title: A framework for developing rural academic general practices: a qualitative case study in rural Victoria.
abstract: BACKGROUND
  There is increasing pressure for Australian rural general practices to engage in educational delivery as a means of addressing workforce issues and accommodating substantial increases in learners. For practices that have now developed a strong focus on education, there is the challenge to complement this by engaging in research activity. This study develops a rural academic general practice framework to assist rural practices in developing both comprehensive educational activity and a strong research focus thus moving towards functioning as mature academic units.
  
  
  METHODS
  A case study research design was used with the unit of analysis at the level of the rural general practice. Purposively sampled practices were recruited and individual interviews conducted with staff (supervisors, practice managers, nurses), learners (medical students, interns and registrars) and patients. Three practices hosted 'multi-level learners', two practices hosted one learner group and one had no learners. Forty-four individual interviews were conducted with staff, learners and patients. Audio recordings were transcribed for thematic analysis. After initial inductive coding, deductive analysis was undertaken with reference to recent literature and the expertise of the research team resulting in the rural academic general practice framework.
  
  
  RESULTS
  Three key themes emerged with embedded subthemes. For the first theme, organisational considerations, subthemes were values/vision/culture, patient population and clinical services, staffing, physical infrastructure/equipment, funding streams and governance. For the second theme, educational considerations, subthemes were processes, clinical supervision, educational networks and learner presence. Third, for research considerations, there were the subthemes of attitude to research and research activity. The framework maps the development of a rural academic practice across these themes in four progressive stages: beginning, emerging, consolidating and established.
  
  
  CONCLUSIONS
  The data enabled a framework to be constructed to map rural general practice activity with respect to activity characteristic of an academic general practice. The framework offers guidance to practices seeking to transition towards becoming a mature academic practice. The framework also offers guidance to educational institutions and funding bodies to support the development of academic activity in rural general practices. The strengths and limitations of the study design are outlined.
authors.affiliation: Southern General Practice Training, Churchill, Victoria, Australia. james.brown@sgpt.com.au.
authors.forename: J B
authors.initials: JB
authors.lastname: Brown
authors.affiliation: Gippland Medical School, Monash University, Churchill, Victoria, Australia. tracy.morrison@vu.edu.au.
authors.forename: Tracy
authors.initials: T
authors.lastname: Morrison
authors.affiliation: Charles Sturt University, Boorooma Street, Wagga Wagga, New South Wales, Australia. mebryant@csu.edu.au.
authors.forename: Melanie
authors.initials: M
authors.lastname: Bryant
authors.affiliation: Southern General Practice Training, Churchill, Victoria, Australia. lisa.kassell@sgpt.com.au.
authors.forename: Lisa
authors.initials: L
authors.lastname: Kassell
authors.affiliation: Gippsland Medical School, Monash University, Churchill, Victoria, Australia. debra.nestel@monash.edu.
authors.forename: Debra
authors.initials: D
authors.lastname: Nestel
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D005180:Faculty, Medical / Q000458:organization & administration / Q000706:statistics & numerical data; D058006:General Practice / Q000193:education*; D006801:Humans; D007407:Interviews as Topic; D019982:Organizational Case Studies; D015279:Organizational Culture; D010361:Patients / Q000523:psychology / Q000706:statistics & numerical data; D010379:Peer Group; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data; D024382:Professional Role; D016730:Program Development; D036301:Qualitative Research; D012107:Research Design; D012108:Research Personnel / Q000523:psychology / Q000706:statistics & numerical data; D012423:Rural Health / Q000193:education*; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population; D013337:Students, Medical / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014739:Victoria
keywords: Administrator; Australia/Pacific; Community Participation; Continuing Professional Education; Economics; Education; Evidence-based Care; General/Family Practice; Health Service reform; Management/Administration; Medical; Postgraduate; Primary Health Care; Qualitative Research; Researcher; Undergraduate; Workforce