Urban Colleagues Research Articles

What is Needed to Support Non-Urban Urology in the United States? Perspectives from Urologists in Rural and Underresourced Areas.

Twenty percent of Americans live in non-urban areas, and the challenges in providing high-quality health care in rural areas are well described. These challenges are further exacerbated by the fact that rural citizens are often older and sicker than their urban colleagues, as well as by the ongoing workforce shortage in urology. This study aims to describe the current practice experiences of non-metropolitan urologists (NMUs) in the United States. Based on the results of the 2022 American Urological Association Census, a secondary questionnaire was developed and distributed electronically to urologists who self-identified in the Census as practicing in non-metropolitan areas. Multiple choice answers were summarized as proportions and free-text answers were collected and grouped by theme. One hundred and thirteen of 552 (20.5%) urologists responded. Most respondents were male (92.9%), aged >55 years (76.1%), in practice >25 years, and in solo practice (25.5%) or a subspecialty group (20.8%). Stressors for NMUs included recruitment (61.3%), call concerns (59.3%), workforce issues (59.3%), difficulty interacting with tertiary medical centers (45.1%), and lack of resources (40.7%). Nearly half of respondents (48.5%) experience burnout more than once monthly, and 31.9% anticipate continuing their current practice and pace for the next five years. Call burden is the most likely reason to leave practice (40%). Most urologists practicing in non-metropolitan areas are older, endorse high rates of burnout, and have active plans to leave or decrease practice within five years. Understanding contemporary stressors can inform policies to support current and future NMUs.

Throughput rates and time to completion of health science students of rural origin in South Africa

Background. There is a shortage of qualified healthcare workers in South Africa (SA), as well as a maldistribution between urban and rural areas. Research has shown that health professionals of rural origin are more likely to live and work in rural areas than their urban colleagues. It has been recommended that student selection policies of higher education institutions should prioritise applicants from rural and remote areas to address the urban-rural maldistribution of graduates and to redress historical equity issues. However, university students in SA have high attrition and low graduation rates. The Umthombo Youth Development Foundation (UYDF) recruits and supports rural-origin health science students, who completed Grade 12 at a rural school, to address staff shortages in rural areas. Objectives. To report on the throughput rates (percentage of cohort who graduate) and time to completion (number of years taken to graduate) of eight cohorts of UYDF-supported rural-origin health science students. Methods. A total of 388 student records from the 2008 - 2015 cohorts, covering 17 different health science disciplines, were analysed, and throughput rates and time to completion for the different cohorts and health science disciplines were calculated. Throughput rates and time to completion were also calculated for 3-year, 4-year and 6-year qualifications. Results. Throughput for the 2008 - 2015 cohorts ranged between 82% (2010 cohort) and 100% (2009 cohort). For 3-year qualifications, five cohorts had 100% throughput and one cohort 50% throughput. For 4-year qualifications, throughput ranged from 75% (2010 cohort) to 100% (2009 cohort). For medical students (6-year qualification), throughput ranged from a low of 81% (2014 cohort) to 100% in two cohorts (2008 and 2009). More female students (n=29) were excluded than male students (n=14). With regard to time to completion, over the eight cohorts 68% of students completed in the minimum time, 23% needed 1 additional year, 6% an additional 2 years, 2% an additional 3 years, and 1% an additional 4 years. For 4-year qualifications, 58% of students completed in the minimum time, 28% needed 1 additional year, 9% needed 2 additional years, 4% needed 3 additional years, and 1% needed an additional 4 years. Of medical students, 76% completed in the minimum time, 19% needed 1 additional year, and 98% had completed after 2 additional years. Discussion. The UYDF students studying for 3-year and 4-year qualifications exceeded the national throughput rates in seven of eight cohorts. UYDF medical students exceeded the national statistics in four cohorts, had similar throughputs in two cohorts, and had lower throughputs than the national statistics in two cohorts. Overall, 91% of UYDF students across the eight cohorts completed in the minimum time plus 1 additional year, exceeding national statistics. Conclusion. The relatively high throughput rates compared with the national statistics highlight the academic ability of rural-origin health science students and provide hope that national shortages of healthcare workers may be addressed if there is an investment in such students..

Prevalence and associations of provision of nursing home visits and home visits by early-career specialist general practitioners.

To establish prevalence and associations of provision of nursing home visits (NHV) and home visits (HV) by early-career specialist GPs. Of particular interest were associations of rurality with performing NHVs and HVs. A cross-sectional study. A questionnaire-based study. Australian general practice. Early-career specialist GPs, practising in Australia, who attained Fellowship between January 2016 and July 2018, inclusive, having completed GP training in NSW, the ACT, Eastern Victoria or Tasmania. Current provision of NHV and HV. NHV were provided by 34% of participants (59% in rural areas) and HV by 41% of participants (60% in rural areas). Remote, rural or regional practice location, as compared to major-city practice, was strongly associated with performing NHV as an early-career specialist GP; multivariable OR 5.87 (95% CI: 2.73, 12.6), p < 0.001, and with the provision of HV; multivariable OR 3.64 (95% CI: 1.63, 8.11), p = 0.002. Rurality of GP training (prior to attaining Fellowship) was significantly univariably associated with providing NHV and with providing HV as an early-career specialist GP. On multivariable analyses, these were no longer statistically significant. Early-career specialist GPs located in regional/remote areas are more likely than their urban colleagues to provide NHV and HV.

Rural general practitioners have different personal and professional trajectories from those of their urban colleagues: a case-control study

BackgroundIn France, rural general practitioner (GP) numbers could reduce by 20% between 2006 and 2030 if no measures are taken to address primary care access difficulties. In countries such as Australia, the USA and Canada, intrinsic and extrinsic factors associated with GPs practising in rural areas include rural upbringing and rural training placements. However, the health systems and rural area definition differ between these countries and France making result extrapolation difficult. These factors must be studied in the context of the French heath system, to design strategies to improve rural GP recruitment and retention. This study aims to identify the intrinsic and extrinsic factors associated with GPs practising in rural areas in France.MethodsThis case–control study was conducted between May and September 2020. Included GPs practised in Brittany, France, and completed a self-administered questionnaire. The cases were rural GPs and controls were urban GPs. National references defined rural and urban areas. Comparisons between rural and urban groups were conducted using univariate and multivariate analyses to identify factors associated with practising in a rural area.ResultsThe study included 341 GPs, of which 146 were in the rural group and 195 in the urban group. Working as a rural GP was significantly associated with having a rural upbringing (OR = 2.35; 95% CI [1.07–5.15]; p = 0.032), completing at least one undergraduate general medicine training placement in a rural area (OR = 3.44; 95% CI [1.18–9.98]; p < 0.023), and having worked as a locum in a rural area for at least three months (OR = 3.76; 95% CI [2.28–6.18]; p < 0.001). Choosing to work in a rural area was also associated with the place of residence at the end of postgraduate training (OR = 5.13; 95% CI [1.38–19.06]; p = 0.015) and with the spouse or partner having a rural upbringing (OR = 2.36; 95% CI [1.12–4.96]; p = 0.023) or working in a rural area (OR = 5.29; 95% CI [2,02–13.87]; p < 0.001).ConclusionsFrench rural GPs were more likely to have grown up, trained, or worked as a locum in a rural area. Strategies to improve rural GP retention and recruitment in France could therefore include making rural areas a more attractive place to live and work, encouraging rural locum placements and compulsory rural training, and possibly enrolling more medical students with a rural background.

Doctors’ experiences of providing care in rural hospitals in Southern New Zealand: a qualitative study

ObjectiveTo explore rural hospital doctors’ experiences of providing care in New Zealand rural hospitals.DesignThe study had a qualitative design, using qualitative content analysis.SettingThe study was conducted in South Island, New...

Using academic detailing to enhance the knowledge, skills and attitudes of clinicians caring for patients with behavioral and psychological symptoms of dementia

AbstractIntroduction: Approximately 90% of persons with dementia experience behavioral and psychological symptoms of dementia (BPSD) over the course of their illness. Primary care clinicians often provide care as specialty geriatric‐medicine or ‐psychiatry consultation may be difficult to obtain. Academic detailing (AD) is an evidence‐based educational approach for engaging and persuading healthcare professionals to make changes in their practice (Avorn 2017). We sought to enhance the knowledge, skills and attitudes of providers’ care of patients with BPSD using the AD model in primary care.MethodsWe implemented AD in an urban clinic serving a largely Black community and a rural clinic serving a large, White community. Each AD visit included didactic content, case discussion, and consultation regarding patients with BPSD. Eleven visits over 18 months are planned for each site. Outcome measures include a 10‐item multiple‐choice assessment of knowledge and an adaptation of the General Practitioners Attitude and Confidence Scale for Dementia (GPACS‐D) (Mason et al. 2019) at baseline before training, and 6 and 18 months, and Likert‐scale measurement of acceptability at 6 and 18 months, all self‐report.ResultsWe present interim data. Five urban and 14 rural providers completed baseline assessments. Providers were mostly White (95%) and Non‐Hispanic (100%); 47% were female. Urban and rural providers had similar baseline BPSD knowledge (mean (SD) of correct answers, 5.4 (1.7) for rural, and 5.0 (2.6) for urban). The adapted GPACS‐D, where higher score indicates more confidence, showed less confidence (mean score 11.4 versus 16.6, p=0.01) in urban versus rural providers. The overall attitudes score indicate there may be more confidence in treating BPSD at baseline among the slightly older rural providers as compared to their urban colleagues. Thus far, eight of 22 planned AD visits have been completed; 6‐month assessments are forthcoming and will be presented.DiscussionAcademic detailing may be a feasible and effective way of increasing self‐reported knowledge and skills and improving self‐reported attitude of primary care providers responsible for the care of patients with BPSD. The pilot data collected in this study will inform the design of a larger study to measure the impact of AD on patient outcomes.

Sachs-Georgi reaction at the site

One of the difficulties in the work of a district doctor is the impossibility, for a number of reasons, to use even such laboratory research data, which, in the conditions of large city medical institutions, are an integral part of a patient's clinical examination. Forced, therefore, when making a diagnosis and subsequent treatment based solely on the existing picture of the disease and anamnesis, the district doctor is thus pushed back decades ago from his urban colleagues, who have the opportunity to use in their daily work many of the most valuable achievements of scientific medicine of the last decades requiring an appropriate laboratory environment. One such achievement is undoubtedly Wassermann's reaction, without which every doctor working in the countryside often has to spend a lot of work and try out methods of treatment before establishing the true etiology of the suffering he is using. The presence of such cases in district practice is all the more inevitable because, as can be judged on the basis of the literature, typical exvisit forms of syphilis in recent years have begun to occur much less frequently, giving way to various manifestations of visceral lues.

The impact of interpersonal relationships on rural doctors' clinical courage.

Clinical courage occurs when rural doctors push themselves to the limits of their scope of practice to provide the medical care needed by patients in their community. This mental strength to venture, persevere and act out of concern for one's patient, despite a lack of formally recognised expertise, becomes necessary for doctors who work in relative professional isolation. Previous research by the authors suggested that the clinical courage of rural doctors relies on the relationships around them. This article explores in more depth how relationships with others can impact on clinical courage. At an international rural medicine conference in 2017, doctors who practised rural/remote medicine were invited to participate in the study. Twenty-seven semistructured interviews were conducted exploring experiences of clinical courage. Initial analysis of the material, using a hermeneutic phenomenological frame, sought to understand the meaning of clinical courage. In the original analysis, an emic question arose: 'How do interpersonal relationships impact on clinical courage'. The material was re-analysed to explore this question, using Wenger's community of practice as a theoretical framework. This study found that clinical courage was affected by the relationships rural doctors had with their communities and patients, with each other, with the local members of their healthcare team and with other colleagues and health leaders outside their immediate community of practice. As a collective, rural doctors can learn, use and strengthen clinical courage and support its development in new members of the discipline. Relationships with rural communities, rural patients and urban colleagues can support the clinical courage of rural doctors. When detractors challenge the value of clinical courage, it requires individual rural doctors and their community of practice to champion rural doctors' way of working.

Cultivating Healthy Governance in Rural Programs.

Cultivating Healthy Governance in Rural Programs.

Combined School/Public Libraries in Israel at the High School Level: Some Results of an Exploratory Field Study

&#x0D; &#x0D; &#x0D; The issue of combined school-public libraries has long concerned researchers and practitioners in the field and is well documented in literature. A literature survey reveals opinion articles as well as empirical field studies, especially in the US, Canada, UK, Australia and Germany, which attempt to determine the advantages and disadvantages of this model, and possible factors associated with its success in practice. Despite the importance of the topic and its potential of budget savings and greater efficiency in use of resources, no large-scale empirical study of the extent and performance of combined school-public libraries in Israel has been conducted.&#x0D; The study aimed to empirically investigate the combined school-public libraries on the high school level existing in Israel. The main research tools were three different written closed questionnaires sent to the school librarian, school principal and one of the school teachers. In 1996 questionnaires were mailed to all 65 schools known to have some type of combination libraries: 26 had a combined school-public library, while in the remaining 39 schools the library was a branch of a regional or municipal public library. Questionnaires were also mailed to 40 randomly-chosen schools, having a 'regular' (i.e. not combined) library, to serve as a control group. Response rate was about 50% and the final sample included 51 libraries: 18 -combined, 11-'branches', and 22-'regular' ones.&#x0D; &#x0D; &#x0D; &#x0D; Main findings were: the number of combined libraries has risen constantly over the decades which seems to be an interesting trend, especially in view of the recent decline reported in the US and Canada. Regarding space and seats the situation in the regional libraries was much better than in the urban ones. Concerning opening hours the urban combined libraries were open longer than the regional combined ones and the control group. The combined libraries, mainly the urban ones, were open for more afternoon hours, all of them were open during school vacations, and they had a higher average number of weekly librarian hours per school. Regional combined libraries had a much larger number of books per student and periodicals and computers per library than the urban combined ones and the control group. The mean number of users of the reading-room was about the same (usually low) in all types of libraries in afternoon hours, but differed considerably in the mornings, probably due to different teaching methods.&#x0D; About half the librarians, the school principals and the teachers in the combined libraries rated their combined library as 'very successful', while the rest rated it as only 'partially successful', or expressed dissatisfaction, pointing out serious problems. Regional librarians were much more satisfied with the combined model, compared to their urban colleagues. Findings indicated that the combined model is more likely to succeed in a regional library, in a rural setting, than in an urban one.

Perceptions of Veterinarians in British Columbia of Cat Management Strategies to Reduce Cat Overpopulation and Impacts on Wildlife Populations

ABSTRACTFree-roaming cats present a multidisciplinary challenge for wildlife conservation and feline welfare. Veterinary professionals are critical stake-holders in the issue of free-roaming cats, making it imperative that their attitudes and perspectives are well understood. In this study, we conducted an electronic survey of veterinarians practicing across British Columbia to evaluate their perceptions of 1) whether cat overpopulation is a concern, 2) the impacts of cats on wildlife, and 3) alternative management strategies for dealing with cat overpopulation. Of the 389 respondents, 56% agreed that cat overpopulation was a local problem, and 91% agreed that veterinarians play a role in reducing cat overpopulation. Veterinarians in rural communities had a greater involvement in cat overpopulation and perceived it as more problematic than their urban colleagues. The majority (70%) of veterinarians reported that they performed early-age sterilization, supported the principle of low-cost spay-neuter services (67%), and 65% of them were involved in these services. Just over half (54%) of respondents reported that they provide permanent identification to cats, typically offering both microchips and tattoos. Veterinarians were less cohesive on their perceptions of the impact of free-roaming cats on wildlife: 53% agreed that after habitat loss cats are one of the most significant, direct causes of bird and wildlife mortality, while 30% were neutral and 17% disagreed. Fifty-six percent of veterinarians felt that keeping cats indoors would be one of the most effective strategies to reduce cat impacts on wildlife, but they also felt that public education programs and low-cost spay-neuter programs would be effective and more popular with cat owners. Most veterinarians (79%) recommended against unsupervised outdoor access, citing safety and disease risks. Rodent control was the most common reason for not recommending an indoor lifestyle. Overall, our survey results suggest that veterinarians are committed participants in the prevention of cat overpopulation. Conservationists need to focus on increased engagement with veterinarians regarding the impact of cats on wildlife.

Procedural Knowledge and Skills of Residents Entering Canadian Family Medicine Programs in Alberta.

Incoming family medicine (FM) residents start residency with different levels of procedural training. Understanding their baseline skill level is necessary to plan the educational experiences and teaching methods that will provide the desired knowledge, skills, and attitudes related to performing medical procedures. A survey of 69 procedures based on the core list issued by the College of Family Physicians of Canada was administered to incoming residents in Alberta (Calgary and Edmonton FM programs). The survey intended to identify the levels of training and confidence acquired for each listed procedure before residency, and plans to perform each of the procedures in future independent practice. A total of 146 residents from both programs responded to the survey (82% response rate). Of the 69 procedures evaluated, 15 (21.7%) had been previously performed at least five times by 50% or more residents. Only five procedures were rated by 80% or more of the residents as being able to perform independently or to teach to others: simple suture, infiltration of local anesthetic, intramuscular injection, cryotherapy of skin lesions and Pap smear. More male residents than female residents felt confident in performing 10 procedures, while female residents were more confident in performing Pap smears. Rural residents felt more confident to perform 22 procedures than their urban colleagues. This information demonstrates limited prior training in procedures among entering residents, and provides guidance to FM programs to develop teaching interventions to achieve competence in those procedural skills seen as necessary for family physicians.

Sexual harassment and gender-based violence in Tanzania’s public service

PurposeThe purpose of this paper is to explore the causes, forms, extent, and consequences of sexual harassment and sexual violence at public sector workplaces in Tanzania.Design/methodology/approachA total of 1,593 civil servants participated in the survey, which was conducted in the Mtwara Region of Tanzania. The quantitative data were complemented with the results from eight focus group discussions.FindingsThe study revealed that 21 percent of women and 12 percent of men had experienced sexual harassment personally. Overall, rural-based public servants had less knowledge of relevant policies, and experienced more sexual harassment than their urban colleagues. The majority of perpetrators were identified as men in senior positions; the majority of victims were recognized to be young female employees. Frequently reported behaviors included sexual bribery with regard to resource allocation, promotions, allowances, and other benefits.Practical implicationsDespite the existence of conducive legal and policy frameworks aimed at protecting employees from sexual harassment and violence, their implementation and effects were found to be limited. Only half of the study population was aware of the existing regulations. The study found that the majority of public servants who had knowledge on the issue had learned about sexual harassment in the context of an HIV/AIDS workplace program. This finding indicates that well-designed workplace interventions can play an important role in creating awareness, addressing gender stereotypes, and informing employees about their personal rights and responsibilities.Originality/valueSexual harassment and gender-based violence at the workplace has never been studied before in Tanzania. The study provides practical recommendations for future preventive interventions.

Language as design tool: an empirical and design perspective in the field of architecture and planning

ABSTRACTThe use of language-based tools is not popular and not common in spatial design processes. But the literature shows the potential of such approaches in different steps of the design process. Thus enhancing the skills of language-based design tools of urban planners and architects can positively influence a design process. The perception and use of such tools was examined in a survey along a standardized questionnaire with 59 urban planning and 42 architecture students at four German universities. Two student groups in urban planning and architecture were asked additionally to apply two specific language-based tools in a design task. The survey results show that students initially evaluated the potential of language as quite low. Introducing students to language-based tools upgraded their assessment. Interestingly, some language-based tools were ranked higher by architecture students than by their urban planning colleagues. Considering that a design process especially in more complex projects asks for different abilities and tools, it seems meaningful to expand the toolbox of professionals also towards language-based approaches. Students also benefit from this because this expansion creates more options for the different ‘design personalities’. Further studies are needed for assessing which language-based tools are specifically qualified to enhance a design.

Communication, Respect, and Leadership: Interprofessional Collaboration in Hospitals of Rural Ontario.

Health care professionals are expected to work collaboratively across diverse settings. In rural hospitals, these professionals face different challenges from their urban colleagues; however, little is known about interprofessional practice in these settings. Eleven health care professionals from 2 rural interprofessional teams were interviewed about collaborative practice. The data were analyzed using a constant comparative method. Common themes included communication, respect, leadership, benefits of interprofessional teams, and the assets and challenges of working in small or rural hospitals. Differences between the cases were apparent in how the members conceptualized their teams, models of which were then compared with an "Ideal Interprofessional Team". These results suggest that many experienced health care professionals function well in interprofessional teams; yet, they did not likely receive much education about interprofessional practice in their training. Providing interprofessional education to new practitioners may help them to establish this approach early in their careers and build on it with additional experience. Finally, these findings can be applied to address concerns that have arisen from other reports by exploring innovative ways to attract health professionals to communities in rural, remote, and northern areas, as there is a constant need for dietitians and other health care professionals in these practice settings.

Tooth-beads, antlers, nuts and fishes. Examples of social bioarchaeology

I am sitting at my computer with a purring cat resting its head against the keyboard – a real animal–animal situation and a reciprocal relationship. For 15 years, my wife and I looked after horses that our children had left behind when they moved off into the world. The reason was that the horses belonged, in their own way, to the extended family. So I have no difficulty understanding what Overton and Hamilakis call ‘social zooarchaeology’. As a pet owner who has personally observed the individuality of animals – from hens to horses – I have no problem accepting their view that animals are individuals, something that my urban colleagues often question. When discussing with hunters who have specialized for many years in one type of hunting, they can describe how different individuals in flocks – for example, among red deer and moose – can behave. They spend many hours moving in the terrain and observe the different animal species, not to hunt them but to acquire further knowledge about the animals, sometimes to find out which animals should later be culled, but often only for the sheer pleasure of feeling a kind of relationship between themselves and the animals they follow.

A Comparative Study of Computer Literacy in Urban And Rural Primary Schools In Rivers State of Nigeria

Aims: To comparatively investigate factors affecting computer literacy in urban and rural primary schools in Nigeria. Study design: This study was a descriptive survey. Place and Duration of Study: Port Harcourt and Obiakpor (representing urban areas), and Asari-Toru and Gokana (representing rural areas) of Rivers State, Nigeria; between March and June 2011. Methodology: A total of 480 primary school teachers were drawn from the four Local Government Areas. An eighteen-item questionnaire, ‘Computer Literacy Inventory’ (CLI) was developed by the researcher and used for data collection. CLI was distributed and collected at teachers’ workshop organized by the State Ministry of Education. Analysis was through simple tables of frequency counts and percentages Results: Out of 240 respondents from rural and urban areas respectively, only 80(33%) rural respondents indicated that there are computers in their schools while 160(67%) were on the contrary, but all the 240(100%) urban respondents admitted that there are computers in the urban schools. The 80(33%) rural respondents that have computers in their schools responded to issues on teachers’ accessibility to computers as never (0(0%) rarely (16(20%), seldom (40(50%) and often (24(30%), always (0). Similarly, their urban colleagues responded: never (16(7%), rarely (63(26%), seldom (96(40%), often (65(27%), and always (0(0%). 184(77%) urban teachers affirmed their possession of computer skills and only 56(23%) did not; while in the rural schools only 40(17%) said they have the skill and the rest 200(83%) admitted that they lack the skill. Rural respondents indicated total absence of computer practical sessions while only 56(23%) urban teachers affirmed to practical computer lessons. The teaching strategy is mostly lecture-based as attested by 240(100%) rural teachers and 184(77%) urban counterparts. On the issue of learning environment, every Computer Science class in rural schools takes place in the classroom 240(100%) and never in any designated equipped room called Computer Lab. This case is only slightly different in urban areas because 32(13%) use computer lab while the majority, 208(87%), do not. Concerning socio-economic background of the class, only 39(16%) rural pupils come from rich homes while majority of them 88(37%) and 113(47%) come from poor and very poor families respectively, while majority (136(57%) of urban pupils belong to rich families with others coming from poor 72(30%) and very poor 32(13%) homes. Conclusion: Challenges retarding computer literacy in Nigerian Primary schools, particularly in the rural areas, are enormous. This reveals the need for urgent interventions from the government and public spirited organizations and individuals. Government should not pay lip service to ICT-policies to afford the teeming population of Nigerian children the opportunity to meet up with rest of the world.

Management of Professional Boundaries in Rural Practice

Rural physicians wrestle with professional boundary issues routinely in everyday interactions, and their situation differs from the experience of their urban colleagues. Medical students receive limited exposure to professional boundary management in preclinical training. Increasingly, schools are implementing rural longitudinal clinical clerkships which expose students to rural boundary setting. This qualitative study explored the management of professional boundaries integral to rural practice and how this management may differ from their urban colleagues. Semistructured interviews were conducted in 2010 with 12 rural physicians across Minnesota exploring their perceptions of professionalism in rural practice. A social constructivist approach to grounded theory was used to analyze the data. Five primary themes regarding rural professionalism emerged from the data: centrality of care, rural influences on choice, individualization of boundary setting, advantages of dual relationships, and disadvantages of them. These themes served to illustrate rural boundary management. This study's findings indicate that rural physicians are routinely confronted with professional boundary issues in everyday situations, and these circumstances do not always reflect those of their urban colleagues. Given the increase in longitudinal immersion clinical clerkship programs to nurture student interest in future rural practice, acknowledgment and acceptance of the nuances of dual relationships and boundary setting in different clinical learning contexts are vital to help students identify their personal needs for privacy and be better prepared to negotiate the realities of rural practice. These findings may inform future medical education initiatives on professional boundary setting as an aspect of professionalism.

Clergy Role Priorities and Congregational Expectations: Rural Differences

In order to explore the many roles that clergy in parish churches play, a self-report ‘Clergy Role Inventory’ is devised. The danger of role conflict leading to poor work-related psychological health leads to an investigation of the role priorities clergy have for themselves and the role priorities that they perceive their congregations have for them. As part of a longitudinal study clergy in their seventh year of ordained ministry within the Anglican Church in England and Wales completed the Clergy Role Inventory. Differences were seen between Anglican, Pentecostal and Evangelical Alliance clergy in the roles to which they gave highest priority. The inventory is then used to explore the hypothesis that clergy working in rural areas are different from their urban colleagues. The study shows significant differences in role prioritization between clergy priorities and the expectations of their congregations. In particular the roles of visitor, fund-raiser and leader in the local community were more highly valued by rural congregations.

Comprehensiveness of care by family physicians in Edmonton

IntroductionThe scope of practice by general practitioners and family physicians in North America has been changing over time. Are academic practices providing residents the same scope of practice as the urban practices into which they are going?MethodsA survey describing the activities and scope of general practice/family practice was constructed from the literature and checked with general practitioners/family physicians for face validity. It was administered by mail to academic family physicians at the University of Alberta Department of Family Medicine in Edmonton and to all practicing general practitioners/family physicians in the city and Capital Region around Edmonton. There was a response rate of 78% and 50.9%, respectively.ResultsAcademic physicians’ practices differed from those of their urban colleagues. The former were all certified by the College of Family Physicians of Canada, worked in group practices, and included more males and fewer immigrants. They worked as many hours, but did less clinical work than their urban colleagues. Even so, 25% did more than 40 hours of clinical work each week compared with 68% of urban physicians. There was a wide scope of services and procedures provided by both groups and other services that were different from group to group. There was no difference between groups in intention to add or remove services in the next two years, but academic physicians had removed more services in the last two years.ConclusionGeneral practitioners/family physicians still provide a wide range of services. Although both academic and urban general practitioners/family physicians have reduced some services in the last two years, they have both added others to their repertoire. Although the teaching and urban general practitioners/family physicians practices have many similarities, they also have differences, which may have implications for the training of future urban family physicians.