BMJ 2005;331:655 (24 September), doi:10.1136/bmj.331.7518.655-c
Students should spend part of training in rural hospitals
Bryan Christie
Edinburgh
Students should spend part of training in rural hospitals
Bryan Christie
Edinburgh
Medical students and junior doctors should receive some of their training in rural and remote hospitals to help produce more doctors suitable to work in such areas. This is one of many ideas to emerge from an initiative organised by the Royal College of Physicians of Edinburgh that examines the sustainability of healthcare provision in Scotland's outlying areas.
The advance of specialisation in medicine, together with the fear of professional isolation, has made recruitment to such posts more difficult in recent years. Legal limitations on working time also threaten the viability of services in rural hospitals.
Despite this gloomy background, many positive ideas about developing rural and remote services are explored in series of personal perspectives commissioned by the college. It includes contributions from physicians, surgeons, an anaesthetist, a general practitioner, a medical director, and a member of the public. An international dimension is provided by an article reviewing developments in Australia.
Some of the suggested ways forward include:
Basing more teaching and training of students and doctors in rural locations
Recognising the value of general medical training for remote or rural practice
Developing remote and rural medicine as an academic discipline
Making a commitment to providing primary and secondary healthcare as close to where people live as possible
Ensuring that doctors have a minimum volume of work to sustain skills but do not suffer from excessive on-call commitments. This can perhaps be achieved through arrangements with larger hospitals
Using telemedicine to provide specialist support to rural practice
Combating "city slicker" and "country bumpkin" perceptions and divisions in medicine.
Remoteness may not all be related to geography, hypothesised one of the contributions. It suggests that doctors working in large central hospitals can be seen as remote as they understand little of what small hospitals are capable of achieving.
The college has not adopted any of the suggestions as policy. Its president, Professor Neil Douglas, said that the intention is to inform the ongoing debate on how best to respond to the pressures on rural healthcare services.
"This is a problem that has been grappled with for over a century in many parts of the world. All sorts of different approaches are being considered at present. Different regions and localities will require different solutions, as will different specialties," he said.
The advance of specialisation in medicine, together with the fear of professional isolation, has made recruitment to such posts more difficult in recent years. Legal limitations on working time also threaten the viability of services in rural hospitals.
Despite this gloomy background, many positive ideas about developing rural and remote services are explored in series of personal perspectives commissioned by the college. It includes contributions from physicians, surgeons, an anaesthetist, a general practitioner, a medical director, and a member of the public. An international dimension is provided by an article reviewing developments in Australia.
Some of the suggested ways forward include:
Basing more teaching and training of students and doctors in rural locations
Recognising the value of general medical training for remote or rural practice
Developing remote and rural medicine as an academic discipline
Making a commitment to providing primary and secondary healthcare as close to where people live as possible
Ensuring that doctors have a minimum volume of work to sustain skills but do not suffer from excessive on-call commitments. This can perhaps be achieved through arrangements with larger hospitals
Using telemedicine to provide specialist support to rural practice
Combating "city slicker" and "country bumpkin" perceptions and divisions in medicine.
Remoteness may not all be related to geography, hypothesised one of the contributions. It suggests that doctors working in large central hospitals can be seen as remote as they understand little of what small hospitals are capable of achieving.
The college has not adopted any of the suggestions as policy. Its president, Professor Neil Douglas, said that the intention is to inform the ongoing debate on how best to respond to the pressures on rural healthcare services.
"This is a problem that has been grappled with for over a century in many parts of the world. All sorts of different approaches are being considered at present. Different regions and localities will require different solutions, as will different specialties," he said.
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