Short-term medical student placements completed consecutively at a rural general practice positively impact chronic disease management.

INTRODUCTION: Little is known about how medical school placements in rural areas impact key stakeholders such as patients, host organisations and the wider rural community. With engagement from rural communities crucial to the success of rural medical training, this case study sought to demonstrate the benefit that rural clinical placements can have on rural general practices (systems) and likely impacts on communities (health outcomes). Specifically, we describe how a series of consecutive short-term student placements in a single rural practice were the drivers of a series of clinical audits and interventions resulting in improved management of chronic disease. METHODS: Data for this project were obtained from student research reports completed as part of a rural and remote medicine rotation at an Australian medical school. For this series of projects, eight consecutive students were based at the same rural medical centre, with each attending for 6 weeks across a 15-month period, completing a report for a quality improvement activity and evaluating the outcomes. Each project related to chronic kidney disease (CKD), with CKD chosen based on the needs of the medical centre and the higher burden of this disease in rural areas. Each project was developed and delivered in consultation with the practice, taking into account student interest and skills, and related projects completed prior or concurrently. Projects were related to database management (n=2), alignment between CKD management and best-practice guidelines (n=3), patient health literacy (n=3), and a summary and staff perceptions of the preceding quality improvement activities (n=1). RESULTS: The combination of student projects led to tangible improvements in CKD management at a rural general practice. All doctors at the medical centre (n=4) reported using the database management tools implemented by the students and felt the interventions were sustainable, long-term solutions for ensuring clinical investigations are not being delayed or missed. Following the various interventions completed by the students, clinician knowledge and implementation of best-practice CKD management increased, and some patients became more aware of their condition and how to manage it. CONCLUSION: This case study provides evidence that short-term rural clinical placements for medical students have the potential to greatly improve health care and clinical practice in rural and remote communities, when designed around a consistent topic within a medical practice. Outcomes of the student projects in combination demonstrate that addressing CKD management longitudinally led to improvements in administrative processes, clinical practices, and patient awareness and accountability, despite each student only being at the medical centre for a short period of time. Similar approaches to structuring rural clinical placements and defining community projects for medical students should be considered more broadly.

Understanding the field of rural health academic research: a national qualitative, interview-based study.

INTRODUCTION: Rural areas depend on a specific evidence base that directly informs their unique health systems and population health context. Developing this evidence base and its translation depends on a trained rural health academic workforce. However, to date, there is limited description of this workforce and the field of rural health research. This study aimed to characterise this field to inform how it can be fostered. METHODS: Qualitative semi-structured interviews of 50-70 minutes duration were conducted with 17 early career rural health researchers based in Australian rural and remote communities, to explore their professional background, training and research experiences. RESULTS: Six key themes emerged: becoming a rural health researcher; place-based research that has meaning; generalist breadth; trusted partnerships; small, multidisciplinary research teams; and distance and travel. The field mostly attracted researchers already living in rural areas. Researchers were strongly inspired by doing research that effected local change and addressed inequalities. Their research required a generalist skill set, applying diverse academic and local contextual knowledge that was broader than their doctoral training. Research problems were complex, diverse and required novel methods. Research occurred within trusted community partnerships spanning wide geographic catchments, stakeholders and organisations. This involved extensive leadership, travel and time for engagement and research co-production. Responding to the community was related to researchers doing multiple projects of limited funding. The field was also depicted by research occurring in small collegial, multidisciplinary teams focused on 'people' and 'place' although researchers experienced geographic and professional isolation with respect to their field and main university campuses. Researchers were required to operationalise all aspects of research processes with limited help. They took available opportunities to build capacity in the face of limited staff and high community demand. CONCLUSION: The findings suggest that rural health research is highly rewarding, distinguished by a generalist scope and basis of 'rural' socially accountable research that is done in small, isolated teams of limited resources. Strategies are needed to grow capacity to a level fit to address the level of community demand but these must embrace development of the rural academic entry pathway, the generalist breadth and social accountability of this field, which underpins the perceived value of rural health research for rural communities.