Australian Rural Health News

[gwenith, BSN, RN]

I do not know what the situation is like in the US but I thought you might like some news and insight into some of the problems faced over here. It's better if you click on the link because there are other links worth looking at just for the scenery:chuckle

http://www.abc.net.au/health/regions/features/healthtrain/

Health education goes bush

by Wendy Oakes

Country people wanting to work as health professionals usually face a move to a capital city, but now universities are addressing the needs of remote students, and offering alternative methods of study.

Published 18/09/2003

Danielle Bowden couldn't wait to move to the city after she finished high school on Kangaroo Island. But five years in Adelaide has changed that. Now as she finishes her third year of nursing training at the University of South Australia she and her husband, who also grew up on Kangaroo Island, are planning to move to Port Lincoln to live.

"At the time I was so sick of small town life I couldn't wait to get to the bright lights. Now I can't wait to get back to the country," she said.

There are probably lots of country kids who'd like to fill the vacancies for doctors, nurses, occupational therapists, physiotherapists, speech pathologists and other health professionals in country areas all around Australia.

The problem they face is how to get the qualifications they need to practice.

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Rural schools

A career in any of the health professions generally requires a university degree which, up until recently, meant a move to one of the capital cities for a minimum of three or four years full-time study. Add to that clinical placements and the supervised practice requirements needed for registration in most professions and it can be several years before a country kid gets back to the bush.

For many that's too late. With relationships, and social and professional networks firmly established in the cities, it's a big ask for someone in their late twenties to make yet another major disruption to their life and set up a new life in a country area.

The crisis in the rural health workforce has now forced universities to re-think the way they train health professionals, so that in future enough of their graduates will want to work in rural and remote areas. Medical schools (with the persuasive force of substantial Commonwealth funding) have led the way by increasing the number of Rural Clinical Schools to nine, and creating ten University Departments of Rural Health to give medical students more experience in working in country areas.

The target set by the Commonwealth is to have at least 25 per cent of medical students receiving at least 50 per cent of their clinical training in rural and remote areas.

But the same level of 'persuasion' hasn't been made available for nursing and allied health education, as Ms Bowden discovered when she tried to do her clinical practice units in hospitals outside Adelaide.

"There was no support to do it. I had to pay for my own travel, find my own accommodation and there's a huge amount of red tape you have to go through," said Ms Bowden. "It's very off-putting."

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Training goes bush

While some University Departments of Rural Health, such as the Mount Isa Centre for Rural and Remote Health currently provide clinical placements, most don't.

But things are starting to look up. The severe shortage of nursing and allied health professionals has prompted some universities to look more creatively at how to make their course more attractive to people living in rural and remote areas. The reasoning is that if you can't get graduates to go to the bush, perhaps you should take the courses there instead.

This approach has already proved successful in training Aboriginal health workers for rural and remote communities. The Batchelor Institute of Indigenous Tertiary Education in the Northern Territory has been training Aboriginal health workers to registration level for over two decades. Aboriginal health workers now make up 25 per cent of the health workforce in remote areas of the Northern Territory and provide essential clinical and health promotion services to their communities.

The secret to the Institute's success is taking courses to where the people live rather than expecting students to leave their communities and travel hundreds of kilometres to a city. Batchelor is 100km south of Darwin, and the Institute has campuses and annexes all over the Northern Territory. As well as Batchelor, there is a campus at Alice Springs. These are supplemented by annexes with a full range of teaching resources at a number of sites including Nhulumbuy, Katherine and Tennant Creek. There are also numerous study centres across the Northern Territory which can be used by visiting lecturers and tutors.

Courses are conducted in 'mixed mode' - for example the three-year fulltime Bachelor of Indigenous Health Studies degree combines work which can be done from home with week-long residential attendances at one of the main campuses.

"Where students have the luxury of a computer in their community we have daily contact with them," said Dr Jan Schmitzer, head of the School of Health and Sciences. "Otherwise we use phone or fax, whatever's available."

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Other options

There are other tertiary courses available to Indigenous people. Yourang Garang, the School of Indigenous Health Studies at the University of Sydney also offers its four-year fulltime Bachelor of Health Science (Aboriginal Health and Community Development) in 'block mode', where face-to-face teaching is conducted over short, high-intensive periods. This gave Daphne Toby from Ipswich the opportunity for a university education she had never previously considered.

"Being Indigenous, I always thought we don't go to university. We just get through school, get a job, have a family," she said. "I'm the first in my family to [go to university]."

Ms Toby comes to Sydney each semester for an intensive teaching block with other students from all around Australia. Between these teaching sessions she has access to a local tutor who has helped her conquer the intricacies of university essay writing and referencing.

"The first year and a half I didn't have a tutor," she said. "It made it a lot harder. I'd never been to Uni before and I could have made my life a lot easier."

Using the experience gained by Yourang Garang, the University of Sydney will be offering fulltime Bachelor of Nursing and Bachelor of Indigenous Nursing degrees in block mode, based out of their Orange campus from 2004.

"The course was originally designed to accommodate the needs of Indigenous students but since we started working on it, it became apparent that it would suit a whole lot of other people," said Professor Jocalyn Lawler, the dean of the Faculty of Nursing.

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Challenges

But don't be fooled into thinking block mode is an easy option. Students in the three or four year fulltime courses undertake the same amount of face-to-face teaching and clinical work as students doing the traditionally structured on-campus courses. They just do it all in one hit - rather than spreading it an hour a week across a semester. Students are also expected to spend the same amount of time each week on assignments and reading.

"Roughly speaking, they'd be spending 15 to 20 hours per week studying, the same as the on-campus students," said Professor Lawler. "It's a highly structured course. They are required to keep a log book and they have something they have to do every week."

Block mode is a popular way of offering post-graduate and post-registration degrees in nursing to people who are already working in the health system. But offering it to people who may not have studied at university level before - especially those fresh out of high school - presents a different challenge.

For young or inexperienced students to study successfully off-campus, universities need to put extra effort into recreating the support facilities available to on-campus students, according to David Lindsay, the director of undergraduate programs for nursing at the James Cook University. James Cook University offers nursing students a range of course options - fulltime and part-time at one of its four campuses in Townsville, Cairns, Mount Isa or Thursday Island, or a six year part-time 'external' course.

"It's not for all students," he said. "Someone out of high school may find it more difficult because you do need to have direction and you do need to feel part of a wider group to keep at it. Universities need to be very creative in socialising the [external] students into the course and organising for the students to interact with the academics as well as the other students."

But with changing technology high school students have become used to socialising via SMS on their mobiles and email on their computers, so this style of education may not be such a hurdle in the future. Technology has revolutionised distance education, replacing whiteboards and lecture halls with CD-ROMs, web-based courses, teleconferencing and even video conferencing - at least for city students. Ironically it's where the technology is most needed - out in the bush - that the benefits are only slowly starting to appear.

"We still offer our subjects [as] text-based [courses]," said Mr Lindsay. "There's no point in developing a web-based course if students don't have fast Internet access. Widespread broadband is probably five years away."

[Ted]

Thanks, Gwenith! Interesting article!

Ted

[mattsmom81]

Very interesting. I have several nurse friends here in the US who have attended nursing and even medical school on full scholarships....paid for 100% by small rural communities who are desperate to attract healthcare professionals. Also this is done by the reservations/ Indian Nations in exchange for x # years of comitted practice in their community. :)