More sense from Australia?

Tuesday, March 5th, 2019 | Rory | No Comments

Benefits of a rural clinical school: An Australian experience

McGirr J, Seal A, Barnard A, Cheek C, Garne D, Greenhill J, Kondalsamy-Chennakesavan S, Luscombe GM, May J, Mc Leod J, O’Sullivan B, Playford D, Wright J. The Australian Rural Clinical School (RCS) program supports rural medical workforce: evidence from a cross-sectional study of 12 RCSs. Rural and Remote Health 2019; 19: 4971.

Open access link

An important paper on rural clinical school outcomes in Australia. What we need to aim for in NZ.

The MMM (modified monash model) is a better indicator of what we would consider ‘rural’ in NZ and that analysis is more relevant.

The take home message – rural origin programmes, yearlong placements in rural communities for undergraduates (the RMIP model) work. There is less evidence for short term rural placements. Rurally focused postgrad training may be at least, if not more important.

Overall 29% of Australian med students in this study undertook a year long RMIP type programme. RMIP is only 6% of the Uni Otago class. We need a more realistic target.



Introduction: Many strategies have been implemented to address the shortage of medical practitioners in rural areas. One such strategy, the Rural Clinical School Program supporting 18 rural clinical schools (RCSs), represents a substantial financial investment by the Australian Government. This is the first collaborative RCS study summarising the rural work outcomes of multiple RCSs. The aim of this study was to combine data from all RCSs’ 2011 graduating classes to determine the association between rural location of practice in 2017 and (i) extended rural clinical placement during medical school (at least 12 months training in a rural area) and (ii) having a rural background.

Methods: All medical schools funded under the RCS Program were contacted by email about participation in this study. De-identified data were supplied for domestic students about their gender, origin (rural background defined as having lived in an Australian Standard Geographic Classification-Remoteness Area (ASGC-RA) 2–5 area for at least 5 years since beginning primary school) and participation in extended rural clinical placement (attended an RCS for at least 1 year of their clinical training). The postcode of their practice location according to the publicly available Australian Health Practitioner Regulation Agency (AHPRA) register was collected (February to August 2017) and classified into rural and metropolitan areas using the ASGC 2006 and the more recent Modified Monash Model (MMM). The main outcome measure was whether graduates were working in a ‘rural’ area (ASGC categories RA2–5 or MMM categories 3–7) or ‘metropolitan’ area. Pearson’s χ2 test was used to detect differences in gender, rural background and extended placement at an RCS between rural and metropolitan practice locations. Binary logistic regression was used to determine odds of rural practice and 95% confidence intervals (CIs) were calculated.

Results: Although data were received from 14 universities, two universities had not started collecting origin data at this point so were excluded from the analysis. The proportion of students with a rural background had a range of 12.3–76.6% and the proportion who had participated in extended RCS placement had a range of 13.7–74.6%. Almost 17% (16.6%) had a principal practice postcode in a rural area (according to ASGC), range 5.8–55.6%, and 8.3% had a principal practice postcode in rural areas (according to MMM 3–7), range 4.5–29.9%. After controlling for rural background, it was found that students who attended an RCS were 1.5 times more likely to be in rural practice (95%CI 1.2–2.1, p=0.004) using ASGC criteria. Using the MMM 3–7 criteria, students who participated in extended RCS placement were 2.6 times as likely to be practising in a rural location (95%CI 1.8–3.8, p<0.001) after controlling for rural background. Regardless of geographic classification system (ASGC, MMM) used for location of practice and of student background (metropolitan or rural), those students with an extended RCS had an increased chance of working rurally.

Conclusion: Based on the combined data from three-quarters (12/16) of the Australian medical schools who had a graduating class in 2011, this suggests that the RCS initiative as a whole is having a significant positive effect on the regional medical workforce at 5 years post-graduation.

Some sense from Australia

Thursday, February 28th, 2019 | Rory | No Comments

Better Health in the Bush

Wakerman, J. and Humphreys, J. S. (2019), “Better health in the bush”: why we urgently need a national rural and remote health strategy. Med. J. Aust.. doi:10.5694/mja2.50041

EZProxy link

“The five key questions are:

  • How do we get health professionals to work in rural areas and retain them?
  • How do we ensure that high quality, comprehensive primary health care (PHC) services are accessible locally?
  • How do we ensure that these services are sustainable?
  • How much should these services cost?
  • How do we ensure that these services meet community needs?"

“In summary, using available evidence, a national strategy can improve access to high quality, comprehensive PHC in a way that results in greater efficiency, improved equity and more effective service provision that will bring about improved health outcomes in rural and remote areas, which has been the quest of the Australian Government for the past 25 years.”

A nice summary of the issues and some solutions from the two Johns in Aussie.

The Trans-Tasman Issue

Saturday, October 13th, 2018 | Rory | No Comments

Australian Journal of Rural Health. Trans‐Tasman Issue. Volume 26, Issue 5. Pages: 303–378 October 2018


A landmark issue – one of the most important publications of the year! Open access until at least December.


Editorial Special issue: Trans-Tasman Issue
Garry Nixon and Oliver K. Burmeister

Alliances and evidence: Building the capacity and effectiveness of rural health
advocacy in Australia
Lesley Barclay and Gordon Gregory

Alliances and evidence: Building capacity and effectiveness of rural health advocacy in Australia: New Zealand commentary
Martin Thomas London

Two decades of building capacity in rural health education, training and research in Australia: University Departments of Rural Health and Rural Clinical Schools
David Lyle and Jennene Greenhill

Grasping the Ongaonga: When will New Zealand really integrate rural clinical education?
Martin T. London and John G. Burton

Learning from history: How research evidence can inform policies to improve rural and remote medical workforce distribution
John Humphreys and John Wakerman

Not counting
David Fearnley

Framework for examining the spatial equity and sustainability of general practitioner services
Jesse Whitehead, Amber L. Pearson, Ross Lawrenson and Polly Atatoa-Carr

Point-of-care ultrasound in rural New Zealand: Safety, quality and impact on patient management
Garry Nixon, Katharina Blattner, Marara Koroheke-Rogers, Jillian Muirhead,
Wendy L. Finnie, Ross Lawrenson and Ngaire Kerse

Kete pikau : A basket of knowledge – ‘guidelines from back home’
Marara Koroheke-Rogers and Katharina Blattner

Kete pikau : A basket of knowledge – ‘guidelines from back home’
Kate Senior

Improving the physical health of people living with mental illness in Australia and
New Zealand
Russell Roberts, Helen Lockett, Candace Bagnall, Chris Maylea and Malcolm Hopwood

Paramedicine in Australia and New Zealand: A comparative overview
Peter O’Meara and Sharon Duthie

Osteoporosis and low bone mineral density (osteopenia) in rural and remote Queensland
Campbell Bruce Macgregor, Jarrod D. Meerkin, Stephanie Jade Alley,
Corneel Vandelanotte and Peter John Reaburn

Perceptions towards research and academia by Māori and Pacific preclinical medical students
Yassar Alamri

Letters to the Editor
Research, education, advocacy: Keys to rural health success
Dalton Kelly

Rural health: An investment in regional development
Mark Diamond