WONCA believes there is an urgent need to implement strategies to improve
rural health services around the world. In order to achieve this, there needs
to be sufficient numbers of skilled rural family doctors to provide the
required medical services. This document has outlined a series of key issues
of concern regarding training for rural practice.
It has been found that the production of more and more doctors does not lead to
an overflow of physicians from the cities to the country. In order to increase
the numbers and quality of rural doctors it is necessary to implement a series
of strategies aimed at establishing an integrated career pathway of education
and training for rural practice. In the long term, it is only this strategic
approach which is likely to improve the recruitment and retention of rural
family physicians.
In order to achieve this goal, WONCA recommends:
1. Increasing the number of medical students recruited from rural areas.
Strategies may include:
1.1 Introduction of programs promoting medicine as a career to rural secondary
students.
1.2 Establishment of scholarships and educational support programs which
identify potential medical students in rural areas and assist them with
secondary and tertiary education in preparation for medical school entry.
1.3 Selection processes that encourage admission of students from rural
areas.
1.3.1 Selection processes including interviews should give specific recognition
and credit for rural background, experience, and interest.
1.3.2 Specific targets for students from a rural background may be needed.
2. Substantial exposure to rural practice in the medical undergraduate
curriculum. This may be achieved through:
2.1 Establishment of "Rural Practice Clubs" which encourage city origin
students to develop an interest in rural practice and support rural background
students in adjusting to the challenges of city living and university
studies.
2.2 Rural doctor mentor schemes which provide rural origin students with
ongoing personal support and encouragement from a nominated rural family
physician.
2.3 An introduction to rural health issues early in the curriculum including
specific rural practice attachments for students early in the
medical course.
2.4 Block clinical rotations to rural hospitals and rural family practice later
in the course.
2.5 A rural medicine stream for a selected group of students who indicate an
early commitment to rural practice. This might take the form of:
2.5.1 One to three years of complete medical curriculum undertaken in the rural
setting.
2.5.2 A thread of rural attachments intertwined through the clinical components
of the curriculum.
2.6 Decentralised medical schools that allow students to take most or all of
their medical school education in centres outside major metropolitan areas.
3. Specific flexible, integrated and coordinated rural practice
vocational training programs. These programs should:
3.1 Be needs driven, evidence based, and learner centred
3.2 Have appropriate faculty, hospital, and financial support
3.3 Provide particular emphasis on training in procedural skills and an
appropriate core curriculum on rural practice in addition to a solid family
medicine foundation
3.4 Provide a major portion of training within the rural context
3.5 Provide the opportunity and funding for advanced rural skills training in
emergency medicine, anaesthesia, surgery, procedural obstetrics and others.
3.6 Provide opportunities for regular family medicine trainees to experience
the joys and challenges of rural family practice
4. Specific tailored continuing education and professional development
programs whch meet the identified needs of rural family physicians.
4.1 Continuing medical education programs should be accessible to rural
practitioners through locating them in rural regional centres and, where
appropriate, making use of distance education methods including modern
information technology.
4.2 Generally rural continuing medical education programs should be developed
by rural doctors for rural doctors.
4.3 Development of appropriate university postgraduate diplomas and degrees
available via distance education so as to allow more remote rural doctors to
pursue higher university studies without leaving their towns or practices.
5. Appropriate academic positions, professional development and financial
support for rural doctor-teachers to encourage rural health research and
education.
5.1 Rural Medical Education and Research Centres should be established
in rural areas with the aim of co-ordinating undergraduate education,
postgraduate vocational training, and continuing medical education for rural
practitioners. Such Centres greatly facilitate implementation of all previous
recommendations. An important consequence of establishing Rural Medical
Education and Research Centres is development of reciprocal links
between country hospitals/practices and medical schools/teaching hospitals.
6. Medical schools should take responsibility to educate appropriately
skilled doctors to meet the needs of their general geographic region including
underserved areas and should play a key role in providing regional support for
health professionals and accessible tertiary heath care.
7. Development of appropriate needs based and culturally sensitive rural
health care resources with local community involvement, regional
cooperation and government support.
7.1 Provide appropriate funding to develop and maintain hospital and other
health services and referral resources to meet the needs of people in
rural and remote communities.
7.2 Establish rural community health centres with facilities and support for
doctors and other health professionals.
8. Improved professional and personal/family conditions in rural practice to
promote retention of rural doctors. Strategies include:
8.1 Locum relief schemes should be established to permit release of rural
family physicians to undertake continuing education as well as recreation and
other forms of leave.
8.2 Targeted financial support for rural practice such as:
8.2.1 Funding models that provide security and flexibility for the doctor to
and recognise the physician as a community resource.
8.2.2 Additional payments to rural practitioners in recognition of the higher
level of clinical responsibility, services provided and on call demands.
8.2.3 Specific incentive payments for practicing in isolated/underserved
areas
8.2.4 Financial assistance to maintain the economic viability of at least two
doctors working together in a rural location.
8.2.5 Funding for travel and other costs for the doctor to attend
continuing medical education.
8.3 Specific programs to meet the needs of rural doctors' spouses and families
such as:
8.3.1 Spouse and family support networks.
8.3.2 Financial assistance with accommodation for the doctor and family.
8.3.3 Financial assistance to facilitate education of the doctor's family.
8.3.4 Funding to permit travel by the doctor and family for recreation and
other forms of leave and to visit family members undertaking secondary or
tertiary education.
8.3.5 Assistance in developing employment opportunities for the doctor's
spouse.
9. Development and implementation of national rural health strategies with
central government support. This requires:
9.1 Cooperative involvement of communities, doctors and other health care
professionals, hospitals, medical schools, professional organisations, and
governments at all levels. Establishment of national rural health research and
education organisations can facilitate this process.