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Title: Evaluation of the Remote Vocational Training Scheme- Impacts and Outcomes

Project description: KBC Australia was commissioned by RVTS Ltd to undertake an evaluation of the Remote Vocational Training Scheme (RVTS).

Aims: The purpose of this evaluation was to assess the outcomes of the RVTS and how it has impacted on the retention of medical workforce in remote communities. The evaluation aimed to answer three questions:

·         What are the key elements of the program that contribute to successful outcomes?

·         What is the impact of the program on health service systems and workforce at a community level?

·         What is the capacity of the program to expand and further develop?

Methods: A mixed method approach was used to collect both quantitative and qualitative information. Components of the project methodology were:

·         An environmental scan of relevant literature and current policy

·         Consultations with key stakeholders

·         Surveys of current and past program participants and supervisors

·         In-depth interviews with a selection of participants and supervisors investigating key themes and factors impacting on the implementation and program outcomes

·         Ethics approval

Results: The overall survey response rate was 39%, which was lower than expected. This opens the potential for non-response bias. However, the registrar survey sample was reflective of the actual RVTS registrar data in terms of demographics. Eleven supervisors and registrars were interviewed, which was also lower than expected. There was particularly an under representation of International Medical Graduates and current registrars in the interviews.

Table 1 Survey Response Rates

Target Group

No. contacted via email

No. of surveys completed

Response rate

Current registrars

104

52

50%

Past registrars

104

42

40%

Current supervisors

83

39

47%

Past supervisors

78

10

13%

TOTAL

369

143

39%

Registrar demographics: The survey showed that the RVTS registrar cohort has changed considerably over the past 15 years. The cohorts are larger and have a higher proportion of overseas medical graduates, females and registrars from NSW.

Community Impact: RVTS contributes significantly to the provision of medical services in rural and remote locations. Benefits to rural and remote communities have had lasting effects, as the majority of survey participants remained in rural or remote practice for some time after completing RVTS. Communities benefit through the retention of medical services, improved access to GP services as well as to hospital and after-hours services. Maintenance of GP services also results in improved health behaviours and reductions in the number of medical emergencies.

Educational components: The educational components of RVTS are well regarded by past and present registrars and supervisors. The biannual workshops are particularly valued because they provide an opportunity for high quality clinical teaching, as well as social and professional networking. Webinars provide regular education relevant to the fellowship curricula, and the introduction of RVTS Online is a useful support for the overall education program. Clinical teaching visits are a crucial element of the program as they are an important opportunity for teaching and assessing registrars’ skills and capabilities.

Supervision: Overall RVTS has developed a sound mechanism for providing remote supervision to GP registrars. The quality of supervision was highly rated by evaluation participants.

Aboriginal Medical Service Stream: Due to the low numbers of AMS registrars who participated in the evaluation it was not possible to fully assess the success and issues of the new stream. The evaluation recommends further review of the experiences of current registrars is warranted in order to better understand the issues involved and potential areas for improvement.

Key Strengths: Overall several key strengths of the program were identified. These include:

  • The organisation responding to emergent issues including changes in the characteristics and learning needs of registrar cohorts
  • The personal approach taken by staff and the organisation as a whole
  • High quality educational program for general practice training
  • The remote supervision model, enabling registrars to work in rural and remote locations where onsite supervision is not possible.

Opportunities for expansion: RVTS has considerable expertise in delivery of remote supervision and educational programs which could be applicable in other medical education and health training sectors. Changes to the structure of the program to enable more than one intake per year could expand the potential market, particularly among International Medical Graduates.

Conclusion: RVTS is highly valued by participants for its personal approach, collegiality and multi-faceted education program. It has also demonstrated capacity to respond effectively to emerging issues such as changes in registrar numbers and characteristics as well as adapting to new technologies to enhance the delivery of educational programs.