Rural practice 6
Track 12
| Saturday, October 28, 2023 |
| 2:00 PM - 3:15 PM |
| Meeting Room C4.4 |
Speaker
Prof Wendy Norman
Professor And Family Planning Research Chair
University of British Columbia
How far is too far: considerations for safe medical abortion care for residents living 4+ hours from emergency services
2:00 PM - 2:55 PMSummary
Audience members will join international experts for a lively discussion exploring considerations for the provision of medical abortion care for residents living in very remote locations.
The Problem:
The rare outcome of massive hemorrhage following medication abortion (one in a thousand cases, often occurring weeks later), drives current cautions to restrict medical abortion to those living close to emergency services. However, people in rural and remote areas could benefit greatly from closer-to-home access to abortion care through provision of medical abortion. Evidence is needed so patients and their health care providers do not need to guess on safe parameters for care, or undertake unnecessary risks or travel.
The Evidence:
Panel experts will summarize current clinical practice guidelines from a range of countries on the provision of medical abortion for residents living 4 hours or more from emergency services (e.g., a transfusion service and surgical facilities capable of uterine evacuation). Evidence from the world literature will then be presented.
Steps to solutions:
Audience members will join the panel to explore considerations for clinical practice, and personal and professional contexts that should be factored in to the counselling and provision of abortion care for residents living in very remote locations. Finally we will summarize the discussions and identify areas that need future research to address evidence gaps.
The Problem:
The rare outcome of massive hemorrhage following medication abortion (one in a thousand cases, often occurring weeks later), drives current cautions to restrict medical abortion to those living close to emergency services. However, people in rural and remote areas could benefit greatly from closer-to-home access to abortion care through provision of medical abortion. Evidence is needed so patients and their health care providers do not need to guess on safe parameters for care, or undertake unnecessary risks or travel.
The Evidence:
Panel experts will summarize current clinical practice guidelines from a range of countries on the provision of medical abortion for residents living 4 hours or more from emergency services (e.g., a transfusion service and surgical facilities capable of uterine evacuation). Evidence from the world literature will then be presented.
Steps to solutions:
Audience members will join the panel to explore considerations for clinical practice, and personal and professional contexts that should be factored in to the counselling and provision of abortion care for residents living in very remote locations. Finally we will summarize the discussions and identify areas that need future research to address evidence gaps.
Takeaways
1. A synopsis of international clinical practice guidelines for the maximum distance to emergency care recommended for provision of medical abortion. 2. Considerations for counselling and clinical care of patients requesting medical abortion when distance to emergency care is 4 hours or more. 3. Reflect on the potential solutions, and next steps required by clinicians and research to ensure safe and appropriate provision of abortion to residents of remote locations.
Biography
Wendy V. Norman, MD, CCFP, FCFP, DTM&H, MHSc, is a Professor in the Department of Family Practice at the University of British Columbia. Dr. Norman founded and leads Canada’s Contraception & Abortion Research Team (CART www.cart-grac.ubc.ca) which convenes government, health system and service decision makers with national family planning organizations, and researchers and health professionals representing a wide range of disciplines. Dr. Norman holds Canada’s only federal Chair in Family Planning Research, and was awarded the prestigious Darroch Award for sexual and reproductive health policy research in January 2016 by the New York-based Guttmacher Institute. In 2021, Dr. Norman received the inaugural National Mentorship Award of the Society of Obstetricians and Gynecologists of Canada, and was named a "Woman of Impact" by the Canadian Government.
Dr Hamish Eske
Doctor
SA Health - RMCLHN
How can practicing rural general practitioners collaborate with a rural hospital network to rapidly increase the rural medical workforce?
3:00 PM - 3:15 PMSummary
Aim
The Covid-19 pandemic has exacerbated the medical workforce maldistribution in rural Australia and decreased enrolments in general practice training. The Riverland region of South Australia has successfully reversed this trend. This presentation seeks to understand why.
Content
The Riverland region of South Australia, with 12 small hospitals and associated private general practices serving 65,000 people, has been at the forefront of rural medical student training for 25 years through Flinders University’s Parallel Rural Community Curriculum. However, there was minimal postgraduate training, so most graduates developed careers elsewhere.
In 2021, the region’s general practices and the local public health service, the Riverland Mallee Coorong Local Health Network (RMCLHN), all significantly affected by medical workforce shortages, decided to take responsibility together for creating their own medical workforce by implementing the National Rural Generalist Pathway. The first step was to develop the postgraduate component of the pathway by creating the Riverland Academy of Clinical Excellence (RACE).
The RACE medical pathway was designed and led by practicing rural GPs to take advantage of local strengths and integrate private general practice and hospital experience throughout the junior doctor and registrar years. Interns are offered a length of training contract by the LHN, contingent on them joining either the RACGP or ACRRM training programs, that enables them to accrue and take advantage of ongoing employment benefits whilst undertaking both hospital and general practice training.
The RACE program has achieved full accreditation and recruited 26 locally trained Trainee Medical Officers who are pursuing general practice training in its first two years. This has resulted in an immediate increase of over 20% in the medical workforce (public and private) in the region.
Goals
This presentation will explain the pedagogic, philosophical and practical rationales behind this success story.
The Covid-19 pandemic has exacerbated the medical workforce maldistribution in rural Australia and decreased enrolments in general practice training. The Riverland region of South Australia has successfully reversed this trend. This presentation seeks to understand why.
Content
The Riverland region of South Australia, with 12 small hospitals and associated private general practices serving 65,000 people, has been at the forefront of rural medical student training for 25 years through Flinders University’s Parallel Rural Community Curriculum. However, there was minimal postgraduate training, so most graduates developed careers elsewhere.
In 2021, the region’s general practices and the local public health service, the Riverland Mallee Coorong Local Health Network (RMCLHN), all significantly affected by medical workforce shortages, decided to take responsibility together for creating their own medical workforce by implementing the National Rural Generalist Pathway. The first step was to develop the postgraduate component of the pathway by creating the Riverland Academy of Clinical Excellence (RACE).
The RACE medical pathway was designed and led by practicing rural GPs to take advantage of local strengths and integrate private general practice and hospital experience throughout the junior doctor and registrar years. Interns are offered a length of training contract by the LHN, contingent on them joining either the RACGP or ACRRM training programs, that enables them to accrue and take advantage of ongoing employment benefits whilst undertaking both hospital and general practice training.
The RACE program has achieved full accreditation and recruited 26 locally trained Trainee Medical Officers who are pursuing general practice training in its first two years. This has resulted in an immediate increase of over 20% in the medical workforce (public and private) in the region.
Goals
This presentation will explain the pedagogic, philosophical and practical rationales behind this success story.
Takeaways
At the conclusion of this presentation, attendees will take away an understanding of
1. how rural general practitioners can lead collaboration with local hospitals to take control of their medical workforce supply chain
2. what local factors have been especially attractive to junior doctors
3. what unexpected bonuses have occurred as a result of this initiative.
1. how rural general practitioners can lead collaboration with local hospitals to take control of their medical workforce supply chain
2. what local factors have been especially attractive to junior doctors
3. what unexpected bonuses have occurred as a result of this initiative.
Biography
Professor Paul Worley is a practicing rural doctor, the Executive Director Clinical Innovation for Riverland Mallee Coorong Local Health Network and a Board Director of the RFDS and MIGA. A Fellow of the Australian Academy of Health and Medical Sciences, Professor Worley continues to lead rural medical education and workforce programs that he has previously championed as Dean of Medicine at Flinders University and the inaugural National Rural Health Commissioner.
