Considerations for Selecting Applicants to Rural Medicine Programs

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.

Teleneurology Teaching Service at a Rural Regional Campus

Regional rural medical school campuses offer many opportunities for medical students to gain more hands-on experience, have more direct interaction with attending physicians, and cultivate a deeper understanding of challenges and opportunities specific to rural medicine. Some specialty services such as neurology are not available at these small regional campuses, and telemedicine technology can be a valuable tool to address this need. We report the implementation of teleneurology stroke consultation services as part of the third-year neurology clerkship at a regional medical school campus. We analyzed daily clinical notes and student satisfaction surveys. Students saw many common and important presentations of cerebrovascular events. Students worked as part of a multi-disciplinary care team while following these patients through their hospital course with effective instruction provided by remote stroke neurologists. All students strongly agreed that telemedicine was a positive component of the clerkship. We conclude that teleneurology is an effective way to provide inpatient neurology clinical exposure, especially when remote attendings have a strong screen presence and are enthusiastic about teaching. We believe these findings could be useful to other campuses considering similar teaching methods, as innovations in telemedicine continue to address challenges in medical education and clinical care. The authors have no conflicts of interest to report and the Baptist Health Madisonville Institutional Review Board found this study to be exempt.

E-HEALTH AND ONLINE HEALTH COMMUNITIES IN THE DAILY LIVES OF OLDER RURAL RESIDENTS DURING THE PANDEMIC

Ситуация пандемии COVID-19 в очередной раз напомнила о необходимости использования онлайн-сообществ здоровья, особенно в тех районах, где не хватает мест в местных больницах или существуют проблемы с получением качественной медицинской помощи. Это, например, сельские районы, где медицина ориентирована на лечение экстренно возникающих заболеваний и у врачей существуют сложности с возможностью лечения новой коронавирусной инфекции. Онлайн-сообщества здоровья в таком случае предоставляют возможность узнать необходимую информацию, а также общаться со специалистами, которые знают особенности нового коронавируса и могут дать необходимые советы. В настоящей статье на примере глубинных интервью с пожилыми людьми из сёл Ленинградской обл. и Республики Карелия рассмотрена роль телемедицины для пожилых людей и общения в онлайн-сообществах здоровья в контексте преодоления одиночества и изолированности, которая существует в сельской местности. В статье проанализированы особенности и основные препятствия для использования пожилыми людьми телемедицины и общения в онлайнсообществах здоровья - это проблемы с инфраструктурой и отключением электричества, отсутствие у пожилых людей компьютерной грамотности для общения и взаимодействия в онлайн-сообществах здоровья. Роль последних рассмотрена с точки зрения развития самозаботы пожилых людей в сельской местности в периферийных поселениях из-за отсутствия необходимой медицинской помощи. The situation of the COVID-19 pandemic has once again reminded of the need to use telemedicine and online health communities, especially in areas where there are not enough places in local hospitals or there are problems with obtaining quality medical care, such as rural areas where rural medicine is focused on treatment of emergency diseases and doctors have difficulties with the possibility of treatment, as well as explaining about the new coronavirus infection to patients and how this disease can be treated. In this case, online health communities provide an opportunity to find out the necessary information, as well as communicate with specialists who know the features of the new coronavirus and can give the necessary advice. Using the example of in-depth interviews with older people from villages in the Leningrad Region and the Republic of Karelia, the article examines the role of telemedicine for older people and communication in online health communities in the context of overcoming loneliness and isolation that exist in rural areas. The article analyzes the features of the use of telemedicine and the key barriers to the use of telemedicine and communication of older people in online disease communities. In rural areas the main barriers to telemedicine use are infrastructure problems and power outages, as well as the lack of computer literacy for communication and elder people’s interaction in online health communities. In the article the role of online health communities is considered in the context of the self-care of older people and from the point of view of the development of self-care of older people in rural peripheral settlements due to the lack of necessary medical care.

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

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.

Development of a Rural Healthcare System in Tomsk Province in the Late XIX – Early XX centuries

The present research featured the rural healthcare system in the late XIX – early XX centuries in the Tomsk Guberniya (Province). The research objective was to deduce the stages of formation of the rural healthcare system and to show the decision-making mechanism at the different levels of government. The author analyzed administrative acts and reference books, as well as various documents that reflect discussing the problems of expanding the rural healthcare system at lower administrative levels. The analysis made it possible to identify the needs of rural population, as well as to see differences in views on the formation of the health districts. Before opening a new medical district or relocating an existing one, many factors were taken into account, e.g. the requests of local residents, the level of their material support of the medical institution, landscape and geographical aspects, etc. As a rule, decisions were based on rational arguments. The government of the province was responsible for gathering data, correcting proposals, and planning further development. The results were assessed and approved on the central level. Some proposals coming from the provincial administration did not find support of the center. The author identified two stages of large-scale expansion of the rural medicine in the Tomsk Province: 1898–1910 and 1912–1914. The First World War ruined the plans for 1915–1917.

The Contribution of Citizens to Community-Based Medical Education in Japan: A Systematic Review

Community-based medical education (CBME) offers vital support to healthcare professionals in aging societies, which need medical trainees who understand comprehensive care. In teaching comprehensive care practices, CBME can involve citizens from the relevant community. This research synthesizes the impact of the involvement of communities on the learning of medical trainees in CBME. We conducted a systematic review, in which we searched ten databases from April 1990 to August 2020 for original articles in Japan regarding CBME involving citizens and descriptively analyzed them. The Kirkpatrick model was used to categorize the outcomes. Our search for studies following the protocol returned 1240 results; 21 articles were included in this systematic review. Medical trainees reported satisfaction with the content, teaching processes, and teachers’ qualities. Medical trainees’ attitudes toward community and rural medicine improved; they were motivated to become family physicians and work in communities and remote areas. This review clarified that citizen involvement in CBME had an effective impact on medical trainees, positively affecting perceptions of this type of education, as well as improving trainees’ knowledge about and attitude toward community and rural medicine.

PROTOCOLS OF THE COMPANY ARKHANGELSK DOCTORS IN THE LIBRARY OF THE KRONSTADT MARINE HOSPITAL

The Society of Arkhangelsk Doctors was founded in 1863 and was one of the first public medical organizations in Russia. The main reason for the differences from medicine in other Russian provinces was the lack of serfdom and rural medicine in the North. The Society has been active for 55 years. Immediately after the revolution (1917) in the Arkhangelsk province, as well as throughout Russia, the activity of the OAB was suspended. In the unique library of the Kronstadt Naval Hospital, 30 copies of the protocols and works of the Society of Arkhangelsk Doctors from 1864 to 1896 are preserved. The activities of the Society played an important role in uniting the doctors of the province, contributed to the growth of their qualifications and the development of healthcare in the Russian North.

Approaches to improve the effectiveness of social support measures provided to young professionals and graduates of medical education organizations. Policy Brief

What is the problem? • Imperfection of the regulatory legal framework for the provision of various measures of social support to young specialists, graduates of medical education and science organizations of the Republic of Kazakhstan and, accordingly, a low level of travel and employment of young specialists at the place of their personal distribution. • Lack of transparency and insufficient efficiency of the distribution mechanism and provided measures of social support for young specialists, university graduates at the republican and regional levels. • Low motivation and satisfaction of medical workers, including young professionals, arriving to work in rural areas of the Republic of Kazakhstan. Policy options Variant of politics 1. Perfection of normative legal base, qualificatory effective measures on social support of young specialists, graduating students of medical Institutions of higher learning. Variant of politics 2. Цифровизация and automation of distribution of young specialists, graduating students of organizations of education and science mechanism, and also the measures of social support rendered to them for an openness and transparency of process on the platform of www.enbek.kz. Variant of politics 3. Development and implementation of a separate section on employment and social support measures in the Concept for the Development of Rural Medicine, taking into account the existing domestic and international experience. Vision for implementing policy options. Estimating possibility of introduction of the offered variants of politics taking into account present barriers and possibilities, we come to the conclusion, that all three variants of politics complement each other. However, taking into account distinctions of variants in the orientation of actions, used resources and methods, more substantial achievement of aim of increase of efficiency of the measures of social support, rendered to the graduating students of organizations of medical education and science, these variants of politics can give during their сочетанной realization.