A qualitative exploration of medical students’ placement experiences with telehealth during COVID-19 and recommendations to prepare our future medical workforce

Abstract Background Clinical practice is increasingly being digitalised. Little is known about how medical students learn and were exposed to telehealth during COVID-19. This is particularly important if we wish to further improve healthcare access and equity in rural areas and vulnerable populations. This formative study sought to explore the exposure and attitudes of medical students on telehealth and COVID-19 during their rural clinical placement in 2020 and provide recommendations. Methods Focus groups were held in August 2020 after completion of a 12-month rural placement. Questions centred around students’ exposure and experiences with telehealth during COVID-19. Data was analysed using thematic analysis. Results There has been a clear shift in students now acknowledging the importance of telehealth and, more importantly, expressing a clear wish for telehealth to be embedded in the curriculum starting in their first year. In tandem with this, students expressed the need for their clinical supervisors or hospital teams to have the capability to practice telehealth efficiently as this will improve the telehealth experience and lead to better engagement for both staff and students. Furthermore, it was felt that rural clinicians should play a lead role in telehealth implementation given it is integral to rural practice. Conclusions Medical students are more exposed to and more interested to learn about telehealth since COVID-19 and wish to see telehealth training built into their curriculum from the outset of medical school. Themes that emerged from this formative study can potentially assist in planning for telehealth education during and post COVID-19 and inform further telehealth research. Embedding telehealth skills training and guidelines into the medical program, and particularly rural medicine training programs, is essential to prepare the future medical workforce to ensure access and quality patient care during pandemics and also to improve access for rural Australians.

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Assessing Initiatives for Rural Health Practices in South Carolina

American Journal of Undergraduate Research ◽

10.33697/jur.2020.028 ◽

2020 ◽

Vol 17 (3) ◽

pp. 61-72

Author(s):

Aalia Soherwardy ◽

Elizabeth Crouch

Keyword(s):

South Carolina ◽

Medical Students ◽

Rural Area ◽

Rural Areas ◽

Financial Incentives ◽

Medical Practitioner ◽

Rural Practice ◽

Incentive Programs ◽

Personal Motivation ◽

Loan Forgiveness

The purpose of this study was to determine which incentives are most effective in motivating medical students to practice in rural areas of South Carolina, which can be informative for the medical practitioner rural recruitment process. Medical students attending the University of South Carolina School of Medicine located in Columbia, South Carolina were surveyed about demographic information, motivations for rural practice, and considerations for choosing a practice location (n=109). Chi-square tests and bivariate analyses were used to test for significant differences. A significant relationship was found between previous residence in a rural area and personal motivation to practice in a rural area (p<0.001). It was also found that 86.2% of students who had previously lived, worked, or served in rural areas had a personal motivation to practice medicine in a rural area, confirming previous research. Loan forgiveness options were the most appealing personal incentive for the students in this study, closely followed by guaranteed minimum incomes and tax incentives; financial incentives were more preferred than non-financial incentives like reduced on-call work and accelerated residencies. The results of this study can be utilized to craft future state-supported incentive programs or to tailor current programs to more effectively recruit students to rural practice. KEYWORDS: Rural; Recruitment; Healthcare Provider; Shortage; Incentive Programs; Medical Student; Southern United States; Loan Forgiveness

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Considerations for Selecting Applicants to Rural Medicine Programs

Journal of Regional Medical Campuses ◽

10.24926/jrmc.v4i4.4284 ◽

2021 ◽

Vol 4 (4) ◽

Author(s):

David Bramm

Keyword(s):

Medical Students ◽

Medical School ◽

Access To Care ◽

Rural Practice ◽

Rural America ◽

Rural Medicine ◽

The Us ◽

Rural Program ◽

Selection Of

The selection of medical students destined for rural practice is important in order to help provide access to care for the 20% of the US population who live in rural America. Knowing which medical school applicants will go into rural practice is an inexact science, although the objective predictive characteristics of future rural doctors are well known and evident in the literature. The role of rural program directors is to identify which applicants will likely choose a FM residency, done primarily by identifying which rural predictive characteristics the applicants possess. Admissions committee members are not expected to determine the likely practice locations of rural applicants, and need only have the responsibility of determining which applicants should become physicians.

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How do rural placements affect urban-based Australian junior doctors’ perceptions of working in a rural area?

Australian Health Review ◽

10.1071/ah15127 ◽

2016 ◽

Vol 40 (6) ◽

pp. 655 ◽

Cited By ~ 5

Author(s):

Wendy Brodribb ◽

Maria Zadoroznyj ◽

Bill Martin

Keyword(s):

Rural Areas ◽

Positive Impact ◽

Learning Experience ◽

Career Aspirations ◽

Rural Practice ◽

Professional Support ◽

Junior Doctors ◽

Rural Medicine ◽

Negative Experience ◽

Speciality Training

Objectives The aim of the present study was to provide qualitative insights from urban-based junior doctors (graduation to completion of speciality training) of the effect of rural placements and rotations on career aspirations for work in non-metropolitan practices. Methods A qualitative study was performed of junior doctors based in Adelaide, Brisbane and Melbourne. Individual face-to-face or telephone semistructured interviews were held between August and October 2014. Thematic analysis focusing on participants’ experience of placements and subsequent attitudes to rural practice was undertaken. Results Most participants undertook rural placements in the first 2 years after graduation. Although experiences varied, positive perceptions of placements were consistently linked with the degree of supervision and professional support provided. These experiences were linked to attitudes about working outside metropolitan areas. Participants expressed concerns about being ‘forced’ to work in non-metropolitan hospitals in their first postgraduate year; many received little warning of the location or clinical expectations of the placement, causing anxiety and concern. Conclusions Adequate professional support and supervision in rural placements is essential to encourage junior doctors’ interests in rural medicine. Having a degree of choice about placements and a positive and supported learning experience increases the likelihood of a positive experience. Doctors open to working outside a metropolitan area should be preferentially allocated an intern position in a non-metropolitan hospital and rotated to more rural locations. What is known about the topic? The maldistribution of the Australian medical workforce has led to the introduction of several initiatives to provide regional and rural experiences for medical students and junior doctors. Although there have been studies outlining the effects of rural background and rural exposure on rural career aspirations, little research has focused on what hinders urban-trained junior doctors from pursuing a rural career. What does this paper add? Exposure to medical practice in regional or rural areas modified and changed the longer-term career aspirations of some junior doctors. Positive experiences increased the openness to and the likelihood of regional or rural practice. However, junior doctors were unlikely to aspire to non-metropolitan practice if they felt they had little control over and were unprepared for a rural placement, had a negative experience or were poorly supported by other clinicians or health services. What are the implications for practitioners? Changes to the process of allocating junior doctors to rural placements so that the doctors felt they had some choice, and ensuring these placements are well supervised and supported, would have a positive impact on junior doctors’ attitudes to non-metropolitan practice.

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Assessing Initiatives for Rural Health Practices in South Carolina

American Journal of Undergraduate Research ◽

10.33697/ajur.2020.028 ◽

2020 ◽

Vol 17 (3) ◽

pp. 61-72

Author(s):

Aalia Soherwardy ◽

Elizabeth Crouch

Keyword(s):

South Carolina ◽

Medical Students ◽

Rural Area ◽

Rural Areas ◽

Financial Incentives ◽

Medical Practitioner ◽

Rural Practice ◽

Incentive Programs ◽

Personal Motivation ◽

Loan Forgiveness

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Influence of student debt on health career location and specialty

Journal of Primary Health Care ◽

10.1071/hc17052 ◽

2018 ◽

Vol 10 (1) ◽

pp. 54 ◽

Cited By ~ 3

Author(s):

Steven Ling ◽

Robert Jacobs ◽

Rhys Ponton ◽

Julia Slark ◽

Antonia Verstappen ◽

...

Keyword(s):

Primary Care ◽

New Zealand ◽

Medical Students ◽

Rural Areas ◽

Student Loan ◽

Rural Practice ◽

Pharmacy Students ◽

Student Debt ◽

Optometry Students ◽

Debt Levels

ABSTRACT INTRODUCTION In New Zealand (NZ), there are shortages of health professionals in rural areas and in primary care. AIM This study aims to examine the association of student debt levels of medical, nursing, pharmacy and optometry students with: (1) preferred geographical location of practice, specifically preference to work in urban vs. rural areas; and (2) preferred career specialties, specifically interest in primary health care. METHODS Medical, nursing, pharmacy and optometry students completed a questionnaire at graduation that included questions about levels of New Zealand Government Student Loan debt and preferences regarding location of practice and career specialty. In an additional survey, medical students were asked to self-rate the effect of financial factors on their career choices. RESULTS Debt patterns varied across programmes. Medical and pharmacy students with high debt were significantly more likely than students with low debt to prefer rural over urban practice (P = 0.003). There was no difference in level of interest in a primary care specialty by debt level for any programme. Medical students reported little influence of debt on career choice, although students with high debt levels were less concerned over career financial prospects than students with lower levels of debt. DISCUSSION Current levels of student debt do not deter students from planning a career in rural or primary care settings. Somewhat surprisingly, higher levels of debt are associated with greater rural practice intentions for medical and pharmacy students, although the underlying reasons are uncertain.

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RURAL MEDICINE. CONDITION AND ISSUES

RSUH/RGGU Bulletin Series Philosophy Social Studies Art Studies ◽

10.28995/2073-6401-2020-2-103-110 ◽

2020 ◽

pp. 103-110

Author(s):

Yuliya M. Beglyakova ◽

◽

Aleksander S. Shchirskii ◽

Keyword(s):

Health Services ◽

Medical Care ◽

Rural Areas ◽

Rural Population ◽

Rural Medicine ◽

Self Medication ◽

Medical Facilities ◽

Treatment Facilities ◽

Number Of Treatment ◽

The Village

The article analyses the accessibility of medical facilities in rural areas of modern Russia and the specifics of their organization and development. The authors reveal causes why rural residents have much less opportunities to seek quality medical care than urban ones, what leads to a disparity between the inhabitants of the city and the village. The thesis is substantiated that state programmes that should make health services accessible to the rural population to a greater extent do not cope with the task at hand. An attempt is made to highlight the public’s response to the existing disparity in the health services of the villagers compared to urban dwellers. Such a reaction can be considered an outflow of people from rural areas, and an increase in self-medication among rural people as a result of the difficulty in obtaining health services. The decrease in the number of treatment facilities in rural areas leads to a deterioration in the medicine situation in rural areas. That, according to the authors of the article, justifies the need to study the issues associated with the provision of medical care to the rural population.

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Collaborative testing in physical examination skills training and the autonomous motivation of students: a qualitative study

BMC Medical Education ◽

10.1186/s12909-021-02618-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jiska A. Patiwael ◽

Anje H. Douma ◽

Natalia Bezakova ◽

Rashmi A. Kusurkar ◽

Hester E. M. Daelmans

Keyword(s):

Medical Students ◽

Physical Examination ◽

Training Session ◽

Autonomous Motivation ◽

Skills Training ◽

Psychological Needs ◽

Active Participation ◽

Basic Psychological Needs ◽

Collaborative Testing ◽

Traditional Format

Abstract Background Teaching methods that stimulate the active learning of students make a positive impact on several aspects of learning in higher education. Collaborative testing blended with teaching is one such method. At our medical school, a training session was designed using a collaborative testing format to engage medical students actively in the theoretical phase of a physical examination training, and this session was evaluated positively by our students. Therefore, we extended the use of the format and converted more of the training into collaborative testing sessions. The literature on collaborative testing and the theoretical framework underlying its motivational mechanisms is scarce; however, students have reported greater motivation. The aim of the current study was to investigate student perceptions of a collaborative testing format versus a traditional teaching format and their effects on student motivation. Methods Year four medical students attended seven physical examination training sessions, of which three followed a collaborative testing format and four a traditional format. The students were asked to evaluate both formats through questionnaires comprised of two items that were answered on a five-point Likert scale and five open-ended essay questions. Content analysis was conducted on the qualitative data. The themes from this analysis were finalized through the consensus of the full research team. Results The quantitative data showed that 59 students (55%) preferred collaborative testing (agreed or strongly agreed), 40 students (37%) were neutral, and 8 students (8%) did not prefer collaborative testing (disagreed or strongly disagreed). The themes found for the collaborative testing format were: ‘interaction’, ‘thinking for themselves’, and ‘active participation’. ‘Interaction’ and ‘thinking for themselves’ were mainly evaluated positively by the students. The most frequently mentioned theme for the traditional format was: ‘the teacher explaining’. Students evaluated this theme both positively and negatively. Conclusions The most frequently mentioned themes for the collaborative testing format, namely ‘interaction’, ‘thinking for themselves’, and ‘active participation’, fit within the framework of self-determination theory (SDT). Therefore, the collaborative testing format may support the fulfilment of the three basic psychological needs indicated in SDT: autonomy, competence, and relatedness. Thus, our findings provide initial support for the idea that the use of collaborative testing in medical education can foster the autonomous motivation of students.

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Start the Way You Want to Finish: An Intensive Diversity, Equity, Inclusion Orientation Curriculum in Undergraduate Medical Education

Journal of Medical Education and Curricular Development ◽

10.1177/23821205211000352 ◽

2021 ◽

Vol 8 ◽

pp. 238212052110003

Author(s):

Denise L. F. Davis ◽

DoQuyen Tran-Taylor ◽

Elizabeth Imbert ◽

Jeffrey O. Wong ◽

Calvin L. Chou

Keyword(s):

Medical Students ◽

Communication Skills ◽

Personal Narratives ◽

Skills Training ◽

Lessons Learned ◽

Relationship Building ◽

Cultural Humility ◽

Mindfulness Skills ◽

Orientation Week ◽

Equity And Inclusion

Problem: Medical students often feel unprepared to care for patients whose cultural backgrounds differ from their own. Programs in medical schools have begun to address health: inequities; however, interventions vary in intensity, effectiveness, and student experience. Intervention: The authors describe an intensive 2-day diversity, equity, and inclusion curriculum for medical students in their orientation week prior to starting formal classes. Rather than using solely a knowledge-based “cultural competence” or a reflective “cultural humility” approach, an experiential curriculum was employed that links directly to fundamental communication skills vital to interactions with patients and teams, and critically important to addressing interpersonal disparities. Specifically, personal narratives were incorporated to promote individuation and decrease implicit bias, relationship-centered skills practice to improve communication across differences, and mindfulness skills to help respond to bias when it occurs. Brief didactics highlighting student and faculty narratives of difference were followed by small group sessions run by faculty trained to facilitate sessions on equity and inclusion. Context: Orientation week for matriculating first-year students at a US medical school. Impact: Matriculating students highly regarded an innovative 2-day diversity, equity, and inclusion orientation curriculum that emphasized significant relationship-building with peers, in addition to core concepts and skills in diversity, equity, and inclusion. Lessons learned: This orientation represented an important primer to concepts, skills, and literature that reinforce the necessity of training in diversity, equity, and inclusion. The design team found that intensive faculty development and incorporating diversity concepts into fundamental communication skills training were necessary to perpetuate this learning. Two areas of further work emerged: (1) the emphasis on addressing racism and racial equity as paradigmatic belies further essential understanding of intersectionality, and (2) uncomfortable conversations about privilege and marginalization arose, requiring expert facilitation.

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Attitudes of final year medical students towards work in rural areas could be a problem for Croatian tourism

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-136637 ◽

2019 ◽

Vol 95 (1127) ◽

pp. 517-517

Author(s):

Karla Margetic ◽

Teo Miric ◽

Eric Nham ◽

Robert Likic

Keyword(s):

Medical Students ◽

Rural Areas

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Career Intentions and Dropout Causes Among Medical Students in Kazakhstan

Medicina ◽

10.3390/medicina49060045 ◽

2013 ◽

Vol 49 (6) ◽

pp. 45

Author(s):

Kamila Faizullina ◽

Galina Kausova ◽

Zhanna Kalmataeva ◽

Ardak Nurbakyt ◽

Saule Buzdaeva

Keyword(s):

Medical Students ◽

Human Resources ◽

Rural Areas ◽

Urban Areas ◽

Human Resources For Health ◽

Medical Schools ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Unequal Distribution ◽

Survey Tool

Background and Objective. The number of new entrants to higher medical schools of Kazakhstan increased by 1.6 times from 2007 to 2012. However, it is not known how it will affect the shortage of human resources for health. Additionally, human resources for health in rural areas of Kazakhstan are 4 times scarcer than in urban areas. The aim of the present study was to investigate the intentions of students toward their professional future and readiness to work in rural areas, as well as to determine the causes for dropping out from medical schools. Material and Methods. A cross-sectional survey was conducted in 2 medical universities in Almaty during the academic year 2011–2012. The study sample included medical students and interns. In total, 2388 students participated in the survey. The survey tool was an anonymous questionnaire. Results. The students of the first years of studies compared with those of later years of studies were more optimistic about the profession and had more intentions to work in the medical field. Only 8% of the students reported a wish to work in rural localities. On the other hand, 4% of the students did not plan to pursue the profession. On the average, every third medical student dropped out on his/her own request. Conclusions. Associations between intentions to work according to the profession and the year of studies, faculty, and residence area before enrolling in a medical school were documented. The majority of the students who came from rural areas preferred to stay and look for work in a city, which might contribute to an unequal distribution of physicians across the country.

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