Medical training designed to meet the health needs of rural communities

The Charles Sturt University (CSU)–Western Sydney University (WSU) Joint Program in Medicine recently hosted a forum to kick off its curriculum planning for the new School of Medicine at CSU’s Orange campus in 2021. Participants from CSU, WSU, The University of Sydney, and the Three Rivers University Department of Rural Health challenged each other to identify the distinctive needs of a medical curriculum that would focus on meeting the health needs of rural communities.
 
The forum generated many ideas and innovations encapsulated by these three key principles:
1.    the Program must recognise the importance of rural models of care underpinned by  principles of rural generalism;
2.    the Program’s curriculum must include substantial Inter-professional education (IPE); and
3.    an Indigenous Curriculum Framework must be threaded through all stages of the curriculum.

Rural generalism: what does it mean to the design of medicine courses?
Models of service delivery and care used in well-populated and resourced centres are ineffective at meeting the needs of rural people. Rural generalism is being reaffirmed as the preferred approach for rural health workforce education and training. The Inaugural World Summit on Rural Generalist Medicine in 2013 generated the ‘Cairns Consensus’ which sets a starting point for student learning and provides a framework for future career development. Rural generalism in the consensus statement is defined as:

“The provision of a broad scope of medical care by a doctor in a rural setting (context) that encompasses the following:
•    comprehensive primary care for individuals, families and communities;
•    hospital in-patient and/or related secondary medical care in the institutional, home or ambulatory setting;
•    emergency care;
•    extended and evolving service in one or more areas of focused cognitive and/or procedural practice as required to sustain needed health services locally among a network of colleagues;
•    a population health approach that is relevant to the community; and
•    working as part of a multi-professional and multi-disciplinary team of colleagues, both local and distant, to provide services within a ‘system of care’ that is aligned and responsive to community needs.”

Inter-professional education: what is it and how does it help rural health care?
Population growth and ageing, the high incidence of chronic diseases, maldistribution of health professionals in rural and remote areas, and rapidly increasing costs have put a strain on health care provision. Effective and sustainable rural health care can no longer be delivered solely by independent practitioners, but requires teams of professionals linked into the broader health system. These factors have led to a need for complex but more efficient models of service delivery; ,for example,  team-based care supported by care coordinators, and more effective care in the community, such as self-management support for chronic disease.

We need to develop a curriculum that embeds inter-professional education and learning principles in the program. A team-based approach to education and learning supports a team-based approach to service delivery.

Indigenous Curriculum Framework
Ensuring good health care outcomes for Aboriginal and Torres Strait Islander peoples requires an explicit attention to the education and training of our future health professionals developed in partnership with Aboriginal and Torres Strait Islander peoples. For this training and education to be effective we need to scaffold and thread developing cultural understanding and providing culturally respectful care through all stages of our curricula. It will require close consultation with Aboriginal health and community services in the region with the dual aim of increasing the number of Aboriginal and Torres Strait Islander students in the program.

The Indigenous Curriculum Framework will capture the essence of the Wiradjuri phrase Yindyamarra Winhanganha (the wisdom of respectfully knowing how to live well in a world worth living in).

For further information contact Glenn McMahon, Project Manager, CSU/WSU Joint Program in Medicine (Mob: 0447 159 622) or Professor Megan Smith, Deputy Dean, Faculty of Science, Charles Sturt University (Ph: 02 6051 9245).

Charles Sturt University is Education Sponsor for the 15th National Rural Health Conference, nipaluna/Hobart, 24-27 March 2019.