Training, Skills and Approach to High‐risk Obstetrics in Rural GP Obstetricians

Watts, Richard W.; Marley, John; Beilby, Justin; R, MacKinnon; Doughty, S.

doi:10.1111/j.1479-828x.1997.tb02451.x

Cited by 5 publications

(7 citation statements)

References 5 publications

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“…In rural Western Australia in the mid-1990s, 62% of GPs reported providing obstetrical care, and 46% had performed a C-section in the previous year 58 . Similar rates of C-section participation were found in the rural areas of southern Australia (43%) 59 and in the Australia state of New South Wales (41%) 60 . In a study of family practice graduates in Alberta from 1985 to 1995 it was found that 78% of those practicing in rural areas performed deliveries, compared to just 53% of graduates in metropolitan practice 61 .…”

Section: Workforce: Training and Case MIXsupporting

confidence: 69%

Satisfaction and sustainability: a realist review of decentralized models of perinatal surgery for rural women

Kornelsen

McCartney

Williams³

2016

RRH

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Introduction: This article was developed as part of a larger realist review investigating the viability and efficacy of decentralized models of perinatal surgical services for rural women in the context of recent and ongoing service centralization witnessed in many developed nations. The larger realist review was commissioned by the British Columbia Ministry of Health and Perinatal Services of British Columbia, Canada. Findings from that review are addressed in this article specific to the sustainability of rural perinatal surgical sites and the satisfaction of providers that underpins their recruitment to and retention at such sites. Methods: A realist method was used in the selection and analysis of literature with the intention to iteratively develop a sophisticated understanding of how perinatal surgical services can best meet the needs of women who live in rural and remote environments. The goal of a realist review is to examine what works for whom under what circumstances and why. The high sensitivity search used language (English) and year (since 1990) limiters in keeping with both a realist and rapid review tradition of using reasoned contextual boundaries. No exclusions were made based on methodology or methodological approach in keeping with a realist review. Databases searched included MEDLINE, PubMed, EBSCO, CINAHL, EBM Reviews, NHS Economic Evaluation Database and PAIS International for literature in December 2013. Results: Database searching produced 103 included academic articles. A further 59 resources were added through pearling and 13 grey literature reports were added on recommendation from the commissioner. A total of 42 of these 175 articles were included in this article as specific to provider satisfaction and service sustainability. Operative perinatal practice was found to be a lynchpin of sustainable primary and surgical services in rural communities. Rural shortages of providers, including challenges with recruitment and retention, were found to be a complex issue, with scope of practice and contextual support as the key factors. Targeted educational programs, exposure to rural practice and living environments, accessible and appropriate continuing medical education, and strong clinical support (including locum coverage and sustainable on-call schedules) were all found to be areas of important consideration in rural service sustainability. Conclusions: Rural practice was found to be a site to actualize personal goals and values for providers. A broad and challenging scope of practice and the opportunity to participate in community level health improvements were seen as critical to the retention of providers. Without proper support, however, providers reported a feeling of being 'in too deep'. Common themes were a lack of health human resource redundancies, compromised access to specialist support and technology, and a lack of work-life balance. Burnout and attrition in perinatal surgical services threaten to destabilize other aspects of rural community health services, making the need to...

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Section: Workforce: Training and Case MIXsupporting

confidence: 69%

Satisfaction and sustainability: a realist review of decentralized models of perinatal surgery for rural women

Kornelsen

McCartney

Williams³

2016

RRH

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“…The majority of them, 83% had completed some formal postgraduate training in obstetrics, including performing Caesarean sections and using forceps and ventouse [36]. As in many other countries, the number of GPs providing intrapartum care declined significantly, with rising indemnity insurance, lifestyle issues and poor remuneration being the most important reasons for ceasing obstetrics [37]. In New Zealand, legislative changes in 1990 established independent midwifery within the health care system.…”

Section: Australia and New Zealandmentioning

confidence: 99%

General practitioners and their role in maternity care

Wiegers

2003

Health Policy

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During the last century the perception of pregnancy and childbirth has changed from a normal, physiological life-event to a potentially dangerous condition. Maternity care has become more and more obstetrical care, focussed on pathology and complications. The involvement of general practitioners (GPs) in maternity care is strongly reduced and almost everywhere the same reasons are found: interference with lifestyle and interruption of office routine, fear of litigation and costs of malpractice insurance, insufficient training and insufficient numbers of cases to retain competency. In Canada, the USA, and to a lesser extent in Australia and New Zealand, GPs still providing intrapartum care are GP-obstetricians rather than maternity care providers. They provide low-risk as well as high-risk obstetrical care, especially in rural areas with few specialist obstetricians. In Europe, GPs do not provide high-risk obstetrical care. Instead they emphasize their role as generalist, and compete with midwives for a central role in maternity care for women with an uncomplicated pregnancy. The ongoing medicalisation of childbirth and the changing attitudes towards the demands of maternity care practice have diminished the role of GPs or family physicians. If they want to stay involved in maternity care in the future they need to cooperate with midwives, preferably in shared care programs.

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“…Factors contributing to the forecast deficit in GP obstetric services included a rise in specialisation, centralisation of services, concerns regarding indemnity and litigation, rural workload and difficulty maintaining competence 9 , 10 . ‐ 13 The problem of maintaining competence in rural environments has been compounded by reported difficulties in accessing appropriate locum coverage to allow attendance at upskilling courses, in addition to the time and travel required to participate 10 …”

mentioning

confidence: 99%

“…9 Factors contributing to the forecast deficit in GP obstetric services included a rise in specialisation, centralisation of services, concerns regarding indemnity and litigation, rural workload and difficulty maintaining competence. 9,[10][11][12][13] The problem of maintaining competence in rural environments has been compounded by reported difficulties in accessing appropriate locum coverage to allow attendance at upskilling courses, in addition to the time and travel required to participate. 10 The impending shortage of GP obstetricians and the need for strategies to train, retrain and retain GP obstetricians in rural practice have been the integral considerations in developing a comprehensive training and support program offered in the Gippsland region of rural Victoria.…”

mentioning

confidence: 99%