Rural, urban: the real world for medical education

To the Editor: I read with interest the article by Hamilton, which refers to the difficulties and inequities faced by the disadvantaged in urban communities.1 Hamilton notes that Flinders University pioneered rural medical education programs last century. It may interest readers to know that the university is now pioneering urban longitudinal community-based medical education.

The Onkaparinga Clinical Education Program (OCEP) is a 1-year program for third-year graduate-entry medical students.2 It is based in an outer suburban area of Adelaide, where there are local government areas that are among those with the lowest socioeconomic status in South Australia.3 Established in 2009, the OCEP provides an urban community-based program for 24 medical students to work for a full year in the community in general practices, local community hospitals and local specialists' practices. For the first 6 months, students are based in a general practice for two to four sessions per week. They also attend the emergency department at Noarlunga Hospital (a 100-bed community hospital) for one or two sessions per week, and a range of specialist and community clinics for one or two sessions per week. In the second 6 months, students undertake 4-week rotations in medicine, surgery and psychiatry at Noarlunga Hospital, augmented by sessions at private specialist consulting clinics. As Noarlunga Hospital does not provide obstetric or inpatient paediatric services, students undertake these components at Flinders Medical Centre (4 weeks for each component). Lectures, tutorials and skills training are provided throughout the whole year at the OCEP in a purpose-built facility opposite Noarlunga Hospital.

As part of the OCEP's commitment to social accountability, students also work with disadvantaged adolescents at the local secondary school.4 The OCEP is working with the school to develop a wellbeing centre based in the school, where medical students will work with adolescents (under supervision) to provide near-peer health advice, counselling, and assistance with referral to mainstream services.

A formal evaluation will be carried out in 2014. However, to date, the program has developed with regular feedback and evaluation from students and clinicians, and academic results have been at least equivalent to those of students at other Flinders University sites.