Sen Gupta T K, Muray R B, McDonell A, Murphy B, Underhill A D
School of Medicine, James Cook University, Townsville, Queensland, Australia.
Rural Remote Health. 2008 Jan-Mar;8(1):827. Epub 2008 Feb 13.
The James Cook University School of Medicine is the only complete medical school in northern Australia, and it has a mission to prepare graduates to meet the unique needs of the region with a particular emphasis on rural, remote, Indigenous and tropical health. Eight-week 'rural internships' have been undertaken by all sixth-year medical students at James Cook University since 2005. Each student had previously completed at least 12 weeks of structured rural placements in years 2 and 4, as well as other core teaching in rural health including the year 2 subject, 'Rural, Remote, Indigenous and Tropical Health'. Students worked in rural hospitals across northern Australia developing and practising clinical skills under the supervision of senior staff. Students undertook full-time inpatient and outpatient responsibilities under supervision, being rostered for after-hours work with appropriate support. Assessment involved a learning portfolio, including multi-source feedback from peers, supervisors and patients, and a population health project and a telephone referral exercise.
This article describes the development, implementation and assessment of the first years of the program, from 2005 to 2007. Evaluation included student questionnaires, site visits and interviews, and follow-up teleconferences with preceptors.
The rural internship provides senior medical students with valuable experience by active participation in the healthcare team. Students reported a rich and varied clinical experience. Students accept limited supervised responsibility and further their ability and confidence to undertake the role of the intern. Importantly, they proved not to be a burden to the system. This rotation therefore appears to meet educational needs without compromising the local workforce (and indeed may add to it). Students felt welcomed by their communities and enjoyed the social and cultural aspects of their attachment, as well as the clinical aspects and the opportunity to further their understanding of rural communities, rural health care and the healthcare team. Preparation of the students, the preceptors and the communities emerged as a key element of success.
This model extends and enhances the traditional apprenticeship model by its rural focus and distributed nature, and involvement of the entire student cohort. In addition, the contribution to patient care by senior students and junior doctors enables a consultant-registrar-resident model, in which experienced rural doctors function as consultants providing advice, support and tuition rather than predominantly face-to-face patient care. This approach also provides a means to address an emerging paradox: rural preceptors and communities want to teach students, appreciating the long-term workforce implications, but are increasingly constrained by resources, particularly time. Similar innovative approaches should be explored in other settings.
詹姆斯·库克大学医学院是澳大利亚北部唯一一所完整的医学院，其使命是培养毕业生以满足该地区的独特需求，特别侧重于农村、偏远地区、原住民和热带地区的健康。自2005年以来，詹姆斯·库克大学的所有六年级医学生都参加了为期八周的“农村实习”。每位学生此前已在二年级和四年级完成了至少12周的结构化农村实习，以及农村健康方面的其他核心教学内容，包括二年级的“农村、偏远地区、原住民和热带地区健康”课程。学生们在澳大利亚北部的农村医院工作，在资深 staff 的监督下培养和实践临床技能。学生们在监督下承担全职住院和门诊职责，并安排了下班后的工作并提供适当支持。评估包括一个学习档案袋，其中包括来自同行、 supervisors 和患者的多源反馈，以及一个人群健康项目和一次电话转诊练习。
本文描述了该项目2005年至2007年第一年的开发、实施和评估情况。评估包括学生问卷调查、实地考察和访谈，以及与带教老师的后续电话会议。
农村实习通过让高年级医学生积极参与医疗团队，为他们提供了宝贵的经验。学生们报告了丰富多样的临床经验。学生们承担有限的受监督责任，并进一步提升了承担实习医生角色的能力和信心。重要的是，他们并未成为系统的负担。因此，这种轮转似乎满足了教育需求，同时又不影响当地劳动力（实际上可能还增加了劳动力）。学生们感到受到社区的欢迎，享受实习期间的社会和文化方面，以及临床方面的内容，并有机会进一步了解农村社区、农村医疗保健和医疗团队。学生、带教老师和社区的准备工作成为成功的关键要素。
这种模式通过其对农村的关注、分散的性质以及全体学生的参与，扩展并强化了传统的学徒模式。此外，高年级学生和初级医生对患者护理的贡献促成了一种顾问 - 注册医生 - 住院医生模式，在这种模式中，经验丰富的农村医生担任顾问，提供建议、支持和指导，而不是主要进行面对面的患者护理。这种方法还提供了一种解决新出现的矛盾的途径：农村带教老师和社区希望教授学生，并认识到对长期劳动力的影响，但越来越受到资源尤其是时间的限制。在其他环境中应探索类似的创新方法。
