Taking Medical Training to Greener Pastures

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Taking Medical Training to Greener Pastures 6
June 2008 Barbara OConnor A Dare, T Fishman, L
Henneveld, P Reid, P Poole, W Bagg
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(No Transcript)
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Background and drivers

• MTB work with educational and training
  organisations to ensure
• all medical practitioners acquire broad general
  foundation, which includes community and regional
  hospital experience, before entering vocational
  training.
• training produces sufficient numbers of doctors
  entering the New Zealand workforce with training
  in general vocational scopes of practice.
• MTB invite proposals primary care-based
  undergraduate programme, which is targeted to
  areas of need such as rural, Maori and high
  deprivation populations.
• National Workforce Taskforce March 2007

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Key Features

• Collaborative and supportive partnership
• Regional and rural learning experiences
• Regional hospital learning
• Rural GP and small hospital learning
• Learning from multidisciplinary teams and
  community health workers
• Equivalent but different programme
• Independent evaluation
• Grow workforce for the future

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The Partnership

• NDHB
• Refurbished accommodation in Maunu House for 20
  students, with IT access for all students
• Provided teaching and administration spaces
• University of Auckland
• Developed the curriculum and resources
• Induction and training
• Hokianga Health Trust
• Northland PHO and Iwi providers
• Northland Community Foundation social
  integration, projects
• Multidisciplinary Team academic,
  administration, IT, library

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Curriculum a different pathway

• Common learning outcomes for all students
• 20 Year 5 students
• Regional and Rural experience (hub and spoke
  model)
• Undifferentiated patients
• Ambulatory care
• Enhanced clinical decision-making
• Generalist-led learning
• Integrated learning
• Maori Health
• Flexibility to maximise special learning
  opportunities

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City clinical programme
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Pukawakawa clinical programme
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Special challenges and how met

• Integrated Care and General Practice
• Longitudinal Case Studies
• Formative Clinical Experience Logbook
• Managing student workload
• Ensuring mainstream programme still highly valued

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Integrated Care and General Practice

• 7-week attachment at one of three smaller sites -
  Kaitaia, Dargaville or Rawene students in pairs
• Key thread is to learn how teams work in rural
  setting, limitations that exist, and when
  referral is necessary
• Key role of generalists in rural medicine
  promoted through immersion with
• Small hospitals run by general practitioners
• selected General Practices
• some of regions Maori Health Providers, and
• several community health care professionals

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Integrated Care Attachment Principles

• Incorporate local strengths learn what rural
  medicine and rural health entail
• Maximise longitudinal exposure to patients
• Maintain balance of in- and out-of-hospital
  learning
• Clinic attendance flexible and minimal
• work in a rural environment, rather than learning
  the actual discipline of the clinic

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Longitudinal Case Studies

• Continuum of care (16 weeks)
• Two cases in pairs patient with a chronic
  medical condition, pregnant woman (with
  complication) in third trimester with follow up
  post-delivery
• Initial meeting and 3 subsequent visits in
  diverse settings
• Specific outcomes
• identify and interact with team(s) responsible
  for care
• study natural history of condition and how
  typical this particular patients case is
• examine social, cultural and/or economic impact
  of the condition and its care, and
• consider effectiveness of linkages between
  relevant parts of health system.

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Formative Clinical Experience Logbook

• Signals essential aspects of learning
• Detail expectations underpinning learning
  outcomes
• Lists clinical and procedural skills
• Learning ladders indicate the level of competency
  required (5 levels)
• Formative purposes only, at this stage

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Staffing and Governance

• Staff profile/appointments at hub and spoke sites
• Regional-Rural Academic Coordinator (PT)
  Whangarei
• Manager of Northland Health Campus (FT) Whangarei
• Clinical Case Coordinator (0.8) Whangarei
• Lead Coordinator at each spoke
• Evaluation Officer (Auckland-based)
• Evaluation Plan
• Ethics application approved
• Challenge to maintain equity across widely
  dispersed programme, so governance is important

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Strengths initial independent feedback

• 19 students and 26 Northland stakeholders
  individually interviewed in March/ April
• Students
• learning opportunities
• standard of teaching
• personal gains from the programme
• realised expectations of the programme
• the Northland lifestyle
• student accommodation
• resources for learning (IT and library)
  particularly Whangarei

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Strengths initial independent feedback

• Staff
• programme preparation and support
• level of student preparation
• merits of Pukawakawa educationally consider it
  an essential part of undergraduate medicine
• gains for the organisation and the community
• gains for the students

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STUDENT FEEDBACK
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LEARNING learning medicine from a mix of
patients
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can follow patients right through - good
dermatology clinics - being able to do things
yourself - going to outpatients clinics and
being involved.
great experiences - positives include practical
clinical work, multidisciplinary stuff, midwife
system (fantastic continued care), interesting
womens health issues
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tutorials with doctors are very good - - nurses
helpful, went out with the District Nurse and
have informal chats with nurse
hands-on teaching...learning roadside
techniques.. also clinical teaching with the
patients miss the occasional didactic lesson
some good teaching from nurses (plastering etc)
more self-directed learning case
presentations have been good have valuable
discussions sitting in the car between clinics
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seeing inequalities of health and barriers to
accessing services a lot more advanced pathology
and Maori cases
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LIFESTYLE
quieter life a real advantage - volleyball,
Athletic running club, church (hugely welcoming)
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joined a rugby team, beach, fishing, socialising
within student group - tribal links meeting
whanau
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people friendly and warm - joined Northland
Symphonia and do recreational sport
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really enjoying it confirms I would like to
work in a rural environment.
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Conclusion

• Early success of the regional-rural training and
  model
• How could it be expanded to be compulsory for all
  students?
• Challenge the dogma that tertiary centre is best
  environment for training medical students

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Kia ora rawa atu
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Pukawakawa

• Whangarei hospital site was a Te Parawhau pa of
  the local hapu, and is still known as Pukawakawa
  
• Pa was shaped like 2 arms, to embrace or defend
  the people
• Name of traditional Whare Wananga
• Reference to Kawakawa, plant common in Northland
  and used as a rongoa by Maori
• Thanks to NDHB Kaunihera Kaumatua

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Essential Considerations of Partnership

• Gain commitment enthusiasm from clinicians,
  midwives, nurse managers, other health
  professionals at NDHB sites, Hokianga Health
  Trust and in PHOs, and community-based health
  professionals
• Induction of staff at each site
• Gain participation for evaluation and research
  purposes
• Support student cohort through differences and
  potential spotlight pressures