Rural medical education comes of age

‘Rural Doctors: Reforming Undergraduate Medical Education for Rural Practice’, the final report of the Rural Undergraduate Steering Committee (RUSC) for the Department of Human Services and Health was published in May 1994.1 This report set out the framework for the Commonwealth government to fund Australian medical schools for undertaking new initiatives in rural medical education. Recommendations in the report were based on research evidence that shows that two major factors associated with entering rural practice after training are: a rural upbringing (i.e. having grown up in a rural area) and positive clinical and educational experiences as part of undergraduate medical education. In the report, medical schools were challenged to develop specific plans to achieve nine key targets for which they would receive ongoing funding subject to satisfactory annual reports. Within two years, all medical schools had signed on to the RUSC targets, which included recruiting rural origin medical students, and ensuring that all students undertake a minimum of eight weeks’ clinical education in rural settings (including four weeks in rural general practice) plus support for rural practitioners as teachers and contributors to curriculum development.2 In addition to targeted funding of medical schools, the RUSC report provided for the funding of projects of national significance. One such project was the Parallel Rural Community Curriculum (PRCC) introduced by Flinders University in the Riverland of South Australia.3 The central feature of this project was students undertaking a full year of clinical education based in rural general practice and living in one rural community. During this year, the students cover the same curriculum as their colleagues in the metropolitan teaching hospital, but rather than undertaking sequential rotations in medicine, surgery, paediatrics and others, they learn clinical medicine by meeting patients and following them over time including into hospital and specialist care. This is supplemented by local and distance education from specialists and general practitioners plus ongoing problem-based learning. The PRCC model has been an outstanding success as measured by the fact that students achieve higher marks in exams than their metropolitan counterparts.4 This success has led to the view that clinical learning in the rural setting has intrinsic educational value for all medical students beyond any potential future rural workforce benefit.5 The PRCC model has been duplicated in other rural communities by Flinders and by other medical schools in Australia and Canada. The success of the RUSC initiatives provided the basis for subsequent Commonwealth rural academic initiatives: University Departments of Rural Health (UDRH) and Rural Clinical Schools (RCS). UDRHs are academic units in rural/remote locations that have a multidiscipline focus on public and Aboriginal health education and research.6 Rural clinical schools have a focus on rural undergraduate medical education and research.7 Many medical schools have combined these initiatives into Schools of Rural Health, which are substantial academic units located in a range of rural and remote community settings. In addition to existing medical schools establishing rural medical education and research units, the success of the RUSC initiatives has provided impetus for the establishment of new medical schools with a specific mandate focused on rural, remote and Aboriginal health. In Australia, James Cook University School of Medicine was established with this mandate and will graduate its first class of doctors this year.8 In Canada, the Northern Ontario School of Medicine, also established in a rural area with a focus on rural, remote and Aboriginal health, has accepted its first class of undergraduate medical students this year.9 The Northern Ontario School of Medicine is the faculty of medicine of Lakehead University in Thunder Bay and Laurentian University in Sudbury. The School has a social accountability mandate, which is to respond to the needs of the people and communities of Northern Ontario. Geographically vast, Northern Ontario has a diversity of communities and cultures including Aboriginal and Francophone communities. Undergraduate medical students will undertake an integrated curriculum involving patient-centred case-based learning and distributed community-based medical education in a range of rural, remote, small urban, Francophone and Aboriginal communities. Graduates of both James Cook University and the Northern Ontario School of Medicine will be highly skilled medical practitioners who are ready and able to pursue further training and practise anywhere in the world, but have a special affinity for living and working in rural, remote and Indigenous communities. In the decade since the RUSC report, rural medical education has come a long way. The establishment of full medical schools that focus on rural, remote and Aboriginal health signifies a new era of medical education for the 21st century.

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