Ashburton-based students (from left) Stephen Potter, Micah Xiang and Hylton Briscoe.
For nearly 20 years, Otago has run New Zealand’s only programme dedicated to training doctors for rural settings – and it has shown its worth.
Rural-origin students who study rural medicine are more likely to return to a rural area when they graduate.
Like so many country things, it is a simple but effective formula, proven through Otago research and experience.
For decades the University has pioneered rural medical health training. It is committed to teaching and supporting students and practicing doctors in rural areas, aiming to strengthen the nation’s rural health workforce and help tackle inequities faced by remote communities.
Since 2007 it has run the Rural Medical Immersion Programme – the only one of its kind in New Zealand – which has proven its worth in motivating graduate doctors to live and work in rural areas.
The one-year academic programme sees fifth-year medical students undertake all their learning in a rural community. Each community has groups of three to four students who work closely with supervisors and local health teams.
The vision of the late Dr Pat Farry, whose passion for rural medicine and medical education drove him to advocate and lobby for funding for both, came to life when a pilot was awarded funding in 2006.
What started with six students in Queenstown and the West Coast, has grown to include 31 living and working in one of nine rural communities across the South and lower North islands this year, with capacity for 35 next year.
Programme Clinical Director Dr Janine Lander says the practical, fully engaged, approach makes for a more effective learning programme.
“The best thing is that they are learning in small teams under the close supervision of a rural GP or rural hospital doctor – all their learning is coming from patient experiences.
“We see real progression, really quickly within the students learning within those teams as they begin to develop their professional identity and continue to acquire all the knowledge and skills they need to become competent doctors.
“Students consistently report the ease of transition to trainee intern and junior doctor roles following their apprentice-style learning in the programme,” she says.
The programme covers clinical knowledge and skills while promoting students' understanding of rural health and healthcare delivery.
Professor Tim Wilkinson
Students follow patients through their healthcare journey across general practice and rural hospital settings, under the guidance and mentorship of experienced general practitioners, rural hospital generalists, visiting specialists, and other members of the healthcare team.
The opportunities are broad and can include experiences in everything from local general practices and rural hospitals, to primary birthing units and more unique ski-field and farm day medical visits.
Not only are their practical skills improved, but they create lasting memories and relationships. The students become part of the community – they join clubs and sports teams, work on community projects, and work with patients and whānau in a variety of contexts.
As Otago Medical School Acting Dean Professor Tim Wilkinson says “we don’t just train doctors, we train doctors for New Zealand”. <
“We are committed to meeting the needs of the communities we serve, and rural health is a really important part of that.
“We know that if students learn in rural communities they are much more likely to come back and practice there. They feel supported, they feel committed to that region, the region likewise supports them and feels supported by them. For me it’s a win-win.” <
And return they do, in fact graduates from the programme are nearly six times more likely to return to rural practice after graduation.
Research has also shown Otago rural entry students are nearly four times as likely to become rural doctors than non-rural entry students.
Dr Rachel Lynskey
The investigation into outcomes of all New Zealand medical graduates between 2011 and 2019 highlighted just how effective affirmative action schemes for rural origin students are.
One such success story is Dr Rachel Lynskey.
She was one of the first RMIP students in 2007 and is now a rural hospital specialist working at Dunstan Hospital.
"The programme really opened my eyes to the world of rural medicine and what felt like a real experience that existed outside of the tertiary centres.
“Prior to the programme I had no idea how much more there was to medicine. I think rural medicine is a really exciting pathway – you have to know a little bit about everything, you get to work with a small cohesive team managing all sorts of things that come in the door. It’s a really nice way to be able to look after your own community,” she says.
Tanira Kingi is following in her footsteps as one of three students undertaking RMIP in Wairoa this year.
“We rave to each other every day about the awesome experiences we get to have, the amazing doctors here and how we are able to learn skills we wouldn’t really otherwise get to do in a large hospital – it’s truly a privilege,” she says.
She encourages other students to get outside their comfort zone and consider the programme.
Tanira Kingi
“Don’t be afraid to put yourself out there and to be uncomfortable. I think a lot of students steer away from rural placements because you’re isolated, you might not be with people that you know very well. But I feel that this year in my entire medical journey has been the most transformative.
“I’ve formed such close friendships and I’ve had the opportunity to be immersed in a Māori community. It’s just so beautiful being able to connect and establish some whakawhanaungatanga with our community.”
Dr Lander says rural medical education has come a long way since RMIP was first established, but knows there is much more to be done to ensure New Zealand has equitable healthcare for all.
“It’s heartening to see the increasing numbers of junior doctors committing to rural generalist training and the attention paid to rural health equity at government level.
“However, there’s still much work to be done to attract health professionals to, and ensure sustainable quality health services within, all our rural communities – it’s a whole pathway.
“At Otago, our focus is on the selection processes that include rural origin students, followed by high-quality rural placements for all medical students and extended ones for those interested, then offering suitable postgraduate training courses and experiences. Finally, the job conditions have to be right to ensure rural practitioners can thrive in their personal and professional lives within their communities.”