'Even if we get one back here, it's worth it...': evaluation of an Australian Remote Area Health Placement Program

Abstract

In 2006 the Kimberley Remote Area Health Placement Program (hereinafter the 'Program') was established at the University of Notre Dame's School of Medicine (Fremantle campus, Western Australia). The Program was developed as one of the strategies to achieve the School of Medicine's mission to graduate knowledgeable, skillful, dutiful and ethical doctors who will want to work in Australian areas of unmet need. The Program aims to immerse medical students in non-clinical settings to provide them with opportunities to learn life skills required for remote area living, and to introduce them to the myriad of socio-cultural, geographic, climatic and economic factors that impact on the health and wellbeing of remote area residents. To meet these objectives, the School organizes for students to live with, and do useful non-clinical work for, a host community or organization for up to one week. In 2008 the Program was evaluated to explore and assess its immediate and potential future benefits and limitations as perceived by Kimberley residents. This paper reports on the evaluation's findings via Kimberley-based narratives and raises some issues that are essential to training and retaining a 'bloody good doctor...' in a remote Australian setting. Using a mix of qualitative, ethnographic methods, the Program was evaluated by an independent researcher during four weeks of field research in late 2008. The methods included a survey, structured and unstructured interviewing and participant observation to elicit data. Thirty-three formal interviews of at least one hour's duration were conducted. Data were also collected via 15 informal discussions. Both formal and conservational interactions occurred in a range of town-based and more remote settings. The majority of persons consulted generally highlighted the Program's benefits. The reasons for this positive evaluation varied, but a common thread was that exposure to the Kimberley introduced the students to local life, a quality that had the potential to result in a medical student returning as a qualified doctor. The Program was seen as beneficial because it provided a structured, constructive means for prospective doctors to appreciate the assets rather than the deficits of remote area living. Another positive implication was that the Program equipped future doctors (regardless of their eventual work location) to treat a person from the 'bush'. It also encouraged students to think and act cross-culturally. An important immediate benefit was that the Program offered human resource support to the host organization at a busy time of the year. In only three of the 33 formal interviews was a negative or ambivalent attitude toward the Program expressed. However, a common concern was the brevity of time students served with their host organization. The data collected revealed that Kimberley people believed that the Program held strong potential for the successful recruitment of doctors prepared to make a long-term commitment to the region. Never far from their minds, conversations and activities was the idea that the effort they put into accommodating, supporting and guiding the students was worth it because 'If only one good doctor comes from the Program, then that's a good thing. A good doctor would have a great impact - the implications are immeasurable...'.