This week in public hospitals around the country, a new batch of medical graduates commence their careers as doctors, starting as newly minted interns.
At the Bendigo Hospital, nearly 60 per cent of the new interns will have been students who studied in the medical education programs at Monash Rural Health - Bendigo.
Many more of the student cohort have taken up intern positions in other regional hospitals, a great indicator that medical students who train in regional Victoria will continue to learn and practice in the bush as well.
But this post-COVID cohort are more than just wedded to staying in the country.
They have studied under extremely challenging circumstances, having completed their clinical training years in the cauldron of a pandemic.
With the support of the senior administration at Bendigo Health, medical students in Bendigo remained on uninterrupted clinical placements, while most other clinical teaching sites across Victoria restricted or cancelled access to wards and clinics during the height of the pandemic.
While medical students in Melbourne spent much of 2020-21 learning via Zoom, not able to see or examine real patients nor participate in the delivery of clinical medicine, in the regions where the lockdown restrictions were less harsh medical students were called on to help out in ways their predecessors could only dream of: giving vaccinations, assisting when emergency departments were struggling, working in remote home monitoring of acute COVID patients in the community or just holding the hands of someone as they passed away because their families couldn't visit them in hospital.
Historically, medical students have fronted-up when needed. In 1918, some medical students were graduated early to help fight the raging Spanish flu. In 1952, medical students in Denmark helped provide polio patients with round-the-clock manual ventilation. In the 1980s, doctors in training were thrust into the burgeoning AIDS epidemic. This pandemic, which is not yet over, has been longer and tougher than anything so far experienced.
What has been created is a next generation of rurally educated junior doctors who may be more experienced, more empathetic and more ready for practice than any cohort before them.
The lucky medical students, and many of them recognise that luck, who spent the pandemic years studying in rural and regional hospitals worked at the coalface, not just following junior and senior doctors around the wards observing, but hands-on providing direct healthcare with real patient outcomes.
The lesson to be learned may be that, rather than excluding them, including students in the core business of healthcare during the most challenging of times may have significant longer-term benefit to the entire system.
However, undergraduate education is only half the story. Rural and regional healthcare has for many years depended on the recruitment and immigration of doctors trained overseas to fill gaps in home grown doctor numbers.
In the COVID era, this source of medical professionals has dried up, leaving healthcare in these areas highly compromised. The challenge now is to provide an environment for comprehensive post-graduate training in rural and regional areas so that the graduates of 2022 can see a clear path to general and specialist roles without the need to return to large metropolitan centres to access the full range of experiences and education they require to become the GPs and specialists of the future.
There is a lack of post-graduate training pathways in rural areas, in part due to restrictive training requirements from the monopoly of large and influential training colleges which fail to recognise the contemporary realities of education, supervision and service outside of major metropolitan centres.
In rural areas, where doctors are older and busier compared to their metropolitan counterparts, there are fewer supervisors to provide the advanced education needed to progress in the training pathways.
Providing more support for training and supervisors, reducing inefficiency in the medical education system, and recognising that more contemporary and less traditional experiences are a valuable and valid part of training for post graduate qualifications will assist rural sites to provide more comprehensive training opportunities. If junior doctors can see a comprehensive training pathway that does not require them to have to return to a metropolitan centre for an extended period to complete their education, it is likely to improve regional and rural retention of locally-trained doctors.
Supervision and education as a core part of medical practice in rural and regional areas is critical to addressing the long-term healthcare workforce needs of our communities.
- Associate Professor Chris Holmes is the deputy head of school at Monash Rural Health.