Archive | International

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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Voices from #ruralwonca: Day 1

Yesterday I caught up with several delegates attending the WONCA World Rural Health conference being held in Cairns, Australia over the next few days.

Hear more about their backgrounds and why they have come to #ruralwonca by clicking on the interviews… and please don’t be shy if you are asked for a similar clip over the next few days.

Thanks to Dr Minh Le Cong of the Flying Doctors Service, who provided a much-needed-but-forgotten cable to make these interviews possible!

Dr Sophia Åman, Sweden

 


Dr Sergius Onwukwe, South Africa

 


Dr Karen Flegg, Australia

 

 

 

 

 

 

 

 


Dr Pratyush Kumar, India

Pratyush has an important job: he is organising next year’s WONCA World Rural Health conference in New Delhi, in April 2018.  Hear a bit more about how the planning for that is going.  You can visit the website for the conference here.

 

 

 

 

 

 

 


Dr David Hogg, Scotland

Karen decided I should be on the other end of the microphone too, so how could I possibly decline!

 

 

 

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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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Setting the right path for Canadian rural practice

Thanks to Dr Douglas Deans for highlighting this recently-published report from a collaborative taskforce in Canada, which has been set up to identify positive actions that are likely to result in a more robust, sustainable and supported rural health service in Canada.  The collaboration comprises the Society of Rural Physicians of Canada (SRPC) and the College of Family Physicians of Canada (CFPC).

The report is refreshingly succinct, relevant and pragmatic, and likely to be of interest to anyone who is trying to work out how to articulate the balance between effective action and strategic direction to influence national policies, in the context of conflicting and difficult policy decision-making.  Many rural GPs and educators will be familiar with the challenge of identifying realistic interventions which can translate into more sustainable recruitment and retention to rural communities, so this road map from Canada is likely to be a welcome read.

Recruiting and retaining family physicians in rural areas through financial incentives alone is not enough.  We need a coordinated and thoughtful alignment of education, practice policies, community involvement, and government support.  Family medicine residents who are educated in rural training sites, who immerse themselves in the communities and who see themselves supported by peers, specialists, health care providers, and evolving distance technologies, are more likely to choose rural and stay rural.

Dr Trina Larsen Soles – SRPC Co-Chair of Taskforce

News Release   Download the Report

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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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New: Historical Perspectives on Rural Medicine

A key new text reflecting the development of rural practice over the last century, has just been published by the Wellcome Witnesses to Contemporary Medicine series.

Introduced by Professor Geoffrey Hudson, this volume comprises edited transcripts of two Witness Seminars held in 2010 and 2015 on the history and development of rural medicine. Participants in London and others world-wide contributing via video link, addressed the development of the curriculum for teaching rural and remote medicine; the importance of community involvement; and the growth of national and international networks and organizations. Discussion also included: the impact of specialization; professional identity and status; the relationship to other health professions; technological developments; and the challenges of isolation.

The collection of evidence for the series included input from UK rural GPs Jim Douglas, Gordon Baird, John Wynn-Jones, Iain McNicol, Jim Cox and David Hogg.  International stalwarts included Bruce Chater, Roger Strasser, Jim Rourke, Sarah Strasser, Ian Couper, Richard Hays, Oleg Kravtchenko, Tanja Pekez-Pavlisko and Jo Scott-Jones.

Subjects ranges from pre-NHS rural practice to modern day technology, and the use of that for activities such as Practice Based Small Group Learning, and initiatives such as the Northern Ontario School of Medicine, and Scottish GP Rural Fellowships.  Themes include 24-hour working, the psychosocial stresses of rural medicine, and the interface between generalist practice and secondary care.

Making this tome available as a free online PDF means it can be easily accessed and searched, including for future research activity.  You can also purchase it online at amazon.co.uk (RuralGP.com does not receive any commission from this).

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Rural Medicine Café discusses Rural Health Research

Mayara Floss, founder of the Café

Readers might be familiar with the Rural Medicine Café, set up by budding rural GP Mayara Floss who is a medical student in Brazil.

Following the 2015 Rural WONCA Conference in Dubrovnik, she set up the virtual Café to create a relatively informal space in which rural medics from all over the world could come together for some conversation to discuss hot topics, and develop collaboration.  Mayara runs these sessions on Google Hangouts, which offers easy access and is fairly successful on most broadband connections.

So far an impressive range of topics have been discussed.  The most recent event took place on Saturday, and involved doctors and students from Brazil, the Caribbean, Halifax in Canada, Scotland and Kenya discussing ways in which research in rural health could be improved and facilitated.

An important outcome of each virtual Café is that the content can be watched later, on YouTube.  The relaxed nature of these sessions means that they can take a fair chunk of time to watch, but for rural health enthusiasts who want to catch up on the conversations, it represents an interesting resource from which to learn from practices across the world.  Where else can you engage so easily in sharing and discussing rural health issues with worldwide conferes?

For future events, take a look at the Café Facebook page.  The most recent Café (running to just over an hour) can be accessed at the following link:

https://youtu.be/SdP53qewijU?t=1s

Well done to Mayara for an impressive result to her initial ambitions to develop this project.  Do contact her via the Facebook page if would like to watch or take part in a future Café.  The next Café will discuss the WONCA Rural Medical Education Handbook on Saturday 4th February.

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WONCA World Rural Health conference all set for April

This year will see the WONCA World Rural Health Conference take place in Cairns, Australia from 29th April.  It will be preceded by the National Rural Health Conference of Australia, which will promise to bring even more research, innovation and collaboration to the wider event.

Registration is now available from the conference website.  The organisers have also put together this film to whet the appetite of potential delegates.  It looks set to be a fantastic event.  RuralGP.com will be there, and we hope to run a similar range of interviews and podcasts like we did from Dubrovnik in 2015.  This reflective commentary from the 2015 conference demonstrates that the conference offers a unique chance to get together with like-minded confreres and share great practice from across the world.

We hope to see you there!

Early bird registration fees available until the end of January.

… and if that’s not enough (!), here’s Ian Couper of South Africa, being interviewed in Dubrovnik in 2015 giving some encouragement for others – particularly students and new doctors – to attend WONCA in Cairns…

ianIan Couper, South Africa

Ian is a rural family doctor, and a stalwart of Rural WONCA.  You can read more about his background here.


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RGPAS Scholarships – for students and GPs

2015logopngApplications are invited for a number of scholarships made available by The Rural GP Association of Scotland (RGPAS).  Funded by the RGPAS Educational Trust (which also receives any monies raised through RuralGP.com advertising) the scholarship scheme aims to:

  1. Encourage and enable Scottish students to experience a Rural GP elective in Scotland, and
  2. Support members of RGPAS (GPs and ST Trainees) to attend international conferences, in a bid to promote international collaboration, awareness of Scottish innovations in rural general practice, and to experience the benefits of seeing innovation from across the world.

Undergraduate Elective Scholarships

In 2017 there will be five student elective scholarships available, each to a value of £200.

  • This can be used to fund accommodation, travel or other associated costs. Receipts may be requested at the committee’s discretion.
  • The student must be doing their elective at a Scottish rural practice where at least one GP is a member of RGPAS. The student must be at least 20 miles away from their home address.
  • Electives may take place at any time of the year, and be for a minimum of 4 weeks.
  • The student must be an undergraduate medical student from a Scottish university.
  • The student should submit either a 500 word report or a video (of 3 minutes or more) about their experience within 2 months of the end of the elective. They may be asked to present at the next RGPAS conference too, if they are able.
  • Details of successfully awarded scholarships will be made available to RGPAS members, and also via the RuralGP.scot and RuralGP.com websites.

GP Travel Scholarships

In 2017 there will be four travel scholarships available. Nominally each of these will be worth £500, however some flexibility may be applied by the Committee to support applications which require more or less than this amount.

  • The applicant will be a member of RGPAS for at least 3 months prior to application. They will be a GP or a GP Trainee (at any stage of ST training) currently practising in Scotland.
  • RGPAS Committee members are eligible to apply.
  • The recipient should attend a conference in a country other than the UK. There will be a preference for activities that foster new relations with other country/world organisations such as WONCA or rural GP associations.
  • The money may be used for travel, accommodation or locum costs associated with attending a conference, event or experience in rural practice
  • The recipient should submit either a 500 word report or video (of 3 minutes or more) about their experience within 2 months of the end of the travel period. They may be asked to present at the next RGPAS conference too, if they are able.
  • Details of successfully awarded scholarships will be made available to RGPAS members, and also via the RuralGP.scot and RuralGP.com websites.

How to Apply

  • Please read the application pack – available from the link button below – and submit it as instructed.
  • Closing date: 6pm Friday 27th January 2017
  • The RGPAS committee will meet virtually, to discuss and judge the applications. Their decision will be final. They may decide not to award all available scholarships.

RGPAS is keen to ensure that this investment in future GPs as well as the development of its existing members, will help to generate innovation, collaboration and inspiration across Scottish rural general practice.  We look forward to receiving applications!

Download application form
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RGPAS Scholarships – for students and GPs

2015logopngApplications are invited for a number of scholarships made available by The Rural GP Association of Scotland (RGPAS).  Funded by the RGPAS Educational Trust (which also receives any monies raised through RuralGP.com advertising) the scholarship scheme aims to:

  1. Encourage and enable Scottish students to experience a Rural GP elective in Scotland, and
  2. Support members of RGPAS (GPs and ST Trainees) to attend international conferences, in a bid to promote international collaboration, awareness of Scottish innovations in rural general practice, and to experience the benefits of seeing innovation from across the world.

In April 2016 we awarded three scholarships:

  • James McHugh of Glasgow University, for his student elective on the Isle of Arran
  • James Durbar of Manchester/St Andrews University, for his student elective on Benbecula
  • Dr David Hogg, Rural GP on the Isle of Arran, to attend a rural research symposium being held at Tromso University in Norway, in September

Student (Undergraduate) Scholarships

In 2016 there are three remaining scholarships available, each to a value of £200.

  • This can be used to fund accommodation, travel or other associated costs. Receipts may be requested at the committee’s discretion.
  • The student must be doing their elective at a Scottish rural practice where at least one GP is a member of RGPAS. The student must be at least 20 miles away from their home address.
  • Electives may take place at any time of the year, and be for a minimum of 4 weeks.
  • The student must be an undergraduate medical student from a Scottish university.
  • The student should submit either a 500 word report or a video (of 3 minutes or more) about their experience within 2 months of the end of the elective. They may be asked to present at the next RGPAS conference too, if they are able.
  • Details of successfully awarded scholarships will be made available to RGPAS members, and also via the RuralGP.scot and RuralGP.com websites.

GP Travel Scholarships

In 2016 there are three remaining travel scholarships available. Nominally each of these will be worth £500, however some flexibility may be applied to support applications which require more or less than this amount.

  • The applicant will be a member of RGPAS for at least 3 months prior to application. They will be a GP or a GP Trainee (at any stage of ST training) currently practising in Scotland.
  • RGPAS Committee members are eligible to apply.
  • The recipient should attend a conference in a country other than the UK. There will be a preference for activities that foster new relations with other country/world organisations such as WONCA or rural GP associations.
  • The money may be used for travel, accommodation or locum costs associated with attending a conference, event or experience in rural practice
  • The recipient should submit either a 500 word report or video (of 3 minutes or more) about their experience within 2 months of the end of the travel period. They may be asked to present at the next RGPAS conference too, if they are able.
  • Details of successfully awarded scholarships will be made available to RGPAS members, and also via the RuralGP.scot and RuralGP.com websites.

How to Apply

  • Please read the application pack – available from the link button below – and submit it as instructed.
  • Closing date: Sunday 19th June 2016.
  • The RGPAS committee will meet virtually, to discuss and judge the applications. Their decision will be final. They may decide not to award all available scholarships.

RGPAS is keen to ensure that this investment in future GPs as well as the development of its existing members, will help to generate innovation, collaboration and inspiration across Scottish rural general practice.  We look forward to receiving applications!

Download an Application Pack
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