title: Obstacles and solutions to maintenance of advanced procedural skills for rural and remote medical practitioners in Australia.
abstract: BACKGROUND
  Most rural communities are too small and remote to sustain specialist services, and therefore some rural and remote doctors in Australia practice advanced procedural skills as part of their comprehensive care to underserved rural communities. The declining number of rural and remote procedural non-specialist doctors poses a problem in Australia. There is, at present, no comprehensive delineation of the obstacles Australian rural doctors face in trying to maintain their skills in the procedural areas of obstetrics, anaesthetics and surgery, nor of the solutions that may overcome the problems. This literature review addresses these two needs.
  
  
  METHODS
  We interrogated the MEDLINE database to find articles about rural and remote medical education, with a specific focus on procedural skills. Other sources, including Google Scholar, were used to find relevant project and conference reports.
  
  
  RESULTS
  The barriers to the maintenance of advanced procedural skills for rural and remote medical practitioners include: lack of opportunity; expense associated with remaining skilled in advanced procedural areas; lack of access to locum relief to attend educational sessions; lack of flexible options for education; lack of access to advanced procedural training; time constraints; multiple credentialing requirements from state health departments and joint consultative committees; family obstacles; and perceived medico-legal problems. Retention of rural doctors and the difficulties faced by them in maintaining advanced procedural skills are related. There is evidence that both these problems can be addressed, at least in part, by increased support for flexible continuing medical education and professional development such as specific skills rural training programs, the availability of group practice opportunities, improved hospital facilities, reasonable workloads, financial incentives, locum assistance, improved housing quality, and better educational support for families. We also noted a positive association between dedicated rural training programs and the recruitment of rural doctors. Factors associated with these successful training programs include: rural fellowships, explicit rural mission, rural location, rural program directors, and procedural orientation.
  
  
  CONCLUSIONS
  The authors investigated the obstacles rural and remote doctors currently face in obtaining and remaining skilled in procedural medicine. The article describes the main barriers and presents some solutions from the literature. It also highlights the areas where work is being done and highlights the need for more quality research in this area.
authors.affiliation: Australian College of Rural and Remote Medicine, Brisbane, Queensland, Australia. roz.glazebrook@health.qld.gov.au
authors.forename: Roz M
authors.initials: RM
authors.lastname: Glazebrook
authors.forename: Simone L
authors.initials: SL
authors.lastname: Harrison
mesh_terms: D001315:Australia; D002983:Clinical Competence; D006801:Humans; D008511:Medicine; D011787:Quality of Health Care; D019035:Rural Health Services / Q000592:standards*; D013038:Specialization