Rural and remote locations-and the facilities available there.

This is the explanation of facilities avaliable in urban and rural areas

1. Rural and remote locations Nabtahil Laraib Bushra Zahid Mubeen Arshad

2. Table of Content Introduction Before the learner arrives The first day During the rotation Assessment and wrap-up

3. Introduction The rural/remote location is an ideal setting for practical community-based learning where medical learners can develop knowledge, skills and attitudes that are useful in any medical practice setting. 20XX presentation title 3

4. Importance of medical learning experience Role in the training and recruitment of rural physician. Have educational value for junior medical students to senior trainees/residents. Placement in rural settings is a positive learning experience that students value and that preceptors find gratifying.

5. Rural/remote practice as a carrier As medical schools expand and address their social responsibility to train medical doctors for locations and in fields here they are most needed, increasing numbers of medical learners are experiencing training in a distributed medical education model. This provides the opportunity for rural general practitioners/family physicians, consultants, and other rural healthcare professionals to become more involved as medical teachers. 20XX presentation title 5

6. Practical approach to teaching/learning in a remote/rural setting. Before the learner arrives The first day During the rotation Assessment and wrap-up. 20XX presentation title 6

7. Before the learner arrives Good planning and preparation prior to the arrival of the medical learner are essential to set the stage for a successful rural learning/teaching experience. Vital steps of this stage include Preceptor preparation Programme support Well-prepared medical doctor’s office and staff Engaged colleagues Helpful hospital and healthcare organizations Community partnership 20XX presentation title 7

8. Preceptor preparation Attributes of community preceptors/rural medical teachers. Welcoming learners as legitimate participants in a community of practice. Creating a central role for learners Regularly engaging learners in self-reflection to monitor their progress. Helping learners discover learning opportunities in routine patient encounters. Using feedback to shape rather than evaluate learner performance Creating an environment where learners felt comfortable practicing new skills with patient . 20XX presentation title 8

9. Programme support It should include Site development visits. Extensive faculty development Information technology Distance learning-supported educational and clinical rounds It should provide clear information that outlines the programmer's learning objectives and expected/required evaluation. It should provide the rural medical teacher with a letter or other indication that the learner is in good standing. Financial support for learner travel, accommodation, information technology and other expenses should be clearly established. 20XX presentation title 9

10. Well prepared medical doctor’s office and staff Staff members should be involved in planning to use the office space, scheduling and handling communication with patients. Staff members should know the dates and plans before the learner arrives. All involved members should understand the skill level, roles and responsibility of the learner. Staff can help select and introduce the most appropriate patients for the learner. 20XX presentation title 10

11. Learner’s manual Preparing a learner’s manual can help consolidate the practice preparation and planning and is an invaluable guide to prepare and orient learners. 20XX presentation title 11

12. Rural medical teacher and engaged colleagues: It is important that there is a main preceptor/rural medical teacher with responsibility for organization, orientation, supervision and evaluation of the learner. Involvement of other colleagues provides a broader rural experience of different teachers’ knowledge, skills and attitudes. This provides the opportunity for experienced rural teachers to help their colleagues in also becoming medical teachers. Care needs to be taken in the choice and role of colleagues to maximize the positive learning experience. 20XX presentation title 12

13. Helpful Hospital and healthcare Organization: The rural community hospital, with its smaller number of healthcare professionals who are accessible and working in close proximity, can be an ideal location to see collegial interdisciplinary team care functioning in practice. Team members can also provide valuable learning opportunities and feedback for the rural medical learners. Before the rotation begins, the rural medical teacher should establish appropriate protocols with the approval of the hospital medical advisory committee to outline the level of activities and supervision for learners at different stages of education. A supportive hospital administration and staff and regional healthcare organization can be very helpful with enabling this process. 20XX presentation title 13

14. Community Partnership: Communities can facilitate the rural medical learner’s welcome and involvement in social and recreational activities and thus spark the learner’s interest in future practice in their own or another rural community. Positive community engagement reduces the potential for rural medical learners’ sense of isolation and shifts some of the organizational burden away from the rural medical teacher. Ongoing communication with all these involved participants – colleagues, hospital, healthcare organizations and community – prior to each learner’s arrival will pave the way for a positive learning experience. 20XX presentation title 14

15. The first day: The main preceptor/rural medical teacher should set aside a block of time on the first day to welcome and orient the learner. The medical doctor’s office staff, hospital staff and community members should play a key role in the orientation as well. Patient care responsibilities should start slowly and be gradually ramped up to help avoid the whirlwind of information and responsibilities that can overwhelm learners at the start of rural rotations. A letter/notice displayed in the reception area and examining rooms signed by the preceptor introducing the learner can help connect the learner and patients. 20XX presentation title 15

16. During the rotation: A learner’s role and contribution to patient care will be dependent on his or her level of education and knowledge, skills and attitudes. As the learner demonstrates competence and commitment to care, her or his level of responsibility can be increased in keeping with the concept of graded responsibility. The learner should be involved in the follow-up care of patients he or she has assessed, as continuity of care is a vital component of rural patient care, learning and teaching. Longitudinal integrated clerkships based on this principle are becoming a core component of many medical schools. 20XX presentation title 16

17. During the rotation 20XX presentation title 17 Adding a learner to the patient care process will require a well planned and flexible schedule to accommodate patient care needs and to optimize the learning experience. Learners can observe how professionalism and compartmentalization allow rural teachers to combine, yet keep separate, patient care responsibilities and social relationships in rural communities. Rural communities often provide opportunities for rural medical doctors to ‘make a difference’, not only in individual patient’s lives, but in the local health system and the community as a whole. Satisfaction of rural medical teacher with his or her professional and personal life is almost always apparent to learner. Many rural medical teachers are also involved in local leadership roles.

18. what is a longitudinal integrated clerkship? This clerkship  allows students to follow a panel of patients over time as they move through various health care settings, observing the continuum of patient services at all levels of health care . 20XX presentation title 18

19. Effective teaching behaviors of rural preceptors/ rural medical teachers: Actively involve the student, providing adequate supervision and appropriate independence. Develop a supportive interpersonal relationship with the student. Emphasize problem solving. Balance clinical and teaching responsibilities. Demonstrate clinical and professional competence. Use an organized approach. Provide the student with ongoing feedback, assessments and evaluations. 20XX presentation title 19

20. The CanMEDS roles describe seven aspects of the ideal physician: Medical/expert/clinical decision-maker: Identify the knowledge and skills required for a rural/community-based practice. demonstrate use of referral resources appropriately. Demonstrate diagnostic and therapeutic skills for ethical and effective evidence-based patient care Communicator: Demonstrate good interviewing and communication skills with patients. Demonstrate effective communication with all members of the rural/community healthcare team as member, coordinator and leader. Collaborator: Demonstrate collaboration with local family physicians, consultants, allied health professionals and tertiary care subspecialists. Identify when and how to effectively transfer patients from smaller referring centers to tertiary care centers. 20XX presentation title 20

21. seven aspects of the ideal physician : Manager: Identify strategies to develop referring and/or referral base. Identify and discuss benefits and risks of investigations and treatments available locally, regionally and at tertiary care centers. Health advocate: Demonstrate preventative healthcare and health promotion. Advocate for accessible and appropriate rural healthcare. Scholar: Identify and develop strategies n to maintain up-to-date and competent skills relevant to a rural/community setting. Professional/personal: Identify and experience the joys and challenges of rural/community medical practice and life. Identify and develop strategies to balance personal, family and professional needs and demands 20XX presentation title 21

22. OBSERVATION/DEMONSTRATION/FEEDBACK There is no substitute for the direct observation of the learner, the direct demonstration of clinical skills by the teacher and the provision of effective feedback. Direct observation at the start of the rotation can help provide the medical teacher with a clear understanding of the medical learner’s knowledge, skills and attitudes that is vital to determining the graded responsibility that can be given. Direct observation helps both learner and teacher identify areas of strength and areas for improvement and can avoid the all too easy over- or underestimation of a learner’s abilities and needs. The one-on-one learning/teaching in rural practice provides the ideal setting for rapid assessment and advancement of learning. 20XX presentation title 22

23. Providing effective feedback is a core skill for medical teachers and often require significant faculty development.

24. Table 14.1 Modified Pendleton’s rules for direct observation and/or videotape review 20XX presentation title 24

25. Assessment and wrap-up In addition to the frequent informal feedback provided throughout the rotation, specific times for more formal assessment should be set aside during and at the end of the rural rotation. Ideally, the assessment is linked to the objectives for the rotation. The CanMEDS roles for physicians provide a broad framework that can be functionally adapted to emphasize the broad and important knowledge, skills and attitudes required for exemplary rural practice If a learner is showing major signs of difficulty by the mid-term assessment, the programme should be notified and involved in planning how best to address this in the remainder of the rotation or in remedial alternatives. A mid-rotation formative assessment provides the opportunity for the learner and main preceptor to discuss progress, problems and planning for the remainder of the rotation. The summative end of rotation assessment should be done with the learner before he or she leaves the rotation. Any major concerns should be clearly outlined and discussed. In addition to assessment of the learner by the medical teacher, the medical teacher should be evaluated by the learner 20XX presentation title 25

26. Areas of focus l earners are often reluctant to give direct negative feedback to and provide assessments of a preceptor or a specific rotation, with concerns that it may affect future training or employment options. for this reason learner assessments of a training location and preceptors are often anonymized, and information is provided back to the medical teacher. In addition to evaluating the medical teacher, the assessment should also include other aspects of the rural experience including accommodation, social/ community aspects and information technology and programme support . 20XX presentation title 26

27. Troubled and troubling learners Learners are not immune from illnesses and emotional stresses. The latter can be aggravated by a rural rotation that places the learner in a new location with new expectations and roles far away from the support of close friends and family. Learners belonging to minority groups may have difficulty finding people with s imilar interests, experiences or cultural norms in the rural community. The teacher and programme should be prepared to help learners with illnesses and stresses by arranging timely and appropriate medical care and counselling as required. While it is important that the rural medical teacher be empathic and supportive. Occasionally the illness has the potential to interfere with competence to provide patient care; particularly with psychiatric illness, the potential for suicide must not be ignored. In all cases of ill, troubled or troubling learners, involvement of physician colleagues and programme support personnel is vital. 20XX presentation title 27

28. Despite the best of intentions, the close one-on-one nature of the rural rotation can potentially lead to conflict between the learner and medical teacher, staff or others. When isolation is a significant problem, consideration should be given to placing two learners at the same site. Pairing of learners at a rural site also provides leadership and teaching opportunities for the learners, particularly if they are at different stages in their learning.

29. Summary Rural and remote locations are becoming an increasingly important setting for medical education. Good planning and effective communication before the learner arrives, on the first day, during the rotation and at assessment and wrap-up can help ensure the success of rural learning experiences. Welcome and orientation on the first day followed closely by contracting regarding programme and individual learner goals, concerns, expectations, roles and responsibilities, and early direct observation of the learner establishes a strong foundation for progress through the rotation. During the rotation, learning is facilitated by appropriate scheduling with case-based time efficient strategies for clinical teaching including demonstration, observation and feedback. It takes courage to welcome learners into one’s rural practice and become a rural medical teacher, but the benefits are many. We have found that learners have stimulated us to demonstrate excellent medical care and to stay up to date. 20XX presentation title 29

30. thank you