Formal assessment of the educational environment experienced by interns placed in rural hospitals in Western Australia.

INTRODUCTION: Increased numbers of rural hospital rotations for interns (first postgraduate year) are being created in Western Australia (WA). This study utilised the Postgraduate Hospital Educational Environment Measure (PHEEM), an internationally validated multidimensional questionnaire, to assess and compare the educational environment of five new or established rural sites and an urban teaching hospital. METHODS: The PHEEM was modified slightly: to make language appropriate for the WA context and to collect information about intern location. It was administered at the completion of each 10-week term over the first postgraduate year in 2009. RESULTS: A total of 147 completed PHEEM questionnaires were returned from 74 interns, evaluating a maximum of 210 individual 10-week terms (105 each from urban and combined rural). Average completion time was 6.4 minutes. The median score for teaching was 45.0 (interquartile range 39.0, 50.0) in rural locations and 43.0 (37.5, 46.0) in urban locations (p=0.046). The median scores for autonomy were 39.0 (35.0, 45.0) and 39.0 (36.0, 41.5) (p=0.672) and for support median scores 33.0 (28.0, 35.0) and 31.0 (28.0, 33.0) (p=0.019) in rural and urban locations respectively. CONCLUSION: This study has utilised an Australian-appropriate version of the PHEEM and has provided the first confirmation that, in terms of educational environment, rural intern rotations compare favourably with those in urban settings in WA.

Regionalisation of general practice training--are we meeting the needs of rural Australia?

The concept of "social accountability" has underpinned the development of many medical education programs over the past decade. Success of the regionalisation of the general practice training program in Australia will ultimately be measured by the ability of the program to deliver a sufficient rural general practice workforce to meet the health needs of rural communities. Regionalisation of general practice training in Australia arose from the 1998 recommendations of the Ministerial Review of General Practice Training. The resultant competitive structure adopted by government was not the preferred option of the Review Committee, and may be a negative influence on rural workforce, as the competitive corporate structure of regional training providers has created barriers to meaningful vertical integration. Available data suggest that the regionalised training program is not yet providing a sustainable general practice workforce to rural Australia. The current increase in medical student and general practice training places provides an opportunity to address some of these issues. In particular, it is recommended that changes be made to registrar selection processes, the rural pipeline and vertical integration of training, and training for procedural rural practice. To achieve these goals, perhaps it is time for another comprehensive ministerial review of general practice training in Australia.

Future models of general practice training in Australia.

Current proposals for significant primary health care reform in Australia create a timely opportunity to reflect on the education and training requirements of future general practitioners. Australian general practice will become increasingly team-based, with growing emphasis on coordinated care, chronic disease management, and disease prevention and self-management, while maintaining its focus on delivering high-quality, patient-centred care. This will require cost-effective application of new technologies and information management systems within new models of delivering health care. Future models of general practice training must respond to these new ways of working to ensure general practice remains an attractive career choice and training programs graduate doctors who are equipped to meet the health needs of Australians. This article discusses potential development of new general practice vocational training models in Australia. This includes hospital rotations that are more directly integrated with general practice placements and have greater emphasis on the needs of the future general practice workforce; and an extension of the training program to 4 years with a final year tailored to future career plans including development of expertise in practice management, specific clinical disciplines or academic skills.

GP 'grand round' - a hospital tradition modified for general practice.

BACKGROUND: The hospital 'grand round' concept was applied to a general practice continuing professional development activity. Interactive learning sessions were developed to deliver evidence based medicine clinical education for general practitioners and general practice learners (registrars/medical students). The acceptability of the GP grand round format was examined through analysis of participant responses to learning objectives. OBJECTIVE: The article explores some of the issues associated with delivery of small group case based discussion. DISCUSSION: Evaluations demonstrated that participants in the grand round valued the opportunity to interact with other participants in a small group format, exchanged and shared knowledge and had their learning needs met. The overall quality of the learning experience for the majority of participants was either good or excellent. The application of vertically integrated continuing professional development through a grand round format appears acceptable and effective.