Volume 192 - Issue 12
Are patients willing participants in the new wave of community-based medical education in regional and rural Australia?
Author: Alan E Dugdale
Med J Aust 2010; 192 (12): 727-728. || doi: 10.5694/j.1326-5377.2010.tb03724.x
Published online: 21 June 2010
Published online: 21 June 2010
To the Editor: Hudson and colleagues showed that rural patients are a willing teaching resource for medical students, but that there are problems in using this resource.1 My experience shows the problems and opportunities.
I have long provided a consultant paediatric service to two rural hospitals and an Aboriginal community in south-east Queensland. Clinical demands are large; resources are minimal. Waiting time from referral to consultation is 4–12 months. Many children with schooling problems lose a year of education waiting for diagnosis and treatment, and many have physical and behavioural conditions seldom seen in city practice. Few families are insured; bulk-billing is the norm. I spend 4 days a month in the area. Hospital staff make the appointments, and I use hospital records for my clinical notes. Hospitals provide clinical and personal accommodation, but not a secretarial service or funds for travel. Facilities are poor by city standards and financial returns meagre. I finish my clinics early then spend 3–4 hours each day typing letters to referring doctors and other paperwork. This is wasteful use of skilled time.
Several problems and opportunities regarding medical education in rural specialist practice are evident:
The need for more clinical teaching for medical students is real and urgent. As rural patients are available and willing, we should use them.
Lack of specialists to meet clinical needs and to meet teaching needs are two sides of the same problem.
Specialist clinics and teaching should be done in local hospitals that already have basic facilities, but most rural hospitals are already stretched and cannot take on an extra load.
Medical specialists must be used efficiently. Additional administrative staff are needed to organise appointments, type letters and do general paperwork. Suitable clinic space and nursing assistance are also needed.
Payments to visiting specialists should be sessional rather than case based, so that teaching carries no financial penalty. Payments for clinical and teaching sessions, travel, and accommodation should be sufficient to attract specialists and consultants. Some costs could be recouped by bulk-billing. Ideally, the specialist or consultant would provide long-term continuity to patients and staff — in contrast to registrars, who tend to be transient.
Rural specialist practice is an untapped resource for teaching. Given suitable conditions, senior medical staff could develop its potential while providing a much-needed clinical service.
References
- Hudson JN, Weston KM, Farmer EE, et al. Are patients willing participants in the new wave of community-based medical education in regional and rural Australia? Med J Aust 2010; 192: 150-153. 0_FJJCFCBB