Rural Doctors Research Articles

Sarcomatous tumor of the right ovary, removed by laparotomy in the gynecological department at the Mogilev obstetric institution

Unfortunately, we do not yet have accurate statistics of malignant neoplasms of the ovaries. Virkhov, for example, of the opinion that they are quite rare. In Schroeder's 600 cases of neoplasms of the ovaries, there are only 10 cases of malignant, consequently somewhat more than 1%. Wert in relation to ovarian cysts determines the frequency of dense neoplasms in 5%. Spencer Wells initially rose 1.72%, followed by even less 1.2%. Leopold), from a more distant time, there are only 8 cases of malignant neoplasms of the ovaries: 4 cases of Spencer Wlls, of which two were fatal, two cases of Spiegelberg, both were fatal, one case of Buren and one recovered a rural doctor whose patient died of a collapse shortly after the operation. Even if we assume that cases of malignant neoplasms of the ovaries are quite rare, then all the same, judging by the latest reports, it cannot be argued that this rarity would be in such a scale as the authors just cited for a longer time estimate it.

Personal resilience and rural doctors retention: a study in Indonesia.

Retaining the health workforce in rural areas is a global problem. Job dissatisfaction or work-related distress are among the factors that drive doctors to leave rural places. Resilience has been recognised as a key component of wellbeing and is associated with better satisfaction with life. Building personal resilience has the benefits of lowering vulnerability to work-related adversity. This study examined the association between rural doctors' personal resilience and the duration of rural practice. This cross-sectional study was set in a rural province in Indonesia. A total sampling procedure was implemented. A total of 528 participants responded to an online survey. The survey tool measured six dimensions of a resilience profile &#40;determination, endurance, adaptability, recuperability, comfort zone and life calling&#41; and collected personal data such as date of birth, practice location and duration of rural practice experience. These participants were classified into four groups: intern, general (GP) with 10 years experience. The data were analysed quantitatively using Oneway analysis of variance (ANOVA). Doctors with longer durations of rural experience showed higher resilience levels in four of the dimensions of personal resilience: endurance, adaptability, recuperabilit&shy;y and comfort zone. Among those four dimensions, endurance and comfort zone showed significant differences between groups with >10 years of difference in rural experience (p<0.05). The other two dimensions, determination and life calling, showed fluctuations across groups with different rural durations. This study provides a preliminary result for understanding the relationship between personal resilience and rural doctor retention. It suggests that resilience is partly associated with rural doctor retention. Further studies are needed to examine the causal relationship between resilience and retention.

Evaluation of the Spring Seedling Project-Zhaotong Program: A study of a novel continuing medical education program for rural doctors in China.

ObjectiveTo evaluate the effectiveness of the Spring Seedling Project‐Zhaotong program, a novel continuing medical education program, to improve the knowledge and skills of rural doctors in China.DesignAn uncontrolled single‐group pre‐ and post‐intervention design based on quantitative and qualitative methods.SettingZhaotong is a prefecture‐level city located in Yunnan, China.ParticipantsA total of 1866 country doctors practising in Zhaotong were enrolled.InterventionsThe Zhaotong program consisted of three stages: remote education, workshops conducted in Zhaotong and field training in Shanghai.Main outcome measuresThe effectiveness of the remote education and Zhaotong workshop stages was assessed based on differences between pre‐ and post‐training test scores. Qualitative comments were collected to assess the experience of country doctors following the Shanghai field training stage.ResultsIn total, 1866 country doctors (46.9% males; mean age: 38.2 ± 9.2 years) participated in the program. The average score of the post‐training test was higher than that of the pre‐training test, both online (P < .001) and offline (P < .001). In regard to the Zhaotong workshops, with the exception of incisions/suturing, the average scores of cardiopulmonary resuscitation, gynaecological examinations and child growth/development were improved after training (P < .001). Qualitative analysis showed that Shanghai field training enhanced understanding of general practice, with the majority of country doctors indicating that they would apply what they learned in daily practice.ConclusionThis study introduced an comprehensive form of continuing medical education for rural doctors in Zhaotong and proved the effectiveness of this program and also provided a reference point for the future development of continuing medical education.

Keys to Expanding the Rural Healthcare Workforce in Kyrgyzstan.

Objective/Background: This study assessed Kyrgyzstan's progress with developing its rural primary care workforce and prioritized next steps to build on its current momentum. Kyrgyzstan has improved rural health care since 1997 through the implementation of family medicine, retraining of rural doctors and nurses, and other efforts. Attrition, emigration, urbanization, and population growth are threatening these hard-won advances. In response, Kyrgyzstan is now educating family medicine residents at rural sites and improving salaries. This study explores other steps to strengthen its rural health care, especially its rural generalists.Methods: This was an observational study using a two-phase survey process. To access the current status of Kyrgyzstan's rural health care system, we surveyed key stakeholders within that system using a draft version of the new World Health Organization Rural Pathways Checklist. To prioritize next steps, we asked rural FM residents to rank the relative importance of 31 possible future actions to support Kyrgyzstan's rural primary care workers.Results: Doctors and nurses involved in teaching rural health workers identified that Kyrgyzstan has made good progress with rural professional support and upskilling of existing health workers through education. They saw the least progress with selection of health workers and monitoring. The rural family medicine residents' top ten suggestions for rural recruitment and retention all involved improving working conditions (providing housing, internet, basic medical equipment, protected time off, better salaries, and more respect) and improving clinic efficiency (switching clinic scheduling from walk-in based to appointment based, optimizing the roles of clinical team members, and decreasing low-value clinic visits).Conclusions: The WHO Rural Pathways Checklist helped to evaluate Kyrgyzstan's current efforts to promote rural primary care. The priorities listed above from the next generation of potential rural family doctors could help guide future steps to promote rural health in Kyrgyzstan and the Former Soviet Union.

Twelve tips for OSCE-style Tele-assessment.

This article was migrated. The article was marked as recommended. The Australian College of Rural and Remote Medicine (ACRRM) has developed a flexible 'tele-assessment' approach to the delivery of its assessment modalities. Candidates can sit their examination remotely, close to their place of practice, which reduces the need for rural doctors - both candidates and examiners - to leave their communities for the purpose of assessment. A major component of the assessment process is the Structured Assessment using Multiple Patient Scenarios (StAMPS) examination, which blends the formats of an Objective Structured Clinical Examination (OSCE) and a traditional viva vocè examination. It is a high-stakes assessment, that was designed to be academically rigorous, flexible, valid, reliable, and fair. Since 2008 ACRRM has provided a videoconferencing option to candidates for their StAMPS examination allowing them to remain in or near their home location, while the examiners meet a central location. Travel restrictions due to the SARS-CoV-2 pandemic meant for the first time both candidates AND examiners participated in StAMPS via videoconference. ACRRM conducted an online StAMPS assessment using videoconferencing technology for 65 candidates in mid-May 2020, with all candidates, examiners and support staff remaining in or near their home communities. These Twelve Tips outline some of the experience gained in providing tele-assessment over the past twelve years.

Exploration of rural physicians’ lived experience of practising outside their usual scope of practice to provide access to essential medical care (clinical courage): an international phenomenological study

ObjectivesRural doctors describe consistent pressure to provide extended care beyond the limits of their formal training in order to meet the needs of the patients and communities they serve. This...

Continuing medical education and work commitment among rural healthcare workers: a cross-sectional study in 11 western provinces in China

ObjectivesContinuing medical education (CME) and work commitment are important for rural healthcare workers (RHWs) and rural medical work. The significant association between continuing education and work commitment has been reported...

The COVID-19 Conundrum

The COVID-19 Conundrum

Capability ... what's in a word? Rural Doctors Network of New South Wales Australia is shifting to focus on the capability of rural health professionals.

Rural health services, and the workforces that provide those services, are under unprecedented pressure due to insufficient health workforce numbers and distribution of health workforce weighted to urban areas. This creates health service access issues in rural areas, compounding existing health inequalities between rural and urban people. Many approaches to date have aimed to rectify these issues, with moderate success. In this article we present a call to action to pursue a complementary approach: supporting the capability of the rural health workforce. We hypothesise that further exploring what it means to be a 'capable' rural health professional and what processes or conditions support or erode capability may additionally bolster efforts toward strong rural and remote health systems. The Capability Approach is a theory proposed by Amartya Sen, who was awarded the Nobel Memorial Prize in Economic Sciences in 1998 for this work. Although the Capability Approach inspired, for instance, the UN's Human Development Index, it has not been deeply explored in the context of rural health workforce. While still untested, a focus on capability may assist us in taking a broader view, which encompasses functioning and the freedom to pursue different functioning combinations. The feasible freedom and opportunities are paramount to the concept of capability. We posit that competence is static and the responsibility of the practitioner (and their education), but that capability is fluid and multi-dimensional and the responsibility of the practitioner, community and system. Therefore, we hypothesise that a focus on a Capability Approach, which modulates the relation between the contextual factors and outcomes, may provide us with greater understanding and avenues for action when we aim to improve outcomes such as rural health service sustainability. Developing a list of appropriate capabilities and setting strategies to support capability and its more nuanced domains may present unique opportunities for influence, and these may have positive effects on the rural health workforce. Of course it will need to be determined if improving rural primary health professionals' capability has positive impacts upon quality and access to care, and whether supporting capability is sustainable and worthy of investment.

Development of the Rural Generalist Program Japan: meeting the needs of Japanese rural communities.

There is a worldwide shortage of physicians, which is worse in rural areas, with a large underserved rural and remote population. Most jurisdictions in countries of all income levels report shortages of rural doctors, often exacerbated where primary care is not strong. Japan is not an exception: Japanese specialist-driven approaches in medical education and public health have resulted in disproportionate distribution of medical services in the country. Rural generalism, or rural generalist medicine, is emerging in many jurisdictions as one approach to training and provision of care for rural communities. While there is considerable variation in titles, the format of the training and models of care, the emphasis is on training a generalist doctor capable of meeting community needs. This usually includes development of appropriate skills in primary care, inpatient care, emergency medicine, public health and one or more extended skills. These models are well established in Australia, particularly in Queensland, which has offered a rural generalist program for over a decade. The Rural Generalist Program Japan (RGPJ) has been developed to meet the needs of Japanese rural communities. This article outlines development of the RGPJ using the World Federation for Medical Education standards. While early evaluations are positive, there is much more to do to develop a mature program capable of meeting the needs of Japan's rural and remote communities.

Dimensions of Existential, Relatedness and Growth (ERG) Needs of Medical Students for Rural Posting: An Analytical Study

The retention of rural doctors in India is a very big challenge. Despite the mandatory rural postings, year by year rural health statistics indicate an abysmal picture of rural doctors’ vacancies and their shortfalls in many states. Various studies stipulate that rural doctors are quitting rural postings; the reasons are job dissatisfaction, lack of physical facilities, and the dearth of educational exposure for children, low advancements opportunities, etc. A reliable instrument to identify the motivational needs of doctors towards their rural postings, suitable to Indian context is the need of the hour for both policymakers and doctors alike. So, this study aims to acquire the reliability of the Existential, relatedness, and Growth needs of Doctors’ questionnaire and to obtain the dimensions of needs as an initial attempt. An ERG motivational need questionnaire was developed to determine the needs of medical students and doctors to practice in rural areas of India. A literature search and pilot study with 203 medical students were carried out and appropriate items were extracted. This study was conducted in Jaipur, Chennai, and Pondicherry with 203 medical students. The developed questionnaire was initially with 58 items and reduction of items was done through Exploratory Factor Analysis (EFA). The reliability of the instrument was measured using internal consistency reliability, by Cronbach alpha coefficient. The instrument is developed with three constructs namely Existential needs (EN), Relatedness Needs (RN), and Growth Needs (GN) with a 5-point Likert scale. The exploratory factor analysis after five rotations converged to 10 factors with 65.971% of the total variance and 0.855 Kaiser-Meyer- Olkin index indicating sampling adequacy. The initial 58 items were reduced by 32 items in the final questionnaire. Factor loading ranged from 0.439- 0.797, consequently the 10 factors were labelled, and their reliability scores are 0.794, 0.782, 0.760, 0.708, 0.788, 0.802, 0.711, 0.615, 0.645, and 0.525. The result obtained has proven that the extracted 10 factors have good reliability to obtain the dimensions of Existential, relatedness, and growth needs. The study results have implications in addressing the problem of rural doctors’ shortage.

História do Grupo de Trabalho em Medicina Rural da SBMFC

Este artigo apresenta a História do Grupo de Trabalho em Medicina Rural da SBMFC, um dos mais ativos grupos de trabalho da SBMFC. São revisados os primeiros passos desde a sua criação e posteriores desenvolvimentos. Um dos principais resultados identificados foi o de ajudar a consolidar a identidade do “MFC rural” e trazer a discussão da saúde das populações rurais para a agenda da saúde, da atenção primária e da medicina de família. Este relato tem também como objetivo auxiliar outros grupos em criação ou já estabelecidos a criar estratégias de fortalecimento de seus trabalhos.

Preferences and pathways of the next generation of rural doctors.

Preferences and pathways of the next generation of rural doctors.

P012: Does physician burnout differ between urban and rural emergency medicine physicians? A comparison using the Maslach Burnout Inventory tool

Introduction: Previous literature suggests that emergency medicine physicians experience high levels of work-related burnout. However, these results are drawn primarily from physicians working in large urban emergency departments. The aim of this study was to compare physician wellness between emergency medicine physicians working in urban versus rural settings. Methods: Emergency medicine physicians were recruited to complete a wellness survey from both urban and rural emergency medicine departments in Southwestern Ontario. The primary outcome measure of interest was physician burnout as measured by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). This survey tool measures physician burnout in the three domains of emotional exhaustion, depersonalization, and personal accomplishment. Descriptive statistics, paired t-tests and Mann-Whitney U tests were used to analyze parametric and non-parametric burnout domain data respectively. Results: Surveys were completed by 67/99 (68%) and 22/66 (33%) of urban and rural emergency medicine physicians, respectively. An emotional exhaustion score ≥27 OR a depersonalization sub-score ≥10 was considered the threshold for burnout and was found in 71.4% (40/56) of urban physicians surveyed and 85.7% (18/21) (P = 0.20) of rural physicians. No statistically significant difference in mean emotional exhaustion, depersonalization, or personal accomplishment was noted between groups. Conclusion: High levels of burnout were noted amongst both urban and rural emergency medicine physicians. No statistically significant differences were noted between groups when compared on the Maslach Burnout Inventory survey tool. Despite many factors differentiating urban from rural practice, rural emergency doctors suffer similar rates of burnout. Thematic qualitative interviews exploring specific burnout factors may offer further insight into the drivers of physician burnout.

Medical student well‐being during rural clinical placement: A cross‐sectional national survey

Understanding rural student well-being is essential to inform the development and training of the future rural medical workforce so as to ensure a pipeline of rural doctors to meet rural communities' needs. However, little is known about the well-being of students who are on rural placement. This study aims to identify the predictors of well-being amongst a national sample of medical students on rural clinical placement. The Federation of Rural Australian Medical Educators (FRAME) 2015 national exit survey of medical students, completed at the end of rural terms, was used (n=644) to test the associations between well-being and demographic, financial, academic, supervisor, placement and clinical skills factors, and attitude to future rural work. Univariate and logistic regression were used. Students aged 18-24years (odds ratio [OR], 8.07 [95% confidence interval {CI}, 2.07-31.46]) and 25-34years (OR, 4.06 [95% CI, 1.35-12.18]) reported higher levels of well-being compared to students aged over 35years. Academic support from the rural clinical school (OR, 5.74 [95% CI, 2.59-12.73]), perceived respect from supervisors (OR, 3.13 [95% CI, 1.23-7.99]), not feeling socially isolated (OR, 2.7 [95% CI, 1.40-5.20]), access to counselling services (OR, 2.05 [95% CI, 1.10-3.83]), rural placement being a first choice (OR, 3.04 [95% CI, 1.58-5.86]) and positive attitudes to being part of a rural workforce in the future (OR, 4.0 [95% CI, 2.0-8.3]) were associated with higher odds of well-being compared to students who felt the opposite. Gender, rural background, financial support, clinical skills and role clarity were not found to be associated with well-being (P>.5). This study may provide guidance to rural clinical schools, policymakers and medical educators in developing rural placement programmes that enhance student well-being so we can address workforce shortages in rural areas.

Effective dimensions of rural undergraduate training and the value of training policies for encouraging rural work.

The implementation of rural undergraduate medical education can be improved by collecting national evidence about the aspects of these programmes that work well and the value of investing in national policies. This study aimed to explore how different durations, degree of remoteness and number of rural undergraduate medical training placements relate to working rurally, and to investigate differences after the introduction of formal national training policies that fund short- and long-term rural training experiences for medical students. A cohort of 6510 Australian-trained doctors who completed the Medicine in Australia: Balancing Employment and Life survey recalled their participation in rural undergraduate medical training. Responses were categorised by duration, remoteness as defined by the Modified Monash Model levels 3-4 and 4-7 compared with 1, and total number of placements. Multivariate regression was used to test associations with working rurally in 2017, and differences between cohorts of students who graduated pre- and post-2000, of which the latter were exposed to formal national training policies. Any rural undergraduate training was associated with working rurally (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.3-1.9) with incrementally stronger associations for longer duration (>1year: OR 3.0, 95% CI 2.3-4.0), greater remoteness (OR 1.8, 95% CI 1.5-2.1) and three placements (OR 2.4, 95% CI 1.9-3.0) compared with none. Rural background (OR 2.6, 95% CI 2.3-3.0) and general practice (OR 2.6, 95% CI 2.2-2.9) were independently associated with working rurally; being female was negatively associated with rural work (OR 0.7, 95% CI 0.6-0.8). The cohort of doctors who trained in a period when national rural training policies had been implemented included more graduates with a rural background and experience of undergraduate rural training but returned equivalent proportions of rural doctors to pre-policy cohorts, and included proportionally more women and fewer general practitioners. Rural undergraduate training should focus on multiple dimensions of duration, remoteness and number of rural undergraduate training experiences to grow the rural medical workforce. Formal national rural training policies may be an important part of the broader system for rural workforce development, but they rely on the uptake of general practice and the participation of female doctors in rural medicine.

Knowledge and Attitudes towards Healthcare Information Technology of the Rural Health Workers in SAMARICA, Occidental Mindoro, Philippines

The descriptive research aims to determine the socio-demographic characteristics of the healthcare providers, the health workers’ knowledge of and attitudes towards computer applications and the relationship between socio-demographic characteristics of the healthcare providers and their knowledge of and attitudes towards computer applications.&#x0D; The study was conducted in the Rural Health Units of San Jose, Magsaysay, Rizal &amp; Calintaan, Occidental Mindoro from March 2017 to June 2018. The 51 health workers were purposively selected as respondents of the study. Survey and interview were used to gather the data needed. Descriptive statistics and Pearson Moment Correlation were used to analyse the gathered data.&#x0D; Results shows the healthcare providers are female, young, college graduate, and have long work experience in the maternal and newborn care section and had assisted the rural health doctor during consultations. The healthcare providers have “high” level of knowledge on computer and its applications and had expressed “positive” attitudes towards the use of computers in their work.&#x0D; Further, only age has a significant relationship with the healthcare providers’ knowledge of and attitude towards computer applications.

Retention of physicians and surgeons in rural areas-what works?

Causes for health inequity among rural populations globally are multifactorial, and include poorer access to healthcare professionals. This study summarizes the recent literature identifying factors that influence rural doctor retention and analyses strategies implemented to increase retention. Uniquely, this study addresses the importance of context in the planning, implementation and success of these strategies, drawing on literature from high-, middle- and low-income countries. A systematic review of the English literature was conducted in two parts. The first identified factors contributing to rural doctor retention, yielding 28 studies (2015-2019). The second identified 19 studies up to 2019 that assessed the outcomes of implemented rural retention strategies. Universal retention factors for health professionals in a rural environment include rural background, positive rural exposure in training or in the early postgraduate years and personal and professional support. Financial incentives were less influential on retention, but results were inconsistent between studies and differed between high-, middle- and low-income nations. Successful strategies included student selection from rural backgrounds into medical school and undergraduate education programs and early postgraduate training in a rural environment. Bundled or multifaceted interventions may be more effective than single factor interventions. Rural health workforce retention strategies need to be multifaceted and context specific, and cannot be effective without considering the practitioner's social context and the influence of their family in their decision making. Adequate rural health facilities, living conditions, work-life balance and family, community and professional support systems will maximize the success of implemented strategies and ensure sustainability and continuity of healthcare workforce in rural environments.

Consolidation of the rural medical community in the Tobolsk Governorate in the early 20th century

The present article is aimed at studying district congresses of rural doctors from the Tobolsk Governorate, a unique phenomenon in the history of the Siberian medical community. Congresses are considered to be an inte-gral part and development indicator of the corporate social initiative, as well as the professional interaction of medical specialists. On the basis of documents being introduced into scientific circulation for the first time, the author analysed the activity of rural doctors within the paradigm of the general theory of modernisation, as well as characterised the materials of meetings, the range of issues under discussion, main recommendations and re-sults. It is shown that the activity of the medical community was not limited to the work of scientific and practical societies of governorate centres — it was much wider and richer. The fact of holding two provincial and a number of district congresses in the Tobolsk Governorate (from 1903 to 1912) was established. District congresses be-came a place for establishing personal contacts between doctors, sharing opinions and experiences, formulating proposals, which were then discussed at the governorate forum and laid the foundation for administrative deci-sions. They demonstrated a strong motivation of rural specialists in medicine, which in fact began to develop in Siberia only starting from the late 1880s, for professional consolidation and for the development of common ap-proaches to solving regional problems. The materials of district congresses also prove the formation of a new health model among the rural population, characteristic of modern society. A doctor became a familiar and neces-sary element of the social environment for a peasant. It should be noted that district congresses were not large-scale, they were not public mouthpieces, did not become the driving force of reforms and the generator of signifi-cant public projects. Their history was too short; the level of rural medicine and, in general, the entire medicine of the governorate was too low. Nevertheless, the need for professional consolidation and communication turned out to be so strong that it allowed doctors, albeit with the support of the administration, to carry out serious prepara-tory work in districts and hold two governorate congresses. Clearly, this constitutes definite evidence of qualitative changes in the state of the local medical community.

EXCHANGE: EXPLAINING THE PASSAGE OF UNIVERSAL HEALTHCARE IN THAILAND

AbstractWhat explains the passage of Thailand's landmark universal healthcare (UHC) policy? In separate contributions, Selway and Harris emphasized the role of electoral rules and political parties, on one hand, and “professional movements” of developmentally minded state bureaucrats on the other. Which is correct? In this article, Selway and Harris respond to each other's work. While Selway agrees that the actions of the professional movement constitute an underappreciated necessary condition for universal healthcare in Thailand, he argues that Harris overstates the role of the movement in implementation. Harris defends his position and maintains that an institution-focused account is insufficient, arguing that the actions of Thailand's Rural Doctors’ Movement not only explain universal healthcare but also gave rise to the very electoral rule changes that Selway argues were so critical to facilitating universal coverage. Selway responds to these criticisms, and the two researchers jointly consider implications for causation, qualitative research, and policymaking theory.