Arvier Peter T, Walker Judith H, McDonagh Tom
Rural Clinical School, University of Tasmania Department of Rural Health, Burnie, Tasmania, Australia.
Rural Remote Health. 2007 Apr-Jun;7(2):705. Epub 2007 Apr 11.
Australia is a country with a relatively small rural population dispersed over an enormous area. Issues similar to how best to deliver health services and recruit health professionals to rural areas exist in other countries. For professional and lifestyle reasons, most specialist doctors (including emergency medicine specialists), choose to live and work in major metropolitan centres. Outside the major Australian cities, most presentations to emergency departments are dealt with by 'non-specialist' doctors, often with limited specialist back up. Recruitment of suitably trained medical staff is increasingly difficult. There is increasing reliance on overseas trained doctors from widely varying backgrounds. In Canada and New Zealand, family medicine trained emergency medicine doctors are a significant proportion of the workforce in rural and regional emergency departments.
To undertake a detailed investigation of the non-specialist emergency medicine doctors in Australia, and examine strategies to secure a more highly trained emergency medicine workforce for rural and regional Australia.
A survey was undertaken of 230 doctors working in 57 rural and regional Australian emergency departments. Consultations and interviews were held with 53 key clinicians, educators and administrators.
There were no training or education standards for doctors working in smaller Australian emergency departments. There was considerable instability in the workforce with many planning to leave their current position or reduce their involvement in emergency medicine. The vast majority felt a need to undertake further emergency medicine training. There was little agreement among stakeholders as to how emergency medicine should be taught, or services delivered in rural and regional Australia.
There is need in Australia to offer a specific postgraduate qualification in emergency medicine for doctors wishing to practise emergency medicine outside major city hospitals. Ideally, such a course would be largely taught in rural and regional hospitals and would contain additional elements relevant to rural practice. The Canadian and New Zealand emergency medicine qualifications may be useful models.
澳大利亚是一个农村人口相对较少且分布在广袤地区的国家。其他国家也存在类似如何最好地提供医疗服务以及招募医疗专业人员到农村地区工作的问题。出于职业和生活方式的原因，大多数专科医生（包括急诊医学专科医生）选择在主要的大都市中心生活和工作。在澳大利亚主要城市以外，大多数到急诊科就诊的患者由“非专科”医生处理，通常专科支持有限。招聘经过适当培训的医务人员越来越困难。越来越依赖背景差异很大的海外培训医生。在加拿大和新西兰，接受过家庭医学培训的急诊医学医生在农村和地区急诊科劳动力中占很大比例。
对澳大利亚的非专科急诊医学医生进行详细调查，并研究为澳大利亚农村和地区确保一支训练有素的急诊医学劳动力队伍的策略。
对在澳大利亚57个农村和地区急诊科工作的230名医生进行了调查。与53名关键临床医生、教育工作者和管理人员进行了咨询和访谈。
在澳大利亚较小的急诊科工作的医生没有培训或教育标准。劳动力队伍存在相当大的不稳定性，许多人计划离开目前的职位或减少参与急诊医学工作。绝大多数人认为有必要接受进一步的急诊医学培训。利益相关者对于在澳大利亚农村和地区应如何教授急诊医学或提供服务几乎没有达成共识。
澳大利亚有必要为希望在大城市医院以外从事急诊医学工作的医生提供急诊医学方面的特定研究生学历。理想情况下，这样的课程将主要在农村和地区医院授课，并将包含与农村实践相关的额外内容。加拿大和新西兰的急诊医学资格可能是有用的模式。
