Medical education 2
Track 14
| Thursday, October 26, 2023 |
| 2:05 PM - 3:40 PM |
| Meeting Room C4.6 |
Speaker
A/Prof Riitta Partanen
Director
The University of Queensland Rural Clinical School
Geographical Narcissism during Medical Education & Training and its role in 'ruling in' or 'ruling out' rural future rural practice
2:05 PM - 2:20 PMSummary
Aim
Better understanding Geographical Narcissism (GN) and its influence on ruling out rural medical practice could improve workforce distribution and thus improved rural health outcomes.
This systematic exploration of GN is necessary to gain a greater understanding both how it is experienced, and its role and influence on Australian medical students and prevocational junior doctors in their deliberations on whether to work in metropolitan, regional, or rural areas during their prevocational years and in the longer term.
Content
There are well understood factors (rural background, rural undergraduate clinical training, rural working experiences and high rural self-efficacy) that increase the likelihood of medical learners choosing rural medical careers, but there are potentially other factors that are less understood on why those with an increased likelihood of working in rural areas do not.
Geographical narcissism (GN) is the subtle, often unconscious, devaluation of non-urban knowledge and expertise due to the belief that urban knowledge and expertise is the norm or even superior.
A qualitative study informed by realistic evaluation was selected to ensure strength and rigor in the research findings. Twenty-nine semi-structured interviews were conducted with rural and metropolitan based university medical students and prevocational junior doctors employed by regional or metropolitan hospitals.
Data analysis suggests GN is a genuine phenomenon influencing medical learners and variably influences the ruling in’ or ‘ruling out’ of rural medical practice. The findings also suggest those with rural background and rural medical education appear to be less influenced by GN.
Goals
A GN framework will be developed from this new evidence to help illustrate its role in rural versus metropolitan medical career development and workforce and is likely to provide valuable insights into an under-recognised barrier to rural medical careers, potentially informing medical workforce policy and medical education and training frameworks.
Better understanding Geographical Narcissism (GN) and its influence on ruling out rural medical practice could improve workforce distribution and thus improved rural health outcomes.
This systematic exploration of GN is necessary to gain a greater understanding both how it is experienced, and its role and influence on Australian medical students and prevocational junior doctors in their deliberations on whether to work in metropolitan, regional, or rural areas during their prevocational years and in the longer term.
Content
There are well understood factors (rural background, rural undergraduate clinical training, rural working experiences and high rural self-efficacy) that increase the likelihood of medical learners choosing rural medical careers, but there are potentially other factors that are less understood on why those with an increased likelihood of working in rural areas do not.
Geographical narcissism (GN) is the subtle, often unconscious, devaluation of non-urban knowledge and expertise due to the belief that urban knowledge and expertise is the norm or even superior.
A qualitative study informed by realistic evaluation was selected to ensure strength and rigor in the research findings. Twenty-nine semi-structured interviews were conducted with rural and metropolitan based university medical students and prevocational junior doctors employed by regional or metropolitan hospitals.
Data analysis suggests GN is a genuine phenomenon influencing medical learners and variably influences the ruling in’ or ‘ruling out’ of rural medical practice. The findings also suggest those with rural background and rural medical education appear to be less influenced by GN.
Goals
A GN framework will be developed from this new evidence to help illustrate its role in rural versus metropolitan medical career development and workforce and is likely to provide valuable insights into an under-recognised barrier to rural medical careers, potentially informing medical workforce policy and medical education and training frameworks.
Takeaways
At the conclusion of the presentation attendees will be able to
1. Understand where & when along the medical learning journey i.e. from medical school to the prevocational years, geographical narcissism occurs.
2. Understand how geographical narcissism impacts the different kinds of learners and trainees.
3. Understand to what degree and why geographical narcissism has influenced intent and decision around future or current rural work locations.
1. Understand where & when along the medical learning journey i.e. from medical school to the prevocational years, geographical narcissism occurs.
2. Understand how geographical narcissism impacts the different kinds of learners and trainees.
3. Understand to what degree and why geographical narcissism has influenced intent and decision around future or current rural work locations.
Biography
Associate Professor Riitta Partanen is the Director of the UQ Rural Clinical School and is a long-term General Practitioner in Maryborough, Queensland.
As the inaugural Head of the Hervey Bay Regional Clinical Unit (HBRCU), she has been involved with UQ Rural Clinical School since 2005. Since then, her roles have also included: the Co-Director of Learning for the UQRCS, GP Academic Lead for HBRCU, Acting Head of the UQRCS, and the Academic Lead for Phase 2 (Years 3 &4) of the UQ Medical Program.
Previously A/Prof Partanen has served as Board member and Chair of the Wide Bay Division of General Practice, member of RACGP Rural Medical Education Committee and currently member of the RACGP Doctors for Women in Rural Medicine Committee. A/Prof Partanen is a member of the FRAME (Federation of Rural Australian Medical Educators) Policy Group and FRAME co-delegate for the National Rural Health Alliance.
Her research interests include rural medical workforce, rural medical education, rural training pathways and General Practice issues such as depression and liver disease. She is currently a PhD candidate exploring Geographical Narcissism during medical education and training and its impact on ruling in or ruling out future rural medical practice.
Dr Lesca Hadley
University of North Texas Health Science Center
One minute preceptor
2:20 PM - 2:35 PMSummary
Aim
Effective teaching requires time. In clinical settings finding the time to teach can be difficult. Teaching models provide a systematic framework for didactic and clinical teaching. The One-Minute Preceptor (OMP) is one teaching model, providing five microskills to organize a learning experience for students in the clinical environment. The OMP model is supported by literature for its effectiveness as a teaching model. It is preferred in studies by both students and preceptors.
Content
Participants will be introduced to the One Minute Preceptor model as a strategy for teaching
Goals
1.Effectively use the One Minute Preceptor model as a systematic framework to teach learners in the outpatient setting.
2. Practice using the One Minute Preceptor model with colleagues
Effective teaching requires time. In clinical settings finding the time to teach can be difficult. Teaching models provide a systematic framework for didactic and clinical teaching. The One-Minute Preceptor (OMP) is one teaching model, providing five microskills to organize a learning experience for students in the clinical environment. The OMP model is supported by literature for its effectiveness as a teaching model. It is preferred in studies by both students and preceptors.
Content
Participants will be introduced to the One Minute Preceptor model as a strategy for teaching
Goals
1.Effectively use the One Minute Preceptor model as a systematic framework to teach learners in the outpatient setting.
2. Practice using the One Minute Preceptor model with colleagues
Takeaways
1.An understanding of the One Minute Preceptorship model as a strategy for use in medical education
2.An understanding of the five steps of the One Minute Preceptor model
3.Ability to use the One Minute Preceptorship model in medical education
2.An understanding of the five steps of the One Minute Preceptor model
3.Ability to use the One Minute Preceptorship model in medical education
Biography
Dr Lesca Hadley is an Assistant Professor at the University of North Texas Health Science Center in Ft. Worth, Texas, USA. She completed medical school at Texas Tech University Health Science Center in Lubbock, Texas, USA followed by a Family Medicine Residency and Geriatrics Fellowship at John Peter Smith Hospital in Ft. Worth, Texas. Dr Hadley received an MBA with a healthcare emphasis from Abilene Christian University. She is Board Certified in Family Medicine with additional certifications in Geriatrics and Hospice and Palliative Medicine. Dr Hadley served as the John Peter Smith Hospital Geriatrics Fellowship Program Director for fourteen years, and currently, she is their first Program Director for the Hospice and Palliative Medicine Fellowship. Dr Hadley serves as a core faculty for the Graduate Certificate in Academic Medicine, the Faculty Development Fellowship, at UNTHSC. She is passionate about global health, and she is inspired by the students she teaches.
A/Prof Lara Fuller
Director, Rural Medical Education And Rural Community Clinical School
Deakin University
Medical students with extended learning in rural primary care: where are they 10 years on?
2:35 PM - 2:50 PMSummary
Background: Medical graduates who have attended a Rural Clinical School (RCS) have consistently been found more likely to become rural doctors, however the majority of this training is delivered in hospital settings, with less focus on the specific workforce outcomes for graduates of Longitudinal Integrated Clerkship (LIC) programs that provide extended periods of training based in rural general practice. Deakin University School of Medicine’s LIC program, located in the Grampians and Southwest regions of Victoria, Australia, began in 2010. During the third year of the 4-year graduate entry MD course, LIC students are hosted for 12 months in rural general practices and affiliated health services. LIC students undertake the same curriculum and assessment as their hospital-based peers albeit within a very different context.
Objective: This presentation will describe the results of a cross-sectional observational study linking 10 years of Deakin University LIC graduates’ (2011-2020) principal place of practice in 2021 (Modified Monash Model) with relevant graduate and training variables and draw comparisons with overall graduate outcomes.
Results: Almost 30% of LIC graduates were working rurally, almost double previously published results for all graduates (16.2%). More than half of those working rurally (55%) were in communities of similar rurality (Modified Monash 3-7) to the LIC program. Graduates were more likely to work rurally if they were from a rural background (OR 3.28 CI 95% 1.63 to 6.59) or completed a further year of rural training (OR 2.76 1.35 to 5.66). There were no significant differences based on postgraduate year of graduates.
Conclusion: A decade of training students in rural primary care is showing promising signs of positive workforce outcomes for communities of similar rurality to the training region. This effect is further enhanced if students complete a further year of rural training or come from a rural background.
Objective: This presentation will describe the results of a cross-sectional observational study linking 10 years of Deakin University LIC graduates’ (2011-2020) principal place of practice in 2021 (Modified Monash Model) with relevant graduate and training variables and draw comparisons with overall graduate outcomes.
Results: Almost 30% of LIC graduates were working rurally, almost double previously published results for all graduates (16.2%). More than half of those working rurally (55%) were in communities of similar rurality (Modified Monash 3-7) to the LIC program. Graduates were more likely to work rurally if they were from a rural background (OR 3.28 CI 95% 1.63 to 6.59) or completed a further year of rural training (OR 2.76 1.35 to 5.66). There were no significant differences based on postgraduate year of graduates.
Conclusion: A decade of training students in rural primary care is showing promising signs of positive workforce outcomes for communities of similar rurality to the training region. This effect is further enhanced if students complete a further year of rural training or come from a rural background.
Takeaways
1. A decade of training students in rural primary care is showing promising signs of positive workforce outcomes for communities of a similar geographic classification to the training region.
2. LIC graduates who completed a second year of rural training were almost three times more likely to work rurally than those who completed subsequent metropolitan training.
3. Rural primary care training capacity should be prioritised for extended rural placements and rural background medical students to maximise workforce outcomes for rural communities.
2. LIC graduates who completed a second year of rural training were almost three times more likely to work rurally than those who completed subsequent metropolitan training.
3. Rural primary care training capacity should be prioritised for extended rural placements and rural background medical students to maximise workforce outcomes for rural communities.
Biography
Associate Professor Lara Fuller is Director of Rural Medical Education and the Rural Community Clinical School at Deakin University. As an academic General Practitioner her teaching and research interests are in curriculum design for rural medical education, learning in Longitudinal Integrated Clerkships, rural clinical training pathways and rural workforce outcomes. She is an active member of the Federation of Rural Australian Medical Educators (AusFRAME) and the International Consortium of Longitudinal Integrated Clerkships (CLIC).
A/Prof Riitta Partanen
Director
The University of Queensland Rural Clinical School
GP First Choice for Medical Graduates: Innovative medical education
2:50 PM - 3:05 PMSummary
Aim
To share the innovative end-to-end Medical Pathways models in Queensland aiming to provide the medical workforce rural communities need, by increasing the percentage of graduates choosing Rural General Practice (GP) Careers as a first choice.
Content
Rural General Practitioners continue to be a scarce resource in Australia and globally. In Australia only 18% of medical school graduates are choosing General Practice (GP) as their first preference for their future medical career. Yet rural communities need more GPs to ensure they receive the care they need; at the time they need close to home. More needs to be done in the medical education and training sector to foster a higher percentage of graduates choosing GP as their preferred career choice.
To facilitate this The University of Queensland, with its re-imagined MD program, has partnered with regional universities and local hospital and health services to develop rural Medical Pathways, which provide end-to-end (end of high school to end of Fellowship) medical education training within rural communities.
The UQ affiliated end-to-end rural Medical Pathways (MP) are an innovative model that will showcase rural General Practice from Year 1 of the 3-year undergraduate degree and throughout the 4-year postgraduate medical degree. Early, longer and longitudinal General Practice experiences in rural communities is aimed to foster more MP graduates to want to become GPs and in particular rural GPs.
Goals
The innovative and unique end-to-end Medical Pathways aims to address the workforce needs of its communities and in particular improve access to primary healthcare, by having more graduates choosing GP as their first career choice, and who choose to work in rural communities.
To share the innovative end-to-end Medical Pathways models in Queensland aiming to provide the medical workforce rural communities need, by increasing the percentage of graduates choosing Rural General Practice (GP) Careers as a first choice.
Content
Rural General Practitioners continue to be a scarce resource in Australia and globally. In Australia only 18% of medical school graduates are choosing General Practice (GP) as their first preference for their future medical career. Yet rural communities need more GPs to ensure they receive the care they need; at the time they need close to home. More needs to be done in the medical education and training sector to foster a higher percentage of graduates choosing GP as their preferred career choice.
To facilitate this The University of Queensland, with its re-imagined MD program, has partnered with regional universities and local hospital and health services to develop rural Medical Pathways, which provide end-to-end (end of high school to end of Fellowship) medical education training within rural communities.
The UQ affiliated end-to-end rural Medical Pathways (MP) are an innovative model that will showcase rural General Practice from Year 1 of the 3-year undergraduate degree and throughout the 4-year postgraduate medical degree. Early, longer and longitudinal General Practice experiences in rural communities is aimed to foster more MP graduates to want to become GPs and in particular rural GPs.
Goals
The innovative and unique end-to-end Medical Pathways aims to address the workforce needs of its communities and in particular improve access to primary healthcare, by having more graduates choosing GP as their first career choice, and who choose to work in rural communities.
Takeaways
At the conclusion of my presentation attendees will be able to:
1. Understand the role of end-to-end rural medical pathway programs play in improving GP career intent in medical school graduates.
2. Understand how a Medical Pathway partnership can work together to help solve the workforce needs of their communities.
3. Understand how a greater focus on General Practice can be achieved in a Medical Program
1. Understand the role of end-to-end rural medical pathway programs play in improving GP career intent in medical school graduates.
2. Understand how a Medical Pathway partnership can work together to help solve the workforce needs of their communities.
3. Understand how a greater focus on General Practice can be achieved in a Medical Program
Biography
Associate Professor Riitta Partanen is the Director of the UQ Rural Clinical School and is a long-term General Practitioner in Maryborough, Queensland.
As the inaugural Head of the Hervey Bay Regional Clinical Unit (HBRCU), she has been involved with UQ Rural Clinical School since 2005. Since then, her roles have also included: the Co-Director of Learning for the UQRCS, GP Academic Lead for HBRCU, Acting Head of the UQRCS, and the Academic Lead for Phase 2 (Years 3 &4) of the UQ Medical Program.
Previously A/Prof Partanen has served as Board member and Chair of the Wide Bay Division of General Practice, member of RACGP Rural Medical Education Committee and currently member of the RACGP Doctors for Women in Rural Medicine Committee. A/Prof Partanen is a member of the FRAME (Federation of Rural Australian Medical Educators) Policy Group and FRAME co-delegate for the National Rural Health Alliance.
Her research interests include rural medical workforce, rural medical education, rural training pathways and General Practice issues such as depression and liver disease. She is currently a PhD candidate exploring Geographical Narcissism during medical education and training and its impact on ruling in or ruling out future rural medical practice.
Dr Shu Li Tan
GP Principle and GP Educator
Primary Care Education, Portsmouth and Isle of Wight
The Thriving GP Trainee in Today’s World
3:05 PM - 3:10 PMSummary
The way GPs consult has changed significantly over the past 3 years. In the UK, there has been changes to the GP specialty training examination as well.
As training programme directors (TPDs), we have seen increased stressors amongst the trainees and current expectations of a GP is testing their resilience. In recognition of this, we have implemented changes in the way we design education sessions for our GP Trainees.
Our final year trainees meet almost once weekly for 4 hours for these sessions. We continued inviting our secondary care (hospital-based) colleagues to speak about updates in their speciality. In addition to this, we have incorporated sessions to address the “softer skills” of being a GP such as medical humanities, medicine and the arts, as well as lifestyle medicine; sessions for “resilience” such as team building, small group work and mindfulness; “exam support” focusing on tips on how to pass the exams; and “career planning” such as practice management, CV writing, job applications and finances.
Have our changes equipped them sufficiently to be a happy and confident GP in today’s world?
We performed a retrospective survey of our recently qualified GPs who trained in our local training area to answer the question above.
Based on these results, we look to further develop our educational sessions to prepare our next generation of GPs for a sustainable and fulfilling career in family medicine.
As training programme directors (TPDs), we have seen increased stressors amongst the trainees and current expectations of a GP is testing their resilience. In recognition of this, we have implemented changes in the way we design education sessions for our GP Trainees.
Our final year trainees meet almost once weekly for 4 hours for these sessions. We continued inviting our secondary care (hospital-based) colleagues to speak about updates in their speciality. In addition to this, we have incorporated sessions to address the “softer skills” of being a GP such as medical humanities, medicine and the arts, as well as lifestyle medicine; sessions for “resilience” such as team building, small group work and mindfulness; “exam support” focusing on tips on how to pass the exams; and “career planning” such as practice management, CV writing, job applications and finances.
Have our changes equipped them sufficiently to be a happy and confident GP in today’s world?
We performed a retrospective survey of our recently qualified GPs who trained in our local training area to answer the question above.
Based on these results, we look to further develop our educational sessions to prepare our next generation of GPs for a sustainable and fulfilling career in family medicine.
Takeaways
1. How, as TPDs, our medical education sessions during GP training years can help prepare newly qualified GPs for the "real world".
2. What are the current needs of today’s generation of GPs
3. What did the newly qualified GPs value during their training years.
2. What are the current needs of today’s generation of GPs
3. What did the newly qualified GPs value during their training years.
Biography
Shu Li Tan is a General Practitioner, a Training Programme Director (TPD) in GP education and a GP trainer in Hampshire, UK. She works at a medium-sized GP practice as a GP partner. She has interest in medical education and has a role as a GP TPD where she is involved in providing education sessions to GP trainees in her local region. She is also a GP trainer.
Dr Darcelle Shouw
Snr Researcher
University of Stellenbosch
Evaluating the implementation of online research training and mentorship among early career family physicians in sub Saharan Africa
3:10 PM - 3:15 PMSummary
Background
Research is needed to improve the performance of primary health care. In Africa, few family physicians conduct research, and therefore an online research training and mentorship programme was developed to build research capacity amongst novice and early career researchers.
Aim
To evaluate the implementation of the AfriWon Research Collaborative (ARC) training and e-mentorship programme in Sub-Saharan Africa.
Methods
A 10-module online curriculum was supported by peer and faculty e-mentorship, to mentor participants in writing a research protocol. A convergent mixed methods study combined quantitative and qualitative data to evaluate nine implementation outcomes.
Findings
Fifty-three participants (20 mentees, 19 peer mentors and 14 faculty mentors), mostly male (70%), participated in the ARC online programme. The programme was seen as an acceptable and appropriate initiative. Mentees were mostly postgraduate students from African countries. Faculty mentors were mostly experienced researchers from outside of Africa. There were issues with team selection, orientation, communication and role clarification. Only 35% of the mentees completed the programme. Alignment of mentoring in teams and engagement with the online learning materials was an issue. Costs were relatively modest and dependent on donor funds.
Conclusion
Despite many challenges, the majority of participants supported the sustainability of the programme. The evaluation highlights the strengths and weaknesses of the ARC programme and e-mentoring. The ARC working group needed to ensure better organisation and leadership of the teams. Going forward the programme should focus more on developing peer mentors and local supervisory capacity as well as the mentees.
Research is needed to improve the performance of primary health care. In Africa, few family physicians conduct research, and therefore an online research training and mentorship programme was developed to build research capacity amongst novice and early career researchers.
Aim
To evaluate the implementation of the AfriWon Research Collaborative (ARC) training and e-mentorship programme in Sub-Saharan Africa.
Methods
A 10-module online curriculum was supported by peer and faculty e-mentorship, to mentor participants in writing a research protocol. A convergent mixed methods study combined quantitative and qualitative data to evaluate nine implementation outcomes.
Findings
Fifty-three participants (20 mentees, 19 peer mentors and 14 faculty mentors), mostly male (70%), participated in the ARC online programme. The programme was seen as an acceptable and appropriate initiative. Mentees were mostly postgraduate students from African countries. Faculty mentors were mostly experienced researchers from outside of Africa. There were issues with team selection, orientation, communication and role clarification. Only 35% of the mentees completed the programme. Alignment of mentoring in teams and engagement with the online learning materials was an issue. Costs were relatively modest and dependent on donor funds.
Conclusion
Despite many challenges, the majority of participants supported the sustainability of the programme. The evaluation highlights the strengths and weaknesses of the ARC programme and e-mentoring. The ARC working group needed to ensure better organisation and leadership of the teams. Going forward the programme should focus more on developing peer mentors and local supervisory capacity as well as the mentees.
Takeaways
1. Strength's and weakness of conducting e-mentorship
2. Process in conducting online mentorship and training for early career family physicians
2. Process in conducting online mentorship and training for early career family physicians
Biography
I am a senior researcher and a registered Biokineticist, specializing in the prevention and control of risk factors associated with non-communicable chronic diseases. My experience includes implementation science, preventative medicine, chronic disease management, orthopedic rehabilitation, behavior change counselling, systems thinking, mentoring, speaking, and presenting. I am self- driven, creative, motivated, passionate, out of the box thinker and innovator. I have 21-year corporate experience and have success in developing a healthy choices at work program (HCWP), associated with clinically significant improvements in behavioral, metabolic and psychosocial risk factors for non- communicable diseases.
Dr Michito Sadohara
Assistant Professor
Kumamoto University Hospital
The educational impact of fieldwork and lodging trip for medical students who have obligation to work at rural area
3:15 PM - 3:20 PMSummary
[Introduction] Kumamoto University Hospital provides a special program of summer field work and lodging trip at rural area as an extra-curricular activity for medical students who have obligation to work at rural area. “Knowing the community” is the aim of program for students who will work there in future. The schedule consists of followings: preliminarily searching about regional medical/welfare, industrial and tourism resources based on administrative materials; visiting to medical, care facilities and town offices as fieldwork; presentation of results learned. [Purpose] The purpose of this study was to estimate educational impacts on community medicine by rural exposure for medical students. [Methods] Two-day trip to rural area was held in 2019. All of 26 participants answered the self-administered questionnaire. The questionnaire included statements asking about their perspectives on the area and community medicine (12 items, 10cm Visual Analogue Scale) and self-evaluation of knowledge comprehension (20 keywords, six rating) comparing before and after the program. [Results] In terms of views on the community, points significantly increased for items including “community medicine has some dream”, “comfortable to live in rural area”, “want to work in area of doctor shortage”, “ready to take their roles in rural medicine in the future”, “highly expected from the community”. Self-rating of points for knowledge significantly increased in 18 for 20 keywords such as “community-based integrated case system”, “regional healthcare vision”, “medical cooperation between facilities”, “muti- and inter-professional collaboration”, “team-based health care”, “home care and visiting care”, “shortage and maldistribution of doctors in rural area”, “aging society with fewer children”, “death-ridden society”, “health life expectancy”, “health promotion campaign”, “marginal village”, and “advance care planning”. [Conclusion] Fieldwork to rural area had educational effects to increase favorable perception and knowledge toward community medicine for medical students.
Takeaways
1. Rural exposure has a certain educational impact for medical students.
2. Visiting the field and knowing the community promote medical students' favorable perceptions towards community medicine.
3. Rural visiting and fieldwork deepen medical students' knowledge concerning community medicine.
2. Visiting the field and knowing the community promote medical students' favorable perceptions towards community medicine.
3. Rural visiting and fieldwork deepen medical students' knowledge concerning community medicine.
Biography
Michito Sadohara is an academic, clinician-educator, researcher. Michito belongs to department to develop and support carrier-path for medical students and graduates who have post-graduation obligation to work in rural area.
