Archive | International

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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RGPAS Launches Scholarships – for students and GPs

2015logopngThe Rural GP Association of Scotland (RGPAS) is pleased to launch a number of scholarships, and is inviting applications now.  Funded by the RGPAS Educational Trust, it was decided at the RGPAS AGM in November 2015 to setup a scholarship scheme to

  1. Encourage and enable Scottish students to experience a Rural GP elective in Scotland, and
  2. To 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.

Student (Undergraduate) Scholarships

In 2016 there will be five 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.

Travel Scholarships

In 2016 there will be four 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: 30th March 2016. If any scholarships remain, they will be readvertised with a closing date of 14th June 2016 (TBC).
  • 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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Reflections from WONCA Rural Dubrovnik 2015

wonca_logo_final_01Today I am attending RCGP Scottish Council in Edinburgh.  As part of this, I was asked to report on my experience in attending the WONCA World Rural Health Conference in Dubrovnik – on 14-18 April 2015.  I thought it might be helpful to share this report here.

WONCA Rural Conference, Dubrovnik – 14-18 April 2015

Report to RCGP Scottish Council

In April 2015 I attended the WONCA World Rural Health conference, held in Dubrovnik.  Five months on, it is helpful to reflect back on the experience of attending WONCA Rural, and what I have acted upon since my return from Croatia.

Firstly, I would like to thank RCGP Scotland for financial support to attend the conference.  Such support is effective and appreciated to help release GPs like myself from practice commitments.  It is clear that Scotland has much to share about developing and innovating rural general practice, as well as being able to learn from approaches taken by our international conferères too.

I am also grateful for support from Drs Miles Mack, John Gillies and the RCGP Scotland team in preparing material for the conference.

WONCA Rural 2015 brought together rural practitioners from across the world. Historically there has been a higher proportion from the UK, Eastern Europe, Canada, USA, Australia and New Zealand.  However it is clear that there is growing membership from African and Asian countries, and indeed there are intentions to hold the next WONCA Rural Conference in Africa.

There were many lessons, benefits and conversations during the 4 day conference.  As usual, informal discussion amongst confrères opened up more learning than the conference presentations: and there was plenty of inspiration and quality research/innovation being presented in these sessions. Whilst in Dubrovnik, I posted a number of podcast interviews to this website.

WONCA World President, Michael Kidd, addresses the conference…


There were a number of core themes that I took away from WONCA Rural…

International similarities

Rural practitioners are united by similar challenges and attractions of rural practice. There are often frustrated levels of bureaucracy as a result of providing a wide spectrum of care across traditional domains of healthcare.  From connectivity and immediate care provision, to blurred funding streams between primary care and community hospital work, and a constant difficulty in navigating the politic that goes with negotiations; it was reassuring to listen to more experienced GPs from other countries who have the same issues that we have in Scotland.  Younger rural GPs all express a frustration with the need to ‘learn politic’ and persuasion skills in order to achieve even basic improvements in clinical care. This is made particularly challenging as management training is lacking from most GP training programmes.

Recruitment and retention challenges exist internationally, and there are common approaches to this.  The role of mentorship models is increasing, along with recognition that ‘single handed practice’ is declining in popularity and sustainability – and are being replaced by federated, group or other networked practice models.  There was interest in the GP Rural Fellowship programme in Scotland, which has helped to introduce recently-qualified GPs into rural posts.  However the challenge of filling posts remains ever-present and similar across the world.

We found that one presentation in particular – on the ‘pipeline approach to (rural) GP recruitment‘ – resonated with taking the recruitment challenge in Scotland forward.

It is widely accepted that harnessing the interest and enthusiasm of medical students in rural practice, can be a powerful means by which the attractions (and realistic perspective) of rural practice can be highlighted.   Action is needed to ensure that funding is increased to facilitate greater involvement of undergraduate training opportunities in rural practice; similarly support to trainees in rural practice needs to be protected and expanded.  The John Flynn programme – run by the Australian College of Remote & Rural Medicine (ACRRM) is a great example of what can be achieved by supported training opportunities in rural practice.  Pragmatic support of undergraduates and trainees is vital: appropriately funded accommodation, travel and consideration of the impact on spouses/partners and family.

That said, we are not alone in having to navigate the constraints of geographically-defined training schemes, although there is work especially in Canada and the USA to provide rural-track training programmes, similar to the ones now in place in Scotland.

Social Media

There are numerous networks to join, and participation in these international approaches is important to develop further within Scotland.  Social media is an easy way of reducing professional isolation, and there were several workshops looking at how to encourage others to join the conversations, and improve fluency in its use.  Throughout the conference, the twitter hashtag #woncarural2015 was used and a search for this now will reveal the active conversations taking place at the time.

I use Twitter regularly to keep an eye on recent trends/new guidelines etc.  It was great to meet some of the faces behind these twitter profiles!

confgroup

@davidrhogg @IVLINE @ruralgreengp @ruralflyingdoc and Leslie Rourke

Identity

Rural practice needs to improve its collective identity.  It was apparent that those countries with a thriving network of rural GPs had a stronger buzz about rural GP opportunities – as well as highlighting generic benefits of general practice.  The ACRRM is perhaps a model that we need to reconsider in Scotland – by building up and consolidating what we already have.  The current setup of relatively un-linked institutions, from RCGP, Rural GP Association of Scotland, School for Rural Health & Wellbeing, NES, RRHEAL, Centre for Rural Health and the RCGP Rural Forum serves to dilute the collective identity, duplicate certain efforts, and I think something needs to be done to pull these organisations tighter together with a more collaborative strategy.

In November 2014 the Rural GP Association of Scotland (RGPAS) became the new name for the Remote Practitioners’s Association of Scotland (RPAS) and we have been building specifically on work to support practising rural GPs, as well as undergraduates in rural practice.  We’ve also improved social media and online presence.

There remains a wider need to realise the potential synergies that could be realised by organisations working better together.

Use of existing mechanisms 

One particularly interesting conversation with an experienced GP in Australia, led to learning about the set up of a ‘Managed Educational Network’ – and how such established routes of networking can be harnessed to achieve wider goals.  He advised on the importance of identifying existing organisations and their objectives, in galvanising resource to make projects happen.

On my return, I met with RRHEAL and NES, and highlighted the obligations from RRHEAL’s mission objective to facilitate managed networks in rural practice.  This has resulted in a PDSA to assess whether a Scotland-wide MCN (clinical network) or MEN (educational network) could help to link up Scotland’s rural GPs by VC on a semi-regular basis.

Innovation in rural health care

There were some great examples of where rural practice is leading new approaches in training, clinical skills development and other aspects of clinical care.  Some of these are similar again to current work in Scotland.  The increasing role of simulation training particularly for high intensity low frequency clinical scenarios was evident from several speakers.

Lessons from conference workshops have already been put into action on Arran where we have been developing the use of simulation training.

The increasing role of ultrasound in clinical practice was also raised frequently.  Given that this is a safe, potentially transmissible and higher acuity diagnostic near-patient test, we are likely to see its use in rural practice develop considerably.

The role of the rural GP in providing leadership and advocacy in more generic challenges of rural living was apparent.  Whether representing rural healthcare on a political level, engaging in media work or leading projects such as improvements in connectivity – all these aspects of professional life were common.

Presentation of ‘RCGP Scotland Being Rural’ 

I presented the RCGP Scotland paper to an audience of approximately 50-60 on the Saturday morning of the conference.  This was well received, and the twitter conversation continued well past the conference conclusion too.   The wider perspective provided by Miles Mack’s mind map of challenges to rural practice, was appreciated and recognised by colleagues across the globe.  In particular, the constraints resulting from infrastructure difficulties in rural areas was a common theme.

Here’s a summary video of the main points of the Being Rural paper.

Summary

Attendance at WONCA Rural allowed an important Scottish input to the debates and conversations about international rural health.  It was an opportunity to obtain a wider perspective on how others are dealing with common challenges including recruitment, retention, burnout, effective training of the ‘next generation’ and representation of the generalist approach amongst an increasingly specialist medical world.  I hope that Dr John MacLeod, Lochmaddy GP and one of the founding members of WONCA Rural, would have been proud of the ongoing Scottish participation from those of us who made it to Dubrovnik.  Personally, it helped to open many doors for future collaborative working, particularly with confrères in Australia, New Zealand and Canada.

Next actions

There have already been outcomes from participating at Rural WONCA.  The priority now is to share the momentum that exists amongst WONCA partners to inform, enthuse and stimulate better representation, and an effective collective identity, amongst rural GPs in Scotland.  RCGP Scotland has a pivotal role in supporting both existing and prospective members and I hope that it will be possible to translate this effectively into useful actions via the RCGP Scotland Rural Strategy Group.

David Hogg, September 2015

Now want a different perspective?  See these other reports from Dubrovnik 2015.

 

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Belford 50:150 Conference: 22-25 October 2015

belfordhospital‘Tis the season it seems, to start looking at what events are happening over the autumn and winter months.  Here’s a new one, which looks exciting and a great chance to join a wide range of fellow clinicians from rural medicine across Scotland and beyond.

The Belford 50:150 Conference will mark the 150th anniversary of the opening of the Belford Hospital in Fort William, and the 50th anniversary of being on its present site.

The Belford Hospital serves a large area of rural Scotland, and as a result has been responsible for producing innovative approaches – and some fantastic characters! – in the provision of rural healthcare.  The conference is aimed at a wide range of attendees – and there is an impressive line-up of speakers from Scotland and beyond covering a stimulating and interesting range of topics – including mountain rescue, difficult ‘oncall’ scenarios,  international perspectives, and reflections from Belford alumni on what their Belford training has done for them in their subsequent careers.

Some of the most recent 'graduates' of the Belford Hospital

Some of the most recent ‘graduates’ of the Belford Hospital

There’s also a social programme, featuring a ceilidh on the Saturday night, and I suspect there will be lots of reunions happening too.

Kudos to current Belford consultants Patrick Byrne and Sarah Prince for putting together such an attractive programme.  I’m booked and hope to see you there.

NB. Closing date for abstract submissions is Friday 28th August – full details on the website.

> Belford 50:150 Conference Website
Belford Hospital image used under Creative Commons licence: N Chadwick
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Must-watch video from @KangarooBeach

When was the last time you watched something that you felt simply had to have a wider audience?

For me that was last night.  Tim Leeuwenburg of Kangaroo Island, Australia had already presented this talk to the wide community of SMACC in Chicago, but by sharing his story and reflections on video, it makes for compulsive viewing by all clinicians, from those about to hit the wards and experience ‘grown up’ clinical responsibility, to those who are approaching burnout – or who are keen to identify burnout in others.

As a rural GP I found Tim’s story compelling and relevant, and I think others will too.  If you can tolerate the graphic nudity (it’s worth it), take or make 30 minutes in your life to watch this.  And share.

 

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Vacancy – GP, Whangamata, New Zealand (Salaried)

Kayaking at the Coromandel Peninsula (Photo by Adam Bryce)

Kayaking at the Coromandel Peninsula (Photo by Adam Bryce)

We are seeking a permanent or long term GP for a centrally located, privately owned medical practice in a popular holiday location – the Coromandel.

  • Attractive salary package
  • Assistance may be provided to cover relocation costs, short term car hire and subsidised accommodation
  • Friendly and supportive team
  • Four days per week with on-call of 1:3
  • Extended hours during summer holiday peak times
  • Working alongside three other General Practitioners, practice nurses, administration and frontline staff
  • The practice holds a PRIME contract and runs two acute clinics daily from noon to 5.00pm for urgent cases
  • The surf town of Whangamata, located in the stunning Coromandel region, is lively in summer and lovely the rest of the year
  • It has a population of 4, 000, swelling dramatically to 60,000+ during the holiday periods

Move here for the best weather in the country, with temperatures ranging from mid to high 20’s in the summer and, on average, 5 to 16 °C in the middle of the winter months. This region is famous for its unique combination of beaches and forests. The spectacular ocean beach provides some of the best surfing breaks and yet the safest swimming in New Zealand. Sea conditions to suit all are available along its four kilometre length or in the safe harbours that lie to the north and south. There are several pre-school facilities including a kindergarten. An area school available within the town which caters for pupils aged 5 to 18. Two golf courses, one 9-hole and an 18-hole course, are also available within the town.

See more of the stunning Coromandel here and Whangamata here.

How to apply

Email us for more information – enquiries@nzlocums.com.

Alternatively, contact Jacinta Sanders, Relationship Manager for a confidential discussion on our freephone number 0808 234 7853.

NZLocums is New Zealand’s only government funded GP recruitment organisation.  www.nzlocums.com

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