A student view of the difference between general practice and rural and remote medicine

Abstract

Shortages in the Australian medical workforce have been a concern for the rural sector and government alike for many years. The Commonwealth Department of Health and Aged Care has implemented the Government's Regional Health Strategy to secure a rural education and training network which, it is hoped, will increase the availability and viability of rural health services in the long term. The University of Western Australia's Rural Clinical School was established in 2002 and has delivered a one-year clinical course to a total of 81 students at eight rural and remote sites throughout Western Australia. To identify student perceptions of rural general practice and whether they perceived any differences from city general practice. All available students in 2005 participated in a mid-year semi-structured interview with an evaluator. This article reports the findings relating to the question: 'In your experience so far, do you think there is a specialty that could be called rural and remote medicine that is different to general practice?' Analysis focussed on aggregating responses to the question so that the greatest variety of differences that students perceived could be identified. A thematic analysis was undertaken. Thirty of 33 (91%) 2005 students were interviewed. All but one student believed that rural practice was different to the general practice they observed in the metropolitan region. All but two students thought that rural and remote medicine was a specialty on its own and needed its own training program that was different from city general practice. Five themes were identified from the data to justify the suggestion that the way medicine is practised is different: the importance of a broader and deeper clinical knowledge; the necessity to develop a different way of thinking and organising knowledge; a more socially oriented, patient-centred model of care; community expectations of social roles; and the personal cost of being a rural doctor. This study provides us with a student view of rural medicine as a discipline distinct from general practice, and one that requires its own training program. Our students recognised the level of expertise of rural practitioners in managing complexity in rural medicine with its lack of resources, its internal diversity of peoples in its communities, the differences of rural living and the tyranny of distance. They also recognise the importance of training additional to the city level of general practice skills, in order to satisfactorily meet healthcare needs in the rural setting.