Rural Doctors Research Articles

The effectiveness of a 'train the trainer' model of resuscitation education for rural peripheral hospital doctors in Sri Lanka.

BackgroundSri Lankan rural doctors based in isolated peripheral hospitals routinely resuscitate critically ill patients but have difficulty accessing training. We tested a train-the-trainer model that could be utilised in isolated rural hospitals.MethodsEight selected rural hospital non-specialist doctors attended a 2-day instructor course. These “trained trainers” educated their colleagues in advanced cardiac life support at peripheral hospital workshops and we tested their students in resuscitation knowledge and skills pre and post training, and at 6- and 12-weeks. Knowledge was assessed through 30 multiple choice questions (MCQ), and resuscitation skills were assessed by performance in a video recorded simulated scenario of a cardiac arrest using a Resuci Anne Skill Trainer mannequin.Results/Discussion/ConclusionFifty seven doctors were trained. Pre and post training assessment was possible in 51 participants, and 6-week and 12-week follow up was possible for 43, and 38 participants respectively. Mean MCQ scores significantly improved over time (p<0.001), and a significant improvement was noted in “average ventilation volume”, “compression count”, and “compressions with no error”, “adequate depth”, “average depth”, and “compression rate” (p<0.01). The proportion of participants with compression depth ≥40mm increased post intervention (p<0.05) and at 12-week follow up (p<0.05), and proportion of ventilation volumes between 400-1000mls increased post intervention (p<0.001). A significant increase in the proportion of participants who “checked for responsiveness”, “opened the airway”, “performed a breathing check”, who used the “correct compression ratio”, and who used an “appropriate facemask technique” was also noted (p<0.001). A train-the-trainer model of resuscitation education was effective in improving resuscitation knowledge and skills in Sri Lankan rural peripheral hospital doctors. Improvement was sustained to 12 weeks for most components of resuscitation knowledge and skills. Further research is needed to identify which components of training are most effective in leading to sustained improvement in resuscitation.

What does personality tell us about working in the bush? Temperament and character traits ofAustralian remote allied health professionals

To describe the personality (temperament and character traits) of remote Australian allied health professionals (AHPs). Recent research shows that health professionals can be differentiated by personality traits but little is known about the personality traits of AHPs. Cross-sectional (online) survey design with snowball sampling of participants. Australian AHPs (N = 561; women, n = 502) classified into Remote (n = 266), Not Remote (n = 295). Demographic variables and the Temperament and Character Inventory (TCI R-140). Remote AHPs were higher in novelty seeking (P = 0.037) and self-transcendence (P = 0.042). Remote women were lower in harm avoidance (P = 0.042). Older remote AHPS were lower in reward dependence (P = 0.001); younger remote AHPs were lower in self directedness (P = 0.001) and higher in harm avoidance (P < 0.001). Women were more reward dependent (P < 0.001) and cooperative (P = 0.008) than men. The sample demonstrated personality trait levels aligned with research on rural doctors and nurses and which might be advantageous for working in a challenging environment. Exploring the more stable nature of temperament traits coupled with the modifiable potential of character traits provides new insight into people who choose to work as a remote AHP. These findings might contribute to a better understanding of the personality trends in these AHPs which might provide clues to improve recruitment and retention strategies.

English

OBJECTIVES: To find out the current Occupational/Academic status of the Alumni of a private Medical College, with special emphasis to ascertain how many were employed in the government’s primary health care setup in rural areas or otherwise practicing in rural areas. MATERIALS AND METHODS: The study was conducted among the old students of Meenakshi Medical College, in Tamilnadu. Data was collected by a brief questionnaire that was sent by reply paid post to all the students who had passed out of the college as on date. The students were requested to fill up and send the same back the department. RESULTS: A total of 117 past students had sent in their replies and out of them 53 (45.3%) were undergoing Postgraduate training. Out of the remaining, 31 (26.5%) were working in corporate hospitals, 10 (8.55%) were preparing full time for their postgraduate entrance examinations, 6 (5.12%) were preparing themselves to go abroad, and only 3(2.6%) were part of the government’s primary health care network in rural areas. CONCLUSION: This study reiterates the fact that joining a postgraduate course is the first choice for all medical graduates. Even among those who have not joined a postgraduate course, working in Primary health care in rural areas seems to the least preferred career choice. INTRODUCTION: India has the highest number of medical colleges in the world.(1) There are around 355 medical colleges in the country imparting undergraduate study (M, B., B.S).. The total numbers of undergraduate medical seats in the country are 44250, and the postgraduate seats add up to another 21282. (2) In spite of this, the estimated doctor population in our country stands at 1:1700 compared to the world average of 1.5: 1000. The Medical Council of India has brought out a “Vision -2015 document” in which it has set an ambitious target of achieving a doctor population ratio of 1:1000 by the 2031. (1) Even though there had been an overall improvement in the India’s health status, there is still a huge burden of disease in this country. There is a wide disparity between the states and also between urban and rural areas with regards to basic medical services and quality health care. The motive behind the Medical council of India’s plan to increase the output of Doctors in this country significantly is commendable, and the ambitious target of the Medical council of India may actually become a reality in future. The real problem though, lies in the distribution of that manpower. Our cities are abundant with all kinds of clinics, diagnostic centers and hospitals. But, having a doctor nearby is a rarity for the vast majority of Indians, who inhabit the country’s rural spaces. Scarcity of rural doctors usually hinders the delivery of even basic clinical services to needy citizens. Most young medical graduates also prefer to start their career in a secondary or tertiary care institution like that of a corporate hospital, rather than working in a primary health centre in a rural area. This

What interventions do rural doctors think will increase recruitment in rural areas: a survey of 2778 health workers in Beijing

BackgroundA shortage of health professionals in rural areas is a major problem facing China, as more than 60% of the population lives in such areas. Strategies have been developed by the government to improve the recruitment of rural doctors. However, the inequitable distribution of doctors working in China has not improved significantly. The objective of this study was to explore the reasons for the poor recruitment and to propose possible strategies to improve the situation.MethodsBetween September 2009 and November 2009 data were collected from 2778 rural doctors in Beijing, China. A quantitative survey was used to explore health workers’ perceptions as to what factors would have the greatest impact on recruitment and whether access to training had been effective in increasing their confidence, enhancing their interest in practicing medicine and increasing their commitment to recruitment.ResultsRural doctors were generally older than average in China. Of the 2778 participants, only 7.23% had obtained a license as a qualified doctor. For 53% of the rural doctors, the job was part-time work. The survey showed that rural doctors considered the training strategy to be inadequate. In general, the initiatives identified by rural doctors as being of most value in the recruitment of doctors were those targeting retirement pension and income.ConclusionsFrom the perspective of rural doctors, specific initiatives that promised a secure retirement pension and an increased income were considered most likely to assist in the recruitment of rural doctors in Beijing.

Access to Medicare-funded annual comprehensive health assessments for rural people with intellectual disability

People with intellectual disability (ID) comprise 2-3% of the Australian population. They mostly rely on their GP for primary health care. In rural areas where there are issues with health workforce shortages, there is a risk that people with ID may not get timely access to primary care or may not be aware of the range of healthcare services available to support them. Internationally, research has shown that regular health assessments are beneficial for people with ID. Annual comprehensive health assessments (ACHAs) have been shown to result in increased detection of medical conditions and could assist in reducing the gap in mortality between people with ID and the broader population. <b> </b>In Australia, people with ID have been eligible to access ACHAs under Medicare since 2007.<b> </b>These provide for a regular review of the person's physical, psychological and social functioning. This study explored the extent to which rural people with ID were accessing these ACHAs, and factors which affected their access to ACHAs. In this qualitative study in-depth interviews were conducted with 18 participants including people with ID, carers/support workers and rural doctors. Interviews were then coded and analysed for themes. Seven themes were identified: (1) healthcare barriers in rural areas; (2) cohesion of rural communities; (3) the way rural doctors practice; (4) lack of knowledge/understanding; (5) venturing into new territory; (6) the role of the practice nurse; and (7) the health communication triangle. Despite the well-known problems of lack of services and distance to specialists in rural Australia, there are compensatory factors which were perceived as improving the wellbeing of people with ID, such as increased social cohesion and community connectedness. More education is needed to ensure that the rationale for ACHAs for people with ID is understood and that doctors feel confident to use them. The number of Medicare reforms implemented in a relatively short period presented change-management challenges for rural practices with rural workforce pressures. The role of the carer/support worker is crucial in the health assessment process and can improve the transfer of information about a client with ID between the disability and health sectors and within the health sector.

Instrumental and socioemotional communications in doctor-patient interactions in urban and rural clinics

BackgroundLocation of practice, such as working in a rural or urban clinic, may influence how physicians communicate with their patients. This exploratory pilot study examines the communication styles used during doctor-patient interactions in urban and rural family practice settings in Western Canada.MethodsWe analyzed observation and interview data from four physicians practicing in these different locations. Using a grounded theory approach, communications were categorized as either instrumental or socioemotional. Instrumental communication refers to “cure-oriented interactions” and tends to be more task-oriented focusing on the patient’s health concerns and reason for the appointment. In contrast, socioemotional communication refers to more “care-oriented interactions” that may make the patient feel comfortable, relieve patient anxiety and build a trusting relationship.ResultsThe physicians in small, rural towns appear to know their patients and their families on a more personal level and outside of their office, and engage in more socioemotional communications compared to those practicing in suburban clinics in a large urban centre. Knowing patients outside the clinic seems to change the nature of the doctor-patient interaction, and, in turn, the doctor-patient relationship itself. Interactions between urban doctors and their patients had a mixture of instrumental and socioemotional communications, while interactions between rural doctors and their patients tended to be highly interpersonal, often involving considerable socioemotional communication and relationship-building.ConclusionsDespite the different ways that doctors and patients communicate with each other in the two settings, rural and urban doctors spend approximately the same amount of time with their patients. Thus, greater use of socioemotional communication by rural doctors, which may ease patient anxiety and increase patient trust, did not appear to add extra time to the patient visit. Research suggests that socioemotional communication may ultimately lead to better patient outcomes, which implies that health differences between rural and urban settings could be linked to differences in doctor-patient communication styles.

Rural Generalism and the Queensland Health pathway - implications for rural clinical supervisors, placements and rural medical education providers

The lifeline for country medicine' was the description by the Rural Doctors Association of Australia of the Queensland Health Rural Generalist Pathway (RGP). The program promises to redress rural medical workforce issues in Queensland. It may fulfil these promises, but only with the support of rural clinical supervisors and medical educators adapting to new expectations of competencies, of training structure and endpoints of training. These adaptations will be a key element of the RGP success, particularly as other states adopt the approach. This article outlines the lessons learnt and adaptations made by clinical supervisors and medical educators in the Queensland Rural Medical Education group, to deliver the Rural Pathway of the Australian General Practice Training program since the first registrars identifying as RGP appeared in this program in 2006.

Effectiveness of cognitive behavioural coaching in improving the well‐being and retention of rural general practitioners

To determine the relationship between cognitive behavioural coaching, the well-being of rural general practitioners (GPs), their intentions to leave and actual leaving of rural general practice. Quasi-experimental study utilising an intervention group of rural GPs and deidentified data for a baseline group and a control group consisting of the remaining population of rural GPs in South Australia. Rural general practice. Rural GPs in South Australia: intervention group (n = 69), baseline group (n = 205) and control group (n = 312). A 9-hour cognitive behavioural coaching program. Rural doctor distress, intention to leave rural general practice and actual retention rate of rural GPs. GPs who underwent cognitive behavioural coaching had lower rural doctor distress scores (mean = 24.50; confidence interval, 21.71-27.29) than the baseline group (mean = 28.63; confidence interval, 27.08-30.17). Before coaching, 81% of rural GPs in the intervention group had considered leaving general practice, which reduced to 40% after coaching (χ(2) (2) = 16.31, P < .001). Over a 3-year period, 94% of the coaching group remained in general practice compared with 80% of the control group (χ(2) (1) = 4.89, P = 0.027). Cognitive behavioural coaching reduced the stress levels of rural GPs who self-identified the need for managing stress and reduced their intention to leave rural general practice. Further, despite initially being more stressed compared with the general population of rural GPs, more GPs from the coaching group remained in rural general practice.

Effectiveness of a brief educational workshop intervention among primary care providers at 6 months: uptake of dental emergency supporting resources

Dental emergencies often present to primary care providers in general practice and Emergency Departments (ED), who may be unable to manage them effectively due to limited knowledge, skills and available resources. This may impact negatively on patient outcomes. Provision of a short educational workshop intervention in the management of such emergencies, including education in supporting resources, may provide a practical strategy for assisting clinicians to provide this aspect of comprehensive primary care. This descriptive study used a validated questionnaire survey instrument to measure the effectiveness of a short multimodal educational intervention through the uptake and perceived usefulness of supporting resources at 6 months following the intervention. Between 2009 and 2010, 15 workshops, of which eight were for regional and rural hospital ED doctors, were conducted by the same presenter using the same educational materials and training techniques. A sample of 181 workshop participants, 63% of whom were in rural or remote practice and engaged in providing primary care medical services, returned responses at 6 months on the perceived usefulness of the dental emergencies resource. Thirty percent of clinicians had used the dental emergencies resource within the six-month follow-up period. Significance was demonstrated between professional category and use of the resource, with emergency registrars utilising this resource most and GPs the least. The Dental Handbook, specifically designed for ED use, and tooth-filling material contained within this resource, were deemed the most useful components. There were overall positive open-ended question responses regarding the usefulness of the resource, especially when it was made available to clinicians who had attended the education workshops. Utilisation and perceived usefulness of a supporting resource at 6 months are indicators of the effectiveness of a short workshop educational intervention in the management of dental emergencies by primary care providers. This education may have greater relevance to rural and remote practice where dental services may be limited.

Role of personality in medical students' initial intention to become rural doctors

Recent efforts to redress the deficit of rural medical practitioners have considered the problem of recruitment and retention of rural doctors as one of influencing individuals' career choices. Exposure to rural medical environments during basic medical training is one long-standing example of an initiative aimed in this direction and there is some evidence that it is effective. This study sought to determine whether or not various domains of personality are related to medical students' attitude to practising as rural doctors after graduation. The sample comprised 914 students commencing medical studies in Australian universities. They were recruited as part of the Medical Schools Outcomes Database project and indicated intended location of future medical practice. Seven Australian basic medical training programs. All students completed the NEO five-factor index (NEO-FFI) and Adjective Checklist (ACL) personality instruments. A preference for a rural practice location was associated with a combination of six domains of personality. The probability of rural preference was greater with higher scores on openness to experience, agreeableness and self-confidence but lower with higher scores on extraversion, autonomy and intraception. Taken together these six domains of personality provide useful although imperfect discrimination between students with a rural versus urban location preference. After controlling for student age the associations with extraversion and agreeableness failed to reach statistical significance. While personality does not fully explain medical students' attitude towards practicing as a rural doctor, the data suggest it is an important factor and that some individuals may be better suited to a rural medical career than others. Considering personality along with other characteristics of the individual might allow targeted 'marketing' of rural practice.

Enabling informal digital guanxi for rural doctors in Shaanxi, China

In China, rural healthcare systems have been neglected in favor of the development of market-driven, largely urban health information systems (HIS). We investigated the effective use of information and communication technologies (ICTs) to develop a healthcare model within the rural healthcare system. We investigated information needs, existing healthcare structure, and the use of informal networks – guanxi – to acquire health information mediated by technology. Qualitative interviews (N = 74) were conducted in Shaanxi province of China. Respondents included village doctors (30), rural patients (10), urban doctors (17), and 17 other healthcare stakeholders. We found benefits of the use of ICT in informal networks for village doctors, including the facilitation of communication, greater time efficiency, and better access to medical information, particularly in mobile phone and QQ online social network usage. Guanxi relationships were established at proximate, distant, and virtual levels. Emergent communicative practices, such as Internet-driven medical research by village doctors, led to negotiations in established relationships. As suggested by the theoretical model, infrastructural, economic, socio-cultural, and technological vulnerabilities were also observed. We caution against the drawbacks of replication of the closed guanxi system in the digital ICT healthcare arena, and discuss the implications for research and policy-making.

An analysis of the current educational status and future training needs of China's rural doctors in 2011

ObjectivesTo analyse the educational status and future training needs of China's rural doctors and provide a basis to improve their future training.MethodsA cross-sectional epidemiological survey was used for the analysis,...

Prevalence of Parkinson’s disease in a rural village of coastal Ecuador. A two-phase door-to-door survey

Occupational exposure to toxic solvents increases the odds for having Parkinson's disease (PD). We performed a door-to-door survey to assess PD prevalence in Atahualpa, a rural village of coastal Ecuador where more than 50 % of men work as carpenters, being in contact with toxic solvents under poor safety settings. During Phase I, rural doctors screened all Atahualpa residents aged ≥40 years with a questionnaire directed to identify those with PD. In Phase II, neurologists evaluated individuals who screened as suspected cases of PD, as well as a random sample of negative individuals to assess possible false negative cases. As a result, the census yielded 642 Atahualpa residents aged ≥40 years. An affirmative response to the questionnaire was obtained in seven persons. Neurological examination confirmed the diagnosis of PD in two of them (both carpenters). Examination of 14 non-suspected individuals disclosed no further PD patients. Prevalence of PD in Atahualpa residents aged ≥40 years was 312 per 100,000 which increased to 671 per 100,000 when only people aged ≥60 years was considered. Job-specific prevalence was 1,470 per 100,000 in carpenters. In conclusions, PD prevalence in Atahualpa is similar to that reported from other regions. However, we noted an increase in PD prevalence when only carpenters were considered. Unsafe occupational exposure to toxic substances may counterbalance the apparently lower risk of PD in the non-industrialized world.

Retention of the rural allied health workforce in New South Wales: a comparison of public and private practitioners

BackgroundPolicy initiatives to improve retention of the rural health workforce have relied primarily on evidence for rural doctors, most of whom practice under a private business model. Much of the literature for rural allied health (AH) workforce focuses on the public sector. The AH professions are diverse, with mixed public, private or combined practice settings. This study explores sector differences in factors affecting retention of rural AH professionals.MethodsThis study compared respondents from the 2008 Rural Allied Health Workforce (RAHW) survey recruiting all AH professionals in rural New South Wales. Comparisons between public (n = 833) and private (n = 756) groups were undertaken using Chi square analysis to measure association for demographics, job satisfaction and intention to leave. The final section of the RAHW survey comprised 33 questions relating to retention. A factor analysis was conducted for each cohort. Factor reliability was assessed and retained factors were included in a binary logistic regression analysis for each cohort predicting intention to leave.ResultsSix factors were identified: professional isolation, participation in community, clinical demand, taking time away from work, resources and ‘specialist generalist’ work. Factors differed slightly between groups. A seventh factor (management) was present only in the public cohort. Gender was not a significant predictor of intention to leave. Age group was the strongest predictor of intention to leave with younger and older groups being significantly more likely to leave than middle aged.In univariate logistic analysis (after adjusting for age group), the ability to get away from work did not predict intention to leave in either group. In multivariate analysis, high clinical demand predicted intention to leave in both the public (OR = 1.40, 95% CI = 1.08, 1.83) and private (OR = 1.61, 95% CI = 1.15, 2.25) cohorts. Professional isolation (OR = 1.39. 95% CI = 1.11, 1.75) and Participation in community (OR = 1.57, 95% CI = 1.13, 2.19) also contributed to the model in the public cohort.ConclusionsThis paper demonstrates differences between those working in public versus private sectors and suggests that effectiveness of policy initiatives may be improved through better targeting.

Issues of creating a new cadre of doctors for rural India

'Health gaps between countries and among social groups within countries have widened'. Health is a basic need of a human being and access to health is a basic human right. Article 47 of the Indian Constitution enjoins the State to improve the standard of Public Health, as it is one of its primary duties. India, forms 17% of the global population and accounts for 20% of the total global disease burden. There are pronounced disparities existing between the rural and urban areas, as indicated by the infant mortality rates. Eighty-two percent are residing in villages. Seventy-four percent of the doctors live in urban areas, serving only 28% of the population. The people in rural areas are still unable to access the services of doctors. In this scenario the Ministry of Health (MOH) Government of India (GOI) announced the start of a new course, to create a cadre of rural doctors. The article will look at the shortfalls in the rural health of India as well as region- and statewise disparities in health status, health infrastructure, and manpower availability and the study was conducted by a literature review of government reports and published articles. There exist gross disparities between rural and urban areas due to negligence of the rulers. Even after initiation of the National Rural Health Mission (NRHM) greater than two-thirds of the funds flow to the urban areas/secondary care. The population based on the 2001 census, shows a shortfall in the rural health infrastructure; Community Health Centers (CHC) - 68%, Primary Health Centers (PHC) - 31%, and Subcenters - (SC) - 29%. The solution by creating a new cadre of doctors without improving facilities in the rural areas or without an equitable distribution of resources is unethical. The scarcity of health manpower in rural areas of India was due to skewed prioritization and distribution of resources. This can be corrected by reversing the urban centric planning and bringing equity in social development.

Évaluation de la prise en charge des diabétiques par le médecin généraliste dans la province de Khouribga (Maroc)

Diabetes is a disease of concern due to its increasing frequency and high cost of care. This cross-sectional study evaluated the types of care provided to diabetes patients in primary care for management of the condition. Between December 2010 and March 2011, 54 general practitioners (CPs) in health centres in Khouribga province were asked to complete a pretested questionnaire on their care of diabetes patients. For type 2 diabetes, 46% of the CPs would prescribe diet and lifestyle treatment alone. The practice setting influenced how treatment was managed for typel diabetes patients: 88.5% of rural doctors prescribed premixed insulin versus 58.3% of urban GPs (P = 0.02). Insulin analogues were prescribed by 20.8% of urban GPs as against 3.8% of rural GPs (P = 0.09). There are several shortcomings in the quality of care for diabetes patients. Training GPs could be a solution, especially with the lack of specialists in our country.

Stated Preferences of Doctors for Choosing a Job in Rural Areas of Peru: A Discrete Choice Experiment

BackgroundDoctors’ scarcity in rural areas remains a serious problem in Latin America and Peru. Few studies have explored job preferences of doctors working in underserved areas. We aimed to investigate doctors’ stated preferences for rural jobs.Methods and FindingsA labelled discrete choice experiment (DCE) was performed in Ayacucho, an underserved department of Peru. Preferences were assessed for three locations: rural community, Ayacucho city (Ayacucho’s capital) and other provincial capital city. Policy simulations were run to assess the effect of job attributes on uptake of a rural post. Multiple conditional logistic regressions were used to assess the relative importance of job attributes and of individual characteristics. A total of 102 doctors participated. They were five times more likely to choose a job post in Ayacucho city over a rural community (OR 4.97, 95%CI 1.2; 20.54). Salary increases and bonus points for specialization acted as incentives to choose a rural area, while increase in the number of years needed to get a permanent post acted as a disincentive. Being male and working in a hospital reduced considerably chances of choosing a rural job, while not living with a partner increased them. Policy simulations showed that a package of 75% salary increase, getting a permanent contract after two years in rural settings, and getting bonus points for further specialisation increased rural job uptake from 21% to 77%. A package of 50% salary increase plus bonus points for further specialisation would also increase the rural uptake from 21% to 52%.ConclusionsDoctors are five times more likely to favour a job in urban areas over rural settings. This strong preference needs to be overcome by future policies aimed at improving the scarcity of rural doctors. Some incentives, alone or combined, seem feasible and sustainable, whilst others may pose a high fiscal burden.

Depression and aggression in never-married men in China: a growing problem

China has the highest excess of male births in the world at 118 to every 100 female, with a current excess of 20 million men of reproductive age. The impact on the psychological well-being of the large numbers of men who will never marry is unclear. This study was carried out to test the hypothesis that older never-married men are more predisposed to depression, low self-esteem and aggression. The study was a cross-sectional survey using a self-completion questionnaire conducted in high sex ratio rural areas of Yunnan and Guizhou provinces. The tools used were the Beck Depression Inventory, Rosenberg's Self-Esteem Scale and the Bryant-Smith Aggression questionnaire. A total of 1,059 never-married men and 1,066 married men aged 30-40 completed questionnaires. Never-married men were financially poorer and had lower education levels than married ones. After adjusting for age, education and income, never-married men were significantly more likely to have lower self-esteem scores (P<0.001), higher depression scores (P<0.001), higher aggression scores (P<0.001) and were more likely to have suicidal thoughts or wishes (P<0.001) than married men. The high prevalence of severe depression and suicide ideation in these men is of particular concern. In rural China mental health services are currently very sparse, but rural doctors could be trained to use a check score to identify severe depression, and refer as appropriate to specialist services.

Physician in practice clinic: educating GPs in endocrinology through specialist-outreach

The escalation in the incidence of diabetes mellitus type 2 requires innovative approaches to manage the increasing burden of service provision, a particularly challenging issue for rural communities. Whereas shared care through specialist outreach clinics is a traditional approach to the management of chronic disease, the results on effectiveness are mixed. Where there is a joint consultation with both the General Practitioner (GP) and specialist present during the patient consultation, benefits are reported; however, this model of specialist outreach is uncommon when compared with the more typical model where a specialist sees the patient alone but at the GP's rooms, and later communicates with the GP. The explicit long-term goal of the Physician in Practice Clinic, which emulates the joint consultation model, is improved patient outcomes through better educated and more confident GPs, easier service access for patients and reduced waiting lists. The education of GPs in endocrinology, an early goal, is the focus of the article. Fifteen GPs were sampled purposively on sex, rural/regional location, place of training, practice size and length of time practising locally. Semi-structured interviews were conducted, transcribed then thematically analysed. General practitioners reported substantial educational benefits. One aspect is the face-to-face contract with the endocrinologist which promotes an interactive learning process. All GPs reported that they acquired new knowledge. An important aspect of this new knowledge is that it could be used quickly, often immediately, and also used in the longer term when generalised for use with other patients. A follow-on effect from the new knowledge and its short- and long-term application was an increase in professional confidence. A benefit with the potential for a long-term effect was improved relationships between the GPs and specialist, and the GPs reporting that they were making fewer referrals. The greatest benefits reported by those in small practices were the interactive learning and being able to generalise the new knowledge to other patients. For rural doctors most benefit was from the interactive learning, whereas for regional doctors it was increased confidence. Australian trained doctors reported mostly the benefits of being able to use the knowledge quickly and the interactive learning. By contrast, doctors not trained in Australia favoured the increased confidence and the generalisability of the new knowledge. Those who had practised locally for up to 10 years benefited most from the new knowledge and the increased confidence, and females benefited most from increased confidence and receiving new knowledge. From the GPs' perspective, the goal of creating better educated and more confident GPs in endocrinology in this rural/regional setting was achieved. Therefore this easily replicated but novel approach to specialist outreach has the potential to improve health outcomes in chronic disease in rural communities. In addition, a more tailored approach to shaping the Clinics based on the socio-demographic categories reported here could have additional short- and long-term benefits.

Association of "Grit" and Satisfaction in Rural and Nonrural Doctors

One potential psychological construct, grit, may help to explain the non-cognitive traits that account for both rural physician satisfaction and retention. We investigated (1) the psychological construct grit among rural and non-rural primary care/specialty care physicians, (2) satisfaction levels and (3), the relationship between the psychological construct grit and satisfaction across combinations of rural/non-rural and primary care/specialty care physicians. We mailed a cross-sectional questionnaire to 2126 active members of the Idaho Medical Association and Idaho Academy of Family Physicians measuring their self-reported level of grit, satisfaction level and area of specialty. We received responses from 564 physicians (26.5%). Idaho physicians have relatively uniform levels of grit independent of specialty or practice location. Specialty care physicians reported significantly higher levels of ambition, regardless of practice location. Most physicians were satisfied with their practice (91.7%). Specialty care physicians reported a significantly higher difference in their levels of satisfaction with their practice compared to primary care physicians. Idaho primary care and specialty care physicians in both rural and non-rural settings reports themselves as individuals who work hard, persevere despite setbacks, and are ambitious. Furthermore, Idaho physicians are satisfied with their current practices.