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The Remote Vocational Training Scheme (RVTS) is a program funded by the Department of Health and Aged Care to train general practitioners in rural, remote, and First Nations communities. The RVTS focuses on more remote locations and uses a unique remote supervision model to support doctors in isolated areas. The program requires doctors to continue working in the same practice while completing three to four years of training, aiming to reduce workforce turnover in underserved areas. The RVTS has grown over time and predominantly enrolls international medical graduates, providing a unique training and support model for doctors in challenging settings. [Extracted from the article]

Objective: To explore continuity of service and longer term retention outcomes of participants of the Remote Vocational Training Scheme (RVTS). Design, setting, participants: Retrospective cohort study of all doctors who participated in the RVTS from 2000 to 2023, many of whom are international medical graduates and are expected to work in the same community for three to four years in remote (Modified Monash Model [MMM] categories 4–7) or rural Aboriginal Medical Services (AMS) streams while undertaking training towards general practice fellowship. Main outcome measures: Continuity of service was measured in the pre‐program period (period working in same practice before commencing) and during‐program period (period completing the RVTS program in same practice as worked in before commencing the program). Retention was measured firstly within two years, and secondly beyond two years (up to 20 post‐completion years) based on: working in the same community (relevant to both streams); working in the same region (Remote Stream only); working in any MMM4–7 community (Remote Stream only); or working anywhere rurally (both streams). Results: From 506 enrolled participants, 373 (73.7%) were international medical graduates. The approximate mean service continuity in the same practice was 1.6 years (standard deviation [SD], 2.2 years) for the pre‐program period and 3.6 years (SD, 1.4 years) for the during‐program period (mean total, 5.2 years). Two years after completion, 21 out of 43 Remote Stream doctors (49%) and four out of five AMS Stream doctors (80%) remained in the same community. Over the long term, retention in the same community stabilised to 44 out of 242 Remote Stream doctors (18.2%) and seven out of 27 AMS Stream doctors (26%); 72 Remote Stream doctors (29.8%) remained in the same region, 70 Remote Stream doctors (28.9%) were in an MMM4–7 community, and 11 AMS Stream doctors (41%) were in a rural (MMM2–7) community. Conclusion: Strong service continuity outcomes have been achieved by the RVTS, which supports mostly international medical graduates in locations typified by the highest workforce turnover. This suggests that continuity of service could be improved for remote and First Nations communities through place‐based retention‐focused programs like the RVTS. [ABSTRACT FROM AUTHOR]

Objective: To develop theory about how and why the supervision and support model used by the Remote Vocational Training Scheme (RVTS) addresses the professional and non‐professional needs of doctors (including many international medical graduates) who are training towards general practice or rural generalist fellowship while based in the same rural or remote practice. Design, setting, participants: We conducted a realist evaluation based on the RAMESES II protocol. The initial theory was based on situated learning theory, networked ecological systems theory, cultural theory and geographical narcissism theory. The theory was developed by collecting empirical data through interviews with 27 RVTS stakeholders, including supervisors, participants and RVTS staff. The theory was refined using a project reference and a stakeholder advisory group and confirmed using individual meetings with experts. Main outcomes measures: Theory about how the contexts of person, place and program interacted to address professional and non‐professional needs. Results: The RVTS program offers remote access to knowledgeable and caring supervisors, real‐time tailored advice, quality resources and regular professional networking opportunities, including breaks from the community. It worked well because it triggered five mechanisms: comfort, confidence, competence, belonging and bonding. These mechanisms collectively fostered resilience, skills, professional identity and improved status; they effectively counteracted the potential effects of complex and relatively isolated work settings. Conclusion: This theory depicts how a remotely delivered supervision and support model addresses the place and practice challenges faced by different doctors, meeting their professional and non‐professional needs. The participants felt valued as part of a special professional group delivering essential primary health care services in challenging locations. The theory could be adapted and applied to support other rural and remote doctors. [ABSTRACT FROM AUTHOR]

Objective: Explore stakeholder perspectives of the benefits of continuously training general practitioners in the same rural or remote practice in distributed locations via the Remote Vocational Training Scheme (RVTS). Design, setting, participants: Online one‐hour semi‐structured interviews were conducted with 27 RVTS staff, participants and supervisors from all states and territories between 16 October and 24 November 2023. Data were deductively and inductively coded by stakeholder type and the range of benefits, and the findings were informed by insights from a project reference group and a stakeholder advisory group. Questions explored the benefits of the RVTS — a program which supports doctors already working in rural, remote and First Nations communities to train towards general practice or rural generalist fellowship while remaining in the same practice. Main outcomes measures: Perspectives on the nature and spread of benefits. Results: Broad benefits were perceived to flow to four system‐level stakeholders: communities, health services, participants and policy makers. Perceived participant and community benefits were doctors staying longer in distributed locations with tailored place‐based supports and training, doctors building relationships with patients, and doctors learning through longitudinal care. Health service benefits included reduced reliance on locums, improved continuity of accessible and appropriate services in areas otherwise facing major recruitment and retention issues, and the doctors having more time to contribute to improving service quality and upskilling local staff. Policy‐maker benefits were sustaining safe and high quality services for distributed populations with high needs. Conclusion: The RVTS model was perceived to offer diverse benefits for different system stakeholders which could improve quality of learning, service delivery and community care. It also aligned with key policy directions for a distributed and sustainable generalist workforce under the goals of the National Medical Workforce Strategy 2021–2031 and the directions set by the independent review of overseas health practitioner regulatory settings led by Robyn Kruk. However, models like the RVTS largely rely on distribution levers to recruit more doctors to the locations it supports. [ABSTRACT FROM AUTHOR]

Context: There is growing evidence supporting a shift towards 'grow your own' approaches to recruiting, training and retaining health professionals from and for rural communities. To achieve this, there is a need for sound methodologies by which universities can describe their area of geographic focus in a precise way that can be utilised to recruit students from their region and evaluate workforce outcomes for partner communities. In Australia, Deakin University operates a Rural Health Multidisciplinary Training (RHMT) program funded Rural Clinical School and University Department of Rural Health, with the purpose of producing a graduate health workforce through the provision of rural clinical placements in western and south-western Victoria. The desire to establish a dedicated Rural Training Stream within Deakin's Doctor of Medicine course acted as a catalyst for us to describe our 'rural footprint' in a way that could be used to prioritise local student recruitment as well as evaluate graduate workforce outcomes specifically for this region. Issue: In Australia, selection of rural students has relied on the Australian Statistical Geography Standard Remoteness Areas (ASGS-RA) or Modified Monash Model (MMM) to assign rural background status to medical course applicants, based on a standard definition provided by the RHMT program. Applicants meeting rural background criteria may be preferentially admitted to any medical school according to admission quotas or dedicated rural streams across the country. Until recently, evaluations of graduate workforce outcomes have also used these rurality classifications, but often without reference to particular geographic areas. Growing international evidence supports the importance of place-based connection and training, with medical graduates more likely to work in a region that they are from or in which they have trained. For universities to align rural student recruitment more strategically with training in specific geographic areas, there is a need to develop precise geographical definitions of areas of rural focus that can be applied during admissions processes. Lessons learned: As we strived to describe our rural activity area precisely, we modelled the application of several geographical and other frameworks, including the MMM, ASGS-RA, Primary Healthcare Networks (PHN), Local Government Areas (LGAs), postcodes and Statistical Areas. It became evident that there was no single geographical or rural framework that (1) accurately described our area of activity, (2) accurately described our desired workforce focus, (3) was practical to apply during the admissions process. We ultimately settled on a bespoke approach using a combination of the PHN and MMM to achieve the specificity required. This report provides an example of how a rural activity footprint can be accurately described and successfully employed to prioritise students from a geographical area for course admission. Lessons learned about the strengths and limitations of available geographical measures are shared. Applications of a precise footprint definition are described including student recruitment, evaluation of workforce outcomes for a geographic region, benefits to stakeholder relationships and an opportunity for more nuanced RHMT reporting. [ABSTRACT FROM AUTHOR]

Academics are expected to publish. In Australia universities receive extra funding based on their academic publication rates and academic promotion is difficult without a good publication record. However, the reality is that only a small percentage of academics are actively publishing. To fix this problem, a number of international universities and other higher education institutions have implemented interventions with the main aim being to increase the number of publications. A comprehensive literature search identified 17 studies published between 1984 and 2004, which examined the effects of these interventions. Three key types of interventions were identified: writing courses, writing support groups and writing coaches. The resulting publication output varied, but all interventions led to an increase in average publication rates for the participants.

The World Health Organization has endorsed the use of outreach to promote: efficient redeployment of the health-care workforce; continuity of care at the local level; and professional support for local, rural, health-care workers. Australia is the only country that has had, since 2000, a sustained national policy on outreach for subsidizing medical specialist outreach to rural areas. This paper describes the adoption, implementation and prioritization of a national specialist outreach policy in Australia. Adoption of the national policy followed a long history of successful outreach, largely driven by the professional interest and personal commitment of the workforce. Initially the policy supported only new outreach services but concerns about the sustainability of existing services resulted in eligibility for funding being extended to all specialist services. The costs of travel, travel time, accommodation, professional support, staff relief at specialists' primary practices and equipment hire were subsidized. Over time, a national political commitment to the equitable treatment of indigenous people resulted in more targeted support for outreach in remote areas. Current priorities are: (i) establishing team-based outreach services; (ii) improving local staff's skills; (iii) achieving local coordination; and (iv) conducting a nationally consistent needs assessment. The absence of subsidies for specialists' clinical work can discourage private specialists from providing services In remote areas where clinical throughput is low. To be successful, outreach policy must harmonize with the interests of the workforce and support professional autonomy. Internationally, the development of outreach policy must take account of the local pay and practice conditions of health workers. L'Organisation mondiale de la Sante a approuve l'utilisation de services de proximite pour promouvoir: le redeploiement efficace du personnel des soins de sante; la continuite des soins au niveau local; et le support professionnel au personnel de sante local et rural. L'Australie est le seul pays qui possede, depuis l'an 2000, une politique nationale soutenue de services de proximite afin de subventionner la presence de medecins specialistes dans les zones rurales. Cet article decrit l'adoption, la mise en oeuvre et la priorisation d'une politique nationale de proximite specialisee en Australie. L'adoption de cette politique nationale a fait suite a une longue histoire de services de proximite dont la reussite est largement attribuable a l'interet professionnel et a l'engagement personnel des professionnels de sante. A l'origine, cette politique soutenait seulement les nouveaux services de proximite, mais les preoccupations concernant la durabilite des services existants ont abouti a l'extension de l'admissibilite au financement a tous les services specialises. Les couts des deplacements, des temps de deplacement, d'hebergement, du soutien professionnel, de personnel de remplacement dans les cabinets primaires des medecins specialistes et de la location d'equipement ont ete subventionnes. Au fil du temps, l'engagement politique national pour le traitement equitable des populations autochtones a entraine un soutien plus cible pour acheminer les services de medecine mobile dans les zones reculees. Les priorites actuelles sont: (i) l'etablissement de services de proximite en equipe; (ii) l'amelioration des competences des professionnels locaux; (iii) la realisation de la coordination locale; et (iv) la conduite d'une evaluation coherente des besoins a lechelle nationale. L'absence de subventions pour le travail clinique des medecins specialistes peut decourager les medecins specialistes prives de venir soigner dans les zones eloignees ou le rendement clinique est faible. Pour quelle reussisse, la politique de proximite doit s'harmoniser avec les interets des professionnels de sante et soutenir l'autonomie professionnelle. A l'echelle internationale, le developpement de politiques de proximite doit tenir compte du salaire local et des conditions d'exercice des professionnels de la sante. La Organizacion Mundial de la Salud ha aprobado el uso de la difusion con el objetivo de promover la reasignacion eficiente del personal sanitario, la continuidad de la atencion a nivel local y el apoyo profesional para el personal sanitario a nivel local y rural. Australia es el unico pais que ha mantenido, desde el ano 2000, una politica nacional continuada en materia de subvencion de la difusion de especialistas medicos en las zonas rurales. Este articulo describe la adopcion, implementacion y prioridad de la politica de difusion de especialistas en dicho pais. La adopcion de la politica nacional obedecio a un largo historial de difusion con buenos resultados, impulsado en gran parte por el interes profesional y el compromiso personal de los trabajadores. En un principio, la politica apoyaba unicamente los servicios de difusion nuevos, pero la preocupacion acerca de la sostenibilidad de los servicios existentes auspicio una ampliacion de la financiacion a la totalidad de los servicios especializados. Se subvencionaron los costes y el tiempo de viaje, el alojamiento, el apoyo profesional, la asistencia al personal en los consultorios principales de los especialistas y el alquiler de equipos. Con el tiempo, el compromiso politico nacional respecto al trato equitativo de los pueblos indigenas se tradujo en un apoyo mas especifico para la difusion en las areas mas alejadas. Las prioridades actuales son: (i) establecer servicios perifericos por equipos, (ii) mejorar las capacidades del personal local, (iii) lograr la coordinacion local y (iv) llevar a cabo una evaluacion cohesiva de las necesidades a nivel nacional. La ausencia de subsidios para el trabajo clinico de los especialistas puede disuadir a los especialistas privados de prestar servicios en zonas remotas, en las que el rendimiento clinico es bajo. Para resultar satisfactoria, la politica de difusion debe armonizar los intereses del personal y apoyar la autonomia profesional. A nivel internacional, el desarrollo de una politica de divulgacion debe tener en cuenta los salarios y las condiciones locales de los miembros del personal sanitario., Introduction The World Health Organization (WHO) recognizes the need for policies designed to overcome the chronic undersupply of health workers in rural areas in both developed and developing countries. (1) [...]

Objective: To outline a new index of access to primary care services in rural areas that has been specifically designed to overcome weaknesses of using existing geographical classifications. Methods: Access was measured by four key dimensions of availability, proximity, health needs and mobility. Population data were obtained through the national census and primary care service data were obtained through the Medical Directory of Australia. All data were calculated at the smallest feasible geographical unit (collection districts). The index of access was measured using a modified two-step floating catchment area (2SFCA) method, which incorporates two necessary additional spatial functions (distance-decay and capping) and two additional non-spatial dimensions (health needs and mobility). Results: An improved index of access, specifically designed to better capture access to primary care in rural areas, is achieved. These improvements come from: 1) incorporation of actual health service data in the index; 2) methodological improvements to existing access measures, which enable both proximity to be differentiated within catchments and the use of varying catchment sizes; and 3) improved sensitivity to small-area variations. Conclusion: Despite their recognised weaknesses, the Australian government uses broad geographical classifications as proxy measures of access to underpin significant rural health funding programs. This new index of access could provide a more equitable means for resource allocation. Implications: Significant government funding, aimed at improving health service access inequities in rural areas, could be better targeted by underpinning programs with our improved access measure. Key words: Access to health care, primary care, rural health, government programs, indexes. doi: 10.1111/j.1753-6405.2009.00422.x