Training of Icelandic rural doctors in managing trauma and acute illness

Abstract

Rural medicine is in many ways different from urban primary care. In addition to providing primary care for a population, the rural doctor is tasked with the initial evaluation and stabilization of all emergencies usually managed by an Emergency Department in urban areas. The goal of this study was to assess rural doctors' in Iceland attendance of courses in Emergency Medicine (EM), how rural doctors grade their own ability to respond to emergencies and evaluate their Continuous Medical Education (CME) within the field of EM. In this descriptive cross-sectional study, all rural general practitioners (GP) in Iceland with at least two years of experience post foundation training and who practiced at least a quarter of every year outside the capital area were surveyed using an electronic questionnaire. T-test and qi-square test were used for analysis and significance determined if p<0.05. The survey was sent to 84 doctors with 47 (56%) completing the survey. Over 90% of the participants reported having completed a course in Advanced Life Support (ALS) but only 18% had completed a course in prehospital EM specifically designed for this group of doctors. Over half of the participants considered themselves to have good training to perform 7 out of 11 surveyed emergency procedures. Over 40% of participants considered it necessary to improve their CME in 7 out of 10 categories of EM. The majority of rural GPs considered shortage of doctors in the rural environment a significant factor limiting their CME. The majority of rural doctors in Iceland consider themselves to have a good training to provide initial EM care in their community. Efforts to improve their training in this field of medicine should focus on scene safety and working in the prehospital setting, pediatrics, labor and deliveries and gynecological emergencies. Rural doctors need to have access to appropriate EM training courses.