Focus on British Columbia: the university perspective Carl Whiteside, MD, CCFP, FCFP Coordinator of the Rural Training Program, Department of Family Practice, University of British Columbia, Vancouver, BC Peter Newbery, MD, CCFP, FCFP Hazelton, BC Coodinator of the Enhanced Skills Program, Department of Family Practice, University of British Columbia, Vancouver, BC Can J Rural Med vol 2 (2):132 © 1997 Society of Rural Physicians of Canada From our involvement in rural practice, and now in the educational preparation of family practice residents for non-urban locations, it has become evident to us that rural medicine is rapidly gaining the respect and recognition it has always deserved. As a result of pressure from groups such as the Society of Rural Physicians of Canada (SRPC), many family practice academic training programs have now initiated rural training tracks,[1] and many provincial medical associations are incorporating societies of rural medicine into their organizations and are combining their efforts to develop a rural curriculum. The University of British Columbia (UBC) is no exception. Department of Family Practice, UBC: mission statement The mission statement of the Department of Family Practice at UBC is "the education of physicians who are effective providers of patient-centred care in the context of family and community. The Department will provide leadership in the stimulation and facilitation of academic and community-based research and education which addresses the needs of communities." With this in mind, the department has developed a community-based program that streams residents into specific areas of need including inner city, urban, regional (Prince George and Chilliwack) and rural community-based locations of training. Rural training program, Department of Family Practice, UBC The rural training program was initiated in 1981 by the late Dr. Mark Longhurst. It is a community-based training program, which focuses on training residents to meet the needs of rural medicine. It has now graduated 91 physicians capable of practising competently in rural Canada.[2­4] A study of graduates between 1981 and 1992 demonstrated that 50% were practising in isolated rural locations and an additional 20% in non-metropolitan areas of BC. Ninety percent of these graduates felt well prepared to practise in rural locations.[5] Recruitment and retention meetings In 1989 and 1991, the Department of Family Practice at UBC hosted meetings to discuss rural recruitment and retention issues. Out of these meetings arose some of the following projects that are now in place and whose effectiveness currently is being assessed.[6] The national recruitment and retention consensus meeting held at the SRPC conference in Banff in April of last year[7] verified the needs and educational strategies identified at the UBC meetings as they related to future rural physician manpower needs. Curriculum change and flexibility One of the problems faced by new graduates practising in rural areas is that they sometimes feel unprepared for rural practice. Our study done on outcome and preparedness of rural graduates from the UBC family practice program looked at areas of underpreparedness.5 An example of underpreparedness identified in the study was in the area of orthopedic skills. We asked an expert group of rural physicians if general orthopedic skills were important to their skill needs and we received an affirmative response. This led to a review of how these skills were taught, who taught them and whether the content of the experience was appropriate. It appeared that the training was not appropriate and, as a result, a curriculum change was made to correct this deficit. The process of relating needs to training is ongoing, requiring flexibility in curriculum development and modification. Enhanced skills program In 1994, the Department of Family Medicine established an enhanced skills program for rural doctors, directed by Dr. Peter Newbery. This program is aimed at meeting specific medical special-skills needs as identified by rural communities. Practising physicians from those communities who are willing to meet these needs are offered the opportunity to train in a user-friendly and flexible curriculum. Candidates are offered the paid opportunity, for up to a year, to train in such areas as psychiatry, anesthesia, surgery, obstetrics and emergency medicine. Other areas can be considered. The aim is that this training would be carried out in a flexible environment, well evaluated, and tailored to the development of skills usable in the individual's home community. We are working to have the training take place, where possible, in a location that will allow individuals to maintain a realistic connection with their home setting and practice. A pilot program is also in place allowing paid periods of 2 months for rural physicians to upgrade their special skills. The Internet The UBC Department of Family Practice has financially supported Internet access for rural doctors and residents who are involved in the UBC training program. Although this has been a slow process to implement, we now offer UBC-based email addresses and World Wide Web access to all participating rural physicians. We have also encouraged them to link into the email discussion groups of both the SRPC (jwootton@fox.nstn.ca) and the Canadian Rural Medicine Network (www.cfpc.ca/carmen/index.htm) of the College of Family Physicians of Canada. Recently, the university has offered 5 hours a month of free Internet access to all our community-based faculty. One problem remaining is to reduce the cost of long-distance access to the UBC server. We expect to have this problem resolved in the near future. In our opinion, networking through this technology is vital to the future of establishing a strong voice for rural medicine in Canada. CME teleconferences The Department of Family Practice, along with the Division of Continuing Medical Education, Faculty of Medicine, UBC, are committed to delivering relevant, cost-effective and appropriate CME to rural doctors and their allied health care colleagues. On alternate Tuesdays throughout the fall and spring of each year, 20 sessions are offered to isolated communities throughout the province. Each presentation is 1 hour long, case-based (for the most part) and, according to our evaluation system, appreciated by the participants. This 2-way audio program allows communication among presenters and participants. Each session involves 170 to 200 rural doctors located in 27 rural communities within BC. Community-based research Clearly, we should not be attempting to meet the perceived needs of rural medicine but rather evidence-based community needs. The Department of Family Practice at UBC is pursuing this type of research. Stage I granting has been awarded to the department by the BC Health Research Foundation to begin a project, based on university­community cooperation, to access the medical special-skills needs of rural communities in BC. Another innovative project directed by the department relates to teaching procedural skills to rural doctors using distance education technology. British Columbia Medical Association (BCMA) In British Columbia, it is anticipated that the BCMA will accept the formation of a rural section. Presently, the rural interest group has the status of a standing committee and, on talking with the chair of this group, Dr. Geoff Appleton of Terrace, BC, it is expected that they will move toward section status in the near future. Members of this committee include Dr. Granger Avery (GP, Port McNeill), president-elect of the BCMA, Dr. Geoffrey Battersby (GP, Revelstoke), Dr. Al Lomax (general surgeon, Dawson Creek) and Dr. George Watson (GP, Prince Rupert). Northern and Rural Task Force In addition to the efforts of rural physicians and the Department of Family Practice to deal with the problems of rural health care delivery , the BC Ministry of Health has taken some early helpful steps toward addressing some physician resource issues. Acting on the recommendations of its multidisciplinary Northern and Rural Task Force, the ministry has established two offices. The first is the Physician Recruitment Office, which to date has had requests from some 40 communities to fill upward of 50 vacancies (including vacancies in general practice, family practice, surgery, GP anesthesia, psychiatry and ophthalmology, to name a few). To date, 21 of the vacancies have been filled (for information contact the Physician Recruitment Office at 604 736-5909 or visit their Web site at www.heabc.bc.ca). The second is the British Columbia Locum Office, at present operated by the Ministry of Health and available to assist in finding locum support for communities with 3 physicians or fewer. This program is flexible and financially rewarding, and it is hoped it will be of interest to a wide range of physicians, including those who have had experience as newly graduated family practice residents trained in rural and regional programs (for information call 250 952-3200). The future UBC's Department of Family Practice, like many family practice academic training programs1 has initiated rural training tracks. The BCMA is forming a section of rural medicine. Rural physicians in BC are linked across geographic barriers by the Internet. The BC government is assisting recruitment for rural communities needing rural physicians. All of these initiatives must be assessed with outcome measurements. If they are not working, they should be revised. Continued leadership from the SRPC, and now the College of Family Physicians of Canada and other national organizations, is essential to ensure that rural communities in BC continue to have access to good medical care. References Rourke JTB. Postgraduate education for rural family practice. Can Fam Physician 1988;34:1057-60. Longhurst MF. Training for rural practice: What is the core curriculum? Can Fam Physician 1987;33:2763-7. Whiteside CBC, Longhurst MF. Establishment of a community-based residency training program. Can Fam Physician 1987;33:2751-4. Fine JPJ. The rural physician as preceptor. Can Fam Physician 1990;36:2020-6. Whiteside CBC, Mathias R. An evaluation of training for rural practice in British Columbia. Can Fam Physician 1996;42:1113-21. Whiteside CBC, Mathias R. Strategies for recruitment and retention of doctors for rural BC [working paper]. Vancouver: University of British Columbia, Department of Family Practice; May 1989. Recruitment and retention: consensus of the conference participants, Banff 1996. Can J Rural Med 1997;2(1):28-31. Table of contents: Volume 2, Issue 3