Patient perceptions of innovative longitudinal integrated clerkships based in regional, rural and remote primary care: a qualitative study.

BACKGROUND: Medical students at the University of Wollongong experience continuity of patient care and clinical supervision during an innovative year-long integrated (community and hospital) clinical clerkship. In this model of clinical education, students are based in a general practice 'teaching microsystem' and participate in patient care as part of this community of practice (CoP). This study evaluates patients' perceptions of the clerkship initiative, and their perspectives on this approach to training 'much-needed' doctors in their community. METHODS: Semi-structured, face-to-face, interviews with patients provided data on the clerkship model in three contexts: regional, rural and remote health care settings in Australia. Two researchers independently thematically analysed transcribed data and organised emergent categories into themes. RESULTS: The twelve categories that emerged from the analysis of transcribed data were clustered into four themes: learning as doing; learning as shared experience; learning as belonging to a community; and learning as 'becoming'. Patients viewed the clerkship learning environment as patient- and student-centred, emphasising that the patient-student-doctor relationship triad was important in facilitating active participation by patients as well as students. Patients believed that students became central, rather than peripheral, members of the CoP during an extended placement, value-adding and improving access to patient care. CONCLUSIONS: Regional, rural and remote patients valued the long-term engagement of senior medical students in their health care team(s). A supportive CoP such as the general practice 'teaching microsystem' allowed student and patient to experience increasing participation and identity transformation over time. The extended student-patient-doctor relationship was seen as influential in this progression. Patients revealed unique insights into the longitudinal clerkship model, and believed they have an important contribution to make to medical education and new strategies addressing mal-distribution in the medical workforce.

Early driving experience and influence on risk perception in young rural people.

Young people, particularly males and those from a rural area, are over represented in road crashes; this occurs in vehicle dependent countries around the world, including Australia. The attitudes, experiences and behaviours of young drivers are some of the key factors which affect their potential to have an early on road driving experience that is crash free. This paper considers the views of young people, some of whom were brought up on rural properties, and had significant, responsible roles in agricultural work, including task related driving from a very early age. This early responsibility and associated awareness of risk of injury in farm related tasks can affect risk perception and impact on later risk taking behaviours. Ten focus groups were conducted with young people attending schools in four towns in rural New South Wales, Australia. These were recorded and analysed using qualitative methodology. The results indicate that risk factors in driving, on and off road, are clearly identified and understood; the majority of young people in rural areas are not "high" risk takers or sensation seekers. They also indicate that, in rural NSW, early vehicle handling, before the age for obtaining a license for driving on roads, is customary practice within the community. Attitudes towards speeding, however, reflect that it is tolerable behaviour, and almost inevitable, and often not considered to be risky. Drink driving is considered more risky, and less acceptable, at both the personal and community levels. Future intervention strategies to reduce crash rates in young rural drivers should aim to address the attitudes and actions associated with speeding on rural roads.