Congratulations to Dr Teariki Puni and Dr Koko Lwin who recently graduated with the Cook Islands General Practice Fellowship.

A ceremony was held in Rarotonga on December 18, 2020 where both doctors were awarded  their Fellowship by former Secretary of Health Dr Josephine Aumea Herman.

The Cook Islands General Practice training programme was established in 2016 by the Cook Islands Ministry of Health under former Secretary of Health Elizabeth Iro, in partnership with University of Otago and the RNZCGP. The aim of the programme is to build local capacity and leadership in primary and frontline care. The academic component of the programme is made up of four distance taught papers from the Rural Postgraduate programme. The clinical component involves 12-24 months in NZ based clinical practice (rural and urban general practice and emergency medicine). The establishment by Otago of a Pacific Islands Nation liaison role (currently held by rural doctor Kati Blattner) provides support and navigation for the doctors studying on the programme. 

Many NZ based doctors know Teariki and Koko having completed postgraduate papers with them, crossed paths during their NZ clinical attachments or spent time working alongside them in the Cook Islands.

Teariki Puni and Koko Lwin follow in the footsteps of Nini Wynn and Mareta Jacobs who completed their fellowship in 2019 and 2017 respectively.

https://www.cookislandsnews.com/internal/national/health/local-doctors-recognised/

Words provided by Dr. Katharina Blattner

Abid Y, Connell CJW, Sijnja B, Verstappen AC, Poole P. National study of the impact of rural immersion programs on intended location of medical practice in New Zealand. Rural Remote Health [Internet]. 2020 Nov 1 [cited 2020 Dec 3];20(4):5785. Available from:https://www.rrh.org.au/journal/article/5785/ 

Open access paper

This recent piece of observational research combined data from the Medical Students Outcome Database (MSOD) for New Zealand graduates of both Medical Schools with University rural experience data. They looked at graduate’s future intentions to work in Rural, Regional or Urban location, comparing those who participated in long rural immersion programmes (RMIP and Pūkawakawa), short interprofessional programmes (RHIP and TIPE) and those who didn’t participate in any specific rural programme.  

Why is this important? 

Essentially this is proof in the value of long rural immersion programmes in Aotearoa! This study has shown that those who participated in long rural immersion programmes were over 6 times more likely to show an intention to work rurally and over 4 times more likely to show an intention to work regionally! This is consistent with overseas research but one of the first pieces to show this in New Zealand.

This study also supports ongoing importance of rural background on career choice while also demonstrating that through long rural immersion programmes we can still convert plenty of city kids.

What’s next? 

This paper only looked at workforce intentions. Next we need to look to see if this finding persists further into postgraduate years and actual changes in workforce outcomes.

Abstract

Introduction:New Zealand (NZ) faces an ongoing shortage of rural medical professionals. In an effort to increase interest in rural practice, both of the medical schools in NZ offer rural immersion programs as well as rural entry pathways. The aim of this study was to compare the effect of long (>33-week) rural immersion with a short (5-week interprofessional) rural immersion or no rural immersion on the career location intentions of NZ medical students.
Methods:  This observational study used linked data from the Commencing Medical Students Questionnaire (CMSQ) and Exit Questionnaire (EQ), collected between 2011 and 2017 as part of the Medical Schools Outcomes Database project, along with information on whether or not a student undertook a rural immersion program. The main outcome measure was EQ career location intention (Rural (population <25 000), Regional (25 000–100 000) or Urban (>100 000)). The explanatory variables were rural immersion (long, short, none), age, ethnicity, background, CMSQ career location intention, gender, specialisation preferences and interest in rural medicine. In addition to univariate analysis, data were used to build a multinomial model to determine relative associations of these variables with the outcome.
Results:  Full data were available for 1367 NZ medical students (47% of all students during the time period). Of these, 17.4% had undertaken a long or short rural immersion program. In univariate analysis, age was the only variable that did not significantly predict EQ rural intention outcome. In the multivariate model, rural immersion was a significant independent predictor of EQ career location intention. Students taking a long rural immersion were 6.4 and 4.4 times more likely to select a Rural or Regional intention, respectively, than those with no rural immersion. This strong effect on rural intentions was seen regardless of background. CMSQ career location intention, background, ethnicity, rural club membership and preference for general practice were also significant predictors. While short rural immersion did not have an independent effect, this finding should be interpreted with caution given the smaller number of students and the response rate.
Conclusions:Long rural immersion is highly beneficial for increasing interest in rural work, increasing the likelihood that medical students will intend to work outside an urban setting. Students who signal an early rural intention are strong candidates for such programs later in their course, regardless of their background. A three-category classification for geographic background and career location intention permitted a more detailed understanding of the interplay among demographic variables and rural immersion in influencing career intentions. Following cohorts into their postgraduate years is needed to ascertain if these career location intentions persist.

Thank you to Katelyn Costello for the review of this paper.

Blattner, K,  Lawrence‐Lodge, R,  Miller, R,  Nixon, G,  McHugh, P,  Pirini, J.  New Zealand’s Rural Hospital Medicine training program at 10 years: Locality and career choice of the first graduate cohort. Aust J Rural Health.  2020; 00: 1– 3. https://doi-org.ezproxy.otago.ac.nz/10.1111/ajr.12678

Pre-publication, open access article available here:

This short report describes the locality and career choice of graduates from the first 10 years of NZ’s Rural Hospital Medicine training programme.

There were 29 graduates, with 26 currently practicing. Of these 24 (92%) are practicing in a rural location, most in a rural hospital. Half were also working in an additional scope. This compares favourably with international literature.

“This study provides the first real evidence on actual postgraduate practice location, as compared to ‘intent to practice’ for rural career choice for NZ medical practitioners.”

A paper further describing this cohort, including active trainees and those that have withdrawn will be published later.

Recording for the 5th episode of the Rural Postgraduate Programme/Division of Rural Hospital Medicine New Zealand’s webinar series. Garry, Rory and Matilda discuss the management of heart failure.

Links:

• Australian heart failure guidelines
• European cardiac society guidelines

ResBaz 2020 : Pick n Mix, 23-27 November 2020. 

This Pick n Mix edition of Research Bazaar is free, open and online – a series of digital research skills workshops, each individually bookable. Some sessions are up now – https://resbaz.auckland.ac.nz/. Bookable links and more sessions will be added during the week. 

ResBaz Pick n Mix sessions are open to NZ researchers, postgraduate students and those supporting research. 

Please take a look and share with your communities. 

#resbazNZ2020 #resbazpicknmix

If anyone is looking for a online conference early next year the ED/ortho conference “CASTED” has decided to offer an online course for Australia and New Zealand participants.

http://casted.ca/schedule/

Go to the Jan 21-22 course for New Zealand and Australia. And click on register. And then another click to get to the registration form.

Thanks Hannah Lawn for the tip.

Note the Rural Hospital Medicine CME planned in October – Queenstown – will almost certainly have sessions on fracture management. Watch this space.

Wellington Public Health Summer School is running again next year:

The 2021 Public Health Summer School will offer 24 short courses (1–2 days long) presented by an outstanding faculty of public health academics and practitioners. There are 12 new courses as well as 12 of our most popular core courses. Courses vary from small group computer lab classes to interactive workshops and multi-speaker symposiums.

You are invited to register in a single course or create a programme based on your interests. Read more about each course below

Research, epidemiology, big data and statistical methods

• Survival skills for health researchers – 5 February
• How to write a paper – 11 February
• Introduction to epidemiology – 5 February
• VHIN introduction to health research in the IDI – 4 February – On hold and likely to be deferred until 2022
• Introduction to R – 1 February
• Introduction to survival analysis – 10 February
• Intermediate concepts of applied statistics – 11 February

Qualitative methods

• Introduction to qualitative methods – 12 February
• Introduction to NVivo – 9 February

Evidence, economics and healthcare systems

• Introduction to the New Zealand health system – 4 February
• Simulation modelling of interventions – 12 February
• Unseen algorithms in healthcare – 9 February
• Countering disinformation in the age of COVID-19 – 10 February

Māori and Pacific health and cultural competencies

• Hauora Māori: Introduction to models, processes and frameworks to advance wellbeing – 17 February
• Introduction to Pacific health: Approaches for action – 3 February (Wellington), 5 February (Auckland)

Population mental health

• Kei te kōrero he rongoā: The healing power of stories for Māori suicide prevention, postvention and well-being – 15 February

Healthy public policy and law

• Public health law – 18 February
• Electronic Nicotine Delivery Systems (ENDS) and Smokefree2025. Where to from here? – 16 February
• Hand in hand – tobacco, alcohol and policy measures – 17 February
• Eviction and its consequences – 18 February

Infectious diseases, environmental health and sustainability

• COVID-19: What we have learnt and where we are going – 1 February
• Post COVID-19 reset: Transformational opportunities for a healthier, fairer, more sustainable Aotearoa – 2, 3 February
• Building for zero carbon by 2050 – 16 February
• 2021 water reforms: A safer healthier, more sustainable drinking water supply system for Aotearoa – 19 February