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Mayara Floss: the challenges for women working in rural health

Mayara Floss

This video of Dr Mayara Floss – rural doctor in Brazil and passionate advocate for international rural health – has recently been publicised via the Rural WONCA email list by Dr John Wynn Jones, chair of the WONCA Working Party on Rural Health.

Mayara was invited to give her perspective on the issue of “Investing in rural health workers for the economic participation and empowerment of rural women and girls” at a meeting of the joint Commission on the Status of Women: a side-event of the World Health Organisation, International Labour Organisation, Permanent Mission of Ireland to the United Nations and Women in Global Health.

John introduced the video more eloquently than I could, and so with his permission, here’s what he said:

Dear All

I want to congratulate Mayara and thank her on behalf of Rural Wonca and all the rural health workers around the world for her presentation and wise words at the United Nations Commission on the Status of Women. Mayara is an exceptional person. I can’t even call her a future leader because despite the fact that this is her first year as a doctor she is already a world leader and an example to us all. It will be the Mayara’s of this world who will take up the mantle for the next generation and its our duty to support them.

Please look at the video of her session. She describes how medical schools in the largely rural country of Brazil do little to promote and teach rural health care. She eloquently describes her own journey against the odds and her quest to work among rural communities and the barriers that she encountered. Everyone needs to watch her presentation! 

During the panel session she implores us first to listen to our patients and are communities before coming up with ” so called helpfull solutions”.

She also asks us to think about the political tragedy that is happening in Brazil and the dismantling of one of the most enlightened primary care systems in the world and its replacement with private health.

We are all very proud of her and the many other members of Rural Seeds who are working so hard around the world to build their careers and make a difference for rural communities.

Kind regards

John

Mayara speaks in the video below for 20 minutes, at 30 minutes in, and there are subsequent (excellent!) contributions to the discussion thereafter.

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Applications invited now for Scottish Rural GP Fellowships 2018

NES Logo 2005Applications are now being invited for the GP Rural Fellowship Scheme, overseen by NHS Education for Scotland.

The Fellowships offer a fantastic opportunity to build skills and experience in rural general practice, whilst experiencing the challenges and opportunities first-hand – during a well-supported year which includes nine weeks of study leave and a generous study budget.

The Fellowships are located across rural Scotland, from Dumfries & Galloway, to the Shetland Isles, including islands such as Islay, Arran, Skye and the Uists.

Many previous rural fellows have stayed in rural practice, and this article published in the Journal of Rural & Remote Health highlights the strengths and successes of the programme which has been running for over ten years.

Rural Fellowship Facebook Page     Rural Fellowship – Official Information

Closing date for applications: Wednesday 11th April 2018

Fellowships (one year) commence in August 2018.

Watch the latest video about the Fellowships…

Former Rural Fellow Gemma Munro explains more about her time as a Rural Fellow.

Why be a rural GP?

This video, as part of the RCGP #ThinkGP project, featured the range of rural GP duties on the Isle of Arran.

 

… and here’s a video from 2016 featuring some of the Fellows and others involved with the scheme…

Interested?  We want to hear from you…

All the Rural Fellowship sites will welcome you to chat on the phone or visit and tour round what’s on offer.  We can fix up a chat with current or previous rural fellows, and you can ask questions on the Fellowship Facebook page.  There is a lot of information available from the websites mentioned already, but sometimes it’s easier to arrange a chat on the phone or Skype… all descriptors of the Fellowships (on the official fellowships page) have contact details where you can find out more.

A couple of years ago we interviewed some of those involved in running the Rural Fellowships.  Hear more from them about what they think the fellowships can offer recently qualified GPs…

Gill Clarke – Fellowships Co-ordinator

gillGill has been running the fellowship scheme now for several years.  I asked her about the opportunities available, and why she thinks the fellowship scheme is a good way to enable recently-qualified GPs to experience rural practice.

Gill is very happy to be contacted about any of the fellowship options.  gillian.clarke1@nhs.net


Angus MacTaggart – Islay Rural GP

angusAngus is one of two principals of Islay Medical Services, which now delivers primary health care across the island, as well as out of hours and hospital services.  He describes the attractions and challenges that he identifies with rural practice.

You can contact Angus at: Angus.mactaggart@nhs.net


 

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NES Annual Educational Awards – nominations invited

Nominations are now invited for the annual NES Education Awards.  With so much quality medical education being delivered across rural Scotland, we would encourage readers to consider whether they can nominate individuals or teams for these awards…

The 5th annual NES Medical Directorate Awards for 2018 is to recognise outstanding contributions to the quality of medical education and training in Scotland. Significant numbers of our undergraduate students excel in national competitions and awards, those who graduate from Scottish Medical Schools rank very highly in Foundation Programme selection processes and many of our postgraduate training programmes rank 1st, 2nd or 3rd in league tables of the 20 UK Deanery/LETBs for “overall satisfaction”.  Due to the current nature of regulatory monitoring, often the focus of quality management processes is on areas of medical education and training that require development, however it is known that many aspects are excellent and deserve recognition.

A core group including representation from the Postgraduate Deans, GP Directors, STB Chairs, Scottish Deans Medical Education Group, Scottish Foundation School, NES General Management, Directors of Medical Education and trainees currently oversee this initiative. Awards will be made at the congress dinner during the 8th Annual Scottish Medical Education Conference on Thursday 26 April 2018.

Award Categories

  1. Lifetime Achievement Award in Medical Education
  2. Award for Scholarship
  3. Award for Process Development and Implementation
  4. Award for Innovation in Training
  5. Team of the Year Award
  6. Award for Staff Support
  7. Award for an Outstanding Role Model
  8. Award for Excellence in Facilitating Transitions in Medical Education & Training

Nomination Process

  1. Nominations can be submitted by following the enclosed Questback link :
  2. The CLOSING DATE for submissions is Friday 16 March 2018.
  3. The nomination statement must indicate the award category, will typically be around 500 words but no more than 750 words in length, take the form of a narrative, and must specifically address the criteria, highlighting why the nominee is deserving of the award.
  4. The nomination statement may be supplemented by a curriculum vitae and up to three supporting materials (if appropriate). These can include: supporting testimonials, documents containing statistics, supporting research, evaluation or inspection reports, press cuttings and promotional material and should be submitted separately to Medical_Awards@nes.scot.nhs.uk
  5. Any queries should be sent to Medical_Awards@nes.scot.nhs.uk

Award Ceremony

Each category winner will be presented with a commemorative certificate at the congress dinner on Thursday 26 April 2018.

Download NES Education Awards Nomination Advice
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BASICS Scotland Adult Tele-education Course Starts 28th August 2017

BASICS Scotland would like to announce the dates for the next Adult Tele-education Course, presented by Karyn Webster. This 10 week course will start on Monday the 28th August and run for 10 weeks with a 2-week break in October.

Tele-education by BASICS Scotland is an online learning resource ideal for remote and rural practitioners eager to reinforce and develop their skills in pre-hospital emergency care. The benefit of Tele-education is that participants can take part without having to leave their home or place of work. The course is delivered entirely over the web, with weekly 1-hour live sessions in a video conferencing format which participants can attend or view the recordings later at a time more convenient for them!

Topics on this course include:

  • Allergy & Anaphylaxis
  • Asthma
  • LVF – Adult Pneumonia
  • Stroke & TIA
  • Chest Pain & Thrombolysis
  • Head Injury
  • ENT Emergencies
  • Wounds
  • Burns & Tetanus
  • Pain Relief
  • Seizures

If you are interested in taking part in this course or would like more information head over to the BASICS Scotland website and complete an application form today!

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Podcast from @fakethom and @RuralGPScot highlights #ruralLGBTQ work in #ruralGP

Back in March, 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.

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.

We are aware that since then a number of GP practices have had discussions in their teams about how to make their health services more LGBTQ+ accessible.  We’ve also had a number of international enquiries about this work – including from Canada, New Zealand and Australia – who have been keen to use this work to increase awareness.

Thom has also been asked to adapt the factsheets for secondary care use in some parts of Scotland too.  So, as expected, the theme seems to have resonated with a wide number of clinicians and service managers.

Thom and David recently caught up to discuss how these guidelines came about, and to explore some of the themes of why LGBTQ+ patients seem to face specific inequalities of access to health care – and how rural practice has some unique opportunities to improve this.  We hope to have Thom back to this year’s RGPAS Conference (2-4 November, once again in Inverness – details soon) for an update on what how this work has been developing.

You can listen to the podcast here:

In the podcast above, we make reference to the work of Alex Bertie about recording his experience of seeking help and assistance with gender dysphoria.  Alex’s videos make for some insightful and compelling viewing, but this one is specifically about his thoughts about the GP consultation – and the difference that a more supportive and informed consultation can make particularly at a challenging and difficult time.

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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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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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Applications due by 7th April for Scottish Rural GP Fellowships 2017

Just a reminder that the closing date for applications to the Rural Fellowship for 2017 close this Thursday, 6th April. See the links below for more information.

beafellow.ruralgp.com

NES Logo 2005Applications are now being invited for the GP Rural Fellowship Scheme, overseen by NHS Education for Scotland.

The Fellowships offer a fantastic opportunity to build skills and experience in rural general practice, whilst experiencing the challenges and opportunities first-hand – during a well-supported year which includes nine weeks of study leave and a generous study budget.

The Fellowships are located across rural Scotland, from Dumfries & Galloway, to the Shetland Isles, including islands such as Islay, Arran, Skye and the Uists.

Many previous rural fellows have stayed in rural practice, and an article was recently published in the Journal of Rural & Remote Health – highlighting the strengths and successes of the programme which has been running for over ten years.

Rural Fellowship Facebook Page     Rural Fellowship – Official Information

Closing date for applications: Thursday 6th April 2017

Fellowships (one year) commence in August 2017.

Watch the latest video about the Fellowships…

Current Rural Fellow Gemma Munro explains more about her time as a Rural Fellow.

Why be a rural GP?

NHS Highland made this video of rural practice in Kintyre…

 

… and here’s a video from last year featuring some of the current Fellows and others involved with the scheme…

Interested?  We want to hear from you…

All the Rural Fellowship sites will welcome you to chat on the phone or visit and tour round what’s on offer.  We can fix up a chat with current or previous rural fellows, and you can ask questions on our Facebook page.  There is a lot of information available from the websites mentioned already, but sometimes it’s easier to arrange a chat on the phone or Skype… all descriptors of the Fellowships (on the official fellowships page) have contact details where you can find out more.

A couple of years ago we interviewed some of those involved in running the Rural Fellowships.  Hear more from them about what they think the fellowships can offer recently qualified GPs…

Gill Clarke – Fellowships Co-ordinator

gillGill has been running the fellowship scheme now for three years.  I asked her about the opportunities available, and why she thinks the fellowship scheme is a good way to enable recently-qualified GPs to experience rural practice.

Gill is very happy to be contacted about any of the fellowship options.  gillian.clarke1@nhs.net


Angus MacTaggart – Islay Rural GP

angusAngus is one of two principals of Islay Medical Services, which now delivers primary health care across the island, as well as out of hours and hospital services.  He describes the attractions and challenges that he identifies with rural practice.

You can contact Angus at: Angus.mactaggart@nhs.net


Jonathan Hanson – Skye Rural Practitioner (Mackinnon Memorial Hospital)

jonathanJonathan has trained in a multitude of specialties, and has found his ‘perfect’ job requiring constant generalism.  He represents the growing number of ‘acute rural GPs’ who provide hospital-based services as well as out-of-hours GP cover.  With additional strings to his bow such as anaesthetics, the services provided in Broadford mean that patients can frequently be treated locally, instead of facing long journeys to secondary care.

The contact for the Skye Fellowships is now Melanie Meecham: melanie.meecham@nhs.net


Fiona Duff – Primary Care Manager for Caithness & Sutherland (NHS Highland)

fionaFiona oversees GP services to the North of Scotland, which covers a wide geographical area.  Two fellowships are available in this area.  In this interview, Fiona highlights why a move to Sutherland could be a great career move to aspiring rural GPs.

Apologies for the phone interference in this interview, hopefully it is not too distracting!  You can email Fiona at: fiona.duff@nhs.net

 

 

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