Doing without the residential component of a blended postgraduate rural medical programme during the 2020 COVID-19 pandemic in New Zealand: student perspectives

Wednesday, January 12th, 2022 | claly44p | No Comments

Katharina Blattner, Rory Miller, Mark Smith & Janine Lander (2022) 

Education for Primary Care, DOI: 10.1080/14739879.2021.2011626

To link to this article: https://doi.org/10.1080/14739879.2021.2011626  

In a post-COVID19 era we have all experienced a move into the virtual environment especially for ongoing education/professional development and will relate to this study’s findings.

ABSTRACT 

Aim: Rural-targeted postgraduate medical training is a key factor associated with entering rural practice. Rural health professionals often experience geographical and professional isolation, which can impact their training and education. In New Zealand, during the 2020 COVID-19 pandemic, an established distance postgraduate rural medical programme replaced its in-person residentials with virtual workshops. This study aimed to gain insights into the student experience of the virtual workshops, with emphasis on exploring the effects of the absence of an in-person component. 

Method: Qualitative exploratory design. All students who had completed a semester one 2020 University of Otago rural postgraduate module were invited by email to participate. Fifteen semi-structured interviews were conducted by video-conference. A thematic analysis was conducted using a general inductive approach. 

Results: Three themes captured the main issues. 1. Making sure everyone is in the same boat: the key roles of an in-person component were identified as consolidation of learning, benchmarking and connectedness. 2. Learning but not connecting: virtual workshops were well facilitated, allowed continuation of study and the convenience of staying home, however connectedness faded. 3. We’ve got to keep a human touch in a digital age: looking beyond the pandemic, opportunities for streamlining virtual content were identified, however there was concern around diminished communication and cultural aspects of learning and the absent connection with rural health services and communities. 

Conclusion: A virtual workshop is valuable in the COVID-19 environment but does not replace an in-person component of a distance postgraduate training programme for rural medicine 

If you would like the full text please contact katharina.blattner@otago.ac.nz

Vacancy – Regional Coordinator Rural Medical Immersion Programme (Wairarapa)

Monday, December 20th, 2021 | claly44p | No Comments

The above part time position is currently being advertised (0.3 to 0.5 FTE). It would suit a general practitioner or rural hospital doctor with an interest in teaching. Should the successful applicant be suitably qualified and seeking a more formal academic role including a research commitment, there is the potential to offer the position at Senior Lecturer level.

For more information & to apply online see:

https://otago.taleo.net/careersection/2/jobdetail.ftl?job=2102418

Ngāti Porou Hauora: COVID-19 Reflections on initial response

Monday, November 15th, 2021 | claly44p | No Comments

Ngāti Porou Hauora (NPH) provides health services to 9000 people in Gisborne and across the East Coast.  In this publication key people in the organisation provide a fascinating insight into how NPH responded to the threat of COVID-19 as it reached Aotearoa in early 2020 and identifies learnings to take forward as Delta threatens.  The importance of keeping connections and communication channels open across the organisation, community and DHB along with resilient and resourceful staff pulling together are highlighted along with fears and vulnerabilities.

The report can be accessed through NPH website:

https://uploads-ssl.webflow.com/5aefea03f167d6220569b7af/5f347b6d56e21a46e3dd9c1c_covid3_compressed.pdf

Exploring the response to the COVID-19 pandemic at the rural hospital–base hospital interface: experiences of New Zealand rural hospital doctors

Friday, November 12th, 2021 | claly44p | No Comments

Just in case you missed the highlight in today’s NZMJ!

Exploring the response to the COVID-19 pandemic at the rural hospital–base hospital interface: experiences of New Zealand rural hospital doctors

Garry Nixon, Katharina Blattner, Stephen Withington, Rory Miller, Tim Stokes. NZMJ 12 November 2021, Vol 134 No 1545

The study found that during the first L4 lock-down that communication and processes linking rural hosptials to base hospitals were disrupted. DHB support for rural hosptials varied widely and an established local leadership facilitiated an effective local response. Equity concerns persist regarding transfer, especially those who are critically unwell.

The paper is open access and can be found at:

https://journal.nzma.org.nz/journal-articles/exploring-the-response-to-the-covid-19-pandemic-at-the-rural-hospital-base-hospital-interface-experiences-of-new-zealand-rural-hospital-doctors-open-access

Along with a couple of media interviews!

https://www.rnz.co.nz/news/national/455546/study-highlights-dangerous-disconnect-rural-hospital-face-as-spectre-of-covid-19-looms

https://www.iheart.com/podcast/211-newstalk-zb-early-edition-25086386/?keyid%5B0%5D=Early%20Edition%20with%20Kate%20Hawkesby&pname=podcast_profile&sc=widget_share

 

Abstract

Aim

The COVID-19 pandemic stress-tested health systems globally and accentuated pre-existing health inequities. There is little understanding of the impact that the 2020 pandemic preparations had on New Zealand’s rural hospitals. This study explores rural hospital doctors’ experiences of the COVID-19 pandemic, with an emphasis on the rural hospital–base hospital interface.

Method

Seventeen semi-structured interviews were conducted with rural hospital doctors across New Zealand. A thematic analysis using a framework-guided rapid analysis method was undertaken.

Results

The regular communication channels and processes linking rural hospitals to their urban base hospitals were disrupted as the pandemic began. Established local leadership facilitated a rural hospital’s ability to make an effective local response. District health board (DHB) support for their rural hospitals varied widely and largely reflected the status of the pre-pandemic relationship. DHB understanding of rural hospital facilities and processes was considered to be poor. Ongoing uncertainty around managing and transferring acutely unwell patients with COVID-19 remained. Equity concerns centred on access to advanced care.

Conclusion

The experience of the COVID-19 pandemic has highlighted the resilience of rural hospitals as well as the challenges they face in operating at the margins of the healthcare system.

 

 

HINTS exam – Head Impulse, Nystagmus, Test of Skew

Tuesday, November 2nd, 2021 | claly44p | No Comments

The HINTS exam: Who to perform the HINTS exam on, how to perform it, and how to interpret the result.

https://www.youtube.com/watch?v=1q-VTKPweuk

Check out this paper:

Quimby, A.E., Kwok, E.S.H., Lelli, D. et al. Usage of the HINTS exam and neuroimaging in the assessment of peripheral vertigo in the emergency department. J of Otolaryngol – Head & Neck Surg 47, 54 (2018). https://doi.org/10.1186/s40463-018-0305-8

Abstract

Background

Dizziness is a common presenting symptom in the emergency department (ED). The HINTS exam, a battery of bedside clinical tests, has been shown to have greater sensitivity than neuroimaging in ruling out stroke in patients presenting with acute vertigo. The present study sought to assess practice patterns in the assessment of patients in the ED with peripherally-originating vertigo with respect to utilization of HINTS and neuroimaging.

Methods

A retrospective cohort study was performed using data pertaining to 500 randomly selected ED visits at a tertiary care centre with a final diagnostic code related to peripherally-originating vertigo between January 1, 2010 – December 31, 2014.

Results

A total of 380 patients met inclusion criteria. Of patients presenting to the ED with dizziness and vertigo and a final diagnosis of non-central vertigo, 139 (36.6%) received neuroimaging in the form of CT, CT angiography, or MRI. Of patients who did not undergo neuroimaging, 17 (7.1%) had a bedside HINTS exam performed. Almost half (44%) of documented HINTS interpretations consisted of the ambiguous usage of “HINTS negative” as opposed to the terminology suggested in the literature (“HINTS central” or “HINTS peripheral”).

Conclusions

In this single-centre retrospective review, we have demonstrated that the HINTS exam is under-utilized in the ED as compared to neuroimaging in the assessment of patients with peripheral vertigo. This finding suggests that there is room for improvement in ED physicians’ application and interpretation of the HINTS exam.

“No better or worse off”: Mycoplasma bovis, farmers and bureaucracy

Monday, October 25th, 2021 | claly44p | No Comments

Chrystal Jaye, Geoff Noller, Mark Bryan, Fiona Doolan-Noble (2021) “No better or worse off”: Mycoplasma bovis, farmers and bureaucracy. Journal of Rural Studies, Volume 88, Pages 40-49, ISSN 0743-0167,

https://doi.org/10.1016/j.jrurstud.2021.10.007.

This paper uses Habermas’ theory of lifeworld and system to dissect the collision that happened on farms during the management of the incursion between farming values of stock welfare and practical and relational forms of knowledge; and policy, regulation, compliance and technical instrumental forms of knowledge.

Abstract:

The 2017 outbreak of Mycoplasma bovis in New Zealand deeply impacted rural communities, particularly cattle farmers. In 2018, the Ministry for Primary Industries (MPI) implemented an eradication programme that involved herd testing, stock culls, restriction of stock movements, decontamination of affected farms, and compensation to farmers for losses associated with the eradication programme. New Zealand news media reported widely on the emotional trauma experienced by affected farmers and MPI was criticised for poor management of the outbreak. We interviewed nineteen farmers and farming couples affected by M. bovis in Southern New Zealand to gain insight into their experiences of the outbreak. In this paper, we present the findings pertaining to one dominant thematic: that of farmers’ interactions with the bureaucracy associated with the management of the outbreak. The farm appeared to quite literally represent a site of collision between farming values of stock welfare and practical and relational forms of knowledge; and policy, regulation, compliance and technical instrumental forms of knowledge. For these reasons, Habermas’ theory of lifeworld and system presented itself as a particularly salient framework for interpreting our data. Participants experienced the eradication programme as intrusive, impractical, and inhumane; while their situated local knowledge and pragmatism were ignored in favour of adherence to wasteful and inefficient bureaucratic processes that while compliant with policy, made no sense to the farmers. We suggest that biosecurity threats such as M. bovis might be more effectively managed when the bureaucracy is attentive to the rural lifeworld and responsive to the situated knowledge of farmers.

 

The impact of interpersonal relationships on rural doctors’ clinical courage

Thursday, October 21st, 2021 | claly44p | No Comments

Walters L, Couper I, Stewart RA, Campbell DG, Konkin J. The impact of interpersonal relationships on rural doctors’ clinical courage. Rural and Remote Health 2021; 21: 6668. https://doi.org/10.22605/RRH6668

https://www.rrh.org.au/journal/article/6668

Commentary Sarah Walker (PhD Candidate): Following on from previous work on the role of clinical courage in rural generalism, Professor Walters and her colleagues explore how the relationships rural doctors develop impact on their clinical courage. The concept of clinical courage can sit uncomfortably with some of us, however the six features of clinical courage described in previous work (Konkin et al. 2020) alleviate those concerns. Although clinical courage Is formed amongst uncertainty (2) in often under resourced (4) settings, clinicians are cautious not to conflate confidence with competence (3) when clearing the cognitive hurdle and deciding on a point of action (5) that is often intrinsically tied to a deep commitment of providing care to their community (1). Critical to this is their “collegial support to stand up again” (6) where rural doctors can share discourse and use their peer reflections to support their own self reflections – it is this feature that Walters seeks to explore further in this study.

The community of practice that rural doctors build with their communities, patients, peers, and local and national healthcare teams and leaders does affect their clinical courage. The social and geographical bond these rural doctors have sets them apart from other medical communities of practice and suggest that clinical courage is seen as a meaningful and encouraged characteristic in rural generalist practice. The relationships formed within their community of practice are not taken lightly, requiring time and effort to develop and maintain. For the healthcare team, only once these relationships are appropriately developed can trust be placed on each other’s skillset, becoming an issue in areas where workforce turnover is unsettling.

Despite not being a rural doctor, Walter’s work piques my interest as a rural health professional. Working as a physiotherapist in a small team, across a large geographical area, and in many clinical areas, the concept of clinical courage resonates well with me as I am sure It does for my other allied health and nursing colleagues. I am certain that furthering our understanding of these other disciplines in rural areas will help in understanding the complex and dependent relationships and skills required for rural generalist practice.

Konkin J,  Grave L, Cockburn E,  et al.   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.  BMJ Open 2020;10:e037705.  doi:10.1136/ bmjopen-2020-037705

 

Abstract:

Introduction:  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. Methods:  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. Results:  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. Conclusion:  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.

 
 
 

Any views or opinion represented in this site belong solely to the authors and do not necessarily represent those of the University of Otago. Any view or opinion represented in the comments are personal and are those of the respective commentator/contributor to this site.

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