Educational needs of Australian rural and remote doctors for intermediate obstetric ultrasound and emergency medicine ultrasound.

INTRODUCTION: The aim of this research was to determine the educational needs of Australian rural and remote doctors for intermediate obstetric ultrasound and emergency medicine ultrasound. The main research questions were: what educational topics would rural and remote doctors prefer to learn about in intermediate obstetric ultrasound and emergency medicine ultrasound, and what were those doctors' preferred methods of delivery for an ultrasound education program. METHOD: A self-administered postal questionnaire containing a pre-paid return envelope was mailed to 344 Australian rural and remote doctors in December 2003. RESULTS: 107 completed questionnaires were returned, giving a response rate of 32.7%. This was after the denominator was adjusted for the 17 doctors whose letters were returned to sender. The respondents included 23 (21.5%) female and 84 (78.5%) male doctors. Eighty doctors (74.8%) stated that they used ultrasound, and 27 (25.2%) said they did not. Seventy-seven (72%) indicated they had previously participated in some ultrasound education and training. The respondents stated that their main areas of educational need in intermediate obstetric ultrasound were ectopic pregnancy (76.6%), miscarriage (72%), intrauterine growth restriction (65.4%), transvaginal scanning (47.7%), detecting fetal abnormalities (47.7%) and morphology scanning at 18-20 weeks (41.1%). The main areas of educational need in emergency medicine ultrasound were focused abdominal sonography in trauma (63.5%), detecting foreign bodies (40.2%), gynecological ultrasound (39.2%), gall bladder and biliary tract (37.4%), abdominal aortic aneurysm (32.7%) and trauma bleeding (31.7%). CONCLUSION: Australian rural and remote doctors are using ultrasound technology to improve the clinical investigation and diagnosis of a large variety of clinical conditions in their family medical practices. This paper describes the results of research into the educational needs of this target group of doctors.

Obstacles and solutions to maintenance of advanced procedural skills for rural and remote medical practitioners in Australia.

INTRODUCTION: Most rural communities are too small and remote to sustain specialist services, and therefore some rural and remote doctors in Australia practice advanced procedural skills as part of their comprehensive care to underserved rural communities. The declining number of rural and remote procedural non-specialist doctors poses a problem in Australia. There is, at present, no comprehensive delineation of the obstacles Australian rural doctors face in trying to maintain their skills in the procedural areas of obstetrics, anaesthetics and surgery, nor of the solutions that may overcome the problems. This literature review addresses these two needs. METHODS: We interrogated the MEDLINE database to find articles about rural and remote medical education, with a specific focus on procedural skills. Other sources, including Google Scholar, were used to find relevant project and conference reports. RESULTS: The barriers to the maintenance of advanced procedural skills for rural and remote medical practitioners include: lack of opportunity; expense associated with remaining skilled in advanced procedural areas; lack of access to locum relief to attend educational sessions; lack of flexible options for education; lack of access to advanced procedural training; time constraints; multiple credentialing requirements from state health departments and joint consultative committees; family obstacles; and perceived medico-legal problems. Retention of rural doctors and the difficulties faced by them in maintaining advanced procedural skills are related. There is evidence that both these problems can be addressed, at least in part, by increased support for flexible continuing medical education and professional development such as specific skills rural training programs, the availability of group practice opportunities, improved hospital facilities, reasonable workloads, financial incentives, locum assistance, improved housing quality, and better educational support for families. We also noted a positive association between dedicated rural training programs and the recruitment of rural doctors. Factors associated with these successful training programs include: rural fellowships, explicit rural mission, rural location, rural program directors, and procedural orientation. CONCLUSION: The authors investigated the obstacles rural and remote doctors currently face in obtaining and remaining skilled in procedural medicine. The article describes the main barriers and presents some solutions from the literature. It also highlights the areas where work is being done and highlights the need for more quality research in this area.

Evaluation of the ACRRM national radiology program for Australian rural and remote medical practitioners.

INTRODUCTION: In 2000, the Australian College of Rural and Remote Medicine (ACRRM) developed a national radiology quality assurance (QA) and continuing medical education (CME) program for rural and remote non-specialist Australian doctors. The program commenced on 1 January 2001. It required rural doctors to obtain 30 radiology QA/CME points over a 4 year period. At least 15-20 of these points had to be obtained by one of two mandatory options of the program, either: (1) film interpretation, report and review clinical audit activity; or (2) a radiology clinical attachment. METHOD: Doctors submitted their completed film review forms and clinical attachment logbooks to the program manager as confirmation of their educational activity to receive their professional development points. Data from film review forms and clinical attachment logbooks were de-identified and entered into two Microsoft EXCEL spreadsheets. The data were categorised and analysed in EXCEL. RESULTS: From 1 January 2001 to September 2004, 823 rural and remote doctors enrolled in the ACRRM radiology program. This included 281 locums who enrolled in the short-term locum option of the program and 563 doctors who enrolled in the full program. In September 2004, 419 doctors had completed a radiology film review with a radiologist and 41 doctors completed a radiology clinical attachment in 31 different public and private radiology practices. One hundred and ninety-five doctors completed the short-term locum activity. Ninety-two different specialist radiologists participated in the program and assisted rural and remote doctors to enhance their radiology knowledge, confidence and skills. This article describes results from the two mandatory activities. CONCLUSION: The evaluation of the ACRRM radiology program after its first 3 years and 9 months shows there are a large number of rural and remote Australian doctors undertaking professional development and quality assurance activities in radiology.

Breast cancer risk factors in Queensland women attending population-based mammography screening.

OBJECTIVE: To investigate the prevalence of established modifiable and non-modifiable risk factors associated with breast cancer in Queensland (Australia) women. STUDY DESIGN: Cross-sectional prevalence study of 9792 women (58% of women sent the questionnaire) attending BreastScreen Queensland Screening and Assessment Services between November 2008 and February 2009. Prevalence and 95% confidence intervals were calculated for each risk factor, stratified by age-group (45-49 years, 50-59 years, 60-69 years, ≥70 years). MAIN OUTCOME MEASURES: First-degree family history (FH) of breast cancer (mother, sister, daughter), reproductive history, behavioural factors, co-morbidities, use of hormone replacement therapy (HRT) and alternatives, and socio-demographic factors. RESULTS: The prevalence of first-degree FH of breast cancer was 16% and a previous diagnosis of breast cancer was 3.5%; both are considered major risk factors for breast cancer. The prevalence of modifiable breast cancer risk factors of moderate risk were: current HRT use (12%), HRT use within the past 5 years (7%), overweight [body mass index 25-29] (33%) or obesity [BMI>30] (27%), alcohol consumption [≥11 drinks/week] (10%), sedentary behaviour (70%), and low fruit (34%) and vegetable consumption (69%). These risk factors tended to be higher in younger women (45-49 years) compared to older women (>50 years). CONCLUSION: Prevalence of risk factors in Queensland women were largely consistent with other Australian and international studies. Hormone therapy use is lower than previously reported estimates in Australia and internationally. The comparatively high prevalence of modifiable lifestyle factors which have been shown to be moderately associated with breast cancer are potential targets for reducing the public health burden of breast cancer.

Evaluation of an ultrasound program (intermediate obstetric and emergency medicine) for Australian rural and remote doctors.

INTRODUCTION: This paper describes the evaluation of an intermediate obstetric ultrasound and emergency medicine ultrasound education workshop for rural and remote Australian doctors, which was developed in response to an educational needs assessment that showed an unmet need in this area. The workshop was held in four Australian states. The participants were 61 rural and remote doctors. METHODS: Data from pre- and post-workshop knowledge tests and general workshop evaluation were analysed. RESULTS: Sixty-one doctors attended an ultrasound workshop and self-reported increases in knowledge, confidence and expertise in ultrasound. The mean pretest score for 56 doctors who completed both the pre- and post-workshop knowledge tests was 31.6 and the post-test score mean was 33.3 out of a possible score of 44, which demonstrated a statistically significant increase in knowledge (P = 0.003). DISCUSSION AND IMPLICATIONS FOR PRACTICE: The evaluation of the workshop demonstrated that it was an effective way of increasing knowledge and confidence in intermediate obstetric ultrasound and emergency medicine ultrasound. The workshop was popular and received very positive feedback from the attendees.

Educational needs of rural and remote Australian non-specialist medical practitioners for obstetric ultrasound.

OBJECTIVE: To determine the educational needs of rural and remote non-specialist Australian doctors for obstetric ultrasound. DESIGN: Survey design. SETTING: The study surveyed rural and remote doctors practising in a variety of settings including general practice, rural hospitals, Aboriginal communities and flying doctor organisations throughout Australia. SUBJECTS: Subjects included 314 solo and group practice rural general practitioners, rural hospital medical superintendents, senior medical officers, Aboriginal community controlled health service doctors, flying doctors, rural locums, registrars and two rural obstetricians. A total of 55% of the subjects were general practitioners in group practice. Respondents included 68 (22%) women and 246 (78%) men. RESULTS: The response rate was 32%. The highest priority areas of need for education included detecting foetal abnormalities and anomalies (19.1%), basic routine ultrasonography (17.17%), placental position (17.17%), dating (17.17%), foetal viability (12.88%) and morphology scan (12.26%). The main areas where doctors stated they lacked confidence included detecting foetal abnormalities (29.09%), basic routine ultrasonography (including machine use), such as, carrying out and interpreting obstetric ultrasound scans (27.27%), morphology scans (16.36%) and placental position (14.54%). CONCLUSION: The study showed there was a large unmet need for education in obstetric ultrasound among rural and remote non-specialist doctors. Information from the needs assessment was used to develop the Australian College of Rural and Remote Medicine national obstetric ultrasound professional development program. WHAT IS ALREADY KNOWN: The authors could not find any published work on the educational needs of Australian non-specialist rural and remote doctors for obstetric ultrasound. There is research about the outcome of obstetric ultrasound education for urban family physicians in the USA, but no information about rural doctors' educational needs or education outcomes. The study needed to be done so that obstetric ultrasound professional development program of the Australian College of Rural and Remote Medicine could be based on the real needs of the target group. WHAT THIS PAPER ADDS: As a result of this research, there is now information on the educational needs of rural and remote Australian non-specialist medical practitioners that can be used by education providers to develop quality education programs in obstetric ultrasound.