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As researchers in the field of primary care, the authors are committed to fostering human resources who will assume responsibility for regional medical care in the future. In this context, the authors found the results of Kolodziejczyk et al’s survey noteworthy, particularly the perceptions of medical students regarding rural placements in Papua New Guinea1. To further elucidate this exploratory work, the authors conducted a study that revealed significant similarities with the findings of Kolodziejczyk et al, which the authors report here as potentially supporting the generalizability of their conclusions.
Semi-structured interviews were conducted with 11 healthcare professionals in rural areas in Japan, including doctors, public healthcare nurses, therapists, nutritionists, pharmacists, and medical clerks. Each interview lasted approximately 60 minutes. The main question posed during the interviews focused on the characteristics required for sustainable human resources and organizations responsible for community medical care in rural areas in the future. The recorded audio data were transcribed, and all potentially identifiable information was removed. Using qualitative content analysis, the transcribed data were segmented into units of meaning, organized into common semantic groups, classified into relevant categories, and subsequently aggregated. The findings revealed the following five characteristics: teamwork and communication, professionalism and courtesy toward older adults, positive vision and future-oriented goals, educating the young successors and addressing their needs, and coexistence and consideration for the next generation (Table 1).
Based on the findings of Kolodziejczyk et al, the authors suggest that ‘communication skills’ and ‘teamwork skills’ (which are both part of ‘clinical exposure experience’) as well as ‘respectful supervisors’, ‘excellent role models’, and ‘useful feedback’ (which are part of ‘clinical supervision’) are the key elements regardless of the geographical location1. Another study, which conducted focus group discussions with global participants, reported that ‘having mentors and role models’ and ‘greater exposure to rural health’ are essential for retaining young healthcare professionals in rural areas as part of the healthcare workforce2.
Younger generations have a high potential for motivation for rural practice. Although securing a sustainable workforce in remote areas is a challenge, younger professionals capable of addressing staff shortages may share certain common traits. A study conducted in Australia reported findings similar to the authors, such as ‘practices holistically’, ‘team player’, ‘respectful’, and ‘compassionate and empathetic’3. The findings of a Canadian study4 that examined the factors influencing the rural career choices among family physicians from urban backgrounds were consistent with those of Kolodziejczyk et al1, highlighting the importance of positive role models, experience living in rural communities, and a personal lifestyle conducive to rural practice.
Although the indications for the future are promising, the authors are concerned that the characteristics of today’s younger generation may be incompatible with those seemingly required to provide a holistic approach in rural areas. The present study findings revealed that young students tend to exhibit preferences such as ‘pragmatic thinking, emphasizing work–life balance’ and ‘preferring outcome-oriented and real-time feedback with good time performance’5. A recent study reported that young Japanese physicians value work–life balance and avoid ‘non-controllable specialties’ such as internal medicine and family practice6, which may hinder sustaining rural health care in Japan. Although further research is required, it is nevertheless essential to understand the characteristics of younger generations and to promote harmonious intergenerational coexistence. Securing a sustainable workforce depends on achieving coexistence with the next generation and cultivating individuals capable of delivering holistic medical care in rural settings with a strong sense of humanity.
Table 1 Summary of characteristics required for sustainable human resources and organizations
|
Category |
Category description |
Participant comment |
|---|---|---|
|
Teamwork and communication |
To hire individuals who are willing to treat patients as a whole person, are empathetic and supportive, and are team players rather than those who only think about their own responsibilities. |
‘Rather than merely sticking to their own tasks as a speech–language–hearing therapist, I need someone with good communication skills to easily connect with all types of patients through casual conversations. For example, something like, ‘‘He fell yesterday and had to put on a bandage. I’m not the one in charge, but I’ll reach out to him too.’’ I need someone who can cooperate and has the mindset of looking after the patient together as a team.’ |
|
Professionalism and courtesy toward older adults |
While taking pride in their profession and fulfilling their responsibilities in accordance with professional autonomy, healthcare professions are expected to behave courteously and be respectful of the lifestyles of each elderly patient, who has lived in the community for a long time. |
‘I think that people who feel a sense of fulfillment or who take some kind of pride or honor in their work really grow as individuals. They’re the ones who can say, ‘‘I’m here because I genuinely want to do this job.’’ I value people who have basic etiquette and are polite. Honestly, if you’ve got that type of passion, you can make it. Maybe I’m a bit conservative or old-fashioned, but that’s how I see it.’ |
|
Positive vision and future-oriented goals |
There is a need to communicate to the outside world that both work and life are enjoyable and that a learning environment is in place where the workers can receive supportive work guidance, as nursing work in the rural areas tends to have a negative image. |
‘An organization’s ability to communicate externally is really important. There’s so much information on the internet saying that nursing care and welfare work isn’t attractive. But I think that a lot of young people are interested in it. The work environment makes a huge difference, so I think that it’s important to show the outside world just how enjoyable the workplace can be.’ |
|
Educating the young successors and addressing their needs |
As a corporate responsibility, it is necessary to improve the educational programs to ensure early exposure and to increase the motivation for learning by recruiting enthusiastic, positive role models who can be easily approached by the young successors. |
‘Leadership within an organization is really important. I think that young people feel much more at ease when there’s a solid support system in place, that is, one where they know that they’ll be guided in all aspects of their work. If the supervisors can be positive role models who take time to teach the younger generation step by step, it makes a huge difference.’ |
|
Coexistence and consideration for the next generation |
To continue to sustainably protect the health of the residents in rural communities, it is important to coexist with the younger generation, become accustomed to their way of thinking and values, and adapt to their strengths. |
‘As seniors, we’re facing the challenge of how to coexist with the younger generation. There’s a lot that we can learn from Gen Z, and we have to keep changing every day. If we can adapt our teaching methods to suit them, then our words and actions will actually resonate with them and that becomes good instruction. In terms of the teaching methods, we have a long way to go.’ |
Ethics approval
This study was conducted with the approval of the Hokkaido University Faculty of Medicine Ethics Committee (No. 23-006).
Acknowledgements
The authors are grateful to all the healthcare professionals who participated in the study.
Dr Shigeki Jin and Dr Akiko Takeuchi, Department of Forensic Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
Associate Professor Manabu Marakami, Department of Medical Education and General Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
References
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