Models of Professional Practice and Learning in Rural and Remote Communities

1. Introduction
2. Main Topics
3. Intended Learning Outcomes
4. Readings and Resources
5. Learning Activities
6. Sneak Peek (at Session 4)
7. References

“…whoever walks through the door, you’re treating.”
(Student Perspectives on Interprofessional Learning in Rural and Remote Placements in Northern Ontario, 2014)

This session, which spans two weeks, will focus on models of healthcare practice that help to address the challenges of delivering care in rural and remote communities. You will explore the nature of practice and learning in rural and remote communities in greater detail, including the concepts of generalist practice, rural and remote practice as a specialty, sole practice, interprofessional collaboration and learning, and the use of technology in supporting rural and remote practice.

• Overview of generalist practice
• The concept of rural and remote generalist practice as a specialist practice area
• Sole professional practice in rural and remote communities
• The nature and importance of interprofessional collaborative practice in rural and remote communities
• The unique nature of interprofessional learning in rural and remote communities as an opportunity and support for learners on placement
• The use of technology in supporting rural and remote practice and learning

1. Define generalist practice; Identify the challenges and rewards of generalist practice.
2. Explain the concept of the rural and remote generalist specialist. Identify the skillset potentially required by generalist practitioners across health care professions, and your profession specifically.
3. Identify the challenges and rewards of being a sole practitioner in a rural or remote community.
4. Define and explore the concepts of interprofessional collaborative practice (IPCP) and interprofessional learning (IPL), particularly as they relate to rural and remote settings.
5. Identify the attitudes and skills necessary for successful IPCP and IPL, and relate them to your own experiences and learning needs.
6. Explore innovative ways of using technology to support rural and remote practice.

Overview:

1. Video: A clinician’s experience of living and practicing in a rural community

Generalist and Sole Practice:

2. Roots RK, Brown H, Bainbridge L, Li LC. Rural rehabilitation practice: perspectives of occupational therapists and physical therapists in British Columbia, Canada¹

3. Health Workforce Australia. Allied health professions – Rural and remote generalist²

4. Australian Rural and Remote Allied Health Resources:

• Services for Australian Rural and Remote Allied Health. Specialist generalist³
• Services for Australian Rural and Remote Allied Health. Sole practice⁴
• Services for Australian Rural and Remote Allied Health. Scope of Practice⁵

Interprofessional Collaborative Practice and Learning

5. Northern Ontario School of Medicine. Interprofessional learning guide⁶

6. Minore B, Boone M. Realizing potential: improving interdisciplinary professional/paraprofessional health care teams in Canada's northern aboriginal communities through education.⁷

• Note: requires institutional subscription for access.

7. Latrobe Community Health Service & the Health & Socialcare Interprofessional Network. Readiness for Interprofessional Learning Scale (RIPLS)⁸

8. Tryssenaar J, Berry S, Briggs M, Winn C, Shimmell L, Chisholm B, Snippe-Juurakko E, Wojkowski S. Student perspectives of interprofessional learning in rural and remote clinical placements in Northern Ontario.⁹

9. Porter, J. First Nations Hurt by Nursing Shortage¹⁰

Technology in Rural/Remote Practice

10. The Network – Cisco’s Technology News Site. True Stories of the Connected: Rural Healthcare in Northern Canada¹¹

11. Ontario Telemedicine Network. Ontario Telemedicine Network website¹²(Review portions relevant to Learning Activity 6.)

12. Ministerial Advisory Council on Rural Health. Rural health in rural hands. Strategic directions for rural, remote, northern and aboriginal communities.¹³

Activity 1:
The resources for Session 3 identify a variety of skills, attitudes, and knowledge that health practitioners may require to work successfully in a generalist rural or remote setting, including the circumstance of sole practice. Based on these resources and the understanding of health needs in northern rural and remote communities you have gained so far in this module:

• Brainstorm with your colleagues to identify the skills, attitudes, or knowledge that would be important to develop for general and/or sole practice. Discuss which clinical skills might be important to your profession specifically. Consider the concepts of “expanded depth” and “expanded breadth” introduced in resource #3 above: ‘Health Workforce Australia. (2015). Allied health professions – Rural and remote generalist’ (http://www.hwa.gov.au/our-work/national-rural-and-remote-health-workforce-innovation-and-reform-strategy/allied-health)
• From the skills/attitudes/knowledge identified in the resources as well as those you have identified yourself, reflect on your areas of strength, as well as areas you could improve. How might you go about this? Discuss A) and post your responses for B) at “Session 3, Learning Activity 1.”

Activity 2:
The resources for generalist and sole practice address the concept of the specialist generalist.

• What are the components that support the specialist generalist model?
• What is your opinion about this model? Share and support your views (200 words max.) in “Session 3, Learning Activity 2.”

Activity 3:
Small group activity: In pairs (within your discipline if possible), discuss how a specialist generalist practice delivery model might affect clients. How might a sole practice delivery model affect clients? Consider challenges and benefits. Discuss in “Session 3, Learning Activity 3.”

Activity 4:
Interprofessional collaboration (IPC) “is a partnership between a team of health providers and a client in a participatory, collaborative and coordinated approach to shared decision-making around health and social issues” (CIHC, 2009). Consider who the members of the team might be for a client from a remote First Nations community who is experiencing rheumatoid arthritis. The sole access point for local health services is the nursing station, and the client must travel to a larger rural community for comprehensive care. Think about people with and without formal training who may impact the client’s health including those within the community and those who may be at a distance. Report in “Session 3, Learning Activity 4.”

Activity 5:
Interprofessional Education (IPE) “occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care” (CAIPE 2002). The Readiness for Interprofessional Learning Scale (RIPLS) examines the attitudes of health and social care students and professionals towards interprofessional learning (IPL). Self-study: Complete the RIPLS survey (link to PDF). Explore the following with your colleagues: A) Is interprofessional learning important for rural and remote health care clinical placements/practice? Explain. B) Are the attitudes/beliefs identified in the questionnaire important factors in interprofessional learning in rural and remote clinical placements? Discuss in “Session 3, Learning Activity 5.”

Activity 6:
Technology is increasingly being utilized to support learning, practice, and care delivery in northern rural and remote communities. Consider this week’s readings and resources related to technology, as well as your own knowledge and experience around technology and:

• Identify ways that you could use technology to support your own learning needs as either a healthcare learner or practitioner. Consider the contexts of generalist practice, sole practice, interprofessional collaborative care, and interprofessional learning.
• Identify uses of technology that could support client care in rural and remote communities with your colleagues. Post your responses to “Session 3, Learning Activity 6.”

Activity 7:
Summarize how your learning in this might apply to your upcoming clinical learning or practice. Post to “Session 3, Learning Activity 7.”

In Session 4, we will explore what happens when professional and personal lives intersect in rural and remote communities. What happens when you are asked to step into your professional role at a community social gathering, or when you arrive home to discover your client has shoveled the snow from your driveway and left you a gift?

We’ll also explore the idea of facing situations that may be emotionally distressing due to feelings of empathy or moral injustice arising from inequities in northern rural and remote communities. Based on what you know so far about living, learning and practicing in rural/remote communities, imagine what challenges and benefits might arise for health care learners or practitioners from overlapping personal and professional lives. We’ll explore these ideas, as well as review the major concepts from this module, in our final session.

1. Roots RK, Brown H, Bainbridge L, Li LC. (2014) Rural rehabilitation practice: perspectives of occupational therapists and physical therapists in British Columbia, Canada. Rural and Remote Health, 14, p. 2506. Retrieved June 10, 2015 from: http://www.rrh.org.au/Articles/subviewnew.asp?ArticleID=2506
2. Health Workforce Australia. (2015). Allied health professions – Rural and remote generalist. Retrieved June 10, 2015 from: http://www.hwa.gov.au/our-work/national-rural-and-remote-health-workforce-innovation-and-reform-strategy/allied-health
3. Services for Australian Rural and Remote Allied Health. (2015). Specialist generalist. Retrieved June 10, 2015 from: http://sarrah.org.au/content/specialist-generalist
4. Services for Australian Rural and Remote Allied Health. (2015). Sole practice. Retrieved June 10, 2015 from: http://sarrah.org.au/content/sole-practice
5. Services for Australian Rural and Remote Allied Health. (2015). Scope of Practice. Retrieved June 10, 2015 from: http://sarrah.org.au/content/scope-practice
6. Northern Ontario School of Medicine. (2015). Interprofessional learning guide. Retrieved June 10, 2015 from: http://www.nosm.ca/uploadedFiles/Education/Health_Sciences_and_Interprofessional_Education/Interprofessional_Education_Program/IPE%20Resource%20Guide.pdf
7. Minore B, Boone M. (2002). Realizing potential: improving interdisciplinary professional/paraprofessional health care teams in Canada's northern aboriginal communities through education. Journal of Interprofessional Care, 16(2), pp. 139-47.
8. Latrobe Community Health Service & the Health & Socialcare Interprofessional Network. Readiness for Interprofessional Learning Scale (RIPLS). Accessed June 15, 2015, from http://www.ihi.org/education/ihiopenschool/Chapters/Documents/riplsquestionnaire19.pdf
9. Tryssenaar J, Berry S, Briggs M, Winn C, Shimmell L, Chisholm B, Snippe-Juurakko E, Wojkowski S. (2014). Student perspectives of interprofessional learning in rural and remote clinical placements in Northern Ontario. Unpublished material, McMaster University, Hamilton Ontario Canada. Excerpts related to IPC and IPL
10. Porter, J. (2012). First Nations Hurt by Nursing Shortage. CBC News. Retrieved June 10, 2015 from: http://www.cbc.ca/news/canada/thunder-bay/first-nations-hurt-by-nursing-shortage-1.1184843
11. The Network – Cisco’s Technology News Site. (2013). True Stories of the Connected: Rural Healthcare in Northern Canada. Retrieved November 2, 2015 from: http://newsroom.cisco.com/video-content?type=webcontent&articleId=1261363 (2:12 minutes)
12. Ontario Telemedicine Network. (2015). Ontario Telemedicine Network website. Accessed June 15, 2015 from: https://otn.ca/en. (Review portions relevant to Learning Activity 6.)
13. Ministerial Advisory Council on Rural Health. (2002). Rural health in rural hands. Strategic directions for rural, remote, northern and aboriginal communities. Retrieved June 10, 2015 from: http://www.ruralontarioinstitute.ca/file.aspx?id=29b5ba0b-c6ce-489f-bb07-2febfb576daa; Health Information Technology, pages 35-40