Outcomes of rural generalist internship training in Victoria, Australia.

INTRODUCTION: Victoria, Australia commenced its first Rural Community Internship Training program in 2012 to support the development of rural generalist (RG) doctors. These general practitioners have additional skills to work at a broad scope to deliver the range of primary care and additional specialist services that communities need. Unlike most internships, which are wholly hospital-based and delivered mostly within larger metropolitan and regional centres, this RG internship training model involves completing general practice experience in smaller rural communities working with RGs and visiting specialists. This study aimed to explore the characteristics and satisfaction of doctors who participate in RG internship training in Victoria and their workforce outcomes. METHODS: Between October and November 2021, a retrospective 10-minute anonymous survey invitation was sent to all contactable interns (n=222) who had completed/were completing the RG internship training (2012-2021). The survey was co-designed with RG internship managers and other stakeholders of a statewide evaluation advisory group, informed by the latest evidence regarding RG medicine and rural training predictors, and outcomes of interest. Participants completed the survey using Microsoft Forms, with three invitations circulated to an up-to-date email address maintained by the internship program. Collected data were analysed descriptively, by subgroup, to explore training pathway outcomes by region, training stage and specialty choice. Workforce distribution outcomes were defined in line with objectives of the program and predetermined indicators of RG scope. Results were compared with the benchmarks of rural workforce training outcomes in Australia using recent research. RESULTS: There were 59 participants (27% response rate); 81% were in postgraduate years 3-7. Respondents included 54% male, 17% rurally bonded, 39% of rural origin, 34% having had more than 3 months rural undergraduate training and 48% doing RG training where they previously did undergraduate training. All were satisfied/very satisfied with the RG training and 61% were working in general practice (excluding the prevocational group). Overall, 40% were currently working in the same rural region as their internship (including three who were currently interns), 56% continued to complete some prevocational training in the same region as their RG internship, while 20% had gone on to be currently based in smaller rural communities (Modified Monash Model locations 4-7) and 44% to be working part-time in smaller rural communities. Overall, 42% self-identified as working as an RG and nearly all (97%) met at least one of the key indicators of extended (RG) scope. In all areas the RG internship outcomes were better than the national benchmarks from published evidence about rural training. CONCLUSION: This study provides evidence from doctors up to 9 years after completing their RG internship. Compared with industry benchmarks, the RG internships attract rurally intentioned and rurally experienced doctors who may be likely to remain in the same rural region as their undergraduate rural medical training and continue their postgraduate training in the same region. They were all satisfied with RG internship training, had high propensity to follow a general practice career and work at broad scope in smaller communities. Importantly, they intended to stay in the region where they trained. This suggests RG internship programs are a positive intervention for promoting an RG workforce.

Twelve tips for OSCE-style Tele-assessment.

This article was migrated. The article was marked as recommended. The Australian College of Rural and Remote Medicine (ACRRM) has developed a flexible 'tele-assessment' approach to the delivery of its assessment modalities. Candidates can sit their examination remotely, close to their place of practice, which reduces the need for rural doctors - both candidates and examiners - to leave their communities for the purpose of assessment. A major component of the assessment process is the Structured Assessment using Multiple Patient Scenarios (StAMPS) examination, which blends the formats of an Objective Structured Clinical Examination (OSCE) and a traditional viva vocè examination. It is a high-stakes assessment, that was designed to be academically rigorous, flexible, valid, reliable, and fair. Since 2008 ACRRM has provided a videoconferencing option to candidates for their StAMPS examination allowing them to remain in or near their home location, while the examiners meet a central location. Travel restrictions due to the SARS-CoV-2 pandemic meant for the first time both candidates AND examiners participated in StAMPS via videoconference. ACRRM conducted an online StAMPS assessment using videoconferencing technology for 65 candidates in mid-May 2020, with all candidates, examiners and support staff remaining in or near their home communities. These Twelve Tips outline some of the experience gained in providing tele-assessment over the past twelve years.