜0．01）。结论一般方式传播模式具有高效、低耗的特点,建议农村小学校采用此方式开展健康教育。     

完善医学教育体系为基层医疗卫生改革提供人才支撑

基层医疗卫生队伍人才缺乏是影响医改正常进行的重要因素。该文针对中国基层医疗人才队伍的基本情况,在深入分析原因后,提出大力发展医学高等教育,是解决基层医疗卫生人才问题,健全基层医疗卫生服务体系的重要支撑,也是实现医改目标的重要举措。     

新形势下村级卫生工作的重心转移

文章结合华北北部农村基层卫生事业现状,研究经济欠发达地区农村医疗卫生存在的问题,提出在现实工作中解决经济欠发达地区村级医疗卫生工作问题的思路和政策性建议。     

Wanted: trainees for rural practice

ABSTRACT: To address the increasing need for rural health practitioners, Canada is trying various methods of medical education, including community based residency streams, additional skills training and teamwork models. This paper discusses some of the factors that may affect the effectiveness of these methods.     

Patterns of computer usage among medical practitioners in rural and remote Queensland

ABSTRACT: As part of a more detailed needs analysis, patterns of computer usage among medical practitioners in rural and remote Queensland were investigated. Utilising a questionnaire approach, a response rate of 23.82% (n = 131) was obtained. Results suggest that medical practitioners in rural and remote Queensland are relatively sophisticated in their use of computer and information technologies and have embraced computerisation to a substantially higher extent compared with their urban counterparts and previously published estimates. Findings also indicate that a substantial number of rural and remote practitioners are utilising computer and information technologies for clinical purposes such as pathology, patient information sheets, prescribing, education, patient records and patient recalls. Despite barriers such as bandwidth limitations, cost and the sometimes unreliable quality of Internet service providers, a majority of rural and remote respondents rated an Internet site with continuing medical education information and services as being important or very important. Suggestions that 'rural doctors are slow to adapt to new technologies' are questioned, with findings indicating that rural and remote medical practitioners in Queensland have adapted to, and utilise, information technology to a far higher extent than has been previously documented.     

Abortion education in the medical curriculum: a survey of student attitudes

BACKGROUND: The purpose of this study was to evaluate student attitudes toward the inclusion of abortion education in the preclinical and clinical medical school curriculum. STUDY DESIGN: All students completing the OB-GYN rotation from May 2004 through January 2005 (n=118) were asked to complete a 21-item survey. Survey questions focused on students' attitudes about the appropriateness of abortion education, reasons for participation or nonparticipation in the abortion care experiences in the clinical curricula and the value of abortion education. RESULTS: One hundred students completed the survey for a response rate of 85%. Nearly all respondents indicated that abortion education was appropriate in the preclinical and clinical curricula (96%). Fifty-three percent of students participated in a clinical abortion care experience. The majority of these students rated it as valuable (84%) and would recommend it to a friend (73%). Most students who planned a career in Family Medicine and OB-GYN preferred the integration of abortion training into the residency curriculum (74%). CONCLUSIONS: Abortion education is acceptable and valued by medical students and should be integrated into the curricula of all medical schools.     

Orienting medical education to community need: a review

The literature on community-oriented medical education is reviewed. In response to major changes in the origin, expression and place of management of much illness, many medical schools are turning their attention increasingly to the community from whence to derive their curriculum and wherein to effect their teaching. The traditional hospital base of teaching is eroding, necessitating new, innovative approaches to medical education. Becoming community-oriented, or using community-based learning, offers potential benefits for the schools, the students, and the public. The experience of others demonstrates the necessity of enlisting community representatives as partners in the process of change. Institutional barriers are significant and careful planning is needed to overcome them.     

Challenges to early childhood education in rural China: lessons from the Hebei province

This research study examined the challenges faced by early childhood education (ECE) in rural China based on a qualitative study of 217 kindergarten classrooms in a large agricultural, rural province. This study utilised onsite teacher surveys, interviews, and observational field notes. This investigation's findings revealed important information in regard to (a) enrollment, class size, and student–teacher ratios; (b) facilities, basic furnishings, and materials; (c) teacher qualifications; and (d) curriculum and pedagogy. Kindergartens in the rural province of Hebei, typical of Chinese provinces with economically disadvantaged students and inadequate ECE funding, were found to be of poor quality across every ECE indicator measured. For the future improvement and well-being of children and their families in rural China, the authors recommend reform policy to increase ECE quality by affiliating quality kindergartens with existing elementary public school structures and to improve teacher quality by advancing teacher benefits, professional status, and professional development opportunities.