Hybrid training in rural, remote and island health care: insights from Scotland and USA

Introduction: Healthcare professionals in remote, rural, and island areas face challenges, including professional isolation, limited access to continuous professional development (CPD), and the difficulty of staying connected with peers. Hybrid training, combining online and in-person learning, has been suggested as a potential solution to address these issues, but its impact on healthcare professionals' practices in such settings remains under-researched. This study explores the perceived benefits, changes in practice, and challenges of hybrid training in Scotland and the USA, focusing on two programs: the Pre-Hospital Emergency Care Program in Scotland and the Tele-Ed Program in Georgia, USA.

Methods: A qualitative case study design was used to explore the impact of hybrid training on healthcare professionals in rural, remote, and island settings. Participants included both learners and trainers from two hybrid training programs conducted between August 2023 and February 2024. Semi-structured interviews were conducted from February to May 2024, and the data were analysed using Reflexive Thematic Analysis. Ethical approval was obtained from the University of Aberdeen and Augusta University Institutional Review Boards.

Results: Eight participants were interviewed (four from Scotland and four from the USA). Data analysis revealed two main themes: (1) Specific Rural Healthcare Challenges and Training Adaptations, and (2) Hybrid Training Modality. Subthemes for the hybrid training modality included training experiences, challenges, and participant evaluations of the training format. Both the Scottish and U.S. participants highlighted challenges unique to rural healthcare, such as professional isolation and limited resources. Regarding hybrid training, some participants valued its structured framework, while others experienced difficulties with online engagement and technical issues.

Discussion: The study reinforces the importance of accessible and flexible education for rural healthcare professionals, demonstrating the potential of hybrid training to reduce professional isolation and build confidence, especially in high-pressure scenarios. However, the findings also highlight challenges, particularly with online engagement and course availability. The training’s practical application in real-world settings was evident, with participants reporting improvements in clinical practice and interdisciplinary teamwork.

Conclusions: Hybrid training holds promise in addressing key challenges faced by healthcare professionals in rural, remote, and island settings. While it can reduce isolation and enhance professional development, improvements are needed in online engagement and contextualisation of content. Future research should explore the long-term effects of hybrid training on healthcare providers' retention, professional isolation, and patient outcomes.

Keywords: continuing education, health workforce, professionalism, rural health services.