Time to revisit the skills and competencies required to work in rural general hospitals.

Cormac Doyle,Pauline Wilson,Chris Isles

doi:10.1371/journal.pone.0240211

Cormac Doyle, Pauline Wilson + Show 1 more

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https://doi.org/10.1371/journal.pone.0240211

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Abstract

To determine the structure and demographic of medical teams working in Rural General Hospitals (RGHs) in Scotland, and to gain insight into their experiences and determine their opinions on a remote and rural medical training pathway. Structured face-to-face interviews. Interviews were partially anonymised, and underwent thematic analysis. Medical departments of the six RGHs in Scotland 2018-2019. 14 medical consultants and 23 junior doctors working in RGHs in Scotland. Inclusion criteria: Present at time of site visit, medical consultant in an RGH or junior doctor working in an RGH who provides care for medical patients. Exclusion criteria: Doctors on leave or off shift. Medical consultants with less than one month of experience in post. Non-medical specialty consultants e.g. surgical or anaesthetic consultants. Of 21 consultant posts in the RGHs, only eight are filled with resident consultants, the remainder rely on locums. Consultants found working as generalists rewarding and challenging, and juniors found it to be a good training experience. Consultants feel little professional isolation due to modern connectivity. The majority of consultants (12/14) and all junior doctors favour a remote and rural medicine training pathway encompassing a mandatory paediatrics component, and feel this would help with consultant recruitment and retention. RGHs medical departments are reliant on locum consultants. The development of a remote and rural training medical training pathway is endorsed by the current medical teams of RGHs and has the potential to improve medical consultant staffing in RGHs.

Highlights

There are six Rural General Hospitals (RGHs) serving Scotland’s most remote and rural (R&R) populations (Fig 1) [1]
Of 21 consultant posts in the RGHs, only eight are filled with resident consultants, the remainder rely on locums
The majority of consultants (12/14) and all junior doctors favour a remote and rural medicine training pathway encompassing a mandatory paediatrics component, and feel this would help with consultant recruitment and retention

Summary

Introduction

There are six Rural General Hospitals (RGHs) serving Scotland’s most remote and rural (R&R) populations (Fig 1) [1] These are NHS hospitals in towns with small populations of over three thousand that require a consultant led service to meet their healthcare needs as they are more than two hours away from larger urban centres [2]. RGHs serve populations of around 20,000–44,000 people (Table 1) [3] They usually have an emergency department (ED), a single medical ward and a single surgical ward staffed by 8–12 junior doctors, and led by 3–4 substantive surgical, medical, and anaesthetic consultants. RGHs can access support from specialist centres by telephone or videolink with options for patient transfer when required. Each of the areas covered by the RGHs have their own primary care team and a local or regional public health team

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