Rural and Remote Health in Medical Education

The Rural and Remote Health in Medical Education (RRHIME) Track aims to increase the numbers of students and doctors practising in rural Wales and raise awareness amongst the GEM students of the benefits and realities of living and working in rural and remote areas.

Background and Context
Practice in rural, remote and underserved areas can offer varied and interesting benefits to a doctor’s career. However, these areas are often perceived as challenging environments in which to practise medicine and this perception contributes to difficulties recruiting doctors to such areas. This is a particular challenge for Wales, which has large rural areas and a shortage of speciality trainees and qualified doctors, particularly in some specialities. Research indicates that early and deep (‘immersive’) experience of rural healthcare by medical students and trainee doctors may facilitate their retention in the rural environment. There is also demonstrated value to teachers and preceptors of having medical students and trainees in rural practice.

The RRHIME Track
RRHIME (Rural and Remote Health in Medical Education) is a clearly defined Rural and Remote Health Track embedded throughout the GEM curriculum which allows selected students the opportunity to focus elements of their education on rural and remote health. A crucial, evidence-based element of RRHIME is that students experience more prolonged immersion in rural health environments and/or focused on rural and remote health issues. For RRHIME these include rural General Practice and District Hospitals, as well as rural secondary care in Aberystwyth and Haverfordwest. RRHIME students also take their 3rd year elective in a rural and remote area, typically overseas. Collaborative agreements have recently been developed with Betsi Cadwaladr Health Board to provide students with secondary care placements and we are in discussion with Brecon War Memorial hospital for the development of further opportunities. This is consistent with the GEM '6S' curriculum philosophy of situated learning.

 

Further Information

Learning Outcomes

 

 

Through engagement in the RRHIME track, projects and placements, students will be able to:

 

 

  • Demonstrate understanding of specific health issues relating to patients, carers and communities in rural and remote areas, including:
    • Chronic and long term conditions
    • Late presentation of disease
    • Treatment of acute and emergency conditions, including pre-hospital care
    • Child and maternal health
    • Elderly care
    • Palliative and terminal care
    • Impact of changing community structures (e.g. mining, farming, demographic shifts
  • Demonstrate awareness of policies and local and national strategies to address issues of access, equity and improvement of health outcomes for those living and working in rural and remote communities
  • Explain the rationale for existing and changing integrated service provision to support individuals and communities in rural and remote areas
  • Make contacts and build national and international networks in rural and remote health
  • Draw from experiences of a range of clinical experiences and settings to identify future career directions

Student Benefits

The principal benefit is to facilitate immersion in rural and remote medicine so that interested students are equipped with the experience to make informed decisions about careers in such underserved communities.

Should students pursue a career in rural and remote medicine, practising in a rural environment will develop additional skills and qualities. Rural practitioners, whether in primary or secondary care, have to adopt a more multi-disciplinary approach to medicine, performing a greater variety of roles. They also assume a more hands-on role in the patient journey and the relevant decision making, as well as a more prominent role in public health. Information Technology skills are essential, including video conferencing and 'telehealth'.

Rural practitioners are often a central part of their community, although this can bring challenges as well as benefits. Resilience and self-motivation play a big part in making successful rural practitioners. Practising in a rural environment also offers the opportunity to experience some beautiful locations with access to great resources for the outdoors enthusiast. Students pursuing the RRHIME track do not 'miss out' on any components of the GEM MBBCh curriculum and will not be disadvantaged should they not choose to pursue a career in rural/remote medicine after they qualify.

Accessing RRHIME

A small number of students in every cohort can pursue RRHIME. Students start on the track in the first year of the programme although students can also join in year 2. Students are asked to submit a reflective application outlining why they would like to follow the track. Preference will be given to applicants with a demonstrable commitment to working in Rural and Remote healthcare after graduating, particularly in Wales. If there are more than six applicants in any one cohort then applications are considered by a subgroup of the Board of Studies in consultation with the Institute of Rural Health (see below). Final decisions are made by the Dean of Medical Education and students will be notified within 6 weeks of the application deadline.

Curriculum Content

To successfully complete the RRHIME track and achieve the learning outcomes, students are expected to participate in the following curricular elements:

  • RRHIME students must complete a minimum of 2 LOCS with a rural or remote focus/reflection. 
  • RRHIME students must complete a minimum of 2 clinical apprenticeships in a rural or remote location during Clinical Apprenticeships 1 to 6 (Years 1-4). 
  • RRHIME students must complete 1 x 4th Year Junior Assistantship in a rural or remote location. If you choose to use your Junior Assistantship CBL placement as your RRHIME CBL element, then you must also complete the Junior Assistantship for either surgery or medicine with a RRHIME focus, in order to fulfil the RRHIME requirements.
  • RRHIME students must complete at least one CBL placement in a rural or remote location during one year of the programme. This may be the one day placements in Years 1 or 2, or the 3rd year block, or the Junior Assistantship in Year 4.
  • RRHIME students must complete a minimum of two RRHIME-related SSCPs. 
  • RRHIME students must relate a fundamental aspect of one yearlong case study to RRHIME. Please give details of these aspects below.
  •  RRHIME students must embark on a RRHIME-related elective placement in year 3. 
  • Participation in the Welsh for Medicine language course is not compulsory, but strongly advised as part of your RRHIME development in Wales.

RRHIME Elective Locations

All our students are given the opportunity to spend up to 6 weeks abroad as an elective placement at the end of their third year. RRHIME students must select to complete this period of study in a RRHIME-related location. Our RRHIME students are well travelled, with electives being completed in Bali, Nazareth, Cape Town, Tromso and Sierra Leone.

RRHIME Elective Locations Examples