Revolutionising rural palliative medicine training

  • Hand holding patients hand with heart monitor on finger
  • Rural and Remote Institute of Palliative Medicine postcard with different rural views. anzspm.org.au
Dr Christine Sanderson
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Dr Christine Sanderson Specialist in Palliative Medicine Medical Director, Territory Palliative Care - Central Australia Alice Springs Hospital and Clinical Lead, RRIPM Project
Australian and New Zealand Society of Palliative Medicine
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Palliative medicine in rural Australia is in crisis, the impact of which seems to be drastically under-appreciated by metropolitan colleagues. The Rural and Remote Institute of Palliative Medicine (RRIPM) project was conceived as a response to the struggles of rural palliative medicine specialists who have identified their shared challenges in building much–needed and much-wanted palliative care services in locations far from city-based hospitals.

In June 2023, the Australian and New Zealand Society of Palliative Medicine (anzspm.org.au) received a FATES grant from the Department of Health and Aged Care, under the auspices of the Royal Australasian College of Physicians, to scope and implement the RRIPM project. Through extensive consultation with stakeholders via online interviews, surveys, and face-to-face workshops, an understanding of the barriers to, and opportunities for rural training has been sought. A combination of challenges experienced by specialists and trainees working in the rural palliative medicine sector have emerged.

Foremost amongst these is the lack of identifiable rural training opportunities and pathways. This means we struggle to train people who want to work rurally, and frequently lose them when they are required to relocate to metropolitan areas. Compounding this issue are the difficulties in getting rural services accredited for training because the benchmarks used for eligibility are based on metropolitan norms that are not meaningful for rural practice. Furthermore, there is a glaring lack of recognition that there are specific competencies and complexities related to rurality that are not addressed by metropolitan training.

To date, specialist training in palliative medicine has largely been focused on city locations. Sufficient opportunity to train rurally does not currently exist despite medical graduates and palliative medicine trainees expressing an interest in rural career pathways. Geographic isolation hinders the ability of rurally based service providers to effectively network and support each other in the absence of a coordinating body, and this results in duplicated effort and missed opportunities to share the recruitment, education, and supervision of trainees.

National and jurisdictional funding to support rural palliative medicine training placements is unreliable and fragmented and requires a stable horizon to develop the training pipeline. It is hoped that with heavy demands on the health system, the value of quality palliative medicine will be seen as a positive investment reducing overall system costs, while adding significant human and local community benefits.

All these problems lead to a crisis of sustainability for the specialists who work in rural palliative medicine, and for the services in which they are employed. The key to surviving and thriving is to be able to train the next generation of rural palliative medicine specialists and create a pipeline of trainees - both specialist and generalist - to meet the future needs of the service and community.

Palliative care is not a high-tech specialty. There is no reason why training and excellent care cannot occur outside metropolitan centres, and those who currently live and work rurally understand this well. They are also eager to ensure that their colleagues and potential trainees understand this too.

The development of a Rural and Remote Institute of Palliative Medicine (RRIPM), grown out of the experiences and advice of those clinicians who can see a way forward, could nurture trainees and palliative medicine specialists to live, work and train in rural settings, and enable them to provide care at the highest standard to their communities.

The capacity created by rurally based specialist services also has flow-on effects that are precious for rural communities: training and support for generalists, catalysing the development of multidisciplinary teams that can sustainably provide care in local communities, and the delivery of excellent care where it is most wanted - close to home.

Keen to know more about the RRIPM project? Read our Scoping Review titled "Beyond the 'Burbs: Specialist Palliative Medicine Training in Rural Australia” here

Share perspectives and feedback at [email protected]

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