Making a difference : education and training retains and supports rural and remote doctors in Queensland

Introduction: Access to appropriate continuing medical education (CME) opportunities has been identified by many researchers as a key factor in retaining medical practitioners in rural and remote communities. There has, however, been very little research that has measured the actual effectiveness of CME programs on retention. The purpose of this article is to provide some evidence as to the efficacy of rurally relevant CME programs in retaining medical practitioners in rural and remote communities. Methods: Evaluation data provided by 426 to 429 CME workshop attendees over a 3 year period has been aggregated to explore participants’ perceptions as to whether access to CME has been effective in increasing their confidence in practising in rural and remote communities, reducing professional isolation and increasing commitment to remain in rural practice. Results: Data from 429 respondents suggest that 94% agree or strongly agree that access to CME contributes to confidence in practising in rural and/or remote locations. Similarly, data suggest that 93% of respondents (n = 427) agree or strongly agree that access to CME alleviates professional isolation. When asked whether they were less likely to remain in rural practice without access to CME, 80% of respondents (n = 426) agreed or strongly agreed that they were less likely to remain without access.


Introduction
Following the recommendations of the General Practice Strategy Review Group 1 , Rural Workforce Agencies (RWAs) were established in all Australian states and the Northern Territory in July 1998.Key activities were to develop and influence policy on the rural general practice workforce and to coordinate rural and remote general practice initiatives at the state and territory levels.They were required to act to promote and facilitate the supply, recruitment, retention, education, support and better distribution of GPs in rural and remote areas.
Core functions of the RWAs were to develop strategic policy and initiatives at the state and territory and local levels to assist in the recruitment and retention of GPs for rural and remote areas by means of: • implementation of continuing medical education (CME) and locum programs The RRMA classification consists of three zones (metropolitan, rural and remote) and seven classes (Table 3) and combines a distance measure with a population density measure.
RRMA is used by a large number of government programs to assist with targeting, to determine eligibility for initiatives or for reporting purposes.CME workshops provided by HWQ are designed for, and targeted to, medical practitioners working in RRMA 4 to 7 locations.

Methods
Each session/topic in each workshop is evaluated on a daily basis using a written questionnaire incorporating 5 point Likert scales in terms of appropriateness to skill level, relevance to learning needs, utility in updating or gaining new knowledge and skills, relevance to the type of work the practitioners and appropriate coverage of topic areas.
Additionally, for all workshops (except those offered during the annual Rural Doctors Association of Queensland [RDAQ] conference), delegates from RRMA 4 to 7 locations are asked to indicate their extent of agreement with a series of statements: • participation in this workshop has assisted in alleviating my sense of professional isolation • access to, and participation in, CME activities contributes to my confidence in practising in a rural and remote locality • without access to CME, I am less likely to remain in rural practice.
Similar to the session/topic evaluations, these questions are asked as part of the overall evaluation on the final day of the workshop, using a written questionnaire incorporating 5 point Likert scales ranging from strongly disagree to strongly agree.It is the extent of agreement to these questions that forms the thrust of this article.

Results
Table

Conclusion
The provision of workshop delivered CME based on the expressed needs of rural and remote medical practitioners tends to be well received and highly valued by workshop respondents.While acknowledging that there are a variety of other factors that influence decisions to remain in rural and remote practice, we would suggest that professional support through the provision of rurally relevant medical education programs is an effective strategy in retaining doctors in rural and remote communities.

Table 1 :
Continuing medical education workshops offered during Doctors Association of Queensland; CRM, Crisis Resource Management.
Over the period 2004 to 2006, a total of 753 medical practitioners participated in medical education workshops offered by HWQ.One hundred and eighty participated in the RDAQ conferences and did not complete the overall evaluation.A small number of medical practitioners from RRMA 1, 2 and 3 locations also participated in some workshops but are not included in the questions pertaining to professional isolation, confidence in practicing in rural and remote localities and likelihood of remaining in rural practice.Excluding RDAQ conference attendees, doctors from RRMA 1 to 3 locations and early leavers, 426 to 429 respondents remained who provided comments in relation to professional isolation, confidence in practising in rural and remote localities and likelihood of remaining in rural practice.It is possible that some of these respondents participated in more than one workshop over the 3 year period.Because these were relatively small in number, multiple responses from the same practitioner over the 3 year period have not been excluded.Evaluation data for all sessions/topics presented and the overall evaluation were entered into SPSS (vers.14)(SPSS Inc; Chicago, IL, USA) for analysis following the workshop.Respondents had the option of either providing or not providing identifying information.A summary report was prepared for each workshop to provide feedback to the Medical Education and Training team and to presenters and attendees.Length of time in rural and remote practice was also calculated for attendees at the 2006 workshops.Reliable duration data was available for 125 of the 227 attendees.
results of the Education Needs Analysis Survey conducted during September and October 2006, displaying the 12 most requested topics for 2007 based on feedback from 369 respondents.Due to multiple responses the percentage of cases does not equal 100%.

Figure 1
Figure1displays the extent of respondents' agreement with the statement that access to CME contributes to confidence in practising in rural and/or remote locations.Data from 429 respondents suggest that 94% agree or strongly agree that access contributes to confidence in practising in rural and/or remote locations.

Figure 1 :
Figure 1: Access to continuing medical education contributes to confidence in practicing in rural and remote locations (n = 429).
or neither agree or disagree

Figure 3 :
Figure 3: Less likely to remain in rural practice without access to continuing medical education (n = 426).