Training generalist doctors for rural practice in New Zealand

Abstract

A B S T R A C TTargeted postgraduate training increases the likelihood young doctors will take up careers in rural generalist medicine. This article describes the postgraduate pathways that have evolved for these doctors in New Zealand. The Cairns consensus statement 2014 defined rural medical generalism as a scope of practice that encompasses primary care, hospital or secondary care, emergency care, advanced skill sets and a population-based approach to the health needs of rural communities. Even as work goes on to define this role different jurisdictions have developed their own training pathways for these important members of the rural healthcare workforce. In 2002 the University of Otago developed a distance-taught postgraduate diploma aimed at the extended practice of rural general practitioners (GPs) and rural hospital medical officers. This qualification has evolved into a 4-year vocational training program in rural hospital medicine, with the university diploma retained as the academic component. The intentionally flexible and modular nature of the rural hospital training program and university diploma allow for a range of training options. The majority of trainees are taking advantage of this by combining general practice and rural hospital training. Although structured quite differently the components of this combined pathway looks similar to the Australian rural generalist pathways. There is evidence that the program has had a positive impact on the New Zealand rural hospital medical workforce.

Faculties to Support General Practitioners Working Rurally at Broader Scope: A National Cross-Sectional Study of Their Value

“…Rural GPs are largely supported by mainstream faculties, but on their own these may provide limited attention to the skills and professional support needed by rural GPs. In response, many countries are developing specific postgraduate training and professional support pathways aimed to grow and support the skills that doctors need in rural practice, especially in primary care [ 7 ]. Australia is a unique case study of a country that developed two national faculties for rural GPs in the late 1990s: the Fellowship in Advanced Rural General Practice (FARGP) and the Fellowship of the Australian College of Rural and Remote Medicine (FACRRM), both of which promote more targeted education and continuous learning ( Table 1 ) [ 8 ].…”

“…Table 1 summarizes the reasoning for each faculty’s emergence, both of which are equivalent for Australian Medical Council accreditation purposes. However, despite their potential value, evidence about rural faculties remains largely descriptive with limited evaluation of their workforce outcomes against mainstream approaches [ 7 , 26 , 27 , 28 ], including limited evidence from small scale rural residencies in other countries and other more localized postgraduate workforce interventions [ 29 , 30 , 31 ].…”

New Zealand's Rural Hospital Medicine training program at 10 years: Locality and career choice of the first graduate cohort

“…The scope was established in response to serious rural hospital workforce shortages and lack of any recognised training pathway. 3 The RHM scope is defined by its rural hospital context and is orientated to secondary care. The RHM professional body, the Division of Rural Hospital Medicine, sits within the Royal NZ College of General Practitioners (RNZCGP).…”

A comparison of teaching opportunities for rural and urban family medicine residents

“…One important strategy emphasises curricula designed to support and encourage rural medicine. However, there is a paucity of literature on the development of curricula to support rural medical education, despite recognition of its importance in building a sustainable training pathway …”