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THE EXPANDING ROLE OF THE RURAL GENERALIST IN AUSTRALIA – A SYSTEMATIC REVIEW. Chater B., Murray R., White C., Erikson L., Du Rietz M., Sheedy V., Pashen D. Australian College of Rural and Remote Medicine . APHCRI Stream Six.

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the expanding role of the rural generalist in australia a systematic review

THE EXPANDING ROLE OF THE RURAL GENERALISTIN AUSTRALIA – A SYSTEMATIC REVIEW

Chater B., Murray R., White C., Erikson L., Du Rietz M., Sheedy V., Pashen D.

Australian College of Rural and Remote Medicine

APHCRI Stream Six

http://www.anu.edu.au/aphcri/Spokes_Research_Program/Stream_Six.php

aim of our systematic review
Aim of our systematic review
  • To define generalist practice in Australian Rural and Remote context
  • To identify the factors which promote or inhibit generalism and generalist practice in rural and remote health
  • To investigate the policy arrangements which impact on generalist practice
  • To recommend policy options that could increase the quality and quantity of rural generalists

Australian College of Rural and Remote Medicine

methods
Methods
  • Systematic review of the literature (grey and black)
  • Consultation with policy makers - state and federal
  • Consultation with communities and the profession

Australian College of Rural and Remote Medicine

medical generalist roles in rural and remote areas
Medical Generalist roles in rural and remote areas
  • Rural generalist offer acceptable, sustainable and cost effective primary health care, anaesthetics, obstetrics, emergency and procedural skills

Australian College of Rural and Remote Medicine

funding rural generalism
Funding Rural Generalism
  • Primary health care is equity producing and ‘generalist’ services are cost effective and sustainable for rural communities.
  • Perverse incentives favouring specialist and sub-specialist practice undermine generalist career choices

Australian College of Rural and Remote Medicine

quality and safety in rural health care
Quality and safety in rural health care
  • Heath outcomes in small rural hospitals - notably in obstetrics - are equivalent to those in major centres, particularly compared with ‘travel-out’ alternatives.

Australian College of Rural and Remote Medicine

service models and regulatory framework
Service models and regulatory framework
  • Generalist workforce, viable service models and regulatory frameworks are linked.
  • Models of delegated practice should be explored for both mid-level providers and for specialist substitution by generalists

Australian College of Rural and Remote Medicine

conclusion from the review
Conclusion from the review
  • The international literature supports the efficacy and safety of rural medical generalist practice.

Australian College of Rural and Remote Medicine

policy options to support rural medical generalist practice
Policy options to support rural medical generalist practice
  • Support for increasing teaching capacity
  • Regional planning
  • Incentives for generalist training and practice
  • Clearly articulated generalist training pathways
  • Infrastructure support
  • Integrated practice models

Australian College of Rural and Remote Medicine

education and training for generalism
Education and training for generalism
  • Rural and regional recruitment and medical training along the rural ‘pipeline’ enhances retention in rural areas and generalist career choices.
  • Regionally planned medical

workforce production is a

key policy goal.

  • Access to hospitals for training

and professional development is a critical challenge

Australian College of Rural and Remote Medicine

slide13
Key issues within the medical education sector that have been identified as enablers of generalism include:

1. Medical student selection and admission policies

2. Generalist curricula

3. Generalist representation on medical school faculty

4. Generalist involvement in learning experiences at teaching hospitals (urban and rural) and in the community

5. Exposure to the broad scope of rural generalist experience at medical school, in prevocational and vocational levels

6. Vertical integration of generalist training;

7. Multidisciplinary focus

8. Need for generalists to have a greater teaching role

9. Recognition for medical generalism as a discipline

Australian College of Rural and Remote Medicine

some issues to consider
Some issues to consider
  • Live in/Fly out training
  • Addressing spouse’s preferences
  • Career planning
  • Integration of initiatives
    • Vertically
    • Regionally
  • Recognition of prior learning
  • Vocational recognition for generalist skills
  • Infrastructure – accommodation, consulting space, IT
  • Aging trainers
  • The future of generalist specialists
    • Emergency medicine
    • Physicians
    • Surgeons

Australian College of Rural and Remote Medicine

generalism
Generalism

Jack of all trades

Master of none

But oft times better

Than master of one

Australian College of Rural and Remote Medicine

contacts
Contacts
  • ACRRM Ph: 1800 223 226

Fax: 07 3105 8299

  • Contact

Assoc Prof Bruce Chater : chater@attglobal.net

Ph.+61 419674164

Assoc Prof Dennis Pashen: dennis.pashen@jcu.edu.au.

Ph. +61 418 771 441

  • Research Group also included .
    • Vicki Sheedy ACRRM –Principle Research Officer
    • Col White (Health Workforce Queensland) – Data Research
    • Lars Erickson (UQ) – Librarian, Literature Review.
    • Richard Murray ACRRM/JCU - Researcher

http://www.anu.edu.au/aphcri/Spokes_Research_Program/Stream_Six.php

Australian College of Rural and Remote Medicine