SHORT COMMUNICATION |
https://doi.org/10.5005/jp-journals-10082-03103 |
Strengthening the Delivery of Rural Medical Education: Identification of the Potential Challenges and Responding to Them with Feasible Solutions
1,2Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth, Ammapettai, Tamil Nadu, India
Corresponding Author: Saurabh R Shrivastava, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth Ammapettai, Tamil Nadu, India, e-mail: drshrishri2008@gmail.com
How to cite this article: Shrivastava SR, Shrivastava PS. Strengthening the Delivery of Rural Medical Education: Identification of the Potential Challenges and Responding to Them with Feasible Solutions. J Basic Clin Appl Health Sci 2021;4(1):23–25.
Source of support: Nil
Conflict of interest: None
ABSTRACT
The existing practice of training medical students in medical colleges is hospital driven, with limited and variable focus toward posting them in rural settings. However, in the global vision to produce a primary healthcare physician and attain universal health coverage, it is a must that all the medical students should be given exposure to rural medical education. The process of planning and implementing the delivery of rural medical education has multiple inherent challenges and each of these needs to be effectively addressed to ensure the accomplishment of the intended learning outcomes. It has been advocated that the outcome of rural medical education is much better once students are posted for longer durations and in settings wherein rural experience opportunities are well distributed throughout the training period. In conclusion, the delivery of rural medical education is the need of the hour and is based on the principle of training medical students in a community-oriented approach. The medical colleges and public health sector have to work with utmost collaboration to ensure that medical students are benefited, and in the long run, the prevailing issue of maldistribution of trained specialists is eliminated and an improvement in health indices is observed.
Keywords: Curriculum, Medical education, Rural.
INTRODUCTION
In general, rural areas lack ready access to healthcare services, including medications, laboratory investigations, infrastructure support, and specialist services. The existing practice of training medical students in medical colleges is hospital driven, with limited and variable focus toward posting them in rural settings.1 It is not an unusual fact that most of the medical colleges are located in urban settings and more often than not does not give an opportunity to medical students to become primary healthcare physician, as there is no practice in the curriculum itself to give adequate amount of learning experiences in a rural hospital or under the guidance of rural physicians.1
RURAL MEDICAL EDUCATION
In the global vision to produce a primary healthcare physician and attain universal health coverage, it is a must that all the medical students should be given exposure to rural medical education.1,2 In fact, in order to accomplish this vision, over a period of time, multiple new medical colleges have been opened in the rural settings, and it is an important step to not only strengthen rural medical education but also gradually eliminate the public health inequality faced by rural people via overcoming the shortage of trained physicians.1,2 The findings of a review depicted that in excess of 95% of the medical graduates who were trained in a medical school in rural areas, decided to work in the same rural location.3
Further, different medical colleges have initiated the practice of posting undergraduate medical students for a variable duration at any stage in their training period (Table 1).2–4 For instance, in Shri Sathya Sai Medical College and Research Institute, a constituent unit of the Sri Balaji Vidyapeeth, Puducherry, students from the first professional year are posted in the local rural community for a period of one week to give them an understanding about the unique problems and challenges faced by rural segments of the community. Moving further, it has been observed that the delivery of rural medical education promotes the recruitment and retention of qualified health professionals and thus addresses the prevailing issue of physician maldistribution.4
Potential challenges | Feasible solutions |
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Fitting the component of rural exposure within the already packed curriculum |
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Lack of clarity among the teachers about the type of rural exposure to be planned for medical undergraduate students |
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Ascertaining the effectiveness of the rural education initiatives |
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Administrative concerns (viz. willingness, transport, accommodation, connectivity, ownership of resources, and sharing of space, etc.) |
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Reluctance of students to prefer rural exposure |
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Resistance from teachers | It can be overcome by the following:
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POTENTIAL CHALLENGES AND SUGGESTED REMEDIAL MEASURES
The process of planning and implementing deliveries of rural medical education has multiple inherent challenges and each of these needs to be effectively addressed to ensure the accomplishment of the intended learning outcomes (Table 1).4–6 From the administrative angle, there can be disputes about ownership of resources and sharing of space between the medical students and the health authorities. This issue can be sorted out by careful planning and proper dialogue with the concerned authorities and convincing them that the posted students can be utilized by them for managing the clinical workload.4 The students often complain about the quality of the teaching to which they are subjected during their rural postings. This can be tackled either by posting a medical teacher or developing a liaison with a public health practitioner in the area (Table 1).5,6
In addition, there are issues pertaining to the transport, accommodation, and lack of connectivity in rural areas which cumulatively accounts for the feeling of anxiety and isolation from family members.4,5 Once again, these are more of administrative concerns and just require careful planning, better communication, and infrastructure support, as the efforts taken in this regard will eventually determine the decision of medical students to practice in rural settings in the future. The overall success of the program will depend on the support offered by all the stakeholders and the commitment towards strengthening of the component of rural medical education.1,5
ADDITIONAL CONSIDERATIONS
The medical college should clearly define the entire program (viz. batch of students to be posted, duration, nature of the posting, competencies to be covered, learning experiences, mode of assessment, curriculum mapping, standard operating procedures, etc.).4,5 It is an encouraging practice to select students from rural backgrounds, especially those who have a desire to work for the well-being of rural populations.3 It has been advocated that the outcome of rural medical education is much better once students are posted for longer durations and in settings wherein rural experience opportunities are well distributed throughout the training period.3–5 Finally, there is a need to periodically evaluate the program to ensure its improvement based on the results of the evaluation.5,6
CONCLUSION
In conclusion, the delivery of rural medical education is the need of the hour and is based on the principle of training medical students in a community-oriented approach. The medical colleges and public health sector have to work with utmost collaboration to ensure that medical students are benefited and in the long run, the prevailing issue of maldistribution of trained specialists is eliminated, and an improvement in health indices is observed.
REFERENCES
1. Van Schalkwyk SC, Bezuidenhout J, Conradie HH, Fish T, Kok NJ, Van Heerden BH, et al. ‘Going rural’: driving change through a rural medical education innovation. Rural Remote Health 2014;14:2493. PMID: 24803108.
2. Brahmapurkar KP, Zodpey SP, Sabde YD, Brahmapurkar VK. The need to focus on medical education in rural districts of India. Natl Med J India 2018;31(3):164–168. DOI: 10.4103/0970-258X.255761.
3. Longombe AO. Medical schools in rural areas—necessity or aberration? Rural Remote Health 2009;9(3):1131. PMID: 19653801.
4. O’Sullivan BG, McGrail MR, Russell D, Chambers H, Major L. A review of characteristics and outcomes of Australia’s undergraduate medical education rural immersion programs. Hum Resour Health 2018;16:8. DOI: 10.1186/s12960-018-0271-2.
5. Farmer J, Kenny A, McKinstry C, Huysmans RD. A scoping review of the association between rural medical education and rural practice location. Hum Resour Health 2015;13:27. DOI: 10.1186/s12960-015-0017-3.
6. Raymond Guilbault RW, Vinson JA. Clinical medical education in rural and underserved areas and eventual practice outcomes: a systematic review and meta-analysis. Educ Health (Abingdon) 2017;30(2):146–155. DOI: 10.4103/efh.EfH_226_16.
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