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The National Conference of Rural Health Training Units

Prof. Roger Strasser

The Australian Journal of Rural Health © Volume 1 Number 3, May 1993

The National Conference of Rural

Health Training Units by PROFESSOR ROGER STRASSER

ABSTRACT: Following the establishment of Rural Health Training Units in most States and the Faculty of Rural Medicine (RACGP), a National Conference of Rural Health Training Units was held on 11 and 12 December 1992, at Moe. Primary focus of the conference was on vocational training for rural general practice, with a secondary focus on development of a multidisciplinary approach in Rural Health Training Unit curricula. It was very much a business meeting in which those actively involved in development and implementation of rural practice training came together and worked through a range of important issues. Recommendations from the conference cover the roles and responsibilities of Rural Health Training Units, curricula and accreditation of rural general practice training, and the importance of adopting a multidisciplinary teamwork approach in developing train- ing programs. The conference recommended formation of a National Association of Rural Health Training Units, which subsequently held its inaugural meeting at the National Rural Health Confer-

ence at A&dale in February 1993. KEY WORDS: Rural Health, Rural Practice Training, Multidisciplinary Education.

Problems with rural health services including the need for education and training for rural

practice, were brought to public and government notice through the Doherty report’ and later the Senate Select Committee into vocational regis- tration of general practitioners.’ Subsequently, the federal and State Health Ministers established an Australian Health Ministers’ Advisory Council

(AHMAC) Rural Health Taskforce. In addition, the federal Department of Health, Housing and Community Services funded the first National Rural Health Conference held at Toowoomba in February 1991. Following from the AHMAC Taskforce report and the National Rural Health Conference recommendations, a National Rural Health Strategy3 was devised. It includes recom- mendations on improving education, training and career development in rural practice and over- coming disincentives to rural practice.

In parallel with the National Rural Health Conference and the AHMAC Rural Taskforce,

Professor Roger Strasser is director of the Monash

University Centre for Rural Health at Latrobe Regional Hospital, Moe, Victoria.

the federal Minister for Health, Housing and Community Services established the Rural Health Support Education and Training (RHSET)

Program.4 The broad aim of this program is to improve the health status of rural and remote com- munities through provision of increased resources for support education and training of rural health workers.

Rural Health Training Units (RHTUs) have been established in several States with the aim of providing a focus for education and training for rural practice. In Queensland the Postgraduate Medical Education Committee (PGMEC) of the University of Queensland was instrumental in the development of the RHTU at Toowoomba Base Hospita1.j To some extent, the Toowoomba RHTU (known as the Cunningham Centre) has provided a model for the establishment of RHTUs else- where. Three other RHTUs in Rockhampton, Cairns and TownsviIle have since been established in Queensland. The Western Australia Centre for Remote and Rural Medicine at the University of Western Australia is establishing a Rural Training Unit at Fremantle Hospital6 A similar

Unit has been established at Modbury Hospital in South Australia.‘In New South Wales, RHTUs

3

4 The Australian Journal of Rural Health

have been initiated at Tamworth and Wagga.8,9

In Victoria, Monash University has established the Centre for Rural Health at Latrobe Regional Hospital, in Gippsland.”

Within the RACGP, a Faculty of Rural Medi- cine (FRM) was established in April 1992.”

The Faculty’s charter focuses specifically on

education and training for rural general practice.

It has moved quickly towards establishing guide-

lines for appropriate vocational training for rural

practice, curriculum development and mechanisms for accreditation of training posts, practices and

programs. With funding from RHSET and co-

operation from the relevant specialty colleges, the

RACGP Faculty of Rural Medicine has developed

specific training curricula in surgery, anaesthe-

tics and obstetrics.

Following the establishment of RHTUs in most

States and the FRM, the time was right to bring

all these parties together for a national confer-

ence. As the RHTUs had each been established

in different ways, reflecting the local context, there

was potential for them to develop training pro- grams which were not consistent with each other

or College guidelines. The Monash University

Centre for Rural Health received funding from

RHSET to organise a national conference of Rural Health Training Units which was held on 11 and

12 December 1992, at Moe.

OUTLINE

Set up to be a working meeting with emphasis on active participation, the conference was structured

so that much of the time was spent in small group

discussion. Prior to the conference, reports from RHTUs and the FRM, including training curricula

in anaesthetics, surgery and obstetrics, were circulated to conference participants. Also, con- ference participants were asked to complete a one

page form which asked them to outline the key

questions, important issues and what they hoped to learn from the conference. The information

gained from these forms was used as a basis for

planning the specific conference program.

Primary focus of the conference was on voca- tional training for rural general practice, with a secondary focus on development of a multidis- ciplinary approach in RHTU curricula. Four broad areas were covered in the conference program.

1. Rural Health Training Units - discussion of issues in setting up RHTUs; existing and planned learning programs, including specific clinical attachments, and development of multidisci- plinary approaches; and roles and relationships of RHTUs.

2. The Faculty of Rural Medicine of the RACGP and the four year training program for rural general practice leading to a higher qualifi- cation in rural medicine to be awarded by the College.

3. Procedural training curricula in surgery, obstetrics and anaesthetics developed by the RACGP Faculty of Rural Medicine with assistance from the specialty colleges of sur- geons, obstetricians and gynaecologists, and anaesthetists.

4. Accreditation of training posts, practices and programs for inclusion in the Rural GP Train-

ing Program.

The conference took place over two days, Friday and Saturday, 11 and 12 December 1992. It was attended by representatives from the exist- ing RHTUs and from several others in various stages of formation in all States and the Northern Territory. Other participants included representa- tives of the Faculty of Rural Medicine, rural train- ees, rural hospital medical directors and the Department of Health, Housing and Community Services.

The first session focused on Rural Health Training Units with small group discussions on:

l setting up RHTUs; l learning programs; and l role and relationships (two groups).

The second session focused on the Faculty of Rural Medicine and the Rural GP Training Pro- gram. After a whole group discussion identify- ing issues from the pre-circulated readings, there were small group discussions on:

l roles and relationships;

l the Rural GP Training Program; and

. retraining and continuing medical education for rural doctors.

Volume 1. Number 3 - Mav 1993 5

On the second day, the conference began with a plenary session drawing together issues raised in the previous two sessions. This was followed by an exposition presented by Dr Branko Cesnik, Director of Medical Informatics, Monash Uni- versity, about the PHOCUS (Primary Health Oriented Computer User System) Network and information technology. This raised considerable

interest regarding the potential for use of elec- tronic means for improving communication

between rural health professionals and RHTUs. The third session of the conference concluded with discussion of the training curricula on obstetrics, anaesthetics and surgery. Those present were asked to provide an indication of where these curricula might be trialled during 1993.

The final session of the conference began with a discussion of the multidisciplinary approach. This involved all conference participants in a wide ranging discussion of multidisciplinary education,

training and practice with respect to RHTUs. The conference then turned its attention to accreditation with a presentation by Dr David Gill? chairman of the Faculty of Rural Medicine Accreditation Committee. Arrangements for interim provisional accreditation of rural train- ing posts, programs and practices were discussed. The conference concluded with a plenary session at which final recommendations and other resolutions were adopted.

RESOLUTIONS AND RECOMMENDATIONS

Space does not permit the reprinting of all the conference recommendations in this article. A copy of the full conference report is available from the author.

A major theme of the conference recommen- dations was that RHTUs should have a wide range of roles and responsibilities and be actively involved in vocational training for rural practice, continuing education and retraining of established rural doctors. RHTUs were encouraged to develop relationships with educational organisations such as universities and professional colleges, as well

as with rural health service providers, including

hospitals, governments and health professionals. Regarding training for rural general practice,

support was expressed for the efforts of the Faculty of Rural Medicine. The importance of

effective communication and close cooperation between FRM and RHTUs was emphasised.

Strong support was expressed for the multidis- ciplinary teamwork approach as outlined in the resolution ‘that Rural Health Training Units should be sensitive to regional needs and where appro- priate adopt a multidisciplinary teamwork approach in developing training programs’.

There was a strong feeling expressed that the

conference was a useful beginning in the process of communication and cooperation between RHTUs in pursuing their collective education and training objectives. Specifically, the conference recommended that a National Association of Rural Health Training Units be formed and that a working party be set up to draft the terms of reference. Working party members were: Charlotte Sandrey

(convener - Rockhampton); Heather Leatham (Alice Springs); John Trollor (Tamworth); Vicky

Sheedy (Toowoomba) and Roger Strasser (Moe). It was recommended also that the first meeting of the National Association of Rural Health Training Units (NARHTUs) be held at the National Rural Health Conference at Armidale in February 1993.

EVALUATION

At the conclusion of the conference all partici- pants were asked to complete an evaluation form which sought ratings of each aspect of the conference followed by comments under the fol- lowing headings: ‘I liked’ ; ‘I disliked’; ‘I learned’ ; ‘I suggest for the future’; and ‘other comments’. Generally, all aspects of the conference were highly rated with many associated positive comments. Of the negative comments! most were to do with logistic details.

Most respondents liked the sharing of ideas, networking, small group discussions and the friendly atmosphere. The main dislikes expressed related primarily to minor aspects of meeting structure and organisation. In terms of what they learned, respondents identified the move to improve rural health services, rural doctor train- ing and relationships between the RACGP, FRM and FMP, and the various roles of RHTUs.

Suggestions for the future included ongoing communication between interested players and future regular conferences, particularly through the NARHTU. Closing comments were

6 The Australian Journal of Rural Health

all positive with some looking optimistically to the future.

Overall, the initial evaluation immediately after the conference was overwhelmingly positive with many comments from conference participants suggesting that the key objectives of the confer- ence had been achieved. A follow-up evaluation of the conference is about to be undertaken.

DISCUSSION

In years to come, it is likely that this conference will be seen as a major event in the process of developing training for rural practice. It may come to be seen as having marked the culmination of the first phase in the development of specific tailored education and training for rural practice. RHTUs had been established in most States

and the RACGP Faculty of Rural Medicine had

developed plans for rural general practice train- ing, specific curricula in procedural disciplines

and draft interim guidelines for accreditation. The conference brought together representatives from all the existing RHTUs and from several others in early stages of development, together with other interested parties from the Faculty of Rural Medicine, the RACGP Family Medicine Program, RDAA, rural hospitals and the federal Depart- ment of Health, Housing and Community Serv-

ices. It was very much a business meeting, in which

those actively involved in development and im- plementation of rural practice training came to- gether and worked through a range of important issues. There was a very positive atmosphere of goodwill and mutual support amongst all those present.

Several major advances emerged from the

conference. All those present left the conference with a more coherent working knowledge of the various issues involved in establishing and running a RHTU, and of current and projected developments in training for rural general practice. There was a strong desire for ongoing cooperation and communication between RHTUs

as reflected in the discussion to move towards

the establishment of a National Association of Rural Health Training Units. Another significant advance from the conference was the strong commitment which emerged towards multidisci- plinary clinical practice and training in the rural setting.

Following the conference, the working party developed draft terms of reference for establish- ing the National Association of Rural Health Training Units. Subsequently, a draft constitu- tion was prepared and put to the inaugural meeting of NARHTU held at the Second National Rural Health Conference at Armidale in Febru- ary 1993. At that meeting, the NARHTU was formally established, an interim constitution adopted and an Executive Committee elected. NARHTU will provide a means of ongoing

communication and cooperation between Rural

Health Training IJnits.

REFERENCES

1.

2.

3.

4.

5.

Doherty RL. Committee of Inquiry into medical educa- tion and medical workforce: Australian medical educa- tion and workforce into the 21st century. Canberra: AGPS, 1988. Senate Select Committee on health legislation and health insurance. Vocational registration of general practition- ers. Canberra: AGPS, 1989. Department of Community Services and Health. A fair go for rural health. National rural health strategy: a dis- cussion paper for the National Rural Health Conference, Toowoomba, 14-16 February 1991. Rural Health Support Education and Training (RHSET) Program. Funding guidelines for grant applications, Au- gust 1992. PGMEC. A rural practice training programme. Mission statement prepared by the Postgraduate Medical Educa- tion Committee, University of Queensland, 5 April 199 1. Jackson W. The University of Western Australia, Cen- tre for Remote and Rural Medicine, September 1992. Gill D. Rural Practice Training Unit, Modbury Hospital, South Australia, 1992. Trollor J. Tamworth Rural Health Training Unit, Sep- tember 1992. Duncan G. Riverina Rural Health Training Unit, Octo- ber 1992.

10,Strasser R. Monash University Centre for Rural Health. MJA 1993;158:297-8.

11, Craig M. Discussion Paper: role of the Faculty of Rural Medicine in the College. Sydney: RACGP, September

1992.