Lucie Walters, Jennene Greenhill, Janet Richards, Helena Ward, Narelle Campbell, Julie Ash & Lambert WT Schuwirth

Outcomes of longitudinal integrated clinical placements for students, clinicians and society

Time to Heal: American Medical Education From the Turn of the Century to the Era of Managed Care

PurposeThe authors conducted a systematic review of the medical literature to determine the factors most strongly associated with localizing primary care physicians (PCPs) in underserved urban or rural areas of the United States.MethodIn November 2015, the authors searched databases (MEDLINE, ERIC,

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Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review.

Access to well trained and motivated health workers is the major rural health issue. Without local access, it is unlikely that people in rural and remote communities will be able to achieve the Millennium Development Goals. Studies in many countries have shown that the three factors most strongly associated with entering rural practice are: (i) a rural background; (ii) positive clinical and educational experiences in rural settings as part of undergraduate medical education; and (iii) targeted training for rural practice at the postgraduate level. This paper presents evidence for policy initiatives involving the training of medical students from, in and for rural and remote areas. We give examples of medical schools in different regions of the world that are using an evidence-based and context-driven educational approach to producing skilled and motivated health workers. We demonstrate how context influences the design and implementation of different rural education programmes. Successful programmes have overcome major obstacles including negative assumptions and attitudes, and limitations of human, physical, educational and financial resources. Training rural health workers in the rural setting is likely to result in greatly improved recruitment and retention of skilled health-care providers in rural underserved areas with consequent improvement in access to health care for the local communities.

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Context counts: training health workers in and for rural and remote areas

Introduction Despite the substantial differences between developing and developed countries, the key themes in rural health are the same around the world Access is the major rural health issue Even in countries where the majority of the population lives in rural areas, the resources are concentrated in the cities All countries have difficulties with transport, communication, services and resources, and they all face the challenge of shortages of healthcare providers in rural and remote areas (1) This paper outlines how medical schools in different regions of the world are using an evidence-based and context-driven approach to training health workers for rural and remote areas We give examples of how context influences the design and implementation of different rural education programmes and highlight major challenges to success The importance of rural training Training for rural practice has become critically important in the context of continuing serious shortages of doctors and other health workers in rural areas and recognition that "the overflow effect" does not happen Producing more health-care providers and expecting the excess to spill over from the cities into rural areas has been shown not to solve the rural medical workforce shortage (2) In fact, no single strategy is likely to be successful Rather, multiple strategies are required at different levels of education and training each of which have a small effect and contribute to an overall substantial change) One key series of initiatives that has been shown to be effective involves rural-based medical education (4-7) To appreciate the requirements of rural training, it is necessary to understand rural communities, their health service needs and the nature of rural practice There are a series of key parameters that provide the framework which determines the structure and function of rural health services, how rural practitioners work and the nature of rural practice These parameters or "rural realities" are: geography and demography; the rural culture; rural morbidity and mortality patterns; resource limitations; and workforce shortages (8) Since the mid-1980s, research evidence has been accumulating regarding the specific range of knowledge and skills required by rural practitioners This has led to the inclusion of specific curriculum content on rural health and rural practice in undergraduate medical programmes and in rural-based family medicine residency programmes (8-10) When compared to their metropolitan counterparts, rural practitioners carry a heavier workload, provide a wider range of services and carry a higher level of clinical responsibility in relative professional isolation (11) These characteristics hold true for all rural practitioners whether they are doctors, nurses, pharmacists or other health workers Also, as rural practitioners are members of the community that they serve, they have a significant public health role that may range from issues such as clean water and sanitation to community health education Initially, the development of rural clinical placements by medical schools was driven by the workforce imperative, ie the serious shortfall of practitioners that creates an urgency to improve recruitment The expectation was that experience in rural settings would encourage a future interest in rural practice Subsequently research evidence demonstrated that this expectation was justified Studies have shown that the three factors most strongly associated with entering rural practice are: (i) a rural background; (ii) positive clinical and educational experiences in rural settings as part of undergraduate medical education; (iii) targeted training for rural practice at the postgraduate level, (7,12-20) In addition, there is evidence that academic involvement (teaching and research) is both a retention and recruitment factor for physicians (62021) In response to the shortage of rural doctors, various medical schools across the world have developed innovative approaches to producing doctors with the knowledge, skills and commitment to practice in underserved, rural and remote regions …

Context Counts: Training Health Workers in and for Rural and Remote areas/De L'importance Du Contexte: La Formation De Professionnels De la Sante Dans et Pour Les Zones Rurales et isolees/La Importancia del Entorno: Formacion De Profesionales De la Salud En Y Para Areas Rurales Alejadas

Purpose To systematically review the outcomes of comprehensive medical school programs designed to increase the rural physician supply, and to develop a model to estimate the impact of their widespread replication. Method Relevant databases were searched, from the earliest available date to October 2006, to identify comprehensive programs (with available rural outcomes), that is, those that had (1) a primary goal of increasing the rural physician supply, (2) a defined cohort of students, and (3) either a focused rural admissions process or an extended rural clinical curriculum. Descriptive methodology, definitions, and outcomes were extracted. A model of the impact of replicating this type of program at 125 allopathic medical schools was then developed. Results

http://krhis.kdhe.state.ks.us/olrh/Notices.nsf/bf25ab0f47ba5dd785256499006b15a4/79edbd02248881d486257402005295c7/$FILE/Medical%20Schools%20and%20Rural%20Physicians.pdf

Medical school programs to increase the rural physician supply: a systematic review and projected impact of widespread replication.

Increasing prevalences of obesity and type 2 diabetes (T2DM) increase cardiovascular risks. Since poor diet and inadequate exercise are primary behavioral causes of obesity and T2DM, our objective was to examine health beliefs and associations with diet, exercise, and metabolic syndrome (MetSyndr) characteristics. A total of 117 overweight and obese family medicine patients enrolled in this study. Subjects completed questionnaires for health beliefs and vegetable, fruit, and fat intake; other data were from medical charts. Seventy-four percent of subjects were women; 69% were black, 72% were obese, 36% were hypertensive, 22% had T2DM, and 23% had hypertriglyceridemia. MetSyndr subjects had significantly higher triglyceride levels and a higher percentage of hypertension and T2DM. Although not statistically significant, overweight subjects without MetSyndr had higher vegetable and fruit intake and lower fat intake than obese subjects without MetSyndr and subjects with MetSyndr. More exercise was associated with less MetSyndr and less obesity; however, this also was not statistically significant. For health beliefs, there were no significant differences between subjects with MetSyndr versus those without MetSyndr or for subjects without MetSyndr who were obese versus those who were overweight. However, for subjects with above-median nutrition scores and exercise, scores were significantly higher for the health belief "certainty" compared to those with below-median scores (P < .0001). This research suggests that health beliefs and specifically less certainty may be a useful marker for individuals who require more education and/or training. Effective programs that address certainty may promote better diets, more exercise, and reduced cardiovascular risk.

https://journals.sagepub.com/doi/pdf/10.1177/2150131910381784

Health beliefs and their associations with dietary intake, exercise, and metabolic syndrome characteristics in an overweight and obese family medicine population.

Jeremy R. Wortman

Papers

Medical school programs to increase the rural physician supply: a systematic review and projected impact of widespread replication.

Health beliefs and their associations with dietary intake, exercise, and metabolic syndrome characteristics in an overweight and obese family medicine population.