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Continuing professional education: A challenge for rural health practitioners

P. Hill and T. Alexander

The Australian Journal of Rural Health © Volume 4 Number 4, November 1996

Aust. J. Rural Health (1996) 4, 275-279

Original Article

CONTINUINGPROFESSIONAL EDUCATION:ACHALLENGEFORRURAL HEALTHPRACTITIONERS

lFaculty of Nursing, University of Sozzth Azzstralia and 2Diabetes Centre: QzLeen Elizabeth

Hospital, .Adeluide: Sozzth Azcstraliu, Azzstraliu

ABSTRACT: Health professionals in rural and remote areas of dustralia are disadvantaged

when accessing continning education. Their geographical isolation kJluences attendance at

seminars; workshops and even informal discussions with colleagues. This paper describes the

strategies adopted to meet the continuing education needs of a group of health professionals

working in diabetes education and discusses how other specialist areas can provide similar

educational opportunities. The education programs for isolated health professionals involved in

diabetes care in Sozzth ilustralia xere creuted b)- a team, and the resources of their associated

institutions. Formal wo&ng agreements xere established to achieve the aim of relevant

continz@g education for rural health professionals arid to ensure ongoing centures. All programs

have been positively. receiced? and eraluations identzyy the need to develop oder. related subjects.

Future developments zzill further utilise advances in teclznologl. to erfend uccess and add to the

current modes of education delicer?: It is the intention of this grozzp to continue to deceloppractice-

based szlbjects capable of meeting rural health practitioners’ needs and thzzs enhance the qzlalit). of

care in rural and remote communities.

KEY WORDS: con&uing education, diabetes: distance education, rzzral health.

INTRODUCTION

Continuing education for health professionals is

important to ensure that their practice remains

contemporal> and of the highest qualitx-. How-

ever, professional isolation in rural and remote

areas limits practitioners’ opportunities to keep

abreast of changes in practice and their access to

quality continuing education programs \rhich are

Correspondence: Pauline Hill. Facult! of Xursing. University of South -Australia. Holbrooks Road, Underdale, SA 503.2, Australia.

Accepted&publication February- 1996.

recognised bx- their respective professions. In

rural areas. the issue of access to continuing edu-

cation for health professionals remains problem-

atic. It is often difficult for healthcare workers to

attend educational programs: due to their hours of

work (i.e. shift work): the cost of trax-el. accommo-

dation, time awa7 from I\-ork and farnil>-> and find-

ing appropriate replacements to carrl- out their

duties in their absence. These obstacles are com-

pounded b!- the geographical isolation of rural

healthcare workers and. combined with limited

professional relationship.. Q in their work environ-

ment, persist as the most influential factors when

276

trying to attract quality staff to rural and remote

healthcare agencies.1

Technology in health care has advanced sig-

nificantly over the past 20 years. However, many

of these advances could also be utilised by health

care professionals for increased professional and

educational opportunities. A widely known exam-

ple is the use of the telephone to comrect a patient

located in a rural hospital to an electrocardiogram

(ECG) monitor, which can be displayed to, and

read by, specialists in a major metropolitan facil-

ity. Such connections allow healthcare workers to

engage in professional discussions about contem-

porary treatments and to extend their current

knowledge and skills base. Just as the ECG infor-

mation can be compressed and transmitted

through the telephone line, so can a wmide variety

of educational information. The telephone is now

relatively commonplace in most rural and remote

locations, so it can be increasingly utilised for

continuing education opportunities. However, the

telephone is often overlooked as a means of

accessing professional education.

This paper discusses a project designed to

address the challenges of continuing education

for rural health professionals in the field of dia-

betes education and management. Two strategies

were utilised in the development and implemen-

tation of the programs that could be adapted by

any discipline or specialty to provide continuing

education in rural and remote areas.

DIABETES AND RURAL HEALTH

Diabetes care is a significant issue in rural areas

as individuals with diabetes in rural locations

continue to have a higher morbidity and mortality

rate than their city counterparts.2,3 Patient educa-

tion is now well established and is considered an

integral part of health care; it is particularly sig-

nificant in the care of people with diabetes.” Indi-

viduals with diabetes need to achieve an

adequate level of understanding of their condition

and its management in order to manage their day-

to-day treatment at home.

Health professionals inevitably encounter

AUSTRALIANJOURNALOFRURALHEALTH

people with diabetes, due to the increasing preva-

lence of the condition, and are required to pro-

vide appropriate education to those individuals

with diabetes.s-7 For health professionals located

in rural and remote areas, access to current direc-

tions in treatment is usually limited. In addition

to this, diabetics in these communities are further

disadvantaged by reduced access to specialist

care and to the resources required for effective

self-care of the condition. Research has shown

that diabetes education can dramatically improve

blood glucose levels, thus decreasing the inci-

dence of complications and subsequent hospital

admissi0ns.a10 Education is therefore a key fac-

tor in the treatment of people with diabetes.

However, the number of rural health profes-

sionals appropriately qualified and educated in

diabetes care is insufficient to address the needs

of people with diabetes requiring such an educa-

tion service.11 Consequently, many health profes-

sionals are working beyond their level of

education and are taking responsibility, without

formal diabetes education, for the management of

people with diabetes. Alexander, in her article on

the development of diabetes services in South

Australia, reported on the ‘inequity in the health

status of urban and rural diabetics’ and identified

that health professionals who gain knowledge and

skills through experience alone are more likely to

provide inaccurate and inconsistent information

about diabetes.r2 This clearly indicates a need for

relevant education programs for rural health pro-

fessionals working in diabetes education.

Opportunities to gain specific qualifications

in diabetes education are limited. There are only

a limited number of diabetes educators’ courses

available in Australia, and all require partici-

pants to attend classes in a major city, thus limit-

ing access for rural health professionals wishing

to gain credible diabetes education. Although the

Australian Diabetes Educators Association

(ADEA) recognises the need for continuing edu-

cation programs in diabetes care,13 they do not

provide such programs.

Issues such as difficulties with access to dia-

betes continuing education programs, the high

CONTINUING PROFESSIONAL EDUC-\TIOiK: P. HILL-\UDT..~LE?I,\~DER 277

morbidity and mortality associated with diabetes in

rural areas, the low numbers of trained staff, and

the potential positive impact of diabetes education

were integral considerations in the initiation of

current diabetes education programs. In recogn-

tion of these facts. a team of concerned health pro-

fessionals in South Australia met to de\-elop

strategies to ol~ercome these problems by increas-

ing the continuing education opportunities for rural

health professionals inr-011.ed in diabetes care.

THE STRATEGIES

In developing continuing education programs. the

importance of content being relevant. practical.

meaningful and accessible to participants xas

recognised. Vith this in mind. txo strategies xere

identified and the programs developed. These two

strategies for program development and imple-

mentation are generic in nature and could be

utilised for any continuing education program

based around a clinical issue. In this case. the

clinical issue was diabetes care.

The first strategy xas to create a team of

people with the necessai?- expertise in diabetes

care, education and distance education strategies.

The team was then charged with the task of

ensuring that the aims and objecti\-es of the con-

tinuing education programs ~oulcl meet the needs

of rural health professionals and be accessible to

those in isolated areas. It was imporlant to use

techniques which encouraged students to interact

both with each other and J\-ith the experts

involved, and for students to feel part of the

learning process. The co-opting of specialist clin-

icians, educators and technologists was identified

as a key element in the SLICC~SS of the project.

This collaboration not onI!- added crecIibilit\~ and

relevance to the content and clelirer!- of the pro-

grams but also extended the participants’ netr\-ork

of professional colleagues.

The second strategy was to identif!- the educa-

tional approach to be taken. The need for clinical

relevance and practice-based issues for partiei-

pants was balanced against the tertiar!- education

aim of a broad learning experience. To combine

these txro important perspectix-es effectively, the

programs were designed to introduce the partici-

pants to learning at a distance, delmeloping skills

in information literacy and then building on this

information with materials, activities and assign-

ments based on diabetes education and manage-

ment issues. Participants woulcl each undertake

generic course activities as part of their learning

and would respond from their work contexts (clin-

ical, education or management). This enabled

students to apply theory to practice and to receive

feedback on their actual practice.

DEVELOPING THE EXTERNllZ,

PROGRmIS

The Diabetes Centre at The Queen Elizabeth

Hospital (TQEH) in Adelaide established an out-

reach service in 1989 to provide continuing eclu-

cation and resources to health professionals

working in diabetes eclucation in South Australia.

Initially, the serl-ice xas funded 1x7 a grant from

the Commonrvealth GOT-ermnent. Since 1990 the

service has continued Trith special funcling from

the South rlustralian Health Commission. One of

the first actiT~ities of the service 1~x3 to conduct an

education needs analysis. throughout country

South rlustralia. of health professionals working

in diabetes care. This identified the need for fur-

ther education in clinical issues, management,

evaluation and education program derelopment

related to the proTmision of an effecti\-e rural

health ser+e. -IboT-e all. responses indicated the

need for diabetes educators to receix~e recognition

as specialist health professionals while adl-an&g

their qualifications.

In order to proI-icle an accessible continuing

education program that is professionall!- recog-

nised and leads to aclranced qualifications: staff

from the Diabetes Centre Outreach Service

approached the Unix-ersitx- of South _lustralia’s

Facult!- of Zursing to create a program to meet

these needs. The Lni\-ersitT- of South -Australia is

committed to ‘educating professionals - apply-

ing knoxleclge - serl-ing the community’.l” The

compatibiliL!m of each institution’s philosophy and

278 AUSTRALIANJOURNALOFRURALHEALTH

their close geographic proximity to each other

fostered what is destined to become a long-term

collaboration.

A management team representing the inter-

ests of the two institutions and the relevant facul-

ties was established to create innovative distance

education programs in diabetes education. The

combined research, clinical and distance educa-

tion expertise resulted in a series of subjects and

continuing education projects.

Each institution shared costs and their exper-

tise in the development and pilot phases of the

package. This was supported by their organisa-

tion’s objectives, which encouraged collaboration.

Development of the pilot subject highlighted the

10 collaboration precepts posed by Paul,15 and

members of the management group agreed with

the conclusions reached by Calvert, Evans and

King? it was important to establish clear guide-

lines and expectations which, when coupled with

a sincere enthusiasm for a project, would allow

all parties involved to achieve successful negotia-

tions and reach mutually satisfying outcomes.

In developing the content of each program,

professional standards of practice set down in

1994 by the Australian Diabetes Educators Asso-

ciation (ADEA) were integrated into the content,

and the foci and boundaries were defined by the

organisations involved. Needs of potential stu-

dents, together with the needs of all the stake-

holders, were also taken into account.

The application of clinically relevant, contem-

porary theoretical knowledge was seen to be cru-

cial to the success of the programs. Access to

experts in diabetes care was sought from through-

out the country, and the clinical content was gen-

erated and delivered by noted specialists from

TQEH Diabetes Centre, Queen Victoria Hospital

South Australia, Diabetes Association of Western

Australia, Royal Prince Alfred Hospital New

South Wales (in collaboration with Sydney Uni-

versity) and Office for Cabinet and Government

Management (South Australia) and from the Uni-

versity of South Australia’s Faculty of Nursing,

School for Human Resource Studies and Flexible

Learning Centre. The formalisation of these links

across organisations and institutions in order to

establish a credible, relevant and high-quality

learning experience in a new health discipline is

unique in health professional education.

The results of these collaborations are two

external diabetes continuing education subjects,

one for registered nurses and one for all health

professionals, and a series of audioconferences

for any health worker interested in diabetes care.

The programs are equivalent to degree-level stud-

ies and credit transfer can be sought. Students

pay fees for each subject. The programs are

designed to be highly interactive, and include

written materials, readings, structured indepen-

dent activities and telephone tutorials.

The telephone tutorials are delivered by a

combination of university staff and specialists

from the collaborating institutions, resulting in a

varied and unique learning opportunity for partic-

ipants. Students and topic experts are able to

engage in the learning experience as peers,

simultaneously enriching each other’s profes-

sional network. The students are further moti-

vated to learn through involvement in discussions

and debates and by the chance to apply this

knowledge and experience in their workplace.

Subsequently, their work practices are also evalu-

ated, validated and improved through this profes-

sional discourse. The design and delivery of the

subjects facilitated this process, providing both

focus and framework. Formative and summative

evaluations continue to be positive, with a high

degree of student satisfaction.

A major aim of these programs is to encourage

networking between students and topic experts,

through highly interactive program design. The

teaching strategies employed can also be used by

participants to continue their professional rela-

tionships and networks beyond the formal course

requirements. Also, these techniques can be used

for the education of peers and patients who may

be geographically isolated, unable to attend ses-

sions at particular times or places, or unable to

travel long distances.

In addition to this, the management team was

keen to foster the notion of self-directed learning

CONTINUING PROFESSIONAL EDUCATIOS: P. HILL AND T. ALEXANDER 279

and critical thinking. iln important aim of tertiarl-

education is to encourage students to be able to

recognise, access and utilise the resources avail-

able, thus ensuring ongoing professional develop-

‘ment which keeps individuals in touch with

current applications in their field.17 These skills

provide individuals with the tools to counter iso-

lation, and are therefore particularly important to

those living in isolated communities. Without

these skills, professionals can be isolated even in

a metropolitan region.

CONCLUSION

The self-directed learning habits. together with the

professional networks established while inroll-ed

in the programs: will help to maintain and increase

the participants’ knowledge as specialist diabetes

health professionals. Through the development of

these associations, professional status and educa-

tional needs have been met.

Initiatives such as these projects reaffirm the

commitment of the Lni\mersitv and the Diabetes

Outreach Service to education for students. pro-

fessionals and the communit!: Future subjects in

this and other areas of professional need are

planned through the continued alliance of The

Queen Elizabeth Hospital Diabetes Centre. Dia-

betes ilustralia (South rlustralia) and the Facult!m

of Nursing, Universit!i of South Australia.

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