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Paddock to campus: Rural high school and medical undergraduate programs in SA

D. Gill and J. Tonks

The Australian Journal of Rural Health © Volume 4 Number 2, February 1996

Aust. J. Rural Health (1996) 4, 111-116

Original Article

PADDOCKTOCAMPUS:RURALHIGH SCHOOLANDMEDICALUNDERGRADUATE PROGRAMSINSOUTHAUSTRALIA

Rural Practice Training Unit, Modbury, South Australia, Australia

ABSTRACT: This paper outlines the programs that support country high school stdents with the

potential to take tertiary health training, particularly in medicine and the details of mentor

support and the transition into medical undergraduate training. Also, the establishment of rural clubs in Adelaide and Flinders Universities, together with their aims, objectives and activities are

highlighted together with details of the evaluation process which has conjirmed the success of rural

clubs. The establishment of an effective database is described, with a summary of its objectives and scope.

KEY WORDS: (lfJirmative action, medical undergraduates, recruitment, rural practice, rural workforce.

BACKGROUND

In October 1991 the Director of the Rural Practice

Training Unit (RPTU), who at the time was the Consultant for rural practice training, made a submission to the South Australian Health Com- mission for high school and undergraduate pro-

grams. This submission formed the basis for

RHSET funding, which enabled the programs to commence in mid 1992.

HIGH SCHOOL PROGRAM

When planning for rural training in South Aus-

tralia it was realised that there is a vital need for a continuing supply of rural graduates. This was

Correspondence: David Gill, Rural Health Training Unit, 1st Floor, Norwich Centre, 55 King William Road, North Adelaide, SA 5006, Australia.

Accepted for publication August 1995.

based on the fact that there was a demonstrated

deficiency in the numbers of rural general practi-

tioners in the long term, and that the yearly attri-

tion rate would be approximately equal numbers. It was decided that the country high school

and area school principals and career counsellors should be identified and placed on a database.

These people were then approached and asked to

supply information to identify students in their respective schools from years 10-12 who had the

career aspirations and capability of becoming

medical students. These students were then targeted with med-

ical careers information contained in a suitably

designed folder, endorsed by both universities

and the president of the Rural Doctors Associa-

tion of South Australia. These measures were

developed with knowledge that the rural reces-

sion was biting deeply into the rural economy of

South Australia, thus providing further disincen- tives for parents to support their sons and daugh-

112 AUSTRALIAN JOURNAL OF RURAL HEALTH

ters who may wish to pursue tertiary education in a ‘one stop shop’. If we don’t know the answer to Adelaide. the question we research it and get back to them.

School staff and parents w-ere delighted to

receive this information and supported the visits

by the RPTU that were made to careers nights

and to the schools. Country field days have also

been targeted, with a display and desk set up by

RPTU in one of the health oriented sections. We

make a special point of visiting high schools in

the area before the field days, with prior pub-

licity, so that after the students are seen parents

can be given advice at the field day.

HIGH SCHOOL INITIATIVES

All these contacts have been major factors in

marketing the RPTU as an advocate for country

students and displaying a strong supportive role

for parents.

City boarding schools have received the same

material and their career counsellors have also

been contacted. In addition RPTU staff have

talked to groups of students of country origin in

the private schools who have shown an interest in

a medical career.

The RPTU has a firm policy of promoting

medicine overall as a career. Although the more

emotive shortage is of general practitioners, there

is still a lack of country-based medical specialists

in South Australia.

It is evident that rural students seem reluctant to seek advice beyond their immediate environ-

ment. This, together with costs of travel, tuition

fees and boarding fees impose financial burdens

on families who in most cases are already experi-

encing hard times due to the recession. Unless

the students are lucky enough to have a support- ive career counsellor or parents who are willing to

seek information, then often their career aspira-

tions are squashed.

By attending these sessions we are able to guide the students and their parents about their

options. We talk about subject choice, marks

needed to gain entry into university, isolated chil-

dren’s allowance for relocation to another school, and the benefits as we see it in becoming a coun- try general practitioner. Residents of the country are often disadvantaged due to the lack of infor-

mation available to them and so we have become

Talks are given at country high schools to years

lo-12 by sixth year medical students on country

placements. These have been invaluable as a

source of up-to-date insight into city and univer-

sity life. This information is unlikely to be pro-

vided from the university and other sources at

that level of small group discussion.

The RPTU has provided assistance in plan-

ning work experience for country students inter-

ested in studying medicine. This has included

hospital and general practice visits in Adelaide,

as well as attendance at other health facilities.

In 1992 the Office of Continuing Education at

the University of Adelaide began vacation revi-

sion and skill development courses for Year I2

students. These courses were designed to support

and enhance the work done in schools, and since

the first program in September 1992 almost 3000

students have been helped to achieve their full

potential. Feedback from students, parents and

schools has been most encouraging. There has

been an increasing number of country students

attending these courses despite the additional

cost of travel and accommodation.

Since 1993 the RPTU has sponsored places in

these courses as an affirmative action supporting

country students. A total of 24 students have

benefited from this scheme. Selection occurs

through a competition, and is judged on the com-

mitment of the student in a 300 word essay, sup-

plemented by a principal’s report. The RPTU is

responsible for the cost of the course (two sub-

jects at $A180 per subject) and contributes up to

a maximum of $A200 per student towards travel

and accommodation costs.

The results have been excellent, with six stu-

dents gaining direct entry from Year 12 into medi-

cine, four in allied health courses and four in

science courses hoping to gain entry into the

graduate program, two in tertiary education and

PADDOCKTO CAMPUS:D.GILL& J.TONKS 113

undecided, six still in the school system and two choosing alternative careers.

In 1995 we extended this program by holding

a workshop for the students while they were in

Adelaide. The aims of the workshop were to

encourage the students to network with other stu-

dents with the same aspirations, to allow access

to relevant and up-to-date information that is not

always readily available in the country and to

make personal contact with staff of the RPTU.

Key people were assembled to give out infor-

mation on coping with year 12, admission to the

medical course and first hand experiences from medical students. Feedback on the courses and

workshop was excellent. The RPTU has decided to join the Australian

Association of Career Counsellors to further the

networking that we see as being so essential in

country and metropolitan high school linkages.

In terms of support the RPTU has an impor- tant role by increasing the contact with the under-

graduate students who have entered other

disciplines, and who plan to transfer to medicine. This is especially true with the graduate medical course being developed at Flinders University

commencing in 1996.

The RPTU is anxious to develop increased

informal contact with country parents and year I2

students about to face the move to Adelaide for tertiary training. Especially in the rural recession

there are many anxieties faced by parents in attempting to fund the education of their sons and

daughters, and children feel guilty and concerned about the continuing financial support their par- ents are having to provide with increasing difficulty.

There is an obvious problem of students being

acclimatised to the changed experience of city

and university life. There is anecdotal evidence that country students under-perform academically

during their first year, directly due to the diff~-

culty of coping with the transition. More support,

both personally and socially~ may be needed to enable students to cope with the move from ‘pad- dock to campus’.

Fairway Scheme whereby students from ‘under-

represented’ high schools are given a greater

opportunity of studying at the university. The

basic operation of the scheme is to add points to

the selection scores that do not reach the cut-off

score for the course for which they are applying.

This has enabled doubling of the intake from

rural high schools into medicine from 5 to 11%

since 1993.

THEFUTURE

The RPTU saw its involvement and emphasis

being changed in mid-1995, when it became part

of the Rural Health Training Unit. It is planned

that the RPTU will be involved in the training

and supply of country specialists as w-e11 as gen-

eral practitioners, and in addition other health

professional programs will have to be dovetailed

into the RPTU activities.

It is hoped that additional funding may be

achieved for an extension of the revision and skill

development course to include a country-based

‘coping with Year 12’ for Year 11 students. This

would reduce the travel to Adelaide and increase

accessibility for country students.

MEDICALUNDERGRADUATE PROGRkM

Orerview

From the onset it was decided that individual

rural clubs would be established in both ildelaide

and Flinders Universities with liaison taking

place between them.

Parallel to this development would be projects

to w-elcome freshers to Year 1 of the medical

course, to attend the first year orientation and to

provide written information on the rural clubs.

In addition it was contemplated that assis-

tance would be given to any students.wanting to

arrange rural electives during their later under-

graduate years.

It was conceived the RPTU would play an

The University,of Adelaide has developed the important role in continuing into undergraduate

114 AUSTRALIANJOURNALOFRURALHEALTH

training its strong mentor role already established

with country high schools and students.

The database would be extended so that rural club members could continue to be monitored

right through graduation, and into the Royal Aus-

tralian College of General Practitioners (RACGP)

Training Program Rural Stream.

The RPTU developed a proposal for rural

undergraduate scholarships that have now been

established.

social networks in a potentially unfriendly city setting.

The RPTU arranges contacts who can help

students with these problems and also provides

information on potential sources of funding for

student support. There is still a lack of this type

of information at a country level which the RPTU

is attempting to correct.

Finally, the RPTU was aware very early in its

existence that the degree of rural exposure of

medical undergraduates was confined to the sixth year, by which time career choices other than

rural medicine may have been made. To counter

this a rural clubs membership exposure to coun-

try practice at the end of the fourth year was

planned. This entailed spending a week with a

rural general practitioner during the summer

vacation, so that it did not impinge on the teach-

ing program of the university. This was not the

only concession to the universities, as we selected host doctors who had not been involved as pre-

ceptors, thereby not, jeopardising the sixth year

program.

The RPTU has developed a short pamphlet

written by a medical student, explaining many of

the problems of moving entitled ‘So You Want To Be A Doctor’.

In addition there is a more-detailed’folder of

information that is available at the orientation sessions for freshers at the beginning of the acad-

emic year. The RPTU also participates in these sessions.

Undergraduate scholarships

Introduction to medical course

The RPTU considered that it had developed a

firm commitment to continue the relationship it had established with country-origin high school

students. As already mentioned there is evidence

(albeit anecdotal) that the transition from country to city involves quite complicated adaptation.

In 1992 the RPTU first made a submission to the

South Australian Health Commission for rural health scholarships, as affirmative action in the

recruitment of country-origin students to tertiary

training in health professions. In I993 the pro-

posal was part of the health platform of the parlia-

mentary opposition, and after the election in

December 1993 the project came to fruition in

mid-1994.

The demographic structure of South Australia dictates that no country students come from a

town with a population more than 25 000, hence there is not a move from ‘small city to big city’ as

occurs in other States. There is the problem of

finding suitable accommodation that is priced at

an affordable level for parents in the severe rural

recession, where the eligibility for Austudy is restricted by the asset component in the farming

community. Further, the move to the city confronts the stu-

dent with the personal problem of being labelled

as a ‘country bumpkin’, and having to create

After investigating scholarship funding in

other States (Western Australia, New South Wales

and Queensland) it was decided that the funding of the tertiary course would be for a maximum of 3 years at the end of the course. This guarantees

that the candidate will have been well established in the course and can provide evidence of satis-

factory progress. Where the training course is 3 years or less in duration, funding will be for the

final 2 years. It is expected that scholarship hold-

ers will spend at least the equivalent of the fund-

ing in a country area of need on completion of

training. It is understood that there is no legal

binding on this arrangement, but it is hoped that

mentoring by the RPTU will maintain the enthu- siasm for a country career.

The ten scholarships each year will be

divided between the professions; the proportion

PADDOCKTO CAMPUS:D.GILL &J.TONKS 115

will be determined by a multidisciplinary com-

mittee that is comprised of a combination of

senior and country based health professionals.

It is hoped that over the next 3 years of guar-

anteed funding that the proportion of medical

undergraduates will enable up to fifteen addi-

tional qualified doctors to practise in country

areas.

Rural clubs

The original submission by the RPTU contained a

proposal to establish rural clubs in both Adelaide

and Flinders Universities, based on the only other rural club in Australia at that time initiated by

WACRRM (Western Australian Centre for Rural

and Remote Medicine; M. Kamien, unpublished

data, 1987).lJ The Flinders University Rural Medicine Soci-

ety (FURMS) began with an enthusiastic nucleus of two fourth year students who had been pro-

foundly affected by rural electives.

The Director of the Rural Practice Training

Unit and the Professor of Primary Health Care

presided at a meeting in April 1992, which was attended by about 25 students. That group has

now grown to over 50, scattered over all under-

graduate years. Due to the change to a graduate

medical degree there has been no intake into the

medical school in 1994 and 1995. It will be of considerable interest to the Unit to see whether

the 1996 entry into the four year medical course will have the same enthusiasm for rural practice.

The University of Adelaide students on the

first fourth year placements in the Christmas vacation 1992/93 had a de-briefing seminar in March 1993 at Modbury Hospital, at which they

decided to form a rural club. The initial member-

ship was 70 members. The club is now- known as

the Adelaide University Rural Medicine Society

(AURMS) and has over 90 members. The important question is ‘how have 200 med-

ical students overall been attracted to join rural

clubs?’ The answers may lie in the increased

rural origin recruitment into the medical course, a

realisation that rural practice will be to an increasing extent supported philosophically and

financially, and finally that students are at least recognising that unless they show some solidarity

and action they will continue to be taught ineffec-

tively in terms of procedures and decision

making.

The clubs have developed their own activities,

with the support of the Rural Practice Training

Unit. They hold meetings with rural speakers,

and recently have held joint university rural club

functions. In addition over 70 students have been

able to participate in weekend attachments with

rural general practitioners. These attachments

include seminars with local speakers.

Out of the rural club concept many benefits

have been gained to the Rural Practice Training

Unit in terms of establishing closer relationships

with the Departments of General Practice in both

Universities, the development of an on-going

database and ultimately the role of the RPIU co-

ordinating all university rural placements under

the Rural Undergraduate Steering Committee of

the Department of Human Services and Health.

Electives

The RPTU has had an effective role in helping

students with electives and research projects. We

see this as an expanding co-operative venture

linking with the undergraduate teaching program.

Mentor role

This summarises most comprehensively the

human aspect of the Rural Practice Training Unit,

filling as it does a unique role in the encourage-

ment of students to achieve academically, to gain personal enrichment and to see a worthwhile medical career structure in a country setting. For

a long time country families in particular have

been starved of information and deprived of the

hope of professional training for their children.

Fourth year country attachment

During the development of the policies of the

RPTU in 1992 it was soon realised that the rural exposure of medical undergraduates in the Uni-

versity of Adelaide was restricted to sixth year. Talking to fourth year students attending the Gen-

116

era1 Practice Training Unit at Modbury Hospital

(where the Director of the RPTU is a teacher) it

became obvious there was a number of students

interested in an additional rural placement, for

which there was no place in the teaching time of

the university. Sufficient rural general practition-

ers not involved in sixth year teaching were found

to enable a week long visit by fourth year stu-

dents during the Christmas vacation of 1992/93.

Over the 3 years all of the host doctors have

stated their willingness to continue the program,

and of the 56 students involved, 32 showed inter-

est in rural practice before and 38 after the

attachment. There was universal acceptance by

the students that they felt better able to cope with

the fifth year after the country attachment, partic-

ularly with procedural skills.

In 1995 there will be a total of 32 rural club

members from both universities in fourth year

due to the growth in interest of the earlier under-

graduate years. Hopefully we shall be able to pro-

vide sufficient host general practitioners for this

cohort, so that the success of the attachments can

be maintained.

THE FUTURE

The development of a Rural Health Training Unit

in South Australia in 1995 means that the exper-

AUSTRALIANJOURNALOFRURALHEALTH

tise of the RPTU in country recruitment can be

shared with all health professionals.

The rural club students of 1994 have become

the graduates of 1995, with some 34 members as

interns compared with eight in 1994. This group

and its successors will be an active force for

change in many ways, influencing both under-

graduate and postgraduate education.

This paper is concerned, primarily, with the

long-term recruitment of country general practi-

tioners and has to be supplemented by other mea-

sures to meet the immediate rural workforce

crisis Australia-wide.

ACKNOWLEDGEMENTS

The authors wish to acknowledge the financial

support for the Rural Practice Training Unit pro-

vided by RHSET and the South Australia Health Commission.

REFERENCES

1 Jackson WD, Jackson DJ. The Western Australian Centre for Remote and Rural Medicine. The Med- ical Journal of Australia 1991; 155: 144-146.

2 Kamien M, Buttfield IH. Some Solutions to the Shortage of General Practitioners in Rural Aus- tralia. The Medical Journal of Australia 1990; 153: 105-106.