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Aust. J. Rural Health (2014) 22, 75–79
Original Research Prevocational exposure to public health in the Kimberley: A pathway to rural, remote and public health practice Alexandra Hofer,1 Jake Parker, Bsc, Msc, MBBS,1 David Atkinson, MBBS, MPH,2,3 Sarah Moore, MBBS, FRACGP, FARGP, FACRRM, DRANZCOG,3 Carole Reeve, MBChB, Dip Obs, DCH, MPH&TM, RACGP, FACRRM, FAFPHM1 and Donna B. Mak, MBBS, MPH, Dip RACOG, FAFPHM, FACRRM4 1
Kimberley Population Health Unit, Western Australia Country Health Service, 2Kimberley Aboriginal Medical Services Council, 3Rural Clinical School of Western Australia, University of Western Australia, Broome, and 4School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
Abstract Objective: To evaluate the Kimberley Population Health Unit (KPHU) prevocational public health placement in terms of its contribution to resident medical officers’ (RMOs’) knowledge, skills, career path and aspirations. Design: All RMOs who had completed a public health placement at the KPHU (n = 27) during 2001–2012 were invited to complete an online survey in September 2012. Setting: The KPHU, based in Broome, provides population health services to the Kimberley region, far north Western Australia. Main outcome measures: The extent to which RMOs perceived the development of public health skills and knowledge during the placement, and the degree to which RMOs believe this placement influenced future career pathways and their current practice. Results: Twenty-three RMOs (85%) completed the survey. Sixty per cent are currently working in general practice or public health medicine; of these, 43% have returned to the Kimberley. Over 70% reported that the placement developed their knowledge of public health and Aboriginal health to a ‘great’ or ‘very great’ extent. Sixty-one per cent felt that their placement influenced their future desire to work in public health ‘a lot’ or ‘a great extent’. Conclusion: This placement provides a unique opportunity for RMOs to undertake public health and Aboriginal health work in a remote setting. Given the
Correspondence: Dr Alexandra Hofer, PO Box 525, Broome, Western Australia, 6725, Australia. Email: alexandra. [email protected] Competing interests: None Accepted for publication 22 November 2013. © 2014 National Rural Health Alliance Inc.
increasing demand for prevocational placements, the value of imparting sound public health knowledge to the next generation of doctors and the urgent need to recruit and retain rural doctors, this placement provides a potential model that could be expanded to other locations. KEY WORDS: Aboriginal health, primary health care, program evaluation, public health, remote health.
Introduction A prevocational placement in public health and primary health was commenced in 2001 and involves a 24-week placement at the Kimberley Population Health Unit (KPHU), based in Broome, far northern Western Australia (WA). This placement has been described as Australia’s first accredited prevocational position in public health medicine (with a primary focus on communicable disease) and primary health care.1,2 In 2010, the program expanded from two to four 24-week resident medical officer (RMO) placements per year, and the placement’s scope broadened to include non-communicable as well as communicable diseases. This change is in line with burgeoning health needs both regionally and globally in chronic non-communicable disease. The Kimberley region has a population of approximately 35 000, with 40% identifying as Aboriginal (compared with 2.5% Australia-wide).3 Health-care services in the Kimberley predominantly involve a combination of primary and secondary services provided by both the State and a network of Aboriginal Community Controlled Health Services with limited availability of private practice. The KPHU provides public health services for the region and manages several remote area primary health services. doi: 10.1111/ajr.12089
76
A. HOFER ET AL.
What is already known on this subject: • There are very few opportunities for prevocational work in public health in Australia. • This placement provides RMOs with a better understanding of public health and Aboriginal health.
During the placement, RMOs (predominantly postgraduate year three) undertake a wide range of public health practices including screening programs, disease surveillance, clinical audits and contact tracing, with a focus on the implementation of these in the context of remote areas and Aboriginal health. RMO experiences in this position have previously been described through the evaluation of reflective journals, interviews and project reports.2 This study aims to evaluate the KPHU placement in terms of its contribution to RMOs’ knowledge, skills, career path and aspirations.
What this study adds: • Prevocational public health placements have been sustained and expanded in a remote region since 2001. • RMOs who have previously completed this placement frequently pursue further training in general practice, public health, Aboriginal health and rural medicine.
and the Western Australia Country Health Service Human Research Ethics Committee.
Results Eighty-five per cent (23/27) of eligible RMOs responded to the online survey. The time interval between placement completion and survey response ranged from four months to 11 years, with a median of four years. Three quarters (74%) of respondents were women.
Methods
Current practice
An online survey with ten questions was developed to examine:
All respondents reported being enrolled in, or having completed, vocational training – 43% in GP, 17% each in public health and internal medicine, and the remaining 23% in paediatrics, anaesthetics, psychiatry and emergency medicine (Fig. 1). Forty-three per cent of those in GP or public health (6/14) have returned to the Kimberley to continue vocational training or pursue further employment. Of those in GP, 50% currently work in rural or remote settings (including 40% who returned to the Kimberley after their placement). Almost one third (30%) of respondents reported that they were currently working in Aboriginal health on a full-time basis, with 57% working in this field at least one
•
Knowledge and skills developed during the KPHU placement • How the placement influenced RMOs’ career path and future aspirations • RMOs’ current career. The survey was purposely brief to maximise response rates. All RMOs who had completed a public health placement at the KPHU (n = 27) during 2001–2012 were invited to complete an online survey in September 2012. Participants were recruited using contact details available in KPHU records. Where contact details were out of date, details were sought through publicly accessible sources, such as the Australian Health Practitioner Regulation Agency. Participants were invited via email to participate in the online survey, and this was followed up by telephone where required. Data were analysed using SPSS Statistics 17.0 (SPSS Inc., Chicago, IL, USA) and Microsoft Excel 2003 (Microsoft Corporation, Redmond, Washington, USA). Quantitative descriptive analysis was undertaken. Free text comments from participant surveys were also recorded and used to support key findings of the quantitative data. Ethics approval was obtained from the University of Western Australia Human Research Ethics Committee
FIGURE 1: Proportion of respondents by current vocation or training program. © 2014 National Rural Health Alliance Inc.
77
PREVOCATIONAL PUBLIC HEALTH IN THE KIMBERLEY
and contributed to eight peer-reviewed publications covering topics including sexually transmitted infections, diabetes and rheumatic heart disease.4–11
Perceived placement value Ninety-one per cent of respondents ‘agreed’ or ‘strongly agreed’ that their KPHU placement was worthwhile. The same proportion of respondents ‘agreed’ or ‘strongly agreed’ that there should be more prevocational opportunities in public health. This was echoed by a participant who suggested that ‘there should definitely be more RMO opportunities in public health as it’s very difficult to gain experience without committing to a masters and/or training program first’. FIGURE 2: Proportion of respondents who developed various skills and knowledge during their placement. (( ) no answer; ( ) no extent; ( ) moderate – some extent; ( ) very great – great extent.)
day per week. Similarly, 30% of respondents identified currently working in rural/remote health on a full-time basis, with 43% working in this field at least one day per week.
Knowledge and skills Figure 2 demonstrates skills and knowledge developed by participants during the placement. One participant reflected that the placement enhanced their views of health as well as other aspects of society, in that it ‘opened my eyes to many aspects of medicine, society, history and geography’. Another respondent reflected that they also ‘learnt a lot about working with a multidisciplinary team, different modes of communication, using initiative to solve problems, and adapting to new environments’. Seventy-eight per cent of respondents identified involvement in screening programs to a ‘great’ or ‘very great’ extent, with 70% identifying involvement in disease surveillance to a similar degree. More than half of respondents identified developing skills in designing a research question and methods of data collection to a ‘great’ or ‘very great’ extent. One respondent reported that the placement provided ‘a good introduction to basic research techniques including developing a research proposal, ethics application, and accessing/collecting data, plus engaging local health workers and experienced practitioners to develop a useful research proposal’. Although difficult to quantify the contribution of RMOs to the overall public health practice in the Kimberley, RMOs have completed more than 20 audits © 2014 National Rural Health Alliance Inc.
Future desire Sixty-one per cent of respondents felt that their placement influenced their future desire to work in public health ‘a lot’ or ‘a great deal’. The same proportion of respondents indicated that the placement also influenced their future desire to work in Aboriginal health to the same degree. Two respondents felt that their placement did not influence or negatively influenced their future desire to work in public health, one of whom suggested that despite this, ‘for the program to be a success, it doesn’t necessarily have to recruit people to public health or the Kimberley, it still provides a unique and valuable experience to doctors who pursue other pathways’. Fifty-two per cent of respondents felt that their placement influenced their future desire to work in rural and remote health ‘a lot’ or ‘a great deal’. Another participant reported that even though ‘I probably wasn’t cut out for remote medicine; I am still passionate about public health and Indigenous health’.
Discussion As described previously,2 this study demonstrates that the KPHU placement provides a unique and ‘worthwhile’ opportunity for prevocational trainees to gain exposure to public health and Aboriginal health in a remote setting. The placement has facilitated the development of research skills, public health knowledge and provided RMOs with exposure to public health and primary health-care activities. In addition, RMOs have contributed to several areas of research and public health operational roles during this placement. Although this study is unable to draw causal inferences regarding the influence of this placement on career pathways, a significant number of previous KPHU RMOs currently work in GP, public health, Aboriginal health and rural/remote health. As such, this placement has
78
provided future GPs who work in remote areas and Aboriginal health with an opportunity to gain a greater population health perspective early in their careers. The survey design involved a limited number of questions to minimise non-response and had a good response rate of 85%; however, there remains potential bias due to non-response. There was a variable and often long time frame between placement and survey completion, leading to probable recall bias particularly for more qualitative variables. The survey did not capture potential exposure to public health or rural and remote health prior to the placement or other experiences during the intervening time between placement and survey. Negative comments may also have been underreported given the nature of the survey categories available to participants. Given that public health physicians account for less than 1% of the Australian medical workforce12,13 and 17% (n = 4) of KPHU RMOs are currently practising or pursuing careers in this field, there appears to be a positive association between the KPHU placement and undertaking training in this specialty area. A similar association was found in GP, with 43% of KPHU RMOs currently working in GP compared with 35% of Australian doctors working in primary care in 2009.12 Additionally, of the GPs or GP trainees, 50% are now working in regional or remote settings compared with 32% of Australian GPs who worked in these areas during 2009–2010.12 Despite Mak et al.’s suggestion in 2006 that ‘more prevocational medical placements in public health and remote area health should be offered’,2 there is only one other similar placement in WA,14 and no public health placements for prevocational doctors identified in other Australian jurisdictions. Public health plays an essential role in disease prevention and health promotion, skills important to all medical practitioners (regardless of their speciality) in a time of burgeoning chronic disease, an aging population and increasing health-care expenditure. The current high demand for prevocational placements to accommodate Australia’s growth in medical graduate numbers15 is predicted to continue, as is the urgent need to recruit and retain rural doctors. Placements such as KPHU’s prevocational public health program have the potential to address these issues. Medical practitioners and the community would benefit from the program being expanded to other locations.
Acknowledgements Thank you to all current and past KPHU supervisors and staff for their support of this placement. We acknowledge the Prevocational General Practice Placement Program (PGPPP) for funding this placement.
A. HOFER ET AL.
Author contributions A.H. and J.P. were involved in study design, data collection, analysis and interpretation of results. D.A. was involved in data collection, analysis and interpretation of results. S.M. and C.R. were involved in study design, analysis and interpretation of results. D.M. was involved in interpretation of results. All authors contributed to drafting and revision of this paper.
References 1 Mak DB, Plant AJ. Reducing unmet needs: a prevocational medical training program in public health medicine and primary health care in remote Australia. The Australian Journal of Rural Health 2005; 13: 183–190. 2 Mak DB, Plant AJ, Toussaint S. ‘I had learnt . . . a different way of looking at people’s health’: an evaluation of a prevocational medical training program in public health medicine and primary health care in remote Australia. Medical Teacher 2006; 28: e149–e155. 3 Australian Bureau of Statistics. 2011 Census Quick Stats – Kimberley [Internet]. Commonwealth of Australia: Australian Bureau of Statistics; c2011 2012. [Cited 30 Oct 2012]. Available from URL: http://www.censusdata.abs.gov.au/ census_services/getproduct/census/2011/quickstat/50804? opendocument&navpos=220 4 Chaves N, Weeramanthri T, Mak D et al. Diabetes audit can aid practice development in a range of indigenous health care settings. The Australian Journal of Rural Health 2001; 9: 251–253. 5 Harch S, Reeve D, Reeve C. Management of type 2 diabetes – a community partnership approach. Australian Family Physician 2012; 41: 73–76. 6 Mak DB, Johnson GH, Plant AJ. A syphilis outbreak in remote Australia: epidemiology and strategies for control. Epidemiology and Infection 2004; 132: 805–812. 7 Marley JV, Davis S, Coleman K et al. Point-of-care testing of capillary glucose in the exclusion and diagnosis of diabetes in remote Australia. The Medical Journal of Australia 2007; 186: 500–503. 8 McIver L, Xiao J, Lindsay MD, Rowe T, Yun G. A climatebased early warning system to predict outbreaks of Ross River virus disease in the Broome region of Western Australia. Australian and New Zealand Journal of Public Health 2010; 34: 89–90. 9 Mossenson A, Algie K, Olding M, Garton L, Reeve C. ‘Yes wee can’ – a nurse-driven asymptomatic screening program for chlamydia and gonorrhoea in a remote emergency department. Sexual Health 2012; 9: 194–195. 10 Rémond MG, Severin KL, Hodder Y et al. Variability in disease burden and management of rheumatic fever and rheumatic heart disease in two regions of tropical Australia. Internal Medicine Journal 2013; 43: 386–393. 11 Tate J, Mein J, Freeman H, Maguire G. Grey nomads – health and health preparation of older travellers in remote Australia. Australian Family Physician 2006; 35: 70– 72. © 2014 National Rural Health Alliance Inc.
PREVOCATIONAL PUBLIC HEALTH IN THE KIMBERLEY
12 Health Workforce Australia. Australia’s Heath Workforce Series – Doctors in focus [Internet]. Health Workforce Australia: Adelaide; 2012. [Cited 17 Dec 2013]. Available from URL: https://www.hwa.gov.au/sites/uploads/ australias_health_workforce_series_doctors_in_focus _20120322.pdf 13 Human Capital Alliance. The unique contribution of public health physicians to the public health workforce. [Internet] Human Capital Alliance: NSW Adelaide; 2010; [Cited 22 Dec 2013]. Available from URL: http://www .racp.edu.au/index.cfm?objectid=14E7A4B4-9C5F-6B8F -66ABAE9BAE3FF9FD
© 2014 National Rural Health Alliance Inc.
79 14 Department of Health (WA). English doctor making a difference in Geraldton. Healthview [Internet]. Government of Western Australia; Summer 2012; p15. [Cited 17 Dec 2013]. Available from URL: http://www.health.wa.gov .au/publications/documents/healthview/HEALTHVIEW _SUMMER2012.pdf 15 Crotty BJ, Brown T. An urgent challenge: new training opportunities for junior medical officers. The Medical Journal of Australia 2007; 186: s25–s27.
Aust. J. Rural Health (2014) 22, 75–79
Original Research Prevocational exposure to public health in the Kimberley: A pathway to rural, remote and public health practice Alexandra Hofer,1 Jake Parker, Bsc, Msc, MBBS,1 David Atkinson, MBBS, MPH,2,3 Sarah Moore, MBBS, FRACGP, FARGP, FACRRM, DRANZCOG,3 Carole Reeve, MBChB, Dip Obs, DCH, MPH&TM, RACGP, FACRRM, FAFPHM1 and Donna B. Mak, MBBS, MPH, Dip RACOG, FAFPHM, FACRRM4 1
Kimberley Population Health Unit, Western Australia Country Health Service, 2Kimberley Aboriginal Medical Services Council, 3Rural Clinical School of Western Australia, University of Western Australia, Broome, and 4School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
Abstract Objective: To evaluate the Kimberley Population Health Unit (KPHU) prevocational public health placement in terms of its contribution to resident medical officers’ (RMOs’) knowledge, skills, career path and aspirations. Design: All RMOs who had completed a public health placement at the KPHU (n = 27) during 2001–2012 were invited to complete an online survey in September 2012. Setting: The KPHU, based in Broome, provides population health services to the Kimberley region, far north Western Australia. Main outcome measures: The extent to which RMOs perceived the development of public health skills and knowledge during the placement, and the degree to which RMOs believe this placement influenced future career pathways and their current practice. Results: Twenty-three RMOs (85%) completed the survey. Sixty per cent are currently working in general practice or public health medicine; of these, 43% have returned to the Kimberley. Over 70% reported that the placement developed their knowledge of public health and Aboriginal health to a ‘great’ or ‘very great’ extent. Sixty-one per cent felt that their placement influenced their future desire to work in public health ‘a lot’ or ‘a great extent’. Conclusion: This placement provides a unique opportunity for RMOs to undertake public health and Aboriginal health work in a remote setting. Given the
Correspondence: Dr Alexandra Hofer, PO Box 525, Broome, Western Australia, 6725, Australia. Email: alexandra. [email protected] Competing interests: None Accepted for publication 22 November 2013. © 2014 National Rural Health Alliance Inc.
increasing demand for prevocational placements, the value of imparting sound public health knowledge to the next generation of doctors and the urgent need to recruit and retain rural doctors, this placement provides a potential model that could be expanded to other locations. KEY WORDS: Aboriginal health, primary health care, program evaluation, public health, remote health.
Introduction A prevocational placement in public health and primary health was commenced in 2001 and involves a 24-week placement at the Kimberley Population Health Unit (KPHU), based in Broome, far northern Western Australia (WA). This placement has been described as Australia’s first accredited prevocational position in public health medicine (with a primary focus on communicable disease) and primary health care.1,2 In 2010, the program expanded from two to four 24-week resident medical officer (RMO) placements per year, and the placement’s scope broadened to include non-communicable as well as communicable diseases. This change is in line with burgeoning health needs both regionally and globally in chronic non-communicable disease. The Kimberley region has a population of approximately 35 000, with 40% identifying as Aboriginal (compared with 2.5% Australia-wide).3 Health-care services in the Kimberley predominantly involve a combination of primary and secondary services provided by both the State and a network of Aboriginal Community Controlled Health Services with limited availability of private practice. The KPHU provides public health services for the region and manages several remote area primary health services. doi: 10.1111/ajr.12089
76
A. HOFER ET AL.
What is already known on this subject: • There are very few opportunities for prevocational work in public health in Australia. • This placement provides RMOs with a better understanding of public health and Aboriginal health.
During the placement, RMOs (predominantly postgraduate year three) undertake a wide range of public health practices including screening programs, disease surveillance, clinical audits and contact tracing, with a focus on the implementation of these in the context of remote areas and Aboriginal health. RMO experiences in this position have previously been described through the evaluation of reflective journals, interviews and project reports.2 This study aims to evaluate the KPHU placement in terms of its contribution to RMOs’ knowledge, skills, career path and aspirations.
What this study adds: • Prevocational public health placements have been sustained and expanded in a remote region since 2001. • RMOs who have previously completed this placement frequently pursue further training in general practice, public health, Aboriginal health and rural medicine.
and the Western Australia Country Health Service Human Research Ethics Committee.
Results Eighty-five per cent (23/27) of eligible RMOs responded to the online survey. The time interval between placement completion and survey response ranged from four months to 11 years, with a median of four years. Three quarters (74%) of respondents were women.
Methods
Current practice
An online survey with ten questions was developed to examine:
All respondents reported being enrolled in, or having completed, vocational training – 43% in GP, 17% each in public health and internal medicine, and the remaining 23% in paediatrics, anaesthetics, psychiatry and emergency medicine (Fig. 1). Forty-three per cent of those in GP or public health (6/14) have returned to the Kimberley to continue vocational training or pursue further employment. Of those in GP, 50% currently work in rural or remote settings (including 40% who returned to the Kimberley after their placement). Almost one third (30%) of respondents reported that they were currently working in Aboriginal health on a full-time basis, with 57% working in this field at least one
•
Knowledge and skills developed during the KPHU placement • How the placement influenced RMOs’ career path and future aspirations • RMOs’ current career. The survey was purposely brief to maximise response rates. All RMOs who had completed a public health placement at the KPHU (n = 27) during 2001–2012 were invited to complete an online survey in September 2012. Participants were recruited using contact details available in KPHU records. Where contact details were out of date, details were sought through publicly accessible sources, such as the Australian Health Practitioner Regulation Agency. Participants were invited via email to participate in the online survey, and this was followed up by telephone where required. Data were analysed using SPSS Statistics 17.0 (SPSS Inc., Chicago, IL, USA) and Microsoft Excel 2003 (Microsoft Corporation, Redmond, Washington, USA). Quantitative descriptive analysis was undertaken. Free text comments from participant surveys were also recorded and used to support key findings of the quantitative data. Ethics approval was obtained from the University of Western Australia Human Research Ethics Committee
FIGURE 1: Proportion of respondents by current vocation or training program. © 2014 National Rural Health Alliance Inc.
77
PREVOCATIONAL PUBLIC HEALTH IN THE KIMBERLEY
and contributed to eight peer-reviewed publications covering topics including sexually transmitted infections, diabetes and rheumatic heart disease.4–11
Perceived placement value Ninety-one per cent of respondents ‘agreed’ or ‘strongly agreed’ that their KPHU placement was worthwhile. The same proportion of respondents ‘agreed’ or ‘strongly agreed’ that there should be more prevocational opportunities in public health. This was echoed by a participant who suggested that ‘there should definitely be more RMO opportunities in public health as it’s very difficult to gain experience without committing to a masters and/or training program first’. FIGURE 2: Proportion of respondents who developed various skills and knowledge during their placement. (( ) no answer; ( ) no extent; ( ) moderate – some extent; ( ) very great – great extent.)
day per week. Similarly, 30% of respondents identified currently working in rural/remote health on a full-time basis, with 43% working in this field at least one day per week.
Knowledge and skills Figure 2 demonstrates skills and knowledge developed by participants during the placement. One participant reflected that the placement enhanced their views of health as well as other aspects of society, in that it ‘opened my eyes to many aspects of medicine, society, history and geography’. Another respondent reflected that they also ‘learnt a lot about working with a multidisciplinary team, different modes of communication, using initiative to solve problems, and adapting to new environments’. Seventy-eight per cent of respondents identified involvement in screening programs to a ‘great’ or ‘very great’ extent, with 70% identifying involvement in disease surveillance to a similar degree. More than half of respondents identified developing skills in designing a research question and methods of data collection to a ‘great’ or ‘very great’ extent. One respondent reported that the placement provided ‘a good introduction to basic research techniques including developing a research proposal, ethics application, and accessing/collecting data, plus engaging local health workers and experienced practitioners to develop a useful research proposal’. Although difficult to quantify the contribution of RMOs to the overall public health practice in the Kimberley, RMOs have completed more than 20 audits © 2014 National Rural Health Alliance Inc.
Future desire Sixty-one per cent of respondents felt that their placement influenced their future desire to work in public health ‘a lot’ or ‘a great deal’. The same proportion of respondents indicated that the placement also influenced their future desire to work in Aboriginal health to the same degree. Two respondents felt that their placement did not influence or negatively influenced their future desire to work in public health, one of whom suggested that despite this, ‘for the program to be a success, it doesn’t necessarily have to recruit people to public health or the Kimberley, it still provides a unique and valuable experience to doctors who pursue other pathways’. Fifty-two per cent of respondents felt that their placement influenced their future desire to work in rural and remote health ‘a lot’ or ‘a great deal’. Another participant reported that even though ‘I probably wasn’t cut out for remote medicine; I am still passionate about public health and Indigenous health’.
Discussion As described previously,2 this study demonstrates that the KPHU placement provides a unique and ‘worthwhile’ opportunity for prevocational trainees to gain exposure to public health and Aboriginal health in a remote setting. The placement has facilitated the development of research skills, public health knowledge and provided RMOs with exposure to public health and primary health-care activities. In addition, RMOs have contributed to several areas of research and public health operational roles during this placement. Although this study is unable to draw causal inferences regarding the influence of this placement on career pathways, a significant number of previous KPHU RMOs currently work in GP, public health, Aboriginal health and rural/remote health. As such, this placement has
78
provided future GPs who work in remote areas and Aboriginal health with an opportunity to gain a greater population health perspective early in their careers. The survey design involved a limited number of questions to minimise non-response and had a good response rate of 85%; however, there remains potential bias due to non-response. There was a variable and often long time frame between placement and survey completion, leading to probable recall bias particularly for more qualitative variables. The survey did not capture potential exposure to public health or rural and remote health prior to the placement or other experiences during the intervening time between placement and survey. Negative comments may also have been underreported given the nature of the survey categories available to participants. Given that public health physicians account for less than 1% of the Australian medical workforce12,13 and 17% (n = 4) of KPHU RMOs are currently practising or pursuing careers in this field, there appears to be a positive association between the KPHU placement and undertaking training in this specialty area. A similar association was found in GP, with 43% of KPHU RMOs currently working in GP compared with 35% of Australian doctors working in primary care in 2009.12 Additionally, of the GPs or GP trainees, 50% are now working in regional or remote settings compared with 32% of Australian GPs who worked in these areas during 2009–2010.12 Despite Mak et al.’s suggestion in 2006 that ‘more prevocational medical placements in public health and remote area health should be offered’,2 there is only one other similar placement in WA,14 and no public health placements for prevocational doctors identified in other Australian jurisdictions. Public health plays an essential role in disease prevention and health promotion, skills important to all medical practitioners (regardless of their speciality) in a time of burgeoning chronic disease, an aging population and increasing health-care expenditure. The current high demand for prevocational placements to accommodate Australia’s growth in medical graduate numbers15 is predicted to continue, as is the urgent need to recruit and retain rural doctors. Placements such as KPHU’s prevocational public health program have the potential to address these issues. Medical practitioners and the community would benefit from the program being expanded to other locations.
Acknowledgements Thank you to all current and past KPHU supervisors and staff for their support of this placement. We acknowledge the Prevocational General Practice Placement Program (PGPPP) for funding this placement.
A. HOFER ET AL.
Author contributions A.H. and J.P. were involved in study design, data collection, analysis and interpretation of results. D.A. was involved in data collection, analysis and interpretation of results. S.M. and C.R. were involved in study design, analysis and interpretation of results. D.M. was involved in interpretation of results. All authors contributed to drafting and revision of this paper.
References 1 Mak DB, Plant AJ. Reducing unmet needs: a prevocational medical training program in public health medicine and primary health care in remote Australia. The Australian Journal of Rural Health 2005; 13: 183–190. 2 Mak DB, Plant AJ, Toussaint S. ‘I had learnt . . . a different way of looking at people’s health’: an evaluation of a prevocational medical training program in public health medicine and primary health care in remote Australia. Medical Teacher 2006; 28: e149–e155. 3 Australian Bureau of Statistics. 2011 Census Quick Stats – Kimberley [Internet]. Commonwealth of Australia: Australian Bureau of Statistics; c2011 2012. [Cited 30 Oct 2012]. Available from URL: http://www.censusdata.abs.gov.au/ census_services/getproduct/census/2011/quickstat/50804? opendocument&navpos=220 4 Chaves N, Weeramanthri T, Mak D et al. Diabetes audit can aid practice development in a range of indigenous health care settings. The Australian Journal of Rural Health 2001; 9: 251–253. 5 Harch S, Reeve D, Reeve C. Management of type 2 diabetes – a community partnership approach. Australian Family Physician 2012; 41: 73–76. 6 Mak DB, Johnson GH, Plant AJ. A syphilis outbreak in remote Australia: epidemiology and strategies for control. Epidemiology and Infection 2004; 132: 805–812. 7 Marley JV, Davis S, Coleman K et al. Point-of-care testing of capillary glucose in the exclusion and diagnosis of diabetes in remote Australia. The Medical Journal of Australia 2007; 186: 500–503. 8 McIver L, Xiao J, Lindsay MD, Rowe T, Yun G. A climatebased early warning system to predict outbreaks of Ross River virus disease in the Broome region of Western Australia. Australian and New Zealand Journal of Public Health 2010; 34: 89–90. 9 Mossenson A, Algie K, Olding M, Garton L, Reeve C. ‘Yes wee can’ – a nurse-driven asymptomatic screening program for chlamydia and gonorrhoea in a remote emergency department. Sexual Health 2012; 9: 194–195. 10 Rémond MG, Severin KL, Hodder Y et al. Variability in disease burden and management of rheumatic fever and rheumatic heart disease in two regions of tropical Australia. Internal Medicine Journal 2013; 43: 386–393. 11 Tate J, Mein J, Freeman H, Maguire G. Grey nomads – health and health preparation of older travellers in remote Australia. Australian Family Physician 2006; 35: 70– 72. © 2014 National Rural Health Alliance Inc.
PREVOCATIONAL PUBLIC HEALTH IN THE KIMBERLEY
12 Health Workforce Australia. Australia’s Heath Workforce Series – Doctors in focus [Internet]. Health Workforce Australia: Adelaide; 2012. [Cited 17 Dec 2013]. Available from URL: https://www.hwa.gov.au/sites/uploads/ australias_health_workforce_series_doctors_in_focus _20120322.pdf 13 Human Capital Alliance. The unique contribution of public health physicians to the public health workforce. [Internet] Human Capital Alliance: NSW Adelaide; 2010; [Cited 22 Dec 2013]. Available from URL: http://www .racp.edu.au/index.cfm?objectid=14E7A4B4-9C5F-6B8F -66ABAE9BAE3FF9FD
© 2014 National Rural Health Alliance Inc.
79 14 Department of Health (WA). English doctor making a difference in Geraldton. Healthview [Internet]. Government of Western Australia; Summer 2012; p15. [Cited 17 Dec 2013]. Available from URL: http://www.health.wa.gov .au/publications/documents/healthview/HEALTHVIEW _SUMMER2012.pdf 15 Crotty BJ, Brown T. An urgent challenge: new training opportunities for junior medical officers. The Medical Journal of Australia 2007; 186: s25–s27.
