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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.
REFERENCES
1 Blue I. A critical anal+ of postgraduate educa-
tion opportunities for rrral nurses pmctising in the
Northern and Western regions qf South .4ustralia.
Masters thesis, Deakin Unirersity. Geelong. 1993.
2 South Australian Health Commission Epidemi-
ology Branch. Deaths Attributed to Diabetes Ilelli-
tzu in South Australia. rldelaide: South _lustralian
Health Commission. 1989.
3 Phillips P. Klson D. Eastermann _?1. Roeder D.
Beilb!~ J. The impact of diabetes in South _lus-
tralia. Australia and \ex Zealand Journal cf
Medicine 1991; 21: 19.
4 Dunning T. Care of People with Diabetes. .-l .llan-
5
6
7
8
9
10
11
12
13
14
15
16
17
ual of Nursing Practice. Melbourne. Blackxell
Science, 1994: 139.
Nutbeam D, Thomas M and Wise hf. National
Action Plan - Diabetes Towards the kar 2000
and Beyond. Canberra: Diabetes, Australia, 1993.
Zimmet P. Lowther 8, Phillips P- Senator G,
Welboin T. Screening for Diabetes. I\~H&!MRC
Series on Diabetes; Paper Ah. 4. Canbelxa: Aus-
tralian Government Publishing %+ce. 1994.
Popplewell P, Burston R, Loxther B. Phillips P.
Shearn M. Diabetes in Older People. !l’H&MRC
Series on Diabetes, Paper \b. .3. Canberra: Aus-
tralian Government Publishing Service, 1993.
Moffitt P, Fowler J. Eather G. Bed occupancy by
diabetic patients. Medical Journal of Australia
1979:1:244-245.
Mazzuca SA et al. The Diabetes Education Study:
il controlled trial of the effects of diabetes patient
education. Diabetes Care 1986: 9: l-10.
Rubin RR; Pqrot MI. Saudek CK. Effective dia-
betes education on self care. metabolic control
and emotional well-being. Diabetes Care 1989;
12: 673-679.
South Australian Health Commission. Report of
the Diabetes Serrices Planning Program: Service
Model K&king Part): .idelaide: South Australian
Health Commission. 1994.
Alexander. T. -1 Diabetes Outreach Serx-ice. Aus-
tralian !\urses Journal 1991: 21: 14-1.5.
Griffiths R. Presidentb Messape. 14rrstralian Dia-
betes Educators lssociation Magazine 1993; 40:
3. 18.
Robinson D. m-elcome to Ye\\- Outlook. Magazine
of the Eni\-ersitx~ of South _1uslralia. Ke7c Outlook
1993: 1: 1.
Paul R. O-pen Learning and Open Management:
Leadership und Integrity- in Distance Education.
London: Kogan Page. 1990.
Cal\-ert J. Erans T. King B. Course De\-elopment
through inter-institutional collaboration: the Xus-
tralian Master of Distance Education. ASPESA
Biennial Forum: Qualit>- in Distance Education.
Forum Papers. 1’01 1. Lismore Heights. NSK
.kustralian and South Pacific External Studies
Association. 1991: 102-110.
Higher Education Councii. Higher Education:
dchiecing Qualitl: Final report. Canberra: Aus-
tralian Go\-ernment Publishing Service. 1992.