A comparative evaluation of quality and depth of learning by trainee doctors in regional, rural, and remote locations

Young, Louise, Anderson, Emily, Gurney, Tiana, McArthur, Lawrie, McGrail, Matthew, O'Sullivan, Belinda, and Hollins, Aaron (2023) A comparative evaluation of quality and depth of learning by trainee doctors in regional, rural, and remote locations. BMC Medical Education, 23. 215.

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Background: An equitable supply and distribution of medical practitioners for all the population is an important issue, especially in Australia where 28% of the population live in rural and remote areas. Research identified that training in rural/remote locations is a predictor for the uptake of rural practice, but training must provide comparable learning and clinical experiences, irrespective of location. Evidence shows GPs in rural and remote areas are more likely to be engaged in complex care. However, the quality of GP registrar education has not been systematically evaluated. This timely study evaluates GP registrar learning and clinical training experiences in regional, rural, and remote locations in Australia using assessment items and independent evaluation.

Methods: The research team retrospectively analysed GP trainee formative clinical assessment reports compiled by experienced medical educators during real-time patient consultations. Written reports were assessed using Bloom's taxonomy classified into low and high cognitive level thinking. Regional, rural, and remotely located trainees were compared using Pearson chi-squared test and Fisher's exact test (for 2 × 2 comparisons) to calculate associations between categorical proportions of learning setting and 'complexity'.

Results: 1650 reports (57% regional, 15% rural and 29% remote) were analysed, revealing a statistically significant association between learner setting and complexity of clinical reasoning. Remote trainees were required to use a high level of clinical reasoning in managing a higher proportion of their patient visits. Remotely trained GPs managed significantly more cases with high clinical complexity and saw a higher proportion of chronic and complex cases and fewer simple cases.

Conclusions: This retrospective study showed GP trainees in all locations experienced comparable learning experiences and depth of training. However, learning in rural and remote locations had equal or more opportunities for seeing higher complexity patients and the necessity to apply greater levels of clinical reasoning to manage each case. This evidence supports learning in rural and remote locations is of a similar standard of learning as for regional trainees and in several areas required a superior level of thinking. Training needs to seriously consider utilising rural and remote clinical placements as exceptional locations for developing and honing medical expertise.

Item ID: 78326
Item Type: Article (Research - C1)
ISSN: 1472-6920
Keywords: Australia, General Practice, Medical Education
Copyright Information: © The Author(s) 2023. This article is licensed under a Creative Commons Attribution 4.0 International License
Date Deposited: 11 Oct 2023 01:33
FoR Codes: 39 EDUCATION > 3901 Curriculum and pedagogy > 390110 Medicine, nursing and health curriculum and pedagogy @ 80%
39 EDUCATION > 3903 Education systems > 390305 Professional education and training @ 20%
SEO Codes: 16 EDUCATION AND TRAINING > 1603 Teaching and curriculum > 160301 Assessment, development and evaluation of curriculum @ 100%
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