College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
School of Psychology and Counselling, University of Southern Queensland, Ipswich, Queensland, Australia.
BMC Med Educ. 2020 Apr 20;20(1):119. doi: 10.1186/s12909-020-02025-4.
The diverse rural medical education initiatives that have been developed in Australia to address the medical workforce maldistribution have been less successful in many smaller and remote communities. This study explored the factors that attract and retain GP registrars and supervisors and the impact that localised training (i.e., rural and remote workplace-based training and support) has on both GP registrars and supervisors, and the GP workforce in rural and remote underserved areas.
A purposive sample of 79 GP registrars, supervisors, practice managers, health services staff and community representatives living and working in areas of low GP workforce in rural and remote Australia were invited to participate in semi-structured interviews and one focus group divided over two phases. Thematic analysis was used to explore themes within the data.
Attractors and barriers to rural and remote practice were identified as the main themes. Attractors include family and community lifestyle factors, individual intrinsic motivators, and remote medicine experiences. In contrast, barriers include work related, location, or family factors. Further, localised GP training was reported to specifically influence GP registrars and supervisors through education, social and financial factors.
The current study has provided a contemporary overview of the issues encountered in expanding GP training capacity in rural and remote communities to improve the alignment of training opportunities with community and workforce needs. Strategies including matching scope of practice to registrar interests have been implemented to promote the attractors and lessen the barriers associated with rural and remote practice.
澳大利亚为解决医疗人员分布不均问题，制定了各种农村医学教育计划，但在许多较小和偏远的社区，这些计划的效果并不理想。本研究探讨了吸引和留住全科医生住院医师和导师的因素，以及本地化培训（即农村和偏远工作场所的培训和支持）对全科医生住院医师和导师以及农村和偏远服务不足地区的全科医生劳动力的影响。
在澳大利亚农村和偏远地区低医生劳动力地区生活和工作的 79 名全科医生住院医师、导师、实践经理、卫生服务人员和社区代表被邀请参加半结构化访谈和一个焦点小组，分为两个阶段。使用主题分析来探讨数据中的主题。
确定了吸引农村和偏远地区执业的因素和障碍是主要主题。吸引因素包括家庭和社区生活方式因素、个人内在动机以及远程医疗体验。相比之下，障碍包括工作相关、地点或家庭因素。此外，据报道，本地化的 GP 培训通过教育、社会和经济因素对 GP 住院医师和导师产生了具体影响。
本研究提供了农村和偏远社区扩大全科医生培训能力以提高培训机会与社区和劳动力需求的一致性所面临问题的最新概述。已经实施了一些策略，包括将实践范围与住院医师的兴趣相匹配，以促进吸引力并减轻与农村和偏远地区实践相关的障碍。
