Objective
To examine associations between extended medical graduates’ rural clinical school (RCS) experience and geographic origins with practising in rural communities five and eight years after ...graduation.
Design, participants
Cohort study of 2011 domestic medical graduates from ten Australian medical schools with rural clinical or regional medical schools.
Main outcome measures
Practice location types eight years after graduation (2019/2020) as recorded by the Australian Health Practitioner Regulation Agency, classified as rural or metropolitan according to the 2015 Modified Monash Model; changes in practice location type between postgraduate years 5 (2016/2017) and 8 (2019/2020).
Results
Data were available for 1321 graduates from ten universities; 696 were women (52.7%), 259 had rural backgrounds (19.6%), and 413 had extended RCS experience (31.3%). Eight years after graduation, rural origin graduates with extended RCS experience were more likely than metropolitan origin graduates without this experience to practise in regional (relative risk RR, 3.6; 95% CI, 1.8–7.1) or rural communities (RR, 4.8; 95% CI, 3.1–7.5). Concordance of location type five and eight years after graduation was 92.6% for metropolitan practice (84 of 1136 graduates had moved to regional/rural practice, 7.4%), 26% for regional practice (56 of 95 had moved to metropolitan practice, 59%), and 73% for rural practice (20 of 100 had moved to metropolitan practice, 20%). Metropolitan origin graduates with extended RCS experience were more likely than those without it to remain in rural practice (RR, 2.0; 95% CI, 1.3–2.9) or to move to rural practice (RR, 1.9; 95% CI, 1.2–3.1).
Conclusion
The distribution of graduates by practice location type was similar five and eight years after graduation. Recruitment to and retention in rural practice were higher among graduates with extended RCS experience. Our findings reinforce the importance of longitudinal rural and regional training pathways, and the role of RCSs, regional training hubs, and the rural generalist training program in coordinating these initiatives.
A key strategy for increasing the supply of rural doctors is rurally located medical education. In 2000, Australia introduced a national policy to increase rural immersion for undergraduate medical ...students. This study aims to describe the characteristics and outcomes of the rural immersion programs that were implemented in Australian medical schools.
Information about 19 immersion programs was sourced in 2016 via the grey and published literature. A scoping review of the published peer-reviewed studies via Ovid MEDLINE and Informit (2000-2016) and direct journal searching included studies that focused on outcomes of undergraduate rural immersion in Australian medical schools from 2000 to 2016.
Programs varied widely by selection criteria and program design, offering between 1- and 6-year immersion. Based on 26 studies from 10 medical schools, rural immersion was positively associated with rural practice in the first postgraduate year (internship) and early career (first 10 years post-qualifying). Having a rural background increased the effects of rural immersion. Evidence suggested that longer duration of immersion also increases the uptake of rural work, including by metropolitan-background students, though overall there was limited evidence about the influence of different program designs. Most evidence was based on relatively weak, predominantly cross-sectional research designs and single-institution studies. Many had flaws including small sample sizes, studying internship outcomes only, inadequately controlling for confounding variables, not using metropolitan-trained controls and providing limited justification as to the postgraduate stage at which rural practice outcomes were measured.
Australia's immersion programs are moderately associated with an increased rural supply of early career doctors although metropolitan-trained students contribute equal numbers to overall rural workforce capacity. More research is needed about the influence of student interest in rural practice and the duration and setting of immersion on rural work uptake and working more remotely. Research needs to be more nationally balanced and scaled-up to inform national policy development. Critically, the quality of research could be strengthened through longer-term follow-up studies, adjusting for known confounders, accounting for postgraduate stages and using appropriate controls to test the relative effects of student characteristics and program designs.
Introduction: There is now strong evidence to support the positive impact of place-based medical education on the recruitment and retention of the rural health workforce in Australia. Much of this ...work, however, has been undertaken in the context of 'extended rural clinical placement' - students undertaking part of their medical degree in a rural location. Until recently, there were only a few places in Australia in which students could undertake the entirety of their medical degree in a rural area. With the introduction of the Murray-Darling Medical Schools Network (MDMSN) initiative, this dynamic is changing. The MDMSN is part of the Stronger Rural Health Strategy and builds on the Australian Government's existing Rural Health Multidisciplinary Training Program to establish a network of rurally based medical programs in the Murray-Darling region. The MDMSN offers a unique opportunity to explore the effect of complete rural immersion during medical school on subsequent rural practice. This article describes the establishment of a research collaboration intended to ensure the harmonisation of research data collection from the outset of the MDMSN program.
Methods: The MDMSN research collaboration is a longitudinal, multi-university program of work to explore the effect of rurally based medical school programs in the Murray-Darling region. Initially it has been agreed that administrative student data will be collected from existing university datasets to help characterise this novel student cohort. Each university will then distribute an entry survey to all first-year MDMSN students. The survey will collect demographic information as well as information regarding rural background, preferences and future practice intention. Questions have been aligned with and adapted from the Medical Schools Outcomes Database survey, the Australian Bureau of Statistics, and from the literature. This information will be combined with graduate information from the Australian Health Practitioner Regulation Agency.
Results: The MDMSN research collaboration will work toward the co-design of research projects, to facilitate and progress multi-site research addressing nationally relevant research questions. Early research efforts are focused on our ability to better understand the new cohort of students embarking on rurally based medical education, their practice intentions and realisation. Subsequent work of the collaboration May lead to deeper understanding of the rural student experience, any effect of 'place', changes in student professional identity over time, and their relationship to subsequent rural practice. Conclusion: The MDMSN research collaboration is a proactive initiative that brings together data and experience from five new rurally based medical programs, and answers calls for multi-institution and longitudinal studies. It is uniquely placed to capture the impact of the MDMSN program, including the effect of complete rural immersion on the future practice location of these graduates. Ultimately, the combined research efforts of the MDMSN research collaboration will add knowledge to address the known rural workforce maldistribution, particularly how to attract and retain medical workforce.
Inequitable distribution of health workforce limits access to healthcare services and contributes to adverse health outcomes. WHO recommends tracking health professionals from their points of entry ...into university and over their careers for the purpose of workforce development and planning. Previous research has focused on medical students and graduates' choice of practice location. Few studies have targeted nursing and allied health graduates' practice intentions and destinations. The Nursing and Allied Health Graduate Outcomes Tracking (NAHGOT) study is investigating factors affecting Australian nursing and allied health students and graduates' choice of graduate practice location over the course of their studies and up to 10 years after graduation by linking multiple data sources, including routinely collected university administrative and professional placement data, surveys of students and graduates, and professional registration data.
By using a prospective cohort study design, each year a new cohort of about 2000 students at each participating university (Deakin University, Monash University and the University of Newcastle) is tracked throughout their courses and for 10 years after graduation. Disciplines include medical radiation practice, nursing and midwifery, occupational therapy, optometry, paramedicine, pharmacy, physiotherapy, podiatry and psychology. University enrolment data are collected at admission and professional placement data are collected annually. Students' practice destination intentions are collected via questions added into the national Student Experience Survey (SES). Data pertaining to graduates' practice destination, intentions and factors influencing choice of practice location are collected in the first and third years after graduation via questions added to the Australian Graduate Outcomes Survey (GOS). Additionally, participants may volunteer to receive a NAHGOT survey in the second and fourth-to-tenth years after graduation. Principal place of practice data are accessed via the Australian Health Practitioner Regulation Agency (Ahpra) annually. Linked data are aggregated and analysed to test hypotheses comparing associations between multiple variables and graduate practice location.
This study seeks to add to the limited empirical evidence about factors that lead to rural practice in the nursing and allied health professions. This prospective large-scale, comprehensive study tracks participants from eight different health professions across three universities through their pre-registration education and into their postgraduate careers, an approach not previously reported in Australia. To achieve this, the NAHGOT study links data drawn from university enrolment and professional placement data, the SES, the GOS, online NAHGOT graduate surveys, and Ahpra data. The prospective cohort study design enables the use of both comparative analysis and hypothesis testing. The flexible and inclusive study design is intended to enable other universities, as well as those allied health professions not regulated by Ahpra, to join the study over time.
The study demonstrates how the systematic, institutional tracking and research approach advocated by the WHO can be applied to the nursing and allied health workforce in Australia. It is expected that this large-scale, longitudinal, multifactorial, multicentre study will help inform future nursing and allied health university admission, graduate pathways and health workforce planning. Furthermore, the project could be expanded to explore health workforce attrition and thereby influence health workforce planning overall.
This article analyzes the representation of fat in the HBO and BBC No 1. Ladies' Detective Agency TV series, assessing, amongst other concerns, whether the depiction of the series' heroine Mma ...Ramotswe as a proudly "overweight" or fat-positive character is dependent on the Western and Hollywoodian portrayal of a naïve, utopian, and exotically "other" Botswana. While Mma Ramotswe is of "traditional build" and proud of that, she must navigate the changes in notions of feminine beauty in Postcolonial Botswana, which are moving from curvaceous and dark to a more Eurocentric look. The TV series negotiates the tension between Mma Ramotswe's traditional build and the thinness regime, skilfully using the visual elements of television to offer its own interpretation of the series' heroine. Jill Scott, who plays Mma Ramotswe, reports wearing a fat suit for the series, but the actress' beauty, the colorful dresses, headscarves, and earrings worn by the TV character, and the regal way in which she carries herself, create a confident, voluptuous and even sensual look that strengthens the image of a woman who is truly comfortable in her body. Though voices in the series reinforce the ideal of thinness, the heroine resists all attempts to discipline her body and offers a countermodel for a fulfilled and satisfied woman.
English Abstract:
The governments of Rwanda and Burundi exhume mass graves with the promise of revealing truths about the contested histories of past conflict and genocide. In Rwanda, exhumations ...recover and conserve the bodies of victims of the genocide against the Tutsi. Since December 2019, the Truth and Reconciliation Commission in Burundi has also begun mass exhumations; these efforts are motivated by truth-seeking and reconciliation aspirations that articulate a specific narrative of victimhood and state legitimacy. The state employs vernacularised forms of forensic practices and ‘international’ rights-based discourses in both cases. Drawing on our respective ethnographic fieldwork, we describe and analyse exhumation practices in Rwanda and Burundi. The ‘forensic turn’ in post-conflict settings has been the subject of much discussion and debate among scholars since the proliferation of the practice over recent decades. We add to these debates in our consideration of two linked settings in which the exhumations had become powerful political tools, in this case serving as a source of power for specific regimes.
French Abstract:
Les gouvernements du Rwanda et du Burundi exhument des fosses communes en promettant d’éclaircir les vérités sur les histoires contestées des conflits et des génocides passés. Au Rwanda, les exhumations ont été organisée pour récupérer et conserver les corps des victimes du génocide contre les Tutsis. Depuis décembre 2019, la Commission Vérité et Réconciliation au Burundi a également entamé des exhumations de masse ; ces efforts sont motivés par des ambitions de recherche de la vérité et de réconciliation articulées autour d’un récit spécifique de victimisation et de légitimation de l’État. Dans les deux cas, l’État utilise des formes vernacularisées de pratiques médico-légales et des discours « internationaux » fondés sur les droits. En nous appuyant sur nos travaux ethnographiques de terrain respectifs, nous décrivons et analysons les pratiques d’exhumation au Rwanda et au Burundi. Le tournant médico-légal » dans les contextes post-conflits a fait l’objet de nombreuses discussions et débats parmi les chercheurs depuis la prolifération de ces pratiques au cours des dernières décennies. Nous contribuant à ces débats en examinant deux contextes liés dans lesquels les exhumations sont devenues de puissants outils politiques, servant dans ce cas de source de pouvoir pour des régimes spécifiques.
This paper will explore Philip Kerr’s Berlin Noir trilogy, composed of March Violets (1989), The Pale Criminal (1990), and A German Requiem (1991), discussing the overlap and blurring of generic ...boundaries in these novels and the ability of this form to reckon with the Holocaust. These detective stories are not directly about the Holocaust, and although the crimes investigated by the mordant Bernie Gunther are fictional, they are interweaved with the greater crimes committed daily by the Nazi Party. The novels are brutally realistic, violent, bleak, and harsh, in a narrative style highly appropriate for crime novels set in Nazi Germany. Indeed, with our knowledge of the enormity of the Nazi crimes, the violence in the novels seems not gratuitous but reflective of the era. Bernie Gunther himself, who is both hard-boiled protagonist and narrator, is a deeply flawed human, even an anti-hero, but in Berlin, which is “alive” as a character in these novels, his insights, cloaked in irony and sarcasm, highlight the struggle to resist, even passively, even just inside one’s own mind, the current of Nazism. Although many representations of the Holocaust in popular fiction strive towards the “feel good” story within the story, Kerr’s morally and generically ambiguous novels never give in to this urge, and the solution of the crime is never redemptive. The darkness of these novels, paired with the popularity of crime fiction, make for a significant vehicle for representing the milieu in which the Holocaust was able to occur.
Los niños, niñas y adolescentes con diabetes mellitus (DM) pueden requerir una cirugía durante su evolución. Estas recomendaciones están orientadas a definir los cambios necesarios en el esquema de ...insulina y monitoreo de glucosa antes, durante y después de la cirugía. Para ello, se realizó una búsqueda bibliográfica de las publicaciones en el tema de los últimos 5 años y se seleccionaron aquellas más relevantes. Las distintas publicaciones sugieren, ante la necesidad de una cirugía menor electiva, mantener el esquema de insulina basal o el perfil basal si el paciente utiliza una bomba de insulina, mantener la glucemia entre 90-180 mg%, controlarla de manera frecuente cada 30 minutos y, de ser necesario, realizar las correcciones con insulina rápida subcutánea. En caso de una cirugía mayor electiva, administrar insulina por infusión endovenosa, suspendiendo la bomba si el paciente la utiliza, mantener el objetivo y el monitoreo glucémico al igual que en la cirugía menor.
This paper is concerned with the mass graves and exhumed bodies of victims of the Rwanda genocide and war of the 1990s. A government-led programme of exhumation of mass burials and individual graves ...has taken place over the last decade. The exhumation of mass graves has been undertaken, in the main, by Tutsi genocide survivors who work under the supervision of state officials. Post-unearthing, these bodies are unravelled, and the remnants of soft flesh, clothing, personal possessions and bones are separated from each other. Skeletal structures are fully disarticulated and the bones pooled into a vast collective, for placement within memorials. The outcome of these exhumations is that remains almost always lack individual identity at the point of reinterring. A productive analytical comparison is found in examining exhumations of Spanish Civil War graves, where the fates of individual dead are closely entangled with the lives of survivors. Here there is a clear contrast with exhumations in Rwanda, in the possible re-articulation of identities with specific human remains. But a similarity is also critical: in both cases the properties of human remains, as unsettling materials, garner specific 'affects', which drive forward national political projects that aim to consolidate particular collective memories of conflict, albeit that this kind of 'material agency' is mobilized to very different ends in each case.
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