Original Research

Developing supervision capacity for training rural generalist doctors in small towns in Victoria

AUTHORS

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Belinda G O'Sullivan1
BPhysio (Hons), MPH (Hons), Grad Dip App Epi, PhD, Director Policy and Engagement GPSA *

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Priya Martin2
BOT, MS (Psych&Counseling;), PhD, Senior Research Fellow

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Carla J Taylor3
BA (Hons), MBA (Int), MComm, Project Manager, GPSA

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Merryn Lodding4
Regional Rural Generalist Coordinator Hume Region

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Gemma Bilardi5
Regional Rural Generalist Coordinator Loddon Mallee Region

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Leanne Dix6
Regional Rural Generalist Coordinator Barwon South West Region

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Jacque Phillips7
Executive MPA, CEO Nathalia, Cobram, Numurkah Health

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Mandy Hutchinson8
Grad Cert (Consumer and Community Engagement), Postgraduate Cert (Case Management), CEO Northern District Community Health

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Rebecca Van Wollingen9
BN, MPH, AFACHSM, CEO Timboon and District Healthcare Service

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Glen Wallace10
MBA, GradCertMgmt, MAICD, Chief Executive Officer GPSA

AFFILIATIONS

1 General Practice Supervisors Australia, PO Box 141, Bendigo North, Vic. 3550, Australia; School of Rural Health, Monash University, PO Box 666, Bendigo Vic. 3550, Australia; Rural Clinical School, Faculty of Medicine, University of Queensland, Locked Bag 9009, Toowoomba, Qld 4350, Australia; and Victorian Rural Generalist Training Program, Department of Health, Vic., Australia

2 General Practice Supervisors Australia, PO Box 141, Bendigo North, Vic. 3550, Australia; and Rural Clinical School, Faculty of Medicine, University of Queensland, Locked Bag 9009, Toowoomba, Qld 4350, Australia

3, 10 General Practice Supervisors Australia, PO Box 141, Bendigo North, Vic. 3550, Australia

4, 5, 6, 7, 8, 9 Victorian Rural Generalist Training Program, Department of Health, Vic., Australia

ACCEPTED: 24 October 2021


early abstract:

Introduction: Rural Generalist (RG) doctors are broadly skilled to provide comprehensive primary care, emergency, and other specialist services in small, distributed communities where access is otherwise limited due to distance, transport and cost limitations. The Victorian Rural Generalist Pathway (VRGP) represents a significant state-wide investment in training and growing the next generation of RGs. The first step of the VRGP is well established through the Rural Community Internship Training (RCIT) program which commenced in Victoria in 2012-2015; however, the second step (RG2) requires expansion by growing supervised learning in small rural communities where RGs will eventually work. This project aimed to explore enablers and barriers to the supervision of RG2 learners across a core generalist curriculum in distributed towns in three rural Victorian regions.
Methods: Data were collected between June and August 2021 through semi-structured, in-depth interviews conducted via Zoom or telephone with general practitioners (GPs), and health service executives from small and big health services in the Hume, Loddon Mallee and Barwon South West regions. Interview questions were shared prior to the interview to support reflective responses. Interviews were an hour in length and data were transcribed verbatim and analysed using an inductive thematic analysis process. The research team met regularly throughout the analysis process to refine theme development, test assumptions, and reduce any subjective biases. This study had ethical approval from Monash University.
Results: Thirty-one participants including 13 GPs working at RG scope in MMM 4-7 and 18 health service executives engaged with rural generalists consented and participated. The supervision of RG2s was affected by multi-layer enablers and barriers. Enablers that emerged were having a critical mass of fellowed doctors using viable models to supervise RG2s, funding for the supervision of RG2s, generalist learning opportunities and coordination and case management. Barriers included insufficient doctors to supervise, the cost and risk of supervising RG2s, developing rural training but finding it was unattractive to trainees and a reliance on rotational staff which limited supervision on the ground. Various regions experienced enablers and barriers to different degrees.
Conclusions: Building supervised training for RG2 learners across a generalist scope in distributed rural communities is a complex undertaking, with multi-layered enablers and barriers at play. A range of issues are beyond the control of the VRGP and rely on advocacy and collaboration with stakeholders. The major themes suggest that supervised learning should be addressed at multiple levels of the system, the community, clinical settings, and clinicians. Expanding supervision of RG2s across core generalist curriculum in small rural communities will also require a regionally guided long-term vision and stepwise planning. With ongoing commitment to rural generalist led care, it is possible to achieve high quality supervision at the RG2 stage, retain RGs on the pathway, and produce skilled RG trainees to serve Victoria into the future.