Review article: Managing medical emergencies in rural Australia: A systematic review of the training needs

Abstract

The aim of the study was to determine the training needs of doctors managing emergencies in rural and remote Australia. A systematic review of Australian articles was performed using MEDLINE (OVID) and INFORMIT online databases from 1990 to 2016. The search terms included 'Rural Health', 'Emergency Medicine', 'Emergency Medical Services', 'Education, Medical, Continuing' and 'Family Practice'. Only peer-reviewed articles, available in full-text that focussed on the training needs of rural doctors were reviewed. Data was extracted using pre-defined fields such as date of data collection, number of participants, characteristics of participants, location and study findings. A total of eight studies published from 1998 to 2006 were found to be suitable for inclusion in the analysis. Six studies cited the results of self-reported questionnaires and surveys, one used a telephone questionnaire on a hypothetical patient and one utilised a theoretical examination. The studies found a significant proportion of participants wanted more emergency training. Junior rural doctors were found to have deficiencies in knowledge about stroke. Emergency skills doctors wanted more training including: emergency ultrasound, paediatric/neonatal procedures and cricothyroidotomy. However, many of the studies were performed by training providers that may benefit from deficient results. Given that the data was over 10 years old and that advances have been made in knowledge, training opportunities and technology, the implications for current training needs of rural doctors in Australia could not be accurately assessed. Thus there is a need for further research to identify current training needs.

Managing Emergencies in Rural North Queensland: The Feasibility of Teletraining

“…Adopting a descriptive qualitative approach, an interview guide based on current literature was developed by the research team and revised after discussion with three rural doctors and the approving Human Research Ethics Committee (HREC) [ 14 ]. The guide was piloted and refined for data collection.…”

One for all, not all for one: Emergency medicine training beyond the metropolis

“…organophosphate poisoning) and indigenous health issues. While on face value, it may seem that these types of cases can sometimes be seen in urban hospitals, the real challenge often arises from the combination of limited resources and ED staffing, lack of subspecialist inpatient teams and complexities around retrieval . FACEM training, therefore, needs to be deliberate in not concentrating its efforts on producing metropolitan emergency physicians, but also experts in true generalist EM.…”

“…Many of the negative aspects of working in regional centres can be similar to those experienced by metropolitan‐based EM clinicians, such as access block, heavy workload and staffing . In addition to these, relatively isolated regional clinicians may also find that the relatively low frequency of high acuity cases, coupled with difficulty accessing courses and conferences, can make maintenance of up‐to‐date complex emergency skills more problematic . Additional challenges affecting ACEM trainees include a need to move across sites, often involving large distances, because of limited accredited training time by ACEM.…”

“…qld.gov.au and complexities around retrieval. 12 FACEM training, therefore, needs to be deliberate in not concentrating its efforts on producing metropolitan emergency physicians, but also experts in true generalist EM.…”

“…8 In addition to these, relatively isolated regional clinicians may also find that the relatively low frequency of high acuity cases, coupled with difficulty accessing courses and conferences, can make maintenance of up-to-date complex emergency skills more problematic. 12 Additional challenges affecting ACEM trainees include a need to move across sites, often involving large distances, because of limited accredited training time by ACEM. Currently there are some states without any accredited rural/regional sites, for example, South Australia and the Australian Capital Territory.…”