Rural generalist training positions: a “how to” guide

Ilsa Nielsen1, Michelle Rothwell2

1A/Director Allied Health, Allied Health Professions’ Office of Queensland, Department of Health, Queensland Government, Cairns.

2 A/Team Leader, Allied Health Education and Training, Darling Downs Hospital and Health Service

Abstract

Introduction

Rural generalist training positions have been successfully trialled in Queensland and are rolling out in other states and territories. This presentation will provide a brief “how to” guide including examples of ways health services have structured and resourced training roles.

Methods/strategy

To be regarded as a rural generalist training position the role will meet the mandatory specifications and support requirements:

  • Minimum 0.1FTE (4 hours) allocated development time
  • Funded enrolment in a formal post-graduate rural generalist education program
  • Profession-specific supervisor:
  • Level 1 training position (graduate): co-located 50% or more work hours
  • Level 2 training position: co-located or remote supervision
  • Service development project implemented in team

Strategies

Health services can use a range of strategies to implement the rural generalist training position specifications and support requirements including:

  • build into business model for new roles and new structures (growth funding),
  • restructure small teams, particularly those with chronic vacancies,
  • utilise funding support available for education to redesign existing early career roles,
  • inter-agency collaboration.

Brief case studies will be discussed.

Conclusion

Consumers’ access to allied health care is dependent on workforce growth, improved distribution, and sustainable models of rural ‘own grown’ workforce development.  Cycles of vacancies and temporary staffing must be addressed to prevent stagnation of service development and resource loss from rural and remote teams.  Health services can capitalise on opportunities presented by workforce turnover, existing and new partnerships and funding bodies to enhance sustainability.

Allied Health Rural Generalist Trainee Positions (AHRGTP); a remote Torres Strait Islands / FNQ experience

Ms Marissa  Arnot1, Ms Jane Doepel1, Ms Kiah Petrie1, Ms Betty Mareko1

1Tores And Cape Hospital And Health Service, Thursday Island , Australia

Abstract:

AHPOQ (Allied Health Professional Office of Queensland) fund supernumerary positions for two years to assist rural and remote health services to expand and enhance their service delivery while developing rural generalist skills in early career allied health professionals. In 2017/18 the Torres and Cape Hospital and Health Service was successful in attracting this funding for two positions to expand the physiotherapy and dietetics services in the northern sector of the HHS which services Thursday Island, the outer islands of the Torres Strait and five mainland communities in the Northern Peninsula Area (NPA) of Cape York. Prior to this both services were delivered by sole rural generalist practitioners.

Challenges include:
• both the supervision of the AHRGTP and project management of service redevelopment project are provided by sole health practitioners (HP4) with large caseloads,
• large proportion of service delivered outside of hub site either by outreach or telehealth – both difficult mediums for early career professionals
• management of leave periods.
• high burden of chronic disease and predominately Indigenous population in this community provides challenges along side a rich learning environment to develop rural generalist skills.
Having two AHRGT positions at the same time has provided peer support for both trainees and supervisors alike which has been highlighted as a huge benefit by all involved.
Service delivery redesigns including expanded scope of practice ( skill sharing) and expansions of telehealth services are being undertaken alongside the workforce development of the early career professions and extended roles of senior supervisors.


Biography:

Marissa Arnot is the senior dietician for the Northern Torres and Cape Hospital and Health Service. Marissa has a Bachelor degree in Nutrition and Dietetics, a Graduate Certificate in Remote Health Practice and a Graduate Certificate in Diabetes Education. Marissa started as an early career professional in the Torres and Cape over 10 years ago and so has lived experience of becoming a rural generalist in a remote context. Marissa remains the sole permanent dietician for the Northern Torres and Cape HHS servicing 25 distinct communities

Allied Health Rural Generalist Training Positions- Changing healthcare in the country

Miss Jaclyn Muscio1

1South West Hospital And Health Service, Roma, Australia

Abstract:

Allied Health Rural Generalist Training Positions are an opportunity for rural and remote Hospital and Health Services to invest in the patient, practitioner and the future of health care, working towards better health outcomes. The position encourages an accelerated graduate experience requiring flexible and adaptable solution-driven treatment, with varied levels of supervision. Rural and remote service locations allow graduates to be ‘Generalists’ working within all facets of their scope. The Rural Generalist Training Program at James Cook University provides a platform of information for graduates to contribute to create positive changes in the workplace. Courses encourage graduates to become involved in project management and build leadership skills in multi-modal work-based assignments. The program encourages graduates to continue study and research to extend themselves within their full scope of practice. By investing in the position, the Health Service can build an adaptive and skillful workforce in rural and remote areas to potentially change how health care is delivered. Patients can benefit from increased accessibility to services and the implementation of service delivery strategies such as delegation and skill sharing with other health care professionals, encouraging multidisciplinary care for patients. With few positions available, it is competitive with graduate positions at major hospitals, encouraging graduates to become leaders in rural and remote health care. The Rural Generalist Training Position gives Hospital and Health Services an opportunity, to invest in improving health services, patient care and challenge the norm, making rural and remote hospital and health services the leaders in health care.


Biography:

Grew up in Regional Western Australia. Studied a Bachelor of Podiatry at University of Newcastle, New South Wales before moving to Roma Hospital in the South West Hospital and Health District working as a Podiatrist in a Graduate Allied Health Rural Generalist Training Position.

Establishment of speech pathology services in a remote Australian hospital

Ms Amanda O’keefe1, Ms Rebecca  Keeley1

1Top End Health Service, Darwin, Australia

Abstract:

The Allied Health Rural Generalist Pathway is a workforce development initiative that aims to support sustainable and accessible rural and remote allied health workforce models of service. An early career speech pathologist was employed utilising an Allied Health Rural Generalist Training Position to fill a service gap within our health service.
The aim of our project was to establish sustainable models of care for speech pathology services in a rural hospital three hours from a regional centre.
An early career speech pathologist was employed at a regional hospital to establish speech pathology services in the remote hospital 319km away. A range of service models were implemented including telehealth, delegation and education and upskilling of support staff. Activities such as dysphagia nurse screening, modified diet audits, service mapping and establishing speech pathology care pathways were also undertaken.
Established staff at the remote hospital were utilised including an allied health assistant, allied health professionals and nursing staff.
Since commencing the program referrals for speech pathology at the remote hospital have tripled. Pre and post education questionnaires indicated a significant improvement in the knowledge of local kitchen, nursing and allied health staff in the areas of dysphagia and communication.
The Allied Health Rural Generalist Training Position is a valuable resource enabling the establishment of speech pathology services in a remote Australian hospital. Despite the absence of an onsite speech pathologist, a variety of strategies ensured improved processes for managing communication and swallowing difficulties.


Biography:

Amanda is a speech pathologist and currently the Manager of Speech Pathology at Royal Darwin Hospital and the speech pathology profession lead for Top End Health Service (TEHS). Amanda has spent most of her 20 year career working in various rural health services delivering clinical services to adults. Rebecca Keeley is a speech pathologist currently employed in an allied health rural generalist training position with the TEHS. She is one of the founding group members for Speech Pathology Australia’s Early Career Reference Group, liaising with the organisation on graduate needs where she leads the rural and remote key issue group.

Implementing quality services in rural health: The workforce challenges of improving Physiotherapy in the Emergency Department at Mount Isa Hospital

Miss Bonnie Collins1

1North West Hospital And Health Service, Mount Isa, Australia

Abstract:

Background:In 2016 Mount Isa Hospital secured a subsidiary position for a new graduate HP3 under the Allied Health Professions Office of Queensland’s Rural Generalist Training Program (RGTP). As part of this program, the hospital is to use the additional FTE to implement an innovative service development initiative. The service initiative at Mount Isa Hospital is Physiotherapy services in emergency department, incorporating early and secondary contact models.

Aim:To improve access of physiotherapy services to Mount Isa Hospital’s Emergency Department.

Methods:To date there has been consultation with external health services about similar past projects, and ongoing consultation between internal stakeholders. The RGTP position holder has developed a presence in the ED. The RGTP position holder is set to develop skills in this area through work experience at a larger hospital.

Results: (so far..)
Increased referrals to physiotherapy from the ED.
Identification of gaps in the ED service at Mount Isa Hospital.
Identification of barriers to the physiotherapist’s role in the ED including service scope and experience, capacity and resources.
Identification of conflicting interests and scope of clinicians.

Discussion And Recommendations: Rural and remote health care in its nature is dynamic: Changing Lanscapes. It is important to remember that the end goal of quality improvement activities like this is to improve services for patients: Changing Lives.
During the planning and implementation of this project we have identified barriers, condensed the scope and now aim to implement a procedure for physiotherapy in the ED that will withstand the changing environment.


Biography:

Bonnie Collins graduated as a physiotherapist in 2016. During her study at the University of Newcastle, Bonnie completed a number of placements in regional and rural NSW, where she developed an appreciation for the generalist role of the rural health worker and the opportunities this field could provide. In 2017, Bonnie commenced a two-year Rural and Remote Allied Health Generalist position at Mount Isa Hospital in Queensland. This position includes provision for the implementation of a service development project, which in Mount Isa involves enhancing physiotherapy services in the ED. Bonnie has experienced, first hand, the challenges of being a new graduate physiotherapist in a transient workplace.

Investigating the hearts, lungs, brains and sleep of regional Australia: A multidisciplinary scientist training model

Mrs Megan HarbourneDonna Rudd2

1Queensland Health, Douglas, Australia  2James Cook University,Townsville,Australia 

Abstract:

In 2012, the Allied Health Professions Office of Queensland funded a pilot project to determine if the traditionally single-discipline trained Clinical Physiologists, could be trained in a generalist model as new graduates. This project provided a workforce pathway specific to regional service provision that has historically been difficult to recruit to.

In 2017, James Cook University implemented a Graduate Diploma based on this multidisciplinary training model to meet the workforce needs of regional Australia.

The overarching aim of the Graduate Diploma in Medical Science (Clinical Science) is to provide students with routine multi-disciplinary skills to support regional and remote workforces. This model includes an apprenticeship style clinical practice component supported by on-line educational content.

Students have been placed at Townsville, Canberra and Melbourne with host sites supporting the students through multi-disciplinary supervision and professional practice. The model adopted is a 38 week clinical placement, allowing 10 week rotations through each single discipline (Respiratory, Sleep and Cardiac); followed by multi-disciplinary placement throughout the three disciplines. The strength of this model is its application to both regional and remote workforces nationally.

The program allows students experience in three clinical science disciplines and has demonstrated anecdotally and coincidentally an improvement of clinical scientist training due to the patient journey clinical encounters. A highlight of the program is a focus on multiple, same-patient investigation referrals by medical officers (sleep tests, cardiac tests, respiratory tests) and a focus on multidisciplinary patient journeys allowing students to gain both experience and clinical learnings of inter-related physiological conditions.

 


Biography:

Megan Harbourne is an accredited Cardiac Sonographer with more than 15 years of experience. Working with James Cook University, Megan is an Adjunct Senior Lecturer who has supported the development of the Graduate Diploma of Medical Science (Clinical Sciences). Megan’s early work with developing rural and remote workforce pathways for clinical scientists has been awarded a workforce innovation award.

Currently, Megan is the Statewide Clinical Education Program Manager in Queensland Health. In this role, she supports 15 separate allied health disciplines to develop their clinical education and clinical placements. These professions include Audiology, Exercise Physiology and Podiatry. With a particular focus on emerging workforces, Megan supports the development of clinical education and training activities within Queensland Health.

Early Career Torres Strait Islander Physiotherapist working for Torres & Cape Hospital & Health Service

Ms Betty Mareko1

1Queensland Health, Thursday Island, Australia

Abstract:

Torres and Cape Hospital and Health Service Northern Sector (TCHHS-North) have one permanent senior physiotherapist to provide services to 16 islands of the Torres Strait and 5 communities within Northern Peninsula Area. The pathway to becoming a senior physiotherapist can take up to eight years which can allow a time to get comfortable in a regional or metro lifestyle and potentially decrease the likelihood of any prior thoughts of working in a rural or remote area. A great way to improve retention in rural and remote areas is to recruit early career professionals and provide generalist development and experience. TCHHS-North has been fortunate in gaining an early career physiotherapist as part of the Allied Health Rural Generalist Training Position for two years. This rural generalist position in TCHHS-North has been filled by a Torres Strait Islander physiotherapist who relocated from private practice in a regional town. Many changes have been identified from regional to remote and for this health professional it includes general changes however also personal changes as a Torres Strait Islander who is able to speak the local language and understand cultural practices.

-General work changes

Private practice > Public

Musculoskeletal > Rural Generalist

Regional > Remote

One manager  > Organisational structure

Home visits > Outreach

-Changes as a Torres Strait Islander working in the Torres Strait

Patient perception on physiotherapy > Health professional one of their own

English language > Torres Strait creole

Immediate family > Extended TSI family

Seeing patients outside of work as an islander


Biography:

I graduated from James Cook University in 2015 with a Bachelor of Physiotherapy. My grandparents originate from Yam and Yorke Island of the Torres Strait. I grew up with the dream of moving to the Torres Strait Islands to assist in Closing the Gap. Following graduating in 2015 I knew it would take time to become a senior before being able to apply for my dream job. I worked in private practice for one year before the AHRGTP became available on Thursday Island. This position has enabled me to enter the job I have always dreamt about whilst being an early career health professional and allowed me to assist my people towards Closing the Gap

Innovative partnership makes rehabilitation service provision a reality in Central West Queensland.

Mr Steve Cadell1

1Central West Rehabilitation Service, CWHHS, Longreach, Australia

Abstract:

Problem: Until 2017, patients residing in Central West Queensland (CW) have been unable to access rehabilitation and restorative care services close to home. Consequently, this has led to increased lengths of stay, resource expenditure and a higher risk of bed-block within the larger regional or tertiary hospitals.

Design: An allied health-led rehabilitation service was established in partnership between Central West Hospital and Health Service and non-governmental aged-care provider Bolton-Clarke Pioneers (BCP).

Setting: The CWRS hub is based in Longreach at BCP where four residential outpatient beds provide clients increased rehabilitation opportunities prior to transitioning home. Allied health assistants are employed at Barcaldine, Blackall and Winton creating a broader hub-and-spoke model utilising telehealth mediums for communication and care delivery.

Key measures for improvement: Outcome measures inclusive of client/stakeholder-satisfaction surveys, service accessibility, responsiveness, burden of care pre/post service and return on investment have been utilised to evaluate service efficacy.

Strategies/Effects of change: Data analysis demonstrates an 8.42% improvement across Lawton’s scores of the clients accessing the service with a 24% return on investment with an exceeded estimate of patients accessing the service prior to end of financial year. Approximately $350,000 is saved in resources across the CW compared to the previous model of care demonstrating a return on investment of ~32%.


Biography:

Steve Cadell is the Team Leader and Advanced Physiotherapist for the Central West Rehabilitation Service. Steve completed both his Bachelor of physiotherapy and graduate diploma in rehabilitation studies through James Cook University. Currently, he is working towards a research masters in the field of persistent pain specifically in relation to the treatment and management of fibromyalgia related pain. Steve’s passion for physiotherapy resides across a diverse spectrum of mental health, neurology, dementia care and persistent pain management. Steve thoroughly enjoys working in Central West Queensland and since arriving in Longreach 2017, he and his team have established an allied-health led persistent pain management clinic in combination with the current rehabilitation service which too is consolidating and expanding across the Central West Hospital and Health Service.

Steve is an active advocate for rural health and currently represents Central West Hospital and Health Service on numerous projects and steering committees inclusive of the AHPOQ Transition2subacute, Tele-handover project/collaborative and the Statewide Persistent Pain Management Steering Network. In Steve’s spare time he trains in the Thompson River and Longreach Aquatic Center in preparation for swimming the English Channel in 2020 to raise funds for rural dementia care.

Rural Generalist Program

Miss Rebecca Le1, Jessica Garner1

1Hunter New England Health, NSW, Australia

Abstract:

Rural Generalism: “a service that responds to the broad range of health care needs of rural communities”1. The HNE generalist program was established to address these needs, in accordance with the Allied Health Workforce Plan.

It’s a strategic pathway created to attract, develop and retain early career Allied Health Professionals, and enhance capacity and sustainability of employees.

This can be difficult in rural communities due to the unique set of challenges encountered. These include wide, varied and large caseloads, lack of professional development and support, isolation, less access to services, travel, and overall poorer health outcomes.

Rebecca Le and myself are currently employed in HNE’s program, and experiencing some of these challenges. We aim to provide insider perspectives on working in rural areas, and discuss how being involved addressed the issues identified.

We identified two major factors we believe make this program successful. Firstly, its supernumerary design allows individual areas of improvement to be identified, and freedom to gain experience across a number of these social, cultural and clinical areas.

Secondly, the program’s heavy emphasis on professional development provided opportunities to courses and training specifically designed to improve rural health outcomes. This program also allowed time spent in tertiary sites, taking experience gained there to more regional locations. We’ve been exposed to rural life and better understand challenges faced. Because of this program, we are able to successfully met health demands of an at risk population, and gained understanding of the patient journey through the healthcare system.


Biography:

Rebecca Le graduated from University of Newcastle in Newcastle in 2017. She is currently working at Hunter New England Health Local Health District and is part of the Rural Generalist Program as a new graduate Rural Generalist. She has a keen interest for regional, rural and remote health and working towards positive outcomes for these respective communities.

Jessica Garner is a Level 1/3 physiotherapist employed as part of the HNE Health Rural Generalist program. She graduated from the University of Newcastle in 2016, and has since been living and working in regional sites throughout HNE. She is passionate about working in these areas, and has a particular interest in the management of chronic disease, as well as acute orthopaedic and musculoskeletal injuries.

Accreditation of rural generalist education programs for the allied health professions

Ms Kylie Woolcock1, Ms Katharine Silk1, Ms Ilsa Nielsen2, Ms Julie Hulcombe3

1Australian Healthcare And Hospitals Association, Deakin West, Australia, 2Department of Health, Queensland Health, Cairns, Australia, 3Department of Health, Queensland Health, Brisbane, Australia

Abstract:

Introduction:Rural generalist training positions supporting post-professional entry development of allied health professionals are being implemented across Australia to address workforce and service sustainability challenges. A robust benchmark for education programs is required to ensure rural generalist trainees possess the skills and capabilities required by rural and remote health services and communities.

Aims/Deliverables

  • Develop accreditation standards for formal education programs in rural generalist practice for nutrition & dietetics, occupational therapy, pharmacy, physiotherapy podiatry, medical imaging and speech pathology
  • Develop recommendations, a plan and resources to support the formation of an accreditation body and process.

Methods: The project includes:

  • a comprehensive environmental scan of accreditation systems and standards,
  • consultation with stakeholders on the rural generalist concept and the rationale and value of an accreditation system for rural generalist education programs, and
  • drafting, national consultation and finalisation of project deliverables.

Outcomes and conclusion

The environmental scan identified relevant examples of education program accreditation systems and standards. These influenced or were integrated into draft project deliverables. The competency framework provides inter-professional and profession-specific statements of capability supporting and facilitating rural generalist professional practice and development. Draft standards align with those used by a range of allied health professions. A roadmap to establish a new independent body to manage the standards was developed. Outputs will be finalised by July 2018.


Biography:

Kylie has a strong interest and diverse background in areas associated with health workforce reform, including competence and competency standards; credentialing for extended scopes of practice; recognition of advanced practice; policy development for regulation and/or funding of services; accreditation of higher education providers; assessment of overseas trained practitioners; development of support staff; education and continuing professional development.
While a registered pharmacist herself, she works with a broad range of health professions, facilitating cross profession activity to increase collaboration and innovation, optimise patient outcomes, maximise efficiencies and achieve a sustainable health system.

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