Chapter 14 Rural medical education learning experiences play an important role in the training and recruitment of rural physicians (Curran & Rourke 2004, Rourke et al 2005, Maley et al 2010). Rural learning experiences have been found to have high educational value from junior medical students to senior trainees/residents (Zorzi et al 2005, Rourke 2005). There is substantial literature that shows that rural medical learners, at a variety of learning stages, do as well as or better than urban learners on medical examinations and other measures of performance (Schauer & Schieve 2006, Power et al 2006, Waters et al 2006, Worley et al 2004, Goertzen 2006, Bianchi et al 2008, Denz-Penhey & Murdoch 2010). A detailed critical review of North American studies identified ‘evidence that placement in rural settings is a positive learning experience that students value and that preceptors find gratifying’ (Barrett et al 2011). Discovering the joys and challenges of rural/remote practice can lead some medical learners to choose rural/remote practice as a career (in this chapter, ‘medical learners’ refers to students, trainees and residents). As medical schools expand and address their social responsibility to train medical doctors for locations and in fields where they are most needed, increasing numbers of medical learners are experiencing training in a distributed medical education model (Rourke 2010, Eley et al 2008, Maley et al 2010). This provides the opportunity for rural general practitioners/family physicians, consultants, and other rural healthcare professionals to become more involved as medical teachers (sometimes called preceptors in the medical literature). Many rural medical doctors are enthusiastic natural teachers with broad clinical skills managing a wide variety of patient care challenges within strong community–patient–physician relationships. This can facilitate excellent learning experiences for medical learners. As in any setting, however, rural teaching and learning experiences can be quite variable. A needs analysis study found that ‘the majority of rural preceptors had no clear understanding of how what they taught fitted into the overall curriculum, their role as a clinical teacher had not been clearly defined … and that undergraduate students had little understanding of what they needed to learn during their attachment’ (Baker et al 2003). In addition, evaluation of feedback from students found that ‘while rural GP preceptors performed well overall in regards to providing quality teaching learning experiences, there was significant spread of scores across all criteria’ (Baker et al 2003). As much of the learning is centred around patient care, the rural medical teacher has a dual role, providing both patient care and teaching effectively and efficiently (Ferenchick et al 1997, Irby & Bowen 2004). 1. Welcoming learners as legitimate participants in a community of practice 2. Creating a central role for learners in patient care and teaching 3. Regularly engaging learners in self-reflection to monitor their progress 4. Helping learners discover learning opportunities in routine patient encounters 5. Using feedback to shape rather than evaluate learner performance 6. Creating an environment where learners felt comfortable practising new skills with patients. Adapted from Manyon et al 2003
Rural and remote locations
Introduction
Before the learner arrives
Preceptor preparation
Rural and remote locations
Learning in rural/remote locations can be an outstanding and sometimes life changing experience.
Consistently positive rural/remote teaching and learning experiences combine good planning and excellent learning settings with interested learners and enthusiastic teachers.
A practical framework approach to teaching and learning in a rural and remote setting:
Six attributes of community preceptors/rural medical teachers who were scored highly by medical students:
There needs to be a clear understanding of the learner’s, the rural medical teacher’s and the programme’s roles and responsibilities.
Preparing a learner’s manual can help consolidate the practice preparation and planning and is an invaluable guide to prepare and orient learners.
Ongoing communication with all these involved participants – colleagues, hospital, healthcare organizations and community – prior to each learner’s arrival will pave the way for a positive learning experience.
