Volume twenty-five, Issue 2

In response to the need to attract and retain more physicians in rural family medicine, much research has focused on the traits of medical students that choose to practice in rural settings. Being a rural doctor has been described as requiring ‘clinical courage, the adaptability and willingness to work at the limits of, or beyond, training and experience to meet the needs of patients. Among other characteristics, clinical courage requires self-efficacy: elements of which include confidence and self-belief. Although there have been no studies looking at rural practice self-efficacy at different stages of medical training, it is expected that this measure could be impacted by the medical school experience. This Original Research study proposes a rural practice affinity model in which general self-efficacy leads to rural practice intentions when mediated by medical training to develop emergency medicine competency and rural practice self-efficacy.

During 2021–2022, corresponding with above-average rainfall and flooding in the region, several critically unwell patients with necrotising fasciitis were admitted to the Hervey Bay Hospital (Qld, Australia) intensive care unit. All patients had been in saltwater rivers hunting for green mud crabs or descaling barnacles from their vessels. Cultures revealed Vibrio species to be the agents of infection in four of the patients. Necrotising fasciitis caused by Vibrio species carries a high morbidity and mortality, and often progresses rapidly into a life-threatening soft tissue infection, multi-organ failure and fatal sepsis. This case series reviews the clinical documents for each patient, and data from Pathology Queensland, to highlight a potential public health issue that could become more common with future floods caused by climate change and the cyclic return of the La Niña.

Research demonstrates rural clinical placements during medical school – especially extended rural placements and especially if they are positive experiences – improve clinical skills and likelihood of practising in rural or remote locations later in a doctor’s career. This Original Research article reports on specific clinical learning experiences during a rural placement that contribute to final-year medical students reporting them as ‘high quality’,  with a focus on whether the supervising doctor’s background and training influences the quality of students’ clinical learning experiences.

Training registrars in rural and remote settings is essential for developing GPs with the relevant skills for the scope of practice and context required. Although many rural and remote doctors may be too busy with their own clinical practice to supervise a registrar, evidence has shown that remote supervision can be effective. Good supervision is more than clinical advice; it also includes attending to the registrar’s wellbeing, supporting them through challenging situations, and brokering their relationship with the practice and the community. Guidelines for remote supervision have been developed by the Royal Australian College of General Practitioners (RACGP) to facilitate supervision and learning. This article reports on the practicality, safety, effectiveness and efficiency of the guidelines for the remote supervision of registrars in pilot locations.

The shortage of health professionals in rural areas is a global issue. One effective approach for increasing the rural health workforce is to establish rural medical education programs involving engagement in rural communities and highlighting rural practice that prepares medical students for careers in rural medicine. In Papua New Guinea, the Divine Word University Bachelor of Medicine and Bachelor of Surgery programs have introduced rural clinical placement blocks for each medical student in the fourth year of study. This Original Research study evaluates medical students’ perceptions of rural clinical placement in Papua New Guinea, including their preference to work in rural locations.

The USA has a shortage of primary care providers in rural areas, especially those trained in pediatrics and mental health. Concerningly, chronic health conditions occur in one out of four children and pediatric mental health diagnoses have increased significantly since the pandemic. Pediatric nurse practitioners in primary care can provide high-level care, positive patient outcomes, lower medical costs, and higher quality of life among patients but the transition to practice in rural settings is challenging and requires training and support. Nurse practitioners who enter practice through residencies or fellowships have better adjustment to practice, reduced burnout and greater intent to stay in their roles. This Project Report uses a pediatric primary care fellowship example to outline the needs of graduate nurse practitioners, describe the rationale for postgraduate training, highlight program content and structure, and identify ways to collect data for evaluating the quality and efficacy of primary care fellowship programs.

Inter-hospital transfers from rural to urban hospitals in Aotearoa New Zealand are often essential for diagnostic investigations or specialist care that is unavailable rurally. Clinical information is coded and stored for health system analyses, including rural-urban differences in health outcomes. Anecdotally, clinical coding is often performed by clinicians or reception staff without formal coding training in many NZ rural hospitals, and by a designated hospital clinical coding team with university or sub-tertiary coding training in urban hospitals. No NZ literature has been found comparing the accuracy of clinical coding between rural and urban hospitals. This Original Research article examines whether any discrepancies exist in primary diagnosis codes for patients who underwent an inter-hospital transfer from a rural to an urban hospital.

Over the past 20 years, nearly half of Australia’s birthing centres, predominantly in rural areas, have closed. This substantial reduction in number of rural birthing centres has correlated with a 47% increase in births occurring before reaching hospitals. Evidence highlights the comparably poorer outcomes for both mothers and neonates in unplanned out-of-hospital births, with increased incidence of post-partum haemorrhage, perineal tears, delayed third stage of labour and need for neonatal resuscitation. This Scoping Review explores paramedics' confidence in managing prehospital obstetric emergencies, identifies influencing factors and examines the implications of confidence on patient and paramedic welfare.

Artificial Intelligence (AI) is permeating every industry, including health care, and has the potential to help address common challenges in primary care settings through increasing workforce capacity, optimizing resource allocation, enhancing health research, and reducing burnout. Many Canadian healthcare settings have begun piloting AI scribes, tools that transcribe patient–PCP interactions and create electronic medical record notes, in the hope that they might significantly alleviate administrative burden. This Commentary outlines the administrative burden on primary care providers and the benefits and challenges of AI scribe technology within the context of northern, rural, and remote primary care settings.

South Africans with disabilities, especially in rural areas, are subjected to poorer access to health care and are more likely to report illness and experience a greater need for healthcare services compared with their non-disabled counterparts. Rehabilitation services in South Africa prior to the pandemic were already considered low priority, but they halted during COVID-19 lockdowns because they were considered non-essential health services. This Original Research article explores the perspectives and experiences of Eastern Cape rehabilitation practitioners who served persons with disabilities in this region during the COVID-19 pandemic.

Adaptation over many generations of living in the harsh and extreme conditions of the Russian Arctic has produced a ‘northern’ type of metabolism, characterized by increased protein–lipid metabolism and minimization of carbohydrate metabolism. Increasing urbanization in the region has resulted in less reliance on traditional diets and lifestyles, leading to increased incidence of obesity and non-communicable diseases. This Original Research study investigates the status of lipid metabolism and variability in body mass related to ethnicity and lifestyle in Russian Arctic residents.

Intimate partner violence (IPV), any behaviour within an intimate relationship that causes physical, sexual or psychological harm, is a major public health concern worldwide. While the violence prevention research landscape is still evolving, only in the past two decades has it started to become a high priority for practitioners and researchers to devote resources into conducting more primary prevention research. Community-based interventions, particularly community mobilisation interventions, can transform attitudes towards social norms and reduce IPV behaviours when rigorously planned, have a robust theory of change and are rooted in knowledge of local context. This Original Research study assessed the effect of a community mobilisation intervention on attitudes supportive of physical IPV, women’s experiences of IPV and men’s perpetration of IPV in rural communities of South West Nigeria.

While incarcerated, women experience multiple barriers to accessing primary and specialty health care. When women are released from prison, they face barriers to timely access to primary health care, substance use disorder support and treatment, and mental health services, compounded by the need to navigate a complex web of services and systems to access housing and food, reconnect with children and access parenting supports. This Scoping Review identifies what is known about the health outcomes and health experiences of women and gender-diverse people who are currently incarcerated or recently released from prison into rural areas.

Multiple international studies have shown that farming is one of the occupations in which workers have the lowest mental health scores. Farmers are exposed to unfavorable working conditions, such as long working hours and great physical demands, and may be more reluctant to seek help regarding their mental health than other occupational groups. This exploratory study investigates which facilitators and barriers farmers perceive as important in their everyday lives regarding their mental wellbeing.

People co-using opioids and methamphetamines are more likely to be homeless, have comorbid severe psychiatric illness and be infected by sexually transmissible infections, and are at higher risk of overdose causing death. Moreover, although medications for opioid use disorder (MOUD) are effective at preventing opioid withdrawal, use, and overdose, research suggests that concomitant methamphetamine use negatively impacts treatment retention and opioid abstinence over time. As opioid and methamphetamine co-use continues to rise in rural counties of the US, the need to understand the prognostic effects of methamphetamine use among individuals initiating MOUD in rural community treatment settings is paramount. This Original Research article examines whether positive methamphetamine urinalysis results predict worse treatment outcomes in four rural US clinics.

Ultrasonography is increasingly used across medical specialties, including family medicine, where it could reduce diagnostic delays, improve accuracy, and lower healthcare costs but ultrasonography training is not standardized in the family medicine curriculum. This Research Letter reports on the the feasibility and perceived usefulness of a one-day introductory ultrasonography course for family medicine interns at the Brest School of Medicine, France.

Australian guidelines for initial management of migraine (an episodic, debilitating form of headache characterised by pain, nausea and aura causing significant personal morbidity), include aspirin, NSAIDs or paracetamol, followed by dopamine antagonists and serotonin receptor agonists, avoiding opioids unless as a last resort. Despite these guidelines, recent Australian studies have shown inconsistency in emergency department prescribing patterns. This Short Communication looks at patterns of prescriber intervention in a rural hospital to hypothesise how rural health barriers and enablers may impact prescription decisions.