Archive | Innovation

Highland innovations in eHealth

Thanks to RGPAS member Dr Richard Weekes for highlighting some fantastic work going on in NHS Highland to innovate eHealth applications aimed at improving access to healthcare in rural settings.

Here’s an introductory video showcasing some of the projects…

…an STV news item about the PILLCAM project in Ullapool to provide easy access to endoscopy facilities – using some very novel technology…

… and more about bringing endoscopy to rural communities…

… and the RAPID project to overcome connectivity challenges in rural Scotland…

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RRH Guide to Getting your work Published

One of the sessions at #ruralwonca was delivered by some of the team at the Journal for Remote & Rural Health.  I was really sorry to miss it, due to presenting in another session, but my tweeted request to make the advice available online was answered quickly and the presentation is now available – see below.

The journal team are keen to encourage and motivate rural healthcare professionals to share their research, and seem genuinely interested in helping budding writers to put pen-to-paper or finger-to-keyboard.

There is a lot of great innovation and problem-solving going on in rural practice.  Rural healthcare professionals tend to know their communities well, are used to dealing with limited resources, and some of the best examples of teamwork are to be found in rural settings.  However ‘being academic does not come easy to everyone, and the process of writing up evaluation and research can sometimes feel tedious and time-consuming.

However, it is now easier than ever to find interested journals, and there seems to be a drive to make the steps to getting work published more accessible.

Watch the presentation below for the RRH team’s top tips on getting your research out to a wider audience.  You can find the guidelines for authors available here.

Also, on the theme of research, here’s a great project that aims to enable rural doctors to develop their research activity through pragmatic and direct support.  Delivered by the Faculty of Medicine at Memorial University in Newfoundland, it’s called the ‘6 for 6’ programme.  Click here for more details or watch the video below.

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Protective personality traits for LICs

Assoc Professor Diann Eley

Today I attended a session at #ruralwonca which was delivered by Associate Professor Diann Eley from the University of Queensland on the role of personality traits on student experience of Longitudinal Integrated Clerkships.

Diann has gained considerable experience in this area, and specifically on how best to support and mentor students effectively whilst encouraging them to reflect on their own personalities – and how that impacts on their clinical decision-making.

I was delighted that Diann gave me a few minutes of her time after her presentation to discuss this in more detail, particularly as this work is highly relevant to the development of LICs in Scotland.

You can listen to our discussion here:

 

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Clinical courage: an evolving concept crucial to rural practice

I was introduced to the concept of clinical courage when attending an International Rural Research Symposium last year at Tromso University in Norway.  Dr Lucie Walters, of Flinders University in Australia, ran an enthralling workshop about some work that she and her team are doing to quantify and understand what we mean and can learn from clinical courage, particularly in the context of professional isolation and delivery of rural health services.

It’s a concept that seems to resonate easily with rural health practitioners, particularly rural GPs.  Despite this, there is relatively little that I have found to expand on the concept.  Two very helpful resources are a “President’s Message. Clinical Courage” by Dr John Wooton (found in Can J Rural Med 2011; 16(2)) and two comments from Peter Dunlop and Keith MacLellan in the followup issue (found in Can J Rural Med 2011; 16(3)).  The latter comment introduces another concept of ‘learned helplessness’, and I suspect that this will be of increasing importance as debate evolves regarding the fragmentation of undergraduate curriculums and the need to consider generalist undifferentiated training versus teaching in more specialist settings.

So, I was delighted to be asked to participate in an interview run by two of the Flinders University students Ella and Laura who are assisting with the project, whilst here in Cairns at the WONCA World Rural Health Conference.  They interviewed me, and they kindly agreed to me interviewing them!

You can hear about their experiences of medical teaching so far, and also more about the concept of clinical courage in the audio clip below:

 

Ella and Laura, 2nd year medical students at Flinders University

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RuralGP.com at #ruralwonca

Today marks the start of the 14th WONCA World Rural Health Conference, being held in Cairns, Australia.

The programme is set to contain a fantastically diverse range of research and workshops covering everything from improvements in patient care, to developing new and effective ways to collaborate across boundaries in rural health.  You can follow the events on twitter using the #RuralWonca hashtag, and already there has been a huge number of comment and links

View the WONCA Rural Conference programme

So far, the vibe at #RuralWonca has been great… benefitting from Cairns hospitality (boosted by a dynamic and helpful team from ACRRM) and a stimulating range of input from stalwart experts in rural medicine, to young, enthusiastic students and young doctors.

Thursday saw a full day of proceedings for the WONCA World Working Party for Rural Health – with the annual Council meeting held in spectacular surroundings of a seminar room looking directly onto rainforest.  As well as hearing about events from the last year, and sorting out logistics for yet another busy year ahead, there was debate about how best to support member organisations and do everything possible to support the growing number of student and young doctor organisations.  The highlight of 2018 is set to be the 15th World Rural Health Conference.  Crumbs, we haven’t even started the 14th conference yet, but for a taster of what’s in store – in New Delhi – see the video below!

Friday brought the World Summit on Rural Generalist Medicine.  The concept and importance of rural generalism in health ecosystems is reaching high levels of resonance now within Australia (where political support for recognising this is higher than ever), and much further afield in both ‘developed’ and ‘developing’ nations.  It is clear that empowering rural generalism within healthcare systems has never been more important, with absolute needs to train future doctors in medical complexity, meet the demands of an ageing population and achieve the levels of health service efficiency that are often more easy to find in the generalist setting.

The Summit also saw the launch of the Japanese Rural Generalist Programme: a major achievement and indicative of the direction that other countries are likely to go too, not least through the inspiration that these developments bring.

You can follow tweets from the Summit meeting using the hashtag #RuralGeneralist

And now for the main event.  This looks set to be a stimulating and busy few days ahead, bringing together an enthusiastic and dedicated group of international confreres giving the opportunity to recognise and drive forward international innovation and collaboration in rural health.  We hope to feature a number of interviews and reports on RuralGP.com over the next few days, like we did with the last conference in Dubrovnik, between a very packed and interesting programme of events.

Follow the WONCA World Rural Health Conference on Twitter:

#ruralwonca

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What happens when Deep End goes Rural?!

Many readers will be familiar with the Deep End project, originating in Glasgow but which has spread far and wide in describing the work of GPs working in areas of urban deprivation.  The original project brought together 100 general practices serving the most socio-economically deprived populations in Scotland.  The project team has carried out a fantastic amount of work to highlight the impact of inequalities on prevalence of medical conditions and access to healthcare.

So what happens when a Deep End GP (or a GP and GP trainee, to be precise!) travel out for some time in a remote island practice?  Dr Maria Duffy and Dr Elizabeth Dryden did exactly that, when they travelled to Benbecula to spend a week with rural GP Dr Kate Dawson… and produced this short video of their experience…

 

You can follow the Deep End project on Twitter – see below.

We look forward to the sequel!

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#RuralGPframed – bringing rural healthcare into focus

Check the end of this article for tweets and images that have been posted online since the hashtag went live… and you can also now view most of the photos from the #ruralGPframed series at gallery.ruralGP.com too

Image from W Eugene Smith’s “A Country Doctor”.  LIFE Magazine, 1948.

the best camera is the one you have with you

1948 saw the beginning of the National Health Service in the UK.  Many of its principles were based on the development of the Highlands & Islands (Scotland) Medical Service which was launched in 1913 following the publication of the Dewar Report into the challenges of rural healthcare in Scotland – and many consider the Dewar Report to be the blueprint of today’s NHS.

1948 was also a key moment in photojournalism, when LIFE Magazine featured the photography of W Eugene Smith. His photoessay of the work of Colorado country doctor Ernest Ceriani became a benchmark for photojournalism, and remains an iconic reference in the power of photography to provide perspective and insight. A YouTube presentation of the article is available too.

Since then, photography and photojournalism has evolved significantly.   Nearly everyone now has a quality camera-phone in their pocket.  The development of digital photography has resulted in the limits of photography being confined only to battery power, memory card space, and creativity.

Dr Greg Hamill (Arran GP) and Dr Stephen Hearns (Consultant, Emergency Medical Retrieval Service) work together using ultrasound-guided vascular access in an acutely unwell patient. (Patient consent obtained).  iPhone; 2017.

And yet, some would argue that this has had the effect of devaluing the art of good photography.  Paradoxically, because photography is within such easy reach, we sometimes fail to document episodes of experience – either as we assume someone else will be, or the immediacy of image capture devalues the art of composition, style and creative depiction.  And because so many images are produced (Facebook estimates that over 300 million photos are uploaded to its website every day), it is likely that great images fail to get the recognition and prominence that they deserve.

In just over a month’s time, I will be running a ‘Practical Tips’ session at the Rural WONCA conference in Cairns, Australia – on The Visible Rural GP: developing an image bank for modern rural practice.  The idea for this evolved through a personal interest in photography and its journalistic role, an interest in ‘how do we represent rural practice to potential rural GPs’ and awareness of projects such as  Document Scotland – just one inspirational project that aims to “photograph the important and diverse stories within Scotland at one of the most important times in our nation’s history”.

A tick that I removed from a patient who presented to our Arran War Memorial Hospital one summer weekend oncall. (Assumed consent from tick).  Canon 60D, with reversed 50mm; August 2016.

Perhaps we should be considering the need for presenting inspiring, accurate visual representations of rural practice today.

And so today, in the run-up to Rural WONCA 2017, I am committing to share (via Twitter, using the hashtag #RuralGPframed) at least one photo per day, from my own images, that depicts an aspect of rural practice.

I would be delighted for others to join me.  The more images that we can collect and share, to represent the stimulation, challenge and professional satisfaction of rural practice, the more insight that others – including potential rural GPs – will have into the opportunities that rural practice can offer.

Dr Kate Dawson (GP, Benbecula) and Dr Charlie Siderfin (GP, Orkney) during a valuable opportunity to get together and discuss research opportunities in rural practice.  Fujifilm XT1; January 2017.

What about video?

‘A picture is worth a thousand words’ but video often allows a narrative and mood to be more easily captured.  Video is important, and submissions of video are welcomed to this project.

Please remember, explicit consent is required for any footage featuring patients or anything related to them. Creativity  is welcomed!

#RuralGPframed

(search Twitter)

4/4/17 Update

Within 24 hours of this post going live, we’ve had an amazing amount of coverage across the world, particularly our Australian confreres.  Keep them coming!  Here’s just a few of the tweets that we’ve picked up on the hashtag…

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Report from Islay: GURRMS Medical Student Conference

Student led conference in Islay provides novel long-term solution to rural GP recruitment

By Keenan Smith, Gregor Stark and Alistair Carr

Six months ago, we were sitting in the Glasgow University Union listening to Alistair explain his plan. He’d just returned from a five week GP placement on Islay where his eyes had been opened to the challenges and excitement that lay in rural general practice.  Despite the recruitment crisis facing general practice everywhere, and rural general practice in particular, he was convinced that if other students could experience what he had, it would inspire them too.

That evening, the five of us formed the Glasgow University Remote and Rural Medicine Society (GURRMS).  Our founding goal was to host a conference with a real and lasting impact.  With a message that no delegate could ignore: rural GP provides an exciting and dynamic career that should not be written off as a sleepy backwater of a career.

We wanted to create something that would change not just how 60 medical students thought, but that would become a staple of the undergraduate social and educational calendar – changing perceptions for years to come.

If we were going to make that much of a difference, we were going to have to think big.  We knew this had to show off everything that rural practice had to offer and that this meant going to Islay.

The Gaelic College in Bowmore was the conference venue

To say we didn’t have doubts would be a lie, we had thousands, but the largest was the central premise of the entire project: if we offered this to students, would they even want to come? A close second to this was: how would we find the funding for a conference involving the immense logistical challenges of providing transport, accommodation, and catering in an island with a permanent population of 3,500.

Despite our reservations our 60 delegate tickets sold out within four and a half hours – clearly demonstrating the demand among medical students for more exposure to rural practice. Following this, we were successful in securing sponsorship from organisations that were able to appreciate the vision and scope of what we were trying to achieve.

Dr Angus MacTaggart explaining the joys of being a rural GP

When Friday 10th of March came around, every seat in the Gaelic College was filled with eager students. Most were from Scotland but some had come from as far away as Plymouth, Oxford and Hull.

A spectacular view across Loch Indaal was the backdrop to the inaugural National Undergraduate Remote and Rural Medicine Conference. The morning session started with a talk by Dr Angus McTaggart defining what rural medicine is and the rewards it can offer. This was followed by the EMRS team talking about their role and how they interact with rural GPs.

EMRS doctors Michael Carachi and Kevin Thomson

Following a short break Dr Kate Pickering talked about the importance of medical leadership, after which a workshop took place. This gave the opportunity for two of Islay’s retired GPs, Drs Chris Abell and Sandy Taylor, to engage the students in a discussion about the benefits and challenges of working in a rural environment. Simultaneously to this another workshop took place, led by the Rural GP Fellows Drs Jess Cooper and Durga Sivasathiaseelan, leading a discussion about how to act in a rural emergency and also providing information about the Rural GP Fellowship programme.

During lunch the students chatted with patients who had volunteered to come in to speak about their experiences of rural healthcare and also to give a flavour of island life. Following lunch, Mr Stuart Fergusson kicked off with a talk about rural surgery in Scotland, after which Professor John Kinsella, Chair of SIGN Guidelines, gave a talk about the limitations of guidelines in a rural setting where he made the interesting comparison of rural medicine to the ICU environment.

Obligatory visit to sample local produce!

After another break, with more excellent catering by the Gaelic College team, the EMRS guys provided a brief overview of the realities of pre-hospital care which was then followed by five student presentations. These provided a showcase of the projects that students have undertaken whilst on rural placements or undertaken during intercalated degrees. The educational content of the day finished with a panel discussion about what Realistic Medicine is and how that applies in the rural context.

The Saturday was used to explore rural life and further experience the community we were being invited to be a part of. Some of the students explored the beautiful scenery by going for a hill walk and some participated in a joint RNLI and coastguard training exercise which involved three of the students being winched out of the sea. For the students that had caught wind of Islay’s whisky reputation, a tour of the Bruichladdich distillery was arranged where they were treated to some proper Islay hospitality.

Students participating in the Saturday hill walk

The informal feedback we have got thus far has been overwhelmingly positive: certainly more than one rural elective is being sought after last weekend. A recurring theme has been how impressed students were by the strength of the island’s community and the generosity of the locals.  Formal feedback is in the process of being collected and will be made available in due course.

The 2017-18 GURRMS committee has now been elected and have exciting plans for the future. Watch this space!

GURRMS 2017-18 committee – what does the future hold?

Cool shades featured throughout the conference!

GURRMS would like to thank all our speakers: Dr Angus MacTaggart; Dr Michael Carachi and Dr Kevin Thomson; Mr Stuart Ferguson; Dr Kate Pickering; Dr Jess Cooper and Dr Durga Sivasathiaseelan; Dr Chris Abell and Dr Sandy Taylor; Professor John Kinsella; Cameron Kay; Beth Dorrans; Josie Bellhouse; James McHugh; Eloise Miller and Hannah Greenlees.

Also our sponsors: the Royal College of Physicians and Surgeons of Glasgow; the Rural General Practitioner Association of Scotland; the Faculty of Pre-Hospital Care of the Royal College of Surgeons of Edinburgh; the University of Glasgow; NHS Highland and Bruichladdich distillery.  And finally a huge thanks to all of the medical team of Islay for your support and for believing in us.

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Longitudinal clerkship vs. Traditional medical curriculum

It’s been a while since the last update and our time on the Longitudinal Clerkship is moving on apace. Here are some views on the difference between an LC and the more conventional medical curriculum.

“tailor the week to the student’s needs”…

Seeing up to 20 patients myself in three days of GP is busy…it opens up lots of learning opportunities, identifies holes in your knowledge and creates space for reflection. However, this comes at the expense of other things – like assessments! The beauty of the LC though, is the flexibility to adapt the programme and tailor the week to the student’s needs. For example, through discussion with my tutor and practice manager, I now have a single slot every week that is fenced off for Mini-CEXs, Case Based Discussion and general PPD topics. We’ll both see the same number of patients in the day, but things have been tweaked a little to run more efficiently – this is a small change that makes a big difference – which can only be afforded by the flexibility of this new curriculum model.

…Secondary Care

Previously, I spent most of my time bouncing between outpatient clinics and ward rounds whilst in Raigmore. This was good for honing practical skills and experiencing various aspects of specialist care. However, more recently I have set up a number of mini-placements in various departments of the hospital. As a student with an enthusiasm towards acute care specialties, I was able to spend a full day in ICU – attending to some really ill patients and putting my long-forgotten physiology/biochemistry knowledge to the test. The great advantage of the LC is being able to arrange your own clinical attachments be it for personal/career interest or to fill in learning gaps. I hope to soon visit Paediatrics, Psychiatry, O&G and A&E as part of my involvement in secondary care.

Skillset…

Something I hadn’t appreciated before embarking on the LC were some of the skills and qualities we would develop throughout the year. The Scottish CMOs report, ‘Realistic Medicine’ really pedals the importance of communication, conversation and organisation. I really like the quote in the report:

The single biggest problem with communication is the illusion that it has taken place.” George Bernard Shaw.
 Relative to the conventional Dundee programme, I will see upwards of 500 patients in GP myself – handing over each and every case to my GP tutors throughout my time here. Furthermore, I write about 2-3 referrals per week to secondary care. No matter which career path I end up taking, the skills I will acquire from these forms of communication will prove hugely advantageous as all doctors are involved in handover and multidisciplinary care. I would have some exposure to these skills within the traditional programme but the constrained nature of 10x four-week blocks means that I wouldn’t get to see the result of the referral or the long-term impact on the patient and clinical team.

 

 

Q&A…

Q: Do you feel your colleagues have a better knowledge grasp because they focus on the same block for weeks at a time?

A: Yes, they probably do. You would expect a student who is studying cardiology for a week to be in the mind frame of cardiology – we can’t be that focussed because General Practice is General! However, I think their expertise is transient by the time finals come around and preparing for 5th Year and FY. We see a little of every speciality throughout the entire year, slowly topping up our memory banks rather than being intensely involved in one speciality for a month before forgetting it all in time for finals.

Q: What elements of the curriculum are you missing out on?

A: This is a hard one. The quick answer is, I dont think there are any big areas we don’t experience. Most of medicine can be seen through the community, (I see my fair share of paediatrics, psychiatry and medicine in GP). Our secondary care time allows us to catch up on the things you naturally won’t see in GP (surgery & acute care for example). Of course there will be some super-specialist things we don’t see in the Highlands as the service isn’t provided here. However, what I think is just as important and to answer a question with a question – what do we experience on the LC that your typical medical student won’t?

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@RuralGPScot launches #ruralLGBTQ resources for #ruralGP

Last week, the Rural GP Association of Scotland (RGPAS) launched a range of guidance designed to make rural practice in Scotland more accessible to lesbian, gay, bisexual, transgender (LGBTQ+) patients.

At the annual RGPAS Conference last year, held in Inverness, we were delighted to welcome Dr Thom O’Neill to talk about LGBTQ+ inequalities in rural areas, and some of the practical ways that as GPs we can reduce barriers to healthcare.  Here he is talking about what doctors can do to better support LGBTQ+ patients.

Thom’s presentation stimulated a lot of discussion, and led to a project whereby he worked with RGPAS to develop factsheets, posters and other materials to help rural GP practices ensure that their services are welcoming to LGBTQ+ patients – especially younger patients.

You can find out more about these resources at: www.ruralgp.scot/lgbtq-plus.

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