6.7.1 Universities

Lyle et al (2007:232) point out that even with the dedicated investment of the Department of Health and Ageing into the RCS and UDRH Programs, universities do not easily produce internal structures and processes which will facilitate rural health workforce choices amongst students. The authors suggest that increased collaboration across university health science departments and faculties might improve the level of promotion of rural health careers. Jones et al (2005:274) suggest that RCSs need to educate medical faculties and university academics to inculcate a positive perception of rural training. Influencing the medical and health system culture towards a more positive understanding of rural health services has been evident through the UDRHs and RCSs. Developing internal university systems which encourage health students to consider rural careers could be considered an in-kind contribution from the universities to the broader rural health workforce agenda.

'There seems to be a perpetual undermining of rural health by people in the city, people get here and realise how great it is and are surprised. This will be hard to overcome, I am not sure how.' (UDRH administrator)
Because the Programs receive dedicated funding from the Department of Health and Ageing, it has been suggested that some universities do not feel as much 'ownership' over the UDRH or RCS as they might if the school or department were fully part of the DEEWR-funded university structure. At the same time, other senior university stakeholders have emphasised the importance of the UDRHs and RCSs as components of their medical or health faculties.

While it was commonly understood that universities' funding is tightly stretched, the universities themselves contribute to the functioning of the RCS and UDRH Programs in many ways through infrastructure and institutional support, and it might be useful to explore ways in which their in-kind contributions to Programs can be measured. As the Programs mature and the individual sites become more embedded within their regions, heightening the universities' collaborations with RCSs and UDRHs would benefit the universities, the RCSs and UDRHs, and local communities. There would potentially be additional opportunities to promote further the universities’ engagement in the rural context.

Recommendation 16:

That the host universities be encouraged to explore new ways of promoting rural health careers, and particularly the opportunities available through the UDRH and RCS Programs, in collaboration with their UDRH and/or RCS.

Recommendation 17:

That the host universities explore, in collaboration with the Department, ways in which the in-kind contribution of the host universities might be recognised and quantified nationally.

6.7.2 Other workforce and training programs

Rural clinical schools and UDRHs also have partnerships with a range of stakeholders outside the university sector. As has been noted, both Programs are reliant on a network of alliances across the Federal and State/Territory-funded health services as well as within rural communities. It appears that all Program sites have made great efforts to make a positive contribution to the local community as well as to be seen as an enabler and support mechanism for the rural workforce. These efforts should continue in order to retain the sense of both Programs being embedded in the life of rural and remote Australia.

Integration with other training systems is primarily an issue for the RCS Program, concerning vertical integration of medical training. However, within the UDRH Program there is probably room for greater integration with other funding initiatives; in particular, funding mechanisms from the Department could probably be streamlined. For example, the processes of the various funding and scholarship initiatives could usefully be examined.

RUSC funding, while a medical initiative primarily affecting RCSs or university departments of general practice, in some instances is administered through the UDRH and creates a substantial additional workload. This is, however, substantially a local issue as each university determines how their RUSC funding is managed and expended. Questions were raised among some informants as to the effectiveness of the RUSC funding, which was generally considered to be insufficient funding in light of the increasing number of rural medical student placements which were required each year. It was recognised that the RUSC Program had contributed greatly to increasing the level of awareness of rural
health careers amongst medical students, and that its support for rural health clubs and short-term placements had been crucial in exposing a majority of medical students to the context of rural health practice. However, the RUSC requirements were considered to be onerous for the level of funding received, and some wondered whether the original aims of RUSC had been subsumed into the more recently-developed RCS Program.

There is great potential for the RCS and UDRH Programs to collaborate further, particularly in the area of interprofessional education. Some sites have developed significant shared training opportunities across disciplines, while others have preferred to maintain a separate and collegial relationship but not to integrate their students formally. In those places where, for instance, joint clinical training using simulation laboratories is available, students and academics perceived that the benefits were greater than simply the imparting of clinical knowledge; students learned to work together across disciplines and to understand what each discipline has to offer. Similar experiences were noted in places where short interdisciplinary placements were supported and students were brought together to spend a week in a rural location, exploring local health issues and learning how rural practitioners addressed population health issues. Most students - nursing, medical and allied health - considered that these types of interdisciplinary training opportunities were very important in preparation for rural health
practice.

However, relationships have evolved organically between UDRHs and RCSs over time, sometimes dependent upon the personality and operating style of the Program leadership. It appears that encouraging collaboration rather than mandating partnership allows each Program partner to recognise the other's distinctiveness and to find where they can each best add value to the other.

The PHCRED Program appears to work well with the UDRH Program, and was favourably mentioned by most informants. The various scholarship opportunities (RAMUS, RAHUS, John Flynn Placement Program) were also mentioned favourably by students, with several saying that the fact that there were a number of opportunities to get rural exposure meant that a student was provided with a variety of experiences and perspectives.

There may be scope to streamline these various mechanisms to support rural student exposure, however it is outside the scope of this evaluation to determine how best this might be realised. There may be efficiencies to be gained, however, from integrating co-ordination of the many funding streams; one example of this which has already been discussed (see section 6.4.2) is the centralising of student placement co-ordination.

Recommendation 18:

That both Programs be encouraged to collaborate and increase partnerships in training, research, and interprofessional clinical training, while recognising the independence of each Program and their different aims.

Recommendation 19:

That consideration be given to the future of the RUSC Program and whether its activities should be wholly absorbed by, and managed through, the RCSs.

Recommendation 20:

That opportunities to streamline some of the student support funding streams be explored.