GP Training In a Rural Hospital

The NT general practice training program offers registrars high quality training in a diverse range of settings, including the unique environment of the small rural hospital.

One of these training locations is Katherine District Hospital (KDH), a GP-run 68 bed hospital serving a regional population of about 18000, of whom 40% are Aboriginal. KDH provides excellent training opportunities for rural doctors who wish to train in emergency and acute inpatient care in an aboriginal health context. There is an opportunity for registrars with prior procedural training to gain further supervised experience in anaesthetics, surgery, and obstetrics. There is a strong emphasis on continuing medical education and clinical teaching.

Diseases long relegated to the textbooks “down south”, such as rheumatic fever, TB, and syphilis, are highly prevalent in Northern Australia. Disproportionately high levels of morbidity and mortality are encountered in the regions Aboriginal population, accounting for 70-80% of the inpatient population.

GP registrars have accepted 3 to 12 month terms as full or part-time hospital medical officers, meeting the requirements of basic, advanced and special skills terms. There is also the opportunity to combine hospital work with community based practice in “composite posts”.

This paper discusses the unique opportunities and limitations of GP registrar training in a small rural hospital setting like that of Katherine District Hospital.

Abstract for presentation to GPET Conference 2003
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Vertical integration in this context refers to the learning occurring for medical students, registrars and general practitioners in each of the settings. The learning is most effective when the objectives are specific to the learner and hence will range from an appreciation of the nature of medical care in community settings (including intercultural settings), a common objective for medical students, to that of the complexities of the doctor patient relationship and patient centred care.

Northern Territory General Practice Education Ltd (NTGPE) has responsibility to co-ordinate and provide support for these learners, provide adequate support for the teachers and collaborate with other organisations in the areas of continuing professional development and workforce support. The large area, intercultural context, high turnover of staff and high burden of illness in the NT creates a fragile balance and significant challenges. A vertically integrated unit can provide continuity of support for each level of learning and between levels that can respond flexibly to these challenges. This includes fostering peer learning between supervisors and medical educators. Our effectiveness relies on an understanding of the context and on good communication, relationships and networks. The benefits of a context-responsive integrated unit outweigh the administrative challenges of reporting satisfactorily to multiple funding agencies and adequately responding to the diverse stakeholder needs.

This paper will discuss the issues and the strategies we have considered to effectively support these learning environments, including a dispersed medical educator network and joint or cross-program appointments. We will also consider some of the challenges for the administration and management structure in integration of separate funding sources and a combination of approaches to achieving sustainability through improved critical mass and credibility.