Archive | Medical Students

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

Continue Reading ·

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.

Continue Reading ·

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?

Continue Reading ·

@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.

Continue Reading ·

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.

Continue Reading ·

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
Continue Reading ·

Longitudinal Clerkship: Community, Collaboration & Consolidation

3 months into our Longitudinal Clerkships and just before our Christmas break… now seems like an appropriate time to discuss the various opportunities afforded to students through the LC, both in academia and the community…

Opportunities in rural practice…

Under a fairly flexible schedule – I currently spend three half days Mon-Wed in General Practice undertaking my own consultations and seeing patients for review. This opens up the rest of these days to experience many other aspects of rural healthcare. Thus far I have been attached to a variety of healthcare providers including ambulance control, district nursing & the local pharmacy. Being one of very few students in the Highlands for a year opens up a number of doors. Last month I attended an Obstetrics Emergency Training session in Invergordon. This was run by midwives and provided some really valuable knowledge and practical experience in dealing with antenatal  emergencies from the maternal and newborn perspectives. Collaborating with various members of the medical/nursing/midwifery MDT makes for a very broad experience and understanding of the rural healthcare system. I hope to further these truly enjoyable and unique insights into next year as well.

…Community Engagement

Helping out at the Ross County match

As part of our time in rural practice, we are encouraged to get as involved as possible with our surrounding communities. The idea behind this, is to encourage seeing our patients as people and not just individuals with a diagnosis. Most of our involvement revolves around youth and sports organisations such as the Scouts or Air Cadets. However, some students are assisting with the likes of the WRVS, Citizens Advice and even with the rehabilitation and well-being of offenders and ex-offenders.

Consolidation & Assessment…

Half of my week – Raigmore Hospital

This week, all of the DLIC Students (Highlands and Dumfries & Galloway) are back in Tayside for one of three ‘Dundee Weeks’ throughout the year. These provide an opportunity for formative assessments – both theoretical and practical OSCEs. This allows us benchmark our performance and identify areas for development, both in knowledge and in practice. These weeks also provide teaching on specialist aspects of medicine we may not cover in more remote settings and focus on particular specialties and presentations we are less familiar with. This week’s focus is on acute presentations in the elderly, medically unexplained symptoms as well as significant event analyses and difficult cases.


And when we’re not being students…

Lunchtime adventures @ Dingwall Mart

Community Torch Procession @ Dornoch

 

Continue Reading ·

Longitudinal Clerkship: “Winter is coming!”

Winter in the Highlands…1017895_99c7aa2c

It’s that time of year again – There’s snow on the Ben (Wyvis), Halloween is a distant memory, and the John Lewis Christmas add has started showing on the tele…or in ‘GP-land’, coughs and colds are doing their rounds and the flu-jab programme is well under way.

Here in the Highlands, we begin the daily windscreen defrosting routine going into week 9 of 40 on the Dundee Longitudinal Integrated Clerkship.

 

 

…”General Practice, it’s not always that simple!”

Since the last update, I have had a vast array of opportunities both in General Practice and in Secondary Care. Currently, I spend 3 days per week in GP, undertaking parallel consultations – this is where I see the patient for 10-20 minutes on my own, before handing over the case to my tutor and having a three-way discussion about the history, examination findings, impression and management plan. This is an ideal system, that gives me confidence in dealing with a range of patient presentations – however, in General Practice, it’s not always that simple!

Some more complex cases can take up to an hour all in, and I often find myself finishing that day with a number of learning points to research in my own time, and more often than not – a patient experience to reflect upon. On an average day, I tend to see between 4-6 patients in this format including routine appointments and on-the-day emergency bookings. This format lets me assess and manage acute cases as well as seeing patients for follow-up, acting on blood results or adapting on-going management strategies for example.


Monday – AM Attachment with Midwifes, seeing my ‘Pregnant Patient’ follow-up; PM Parallel Consultations GP

Tuesday – AM Parallel Consultations GP; PM Self-Directed Learning

Wednesday – AM Parallel Consultations GP; PM Practice Led Training

Thursday – AM Outpatient Rheumatology Clinic; PM Radiology, Abdominal Ultrasounds and Echocardiograms

Friday – AM Medical/Surgical Admissions ward round; PM Outpatient Renal Clinic


explore the dynamics of different teams and environments”… 

8 weeks have passed since I started on the L.C – this is the equivalent to 2 blocks within the traditional Dundee 4th Year programme. Accordingly, I have had the chance to really integrate with the medical team here in NHS Highlands. From liaising with nurses and HCAs to arrange basic testing for patients within the practice, collaborating with the secretaries for making referrals to Secondary care, to experiencing the processes behind Ambulance control – the other side of the phone call when I book a patient transfer or indeed when a 999 call goes out.

On the other two days of my working week, I go searching for activities within Raigmore Hospital. Often this will involve attending Outpatient Clinics – advancing my knowledge in areas I feel particularly weak in or those which I may have a particular interest in. Turning up to regular surgical and medical admissions ward rounds allows me to see a range of presentations and explore the dynamics of different teams and environments. Spending time on the wards allows me to keep my practical skills up-to-date, an important part of medical practice and, indeed, my Preparation in Practice assessment. Through attending ward rounds, I have had the opportunity to assist in theatre, acting as cameraman for various laparoscopic (key-hole) procedures. Having the flexibility to choose where and when I spend my time in hospital is great, as I can tailor clinical experiences to my own learning needs and interests. I hope to make arrangements in the near future to spend short blocks of 2-3 days at a time in the one specialty, particularly in Acute Care/Anaesthesia, Psychiatry, Paediatrics & Obstetrics – departments which require a bit more continuity to gain valuable clinical experience.


In the next update…I will be discussing the various opportunities a rural longitudinal clerkship offers and the highlights of community integration.


 

Continue Reading ·

#RGPAS16 a major success

Last week, over eighty students, trainees, new and more experienced GPs from across Scotland and beyond, met at the annual conference of RGPAS.  An action-packed programme provided a wide variety of clinical and non-clinical topics, and there were plenty of opportunities to meet and discuss rural practice.  Rural GP-ing in Scotland is a simulating place to be!

rgpas16_-1

Scroll to the bottom of the page for more conference photos…

ruralgpscot_2016-oct-24

But we had some GPs from further afield too!

screen-shot-2016-11-03-at-00-44-28

Rural GPs from across Scotland came for the conference…

Kicking off the programme, we heard from Dr Helen Brandstorp of the National Centre for Rural Medicine in Tromso, Norway.  Helen provided a good backdrop to the fact that “we’re all in this together” – the challenges and delights of rural practice are prevalent in Norway in similar levels to Scotland.  The ground is fertile for further collaboration with international confreres and we hope to see ongoing links with our Norwegian counterparts in rural medicine.

The rest of the conference featured a rich variety of clinical and non-clinical topics of relevance to rural practice.  We were lucky to have an excellent range of engaging and entertaining speakers.  From updates in emergency medicine, to humanitarian and MSF work, to developing rural LGBT-friendly health services, to IT Reprovisioning, to research tips, to rural surgery, to featured student presentations… there was plenty going on, and the conference dinner provided plenty of opportunity to make further connections and allow the conversations to flow, along with a bit of traditional music too.

We were delighted to host a good number of students, trainees and new doctors… in particular there were nineteen heavily-subsidised student places – and they didn’t disappoint in their contributions of innovative ideas throughout the conference.

Instead of listing all the speakers here, the programme remains available – and we were delighted that over 200 #rgpas16 tweets were exchanged in the course of the conference.  We’ve collated these with Storify, and you can view the Storify timeline here.

Here’s a few of the twitter highlights:

The conference rounded off on the Saturday with a visit to the Bristow Coastguard helicopter base at Inverness Airport, where Winchman Paramedic Duncan Tripp and his colleagues treated student and experienced GPs to a tour round the facilities, including one of their £26 million Sikorsky search and rescue helicopters.

Thanks to all those who presented, and to all others who contributed to the conference planning.  The event proved to be fun, engaging and relevant to rural practice.  We hope to do the same next year – provisionally booked at the Craigmonie Hotel again on 2nd-4th November 2017.  Meantime, at RGPAS we are keen to stimulate and encourage further work in Scottish rural practice.  A new committee was formed, and I am delighted to take the helm of an able and enthusiastic team.  It’s going to be an exciting year!

Here’s some photos of the event…

 

Continue Reading · 2

#RGPAS16 brimming with student ideas for #ruralGP

newlogosquaretextToday over 80 students, trainees and rural GPs will meet up in Inverness, for the annual conference of the Rural GP Association of Scotland.

This year’s event has attracted record numbers of attendees, and a stimulating programme of events is in store, along with lots of opportunities to chat, network and seek new ideas for rural practice.

As part of the RGPAS student scholarship programme, we have encouraged student delegates to submit video or audio clips of around 60 seconds, outlining their visions of the future of rural practice.

Not all clips are available as yet, and we will develop this page over the next week to include more clips, as well as add the photos of RGPAS students on this page too.  In the meantime, take a listen to the diverse and innovative ideas being put forward by the students below, all of whom will be joining us in Inverness.  Great to hear such an inspired group of students!

The conference will run from 2pm today – Thursday 3rd November – to Friday 4th November.  You can follow events on twitter using the hashtag #RGPAS16 – we hope to share reports and presentations from the conference on RuralGP.com soon after the conference too.

 

Innovation ideas

Sally Andrews (Aberdeen University): On the role of telemedicine to improve patient care and good housing availability to improve recruitment to rural areas…


Joe Daley (Glasgow University): Improving the interface between rural primary care and secondary care input…


Rhys Hall (Glasgow University):  The use of drones to overcome geographical barriers of rural practice…


Catherine Lawrence (Hull & York Medical School): Reflects on her experience of a Scottish rural GP elective…


Scott MacDonald (Glasgow University): Using technology to allow patients to take more responsibility for monitoring their health…


Lean-Lik Ng (Dundee University): How to engage with medical students of today to pave the way for future rural general practice…


Iona Robertson (Dundee University): Describes the increasing role of telemedicine in reducing the need to travel longer distances to secondary care…


Keenan Smith (Glasgow University): Reflecting on infrastructural revolution to provide better access to rural healthcare…


Blair Wallace (Dundee University): On the role of point-of-care investigations in improving efficiencies and quality of care offered to rural patients…

 

Continue Reading · 0