1. How well can a rural longitudinal
integrated clerkship prepare a medical
student for internship?
SCHOOL OF PUBLIC HEALTH
Jane Barker, Hudson Birden

2. • Presenters name Jane
Barker, UCRH Lismore
• Relationships with
commercial interests:
NIL

3. Methods
University
Centre for
Rural Health,
North Coast
(UCRH)
•Qualitative study
•Doctors 3-4 years post
graduation who had attended
longitudinal integrated
clerkships at UCRH as students
•Purposive sampling,
snowballing
•15 interviews, face to face or
telephone
•Thematic analysis

5. • Opportunity to develop longitudinal
relationships with supervising clinicians
•One to one supervision
•Development of mutual respect and trust
•Teacher, mentor, friend
“I think one of the best parts of it is that you
form quite good relationships with senior
clinicians. You identify different role models
and mentors, doing it this way you are a lot
closer to them.”
RELATIONSHIPS

6. • Many opportunities to be first to see
undifferentiated cases and practice clinical
reasoning skills
•Develop competency in management of
commonly presenting diagnoses
•Develop competency in clinical “handover”
•Over time develop professionalism and
professional identity
“...on your own had to take a history from a
patient, examine a patient, and come up
with the management plan before you
discussed it with your preceptor. Which is
actually very similar to what you do in
internship”
DEVELOPING CLINICAL
SKILLS

7. Develop proficiency in common procedural skills
Suturing
Cannulation
ABGs
Catheterisation
Plastering
“I spent a lot of time in emergency department and
had a lot of independence there and I guess a lot
more responsibility placed on us as students than
we possibly would have gotten elsewhere, ...and
my first term as an intern was in the emergency
department and so I just felt very well prepared for
that term”
PROCEDURAL SKILLS

8. “For developing confidence ... being given the
opportunity to have some autonomy early on is
invaluable.”
INCREASING
AUTONOMY

9. “It made me be more of an independent thinker, ...... I
remember feeling very out of my depths and out of
my comfort zone. Having a patient in front of you and
having to deal with their problems and think about
what you’re going to do with them, I think prepared
me quite well for internship. It is such a huge step
acting independently”
INCREASING
SELF-RELIANCE

10. • Over time became valued member of team
increasing professional identity
•Understood contribution of health workers
both in the hospital and in the community
•Valued peer group learning
“By the end of the year you are working
within a team, in the hospital, and you
understand how the systems work and so
when you start internship you have
confidence”
TEAM WORK

11. “We have so much experience working ...under
supervision and doing essentially an intern’s job.”
“by the time you got to internship, ...you already knew
who to ask for help when, or who to go to for the
medication list or past medical history and the most
efficient way of doing that”
TAKING ON AN
INTERN ROLE

12. “Whereas that general practice component of phase
three, there were patients that you would see on an
ongoing basis and be able to develop of rapport with
them. ...I think that that’s a really good experience to
have as a student.”
RELATIONSHIPS WITH
PATIENTS

14. Our hope for rural Australia?u