RURAL AND REMOTE ALLIED HEALTH PROFESSIONALS: IS DISTANCE EDUCATION A VIABLE OPTION FOR POSTGRADUATE STUDY?

ABSTRACT: The community expectations and professional needs of rural and remote area allied health professionals differ from their city counterparts. For example, career opportunities within the rural and remote area service are limited as is access to continuing education and peer group support. In addition, their role is more diverse than that of their city counterparts as they are called upon to provide expert knowledge over a wider range of areas.
Community expectations of rural and remote area allied health professionals has led to differences in educational needs. Clearly continuing education needs to be broadly based across specialisations and delivered in ways that allow access and are supportive of the circumstances of rural and remote area service workers.
This paper aims to introduce research about the professional educational needs of rural and remote area physiotherapists in South Australia and the Northern Territory. In a response to these needs a trial and evaluation of two postgraduate distance education subjects in relation to their suitability in meeting these needs is discussed. Finally, a Graduate Certificate in Physiotherapy (Rural and Remote Area Studies) will be presented as one possible solution to these dilemmas.     

Use of the Internet as a medical resource by rural physicians

BACKGROUND: Internet has become an integral tool for modern physicians, and those not ready to embrace this new technology will be missing a valuable resource. This pilot study reviews rural physicians' usage patterns of the Internet as a medical resource and examines the barriers that might preclude rural providers from using this technology. METHODS: We undertook a questionnaire survey of rural providers in Wyoming, Montana, and Idaho. Information was elicited about the physicians' Internet access, frequency of Internet use, the different Internet categories used, and the barriers they encountered to using the Internet. A background MEDLINE search was performed using the MeSH headings "Internet," "medical informatics," "and rural health." RESULTS: Eighty-five percent of providers had Internet access, and 75% of respondents reported using the Internet either daily or one to four times a week. E-mail was the most frequently used category. The next most frequent categories were on-line literature search, professional organizations, special interest Web sites, clinical reference Web sites, on-line journals, and patient education. Lack of time and having no computer were the most important barriers cited. CONCLUSIONS: Although the findings of this survey suggest that, compared with broader physician populations, rural physicians are using the Internet with the same frequency, their scope of use might be much more limited. Barriers to using the Internet are difficult to determine, but lack of time, hardware, and a sense of need appear to be important factors.     

Physicians' Internet information-seeking behaviors

INTRODUCTION: Our understanding about the role of the Internet as a resource for physicians has improved in the past several years with reports of patterns for use and measures of impact on medical practice. The purpose of this study was to begin to shape a theory base for more fully describing physicians' information-seeking behaviors as they apply to Internet use and applications for continuing education providers to more effectively support learning. METHODS: A survey about Internet use and physician information seeking was administered by facsimile transmission to a random sample of 3,347 physicians. RESULTS: Almost all physicians have access to the Internet, and most believe it is important for patient care. The most frequent use is in accessing the latest research on specific topics, new information in a disease area, and information related to a specific patient problem. Critical to seeking clinical information is the credibility of the source, followed by relevance, unlimited access, speed, and ease of use. Electronic media are viewed as increasingly important sources for clinical information, with decreased use of journals and local continuing medical education (CME). Barriers to finding needed information include too much information, lack of specific information, and navigation or searching difficulties. DISCUSSION: The Internet has become an important force in how physicians deliver care. Understanding more about physician information-seeking needs, behaviors, and uses is critical to CME providers to support a self-directed curriculum for each physician. A shift to increased use of electronic CME options points to new demands for users and providers. Specific information about how physicians create a question and search for resources is an area that requires providers to develop new skills.     

Physician Internet medical information seeking and on-line continuing education use patterns

INTRODUCTION: Although physician Internet use patterns have been studied, little attention has been paid to how current physician learning and change theories relate to physician Internet information seeking and on-line learning behaviors. The purpose of this study was to examine physician medical information-seeking behaviors and their relevance to continuing education (CE) providers who design and develop on-line CE activities. METHODS: A survey concerning Internet use and learning was administered by facsimile transmission to a random sample of 2,200 U.S. office-based physicians of all specialties. RESULTS: Nearly all physicians have access to the Internet, know how to use it, and access it for medical information; the Internet's professional importance to physicians currently is in the area of professional development and information seeking to provide better care rather than for patient-physician communication. A particular patient problem was the most common reason for seeking information. The credibility of the source, quick and 24-hour access to information, and ease of searching were most important to physicians. Barriers to use included too much information to scan and too little specific information to respond to a defined question. DISCUSSION: The importance of the Internet to physician professional development is growing rapidly. Access to on-line continuing medical education must be immediate, relevant, credible, and easy to use. A sense of high utility demands content that is focused and well indexed. The roles of the CE provider must be reshaped to include helping physicians seek and construct the kind of knowledge they need to improve patient care.     

Information needs of university programs in health administration: report of survey response.

Program directors and librarians providing information support for academic programs in health administration share similar perceptions of the information needs of their students and faculty. Where they differ in identification of helpful products or key discussion topics, the difference appears to be a function of their role. For example, it is probable that librarians do not consider preparation of user-specific bibliographies from on-line databases as an important AHA Resource Center product because they prepare these themselves at the local level. Conversely, it is probable that program directors do not see an overview of current issues in health administration as a high-priority topic for a meeting because they have access to more immediate resources for that kind of information. Not unexpectedly, program directors and librarians alike see the AHA Resource Center's role as a secondary one and look within their own institution first for information support. A report of survey results and information about the AHA Resource Center were shared with survey respondents and nonresponding program directors in January 1985. The AHA Resource Center is utilizing responses to this survey to plan services and programs that will be helpful to faculty and students in university programs in health administration and to library staff serving these programs.     

Continuing Education: A Survey Among General Practitioners

A survey of perceptions of continuing education—content,methods and current provision—was undertaken among allestablished general practitioners in one health region of theUK using a postal questionnaire. Interviews were conducted witha small random sample of respondents and with a larger sampleof non-respondents to the questionnaire. Data from the questionnaireand interviews demonstrated overall a wide diversity of contentand methods of continuing education perceived as appropriate,with duration of experience and involvement in undergraduateteaching or postgraduate training as significant determinants.The findings are used to review, critically, current provisionof continuing education for general practice and to suggestways in which future provision might reflect the range of educationalneed perceived by doctors.     

Self-assessment in CPD: lessons from the UK undergraduate and postgraduate education domains

UK continuing education is moving from credit-earning, taught continuing medical education (CME) to a continuing professional development (CPD) system that explicitly links education to change in practice, managed and monitored through mandatory peer appraisal. Alongside multisource feedback and consideration of issues of poor performance, satisfactory personal development planning will be required for relicensure and recertification. That system gives self-assessment, in the guise of reflection, a central place in personal development. This article uses instances of directed self-assessment drawn from undergraduate and early postgraduate medical education to consider how a positive system of self-assessment and professional self-regulation could be operationalized. It explores why medical students made avid use of an e-technology that presents the intended outcomes of their problem-based curriculum in a way that helps them seek out appropriate clinical opportunities and identify what they learned from them. It contrasts the experience of early postgraduate learners who, presented with a similar e-technology, found it hard to see links between their official curriculum and their day-by-day learning experiences, at least partly because the intended outcomes it offered were remote from what they were actually learning. Any extrapolation to CPD must be very tentative, but I advocate continued exploration of how best to use e-technology to support and structure (ie, direct) self-assessment. Direction could originate from consensus statements and other well-defined external standards when learners lack mastery of a domain. When learners must respond to institutional demands, direction could be provided by corporate goals. In areas of mastery, I propose learners themselves should define personal standards. In areas of difficulty, external assessment would take the place of self-assessment.     

The role of low cost communications in health in the redevelopment of the indigenous physician workforce among selected jurisdictions of the US-associated Pacific Islands

Low cost communications in health are key to the strategic redevelopment of the indigenous physician workforce among select countries of the U.S-Associated Pacific Islands. In conducting the Pacific Basin Medical Officers Training Program (PBMOTP) from 1986-1996, the University of Hawaii established five key strategic objectives to train and support physician graduates from the Freely Associated States of the Federated States of Micronesia and the Republics of the Marshall Islands and Palau. These objectives were to: conduct a basic medical education program which graduated 70 physicians; promote regional internship training programs; assist in establishing formal postgraduate training opportunities; reestablish a regional physician's professional organization; and promote both regional and local continuing medical education activities. Inherent in the PBMOTP training program was familiarising students with hands on research methodologies, use of computers and information systems, and the processes of "store and forward" distant medical consulting. This paper documents the regional development of expanded access to medical information and distance medical communications technology and processes, including CD_Rom, Epiinfo, Picasso phone, E-mail, and Website based consult and Medical information search. Recently, email and Internet processes have promoted access to and the use of low cost communications in health thereby further reducing professional isolation among the new physician workforce in Micronesia.     

宁夏医疗机构临床实验室人力资源现状调查与分析

目的 了解宁夏医疗机构临床实验室人员构成及继续教育的现状及存在的问题.方法 对全区各医疗机构临床实验室人力资源基本情况进行统一的问卷调查,并对数据进行分类统计.结果 75家临床实验室共有检验人员676名,高、中、初级职称之比为:1.0:5.2:5.1;硕士、本、专科、中专、无学历之比为:1.0 : 11.6:23.4:10.5:1.8.继续教育情况差异有统计学意义.结论 各级医院临床实验室职称、学历、年龄分布不平衡,高学历、高职称人才匮乏,继续教育现状参差不齐.     

四川省县乡农村卫生人员继续医学教育现状调查

目的了解四川省农村卫生人员继续医学教育现状,为评估和改善现有农村继续医学教育体制提供依据。方法采用文献调研、专家咨询、问卷调查和小组访谈等方法,对四川省射洪县和仪陇县的12个乡镇卫生院163名卫生技术人员和224个村卫生站的230名乡村医生进行调查。结果大多数乡村卫生人员参与了继续医学教育培训,主要的培训方式是在职学习,其平均每周参与培训的时间在4h左右。58.9%的乡村卫生人员未主动制定过个人继续医学教育计划,70%以上的人认为参加了在职培训后对实际工作有指导作用;参与继教培训的费用80%以上由个人支付。结论农村卫生人员继教需求大,但应选择适合的培训内容和方式。国家及相关单位应加大对农村卫生人员继续医学教育培训的资金投入,采用多种方式改进农村卫生人员继续医学教育的状况,完善继教的评估和管理体制。     

Socially unbiased parenting support on the Internet: a cross-sectional study of users of a large Swedish parenting website

BACKGROUND: The Internet is becoming increasingly recognized as a source of social support. Parents of children with cancer and autism have been shown to find social support online, and many parents of healthy infants and children seek information about parenting online. However, access and use of the Internet is greater among socio-economically advantaged groups, a phenomenon known as the 'digital divide'. Our aim was to investigate whether users of a Swedish general parenting website perceived support in the parenting role and, if so, whether this support was socially biased because of the digital divide phenomenon. METHODS: Users of the largest Swedish parenting website were asked to participate in the study. A total of 2221 users completed the anonymous survey posted on the website during a one-week period. RESULTS: Most respondents (95%) were female (mean age 30.6 years). Respondents' educational level was slightly, but not significantly, higher than that in the general population, whereas 68% had income levels at or under the national average, contradicting the intuitive hypothesis that users would be socio-economically privileged. Perceived social support, measured by the Interpersonal Support Evaluation List (ISEL) appraisal subscale, indicated high perceived support. Living without a partner and having lower levels of income and education increased perceived support. The perception that other parents' opinions are more valuable than the advice of experts was influential in the regression equation for ISEL scores, indicating that peer help is important in online social support. CONCLUSIONS: Internet use for general parenting issues in Sweden, mainly by women, does not seem to follow the digital divide phenomenon. Therefore, the internet provides an exciting opportunity for future infant and child public health work. The lack of fathers, however, was a surprising finding and introduces a gender bias into this seemingly socially unbiased medium.     

Continuing Education in General Practice in the UK: A Review

Wood J. Continuing education in general practice in the UK:a review. Family Practice 1988; 5: 62–67. This paper reviews developments in continuing education in generalpractice in the UK in the 1980s. It highlights the growing awarenessat national level of the need to develop.performance reviewas a form of continuing education in general practice and thesteps that have been taken to restructure the postgraduate medicaleducation system. It also draws attention to the lack of changein the general pattern of continuing education, despite someuncoordinated growth of activity outside postgraduate centresand the emergence of some educational innovations. The paperconcludes by putting forward proposals for a programme of actionand for the appointment of properly trained general practitionertutors in each district to support, coordinate and extend educationalinitiatives.     

Continuing education credit through the internet

In summary, CEC by Internet offers many advantages, including the convenience of learning at your own pace, reduced stress during the learning process, and ease in learning topics you are interested in and need to know. Continuing education by Internet uses the highest quality audiovisual technology and provides the opportunity to print presentation materials. This approach to continuing education appears to be an emerging trend that certainly will become prevalent in professional advancement.     

Information-seeking behaviors and reflective practice

INTRODUCTION: As they care for patients, physicians raise questions, but they pursue only a portion of them. Without the best information and evidence, care and patient safety may be compromised. Understanding when and why problems prompt physicians to look for information and integrate results into their knowledge base is critical and shapes one part of reflection about care. This study explores the role of the Internet in gathering medical information as one step in that reflective practice, the barriers to its use, and changes in utilization over time. METHODS: A questionnaire with 18 items adapted from previous studies was sent by facsimile to a randomly selected sample of U.S. physicians in all specialties and active in practice. RESULTS: Specific patient problems and latest research in a specific topic most often prompt physicians to search on the Internet. Younger physicians and female physicians were most likely to seek information on a specific patient problem. Only 9% of all respondents (n = 2,500) searched for information during a patient encounter. When unsure about diagnostic and management issues for a complex case, 41.3% chose to consult with a colleague or read from a text (22.8%). Searching most often occurred at home after work (38.2%) or during breaks in the day (35.7%). Most (68.7%) found the information they were looking for more than 51% of the time. Searching was facilitated by knowing preferred sites and access in the clinical setting. The greatest barriers to answering clinical questions included a lack of specific information and too much information to scan. DISCUSSION: Although physicians are increasingly successful and confident in their Internet searching to answer questions raised in patient care, few choose to seek medical information during a patient encounter. Internet information access may facilitate overall reflection on practice; physicians do not yet use this access in a just-in-time manner for immediately solving difficult patient problems but instead continue to rely on consultation with colleagues. Professional association Web sites and point-of-care databases are helpful. From physicians' use of the Internet, professionals in continuing medical education must learn which search engines and sites are trusted and preferred.     

Formative Evaluation of a Family Life Education Web Site*

Hundreds of family life education Web sites are available on the Internet, allowing individuals and families unprecedented access to family life education information. Evaluation is critical to ensuring the quality of and improving these Web sites; yet, few Web site evaluations have been conducted. We formatively evaluated a new family life education Web site, Forever Families ( http://www.foreverfamilies.net ), assessing site use with Web‐based software and receiving visitor feedback through an online survey. Findings revealed that the site was highly used by individuals throughout the world, that the site was viewed positively and had a positive impact on users, and that site ratings did not substantially vary by user characteristics. Users provided many helpful suggestions for improvement.     

Impact of commercial support on continuing pharmacy education

INTRODUCTION: There is a serious debate over the involvement of the pharmaceutical industry in continuing education. Policies that govern the planning of continuing education for pharmacists center on the potential conflict of interest when there is commercial support for programs. The purpose of this study was to investigate the impact of commercial support on the provision and perceived outcomes of continuing pharmacy education. METHODS: A survey was administered online to a national sample of accredited providers of continuing pharmacy education, resulting in 134 responses. The 64-item survey was developed to measure the planning practices of these providers and their perceptions of the educational and noneducational consequences of commercial support for continuing education. RESULTS: One hundred thirty-four usable questionnaires (34%) were received from 386 leaders in pharmacy education. Approximately 86% of providers and 43% of programs received commercial support. Although the Accreditation Council for Pharmacy Education requires that providers review instructional content and materials for commercially supported programs before delivery, only 43% always did so. Commercial support was perceived to have consequences for provider organizations, pharmacists, and patients, such as increased cost and use of drugs and financial dependency of providers and participants on industry support. DISCUSSION: The results of our study lead to the conclusions that commercial support of continuing education is widespread, affects continuing education programs, and is perceived to have significant educational and noneducational consequences. The profession should ensure that continuing education guidelines are unambiguous related to specific practices that are allowable and unallowable when receiving commercial support. Future research should study the consequences of commercial support behaviorally by examining the effects on pharmacy professionals' practice and pharmaceutical care.     

General practitioners and postgraduate education in the Northern Region.

We describe a survey of general practitioners in the Northern Region which was carried out during the summer of 1977 as the result of a commission from the Education Committee of the North of England Faculty of the Royal College of General Practitioners. Seventy-five per cent of a one in two random sample of general practitioner principals returned a postal questionnaire in which their perceptions of postgraduate education were sought and their behaviour measured by the number of sessions they attended during the previous year at their ''usual'' and other postgraduate centres. Almost half the respondents had more than a basic qualification and all but three per cent had held full-time hospital appointments, two thirds of them at the level of senior house officer or above. Their experience as general practitioner principals averaged 15 years and 57 per cent held part-time appointments outside their practices. Only four per cent had not attended any postgraduate events during the previous year but the remaining respondents had attended eight sessions on average, six of which were at their usual centres. Those attending more than the average number of sessions tended to have registered between 1950 and 1969, to work in larger practices, to hold additional appointments, or to be trainers or College tutors. Most of the respondents were conservative in their perceptions of teaching methods, the topics discussed at meetings, and the contributors to postgraduate education but the younger general practitioners and a group of established general practitioners affiliated to the Royal College of General Practitioners held more radical views. They agreed about the primacy of traditional clinical topics but were sceptical of the value of ward rounds and formal lectures and favoured the seminar and clinical attachments. They saw a need for more material about practice management and wanted experienced general practitioners and community paramedical staff as teachers in addition to hospital consultants. Most of the respondents believed that their usual centres were well organized and managed but failed to cater for the special requirements of general practitioners in non-clinical aspects of practice. Lunchtime and evenings were seen as the most convenient for weekday meetings and Sunday as the most convenient day of the week. A majority of respondents believed that post-graduate education had altered their practice of clinical medicine but only 15 per cent believed it had caused changes in their practice organization.     

Teaching nutrition to medical doctors: the potential role of the State Registered Dietitian

Medical doctors ought to have a sound knowledge of nutrition, but it is clear that most do not. Teaching nutrition to medical doctors should start during undergraduate training. Dietitians have a vital role to play—acting as consultants for the course, in formulating learning objectives, teaching, organizing practical sessions, assisting with clinical demonstrations and writing exam questions. Dietitians could also be encouraged to become more involved in the clinical training of medical students by assuming a more active role in the provision of seminars, grand rounds, clinical case presentations and conferences. Finally, dietitians may attract more medical doctors to nutrition conferences and meetings if these are registered for CME (continuing medical education) and PGEA (postgraduate education allowance). The dietitian has a unique role and responsibility for teaching nutrition to medical doctors. The task ahead is a difficult one, but if successful will surely result in improvements to the nutritional status of both patients and the general public.     

Internet and health: lessons learned from the French national survey on households living conditions in 2005

BACKGROUND: The Internet is a major source of information for the general public in the field of health. However despite ever-increasing connection rates, a digital divide persists in the industrialised countries. The objective of this study was to assess the determinants involved in Internet access and then in Internet use for health information seeking. METHODS: This study is based on a cross-sectional survey of a representative random sample of French inhabitants: the Enquête permanente sur les conditions de vie des ménages conducted by Insee in 2005, which included a specific investigation on information and communication technology. RESULTS: Fifty-two percent of the French adult population had Internet access, and 28.5% of the Internet users had previously searched for medical information during the month before the survey. A first level of socioeconomic divide has been shown in Internet access: poor socioeconomic status, health problems. In terms of health information seeking among Internet users, the divide was not socioeconomic but more related to gender, the health care system utilization, and the diversified use of the Internet. CONCLUSION: In a public health perspective, this study suggests that promoting Internet access and utilization is still necessary in order to make it a widely used tool for prevention and health promotion.     

Long-term effects of a cancer awareness program for community pharmacists.

A continuing education program resulted in a 52% improvement in the specified professional behaviors of community pharmacists within one month. However, surveyed effects were not permanent and decreased significantly within 18 months. Following a simple mailing of specially designed literature, desired behaviors again underwent significant improvement comparable to that attributed to the original continuing education program. A better understanding of professional behaviors as functions of time and different educational modes would be invaluable to educators in both academic and postgraduate programs.