Components of Training

There is no formal core or elective training for rural medicine. If a trainee is undertaking subspecialty training, the subspecialty requirements for the two core years must be met. If the trainee is undertaking general medicine training, this should complement training already undertaken and should include acquisition of practical skills such as upper GI endoscopy and echocardiography to a level that may be required in a regional or rural setting. (This should take into account current and potential requirements for formal credentialling in the various modalities).

As a general guide, by the end of basic and advanced training most trainees should have had experience in most of the 'core' medical specialties - cardiology, respiratory medicine, gastroenterology, nephrology, neurology, rheumatology, oncology and endocrinology. Increasingly training in geriatrics and palliative medicine is being required to adequately treat the range of patients encountered in nonmetropolitan practice.

Furthermore trainees who are contemplating a rural career should appreciate that they will not have access to the same range of diagnostic imaging as their colleagues in major metropolitan centres and that access to specialist reporting of imaging procedures will be limited. Therefore trainees should aim to increase their experience with the interpretation of common imaging procedures - cardiac and thoracic imaging, abdominal imaging including ultrasound, renal imaging and musculoskeletal imaging - during advanced training.

At least one year of advanced training shall be undertaken in nonmetropolitan hospitals or sites. This can be either general medicine or subspecialty medicine, depending on the trainee and the rural hospitals involved.

The unique characteristics of rural medicine listed in 'Definition of Specialty' above mean that advanced trainees in rural medicine should:

• Ensure that they undertake terms (if not undertaken during basic training) in which the most recent resuscitation and basic intensive care skills can be learned (e.g. cardiopulmonary resuscitation, central and arterial lines, temporary pacemakers);
  
• Pay particular attention to the generic physician qualities previously discussed. This is because the consultant physician in rural Australia is likely to have a pivotal role in management in the majority of patients under his or her care owing to the shortage of other specialists (both internal medicine and others) and because the health care infrastructure in rural areas is less developed. In general, compared with the metropolitan physician, the rural physician will liaise to a greater extent both within and outside the health system;
  
• Make themselves aware of the range and limitations of telemedicine as it is likely that they will use this developing technology to an increasing extent, particularly if they practise in a smaller centre;
  
• Consider undertaking a course in indigenous health (such as the on-line module supplied by the College) as they are generally more likely to treat indigenous Australians during their practice, particularly if they are practising in more remote areas or larger centres that act as referral bases for indigenous populations.

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