Medical education: Overview

Abstract
Introduction: Wilderness medicine is a growing field focused on delivering quality medical care in austere environments. Simulation-based education has proven effective in emergency and wilderness medicine, particularly in graduate medical education. We propose that introducing wilderness medicine concepts earlier in medical education as part of a high-fidelity simulation for medical students could both increase interest in wilderness medicine and have widely applicable educational benefits.

Methods: We developed a novel 1-day case-based simulation curriculum to be performed in a wilderness environment and invited undergraduate medical students to participate. A 25-question survey was administered before and after the simulation to assess subjective change across various topics.

Results: The 10 of 12 students who responded to the survey indicated that the simulation significantly increased their confidence in managing urgent medical cases and increased their interest in the wilderness medicine field. All students agreed that simulation was an effective way to learn this material.

Discussion: Implementing a wilderness medicine simulation in medical curricula appears feasible and provides a comprehensive model that can be easily adapted to other institutions.

Abstract
Background: In response to rural medical workforce shortages in Western and Southwestern Victoria, Australia, Deakin University's School of Medicine established a dedicated Rural Training Stream (RTS) within its graduate entry Doctor of Medicine course in 2022. Consistent with the school's intention to promote social accountability, the RTS embodies a place-based approach, aiming to recruit 30 local applicants annually and train them in situ, thereby maximising opportunities for deeper connections with their communities and enhancing the likelihood of future local workforce retention. To underpin and facilitate collaborative program evaluation and research conceptually, a Program Logic Model (PLM) was developed. A PLM was chosen as the basis of this evaluation framework due to its foundations in systems and complexity theory and its amenity to collaborative development.

Methods: The PLM was developed using a stepwise, participatory approach, incorporating the contributions of a broad range of educators involved in the RTS program. Over a period of three months, participant input was provided through individual submissions and group workshops, sequentially developing each component of the model. Data gathered were summarised, reviewed and validated by the group periodically.

Results: The development of the PLM brought together a diverse group of academic and professional educators during the early stages of delivery of a new program, providing an opportunity for consensus building and the development of a shared understanding of the goals and objectives of the program. The developed PLM provides three clear objectives related to recruitment, training and professional identity formation. Short, medium and long-term outcomes aligned with each of these areas provide key reference points for the design of a comprehensive program of evaluation and research that is clearly linked to the program's goals.

Conclusion: The development of a PLM for Deakin's new RTS has provided an accessible roadmap that transparently communicates the design of the program to enhance local workforce outcomes for the rural communities that Deakin serves. The PLM provides a shared foundation for program-related evaluation and research, that is aligned with the strategic goals and desired outcomes.

Trial registration: Clinical trial number: not applicable.

Abstract
The value of distributed training of the medical workforce is well documented. Australia's Remote Vocational Training Scheme (RVTS) provides a scalable approach to specialist training in general practice that utilizes distance education and remote supervision. RVTS enables trainees to stay in their rural, remote and First Nations communities while working toward specialist certification as a general practitioner. The program, which supports both international and domestically trained graduates through tailored supervision and education, has operated across Australia for 25 years. Trainees are supported both professionally and socially over 4 years. An independent evaluation (2023-24) demonstrated a 78% completion rate among participants who remained in the same rural or remote practice for an average of 5.2 years. Two years after completing the program, 49% were still working in the community where their training commenced, well above documented retention benchmarks for these settings. High levels of participant satisfaction were reported, ranging from 88 to 100% across various indicators. The evaluation found that the program supports retention by eliciting five participant responses: comfort, confidence, competence, belonging, and bonding. Engagement and connection between participants are maintained through accessible technology, real-time support, virtual small-group learning, and twice-yearly in-person workshops. Despite the program's focus on high-need areas, it is cost-effective compared to similar rural training schemes. The experience of RVTS can inform other countries seeking to enhance rural workforce retention, particularly for underserved populations and migrant healthcare workers. The adaptable structure of the program aligns with the global development goals of the World Health Organization.