Remote learning – how Broken Hill helps teach doctors

Sarah Wray’s work with the Royal Flying Doctor Service (RFDS) outreach clinics opened her eyes to challenges people face in rural Australia, particularly with continuity of care.

Ms Wray has been advocating for long medical student placements in rural areas and continuity of care since she finished an 18-month placement in Broken Hill with the University Department of Rural Health in 2021.

“I think it is important for medical students to do long placements in rural areas. You can’t appreciate how important continuity of care is for a patient unless you are there,” Ms Wray said.

Ms Wray captured her experience, and the challenges doctors face with continued care, in the Australian Medical Student Journal.

Before studying medicine at Wollongong University, Ms Wray grew up in Cairns, where she loved scuba diving, was interested in tropical medicine, and worked as a nurse in the dialysis unit.


In her final year studying medicine, she chose Broken Hill for her student placement because it seemed to be one of the more isolated places.

She wanted to see if there were similarities to Cairns.

After 12 months in Broken Hill, she planned to complete electives in Darwin and Vietnam.

But those placements were cancelled because of the COVID pandemic, so she extended her stay in Broken Hill for a further six months.
“Overall, it was a fantastic placement,” she said.

Ms Wray’s placement helped her to understand some of the hardships of working and living in a rural area, and the difficulties of providing continuity of healthcare in an isolated location.

“I hadn’t realised how much small places like Tibooburra rely on the RFDS,” she said.

The whole community gathers around when the RFDS doctors visit, from babies to older people, it becomes a real social event, with cake and tea, and everyone gets to know all the doctors and nurses that go out there.

The complexity of care that general practitioners deliver to these communities is very different to metropolitan areas which typically have many more services available.

“General practitioners have to upskill to deliver the level of care needed for these communities,” Ms Wray said.

She explained that practitioners face many challenges in rural areas.

Continuity of care is the ability to build a strong health practitioner-patient relationship that retains patient choice and satisfaction.

A spokesperson from the Far West Local Health District (FWLHD) explained they work in collaboration with the RFDS and Maari Ma to provide an extensive range of general medical and specialist care services to our remote communities.

The FWLHD increased its permanent workforce by 26.2 per cent, or an additional 141 full-time equivalent staff from mid-2012 to mid-2022 to address some of the rural challenges.

The workforce boost added three more doctors, 48 additional nurses and midwives, and 22 more allied health staff.

“Recruiting GPs to rural and regional areas is a challenge nationally and internationally,” the spokesperson said.

Student placements also help to fill the needs of the Broken Hill community.

The training and experiences medical students receive here are unique and varied.

The placement arms them with the robust skill set and knowledge they need to become confident and highly effective doctors, said the FWLHD spokesperson.

This was the experience for Ms Wray, who said her time in Broken Hill helped to equip her for her latest role in Adelaide.

“The program coordinators at Broken Hill helped me to achieve the goals I set out to achieve at the beginning of the year,” Ms Wray said.

“I got to do quite a lot of surgical assistance in obstetrics, and I know not every placement hub offers that.”

She later took on the role of Assistant in Medicine, a position unique during the COVID-19 pandemic because they needed more doctors.

“I felt more prepared for the work I’m doing now in obstetrics and gynaecology because of my experience in Broken Hill,” she said.

You can read more about Ms Wray’s time in Broken Hill in a journal article called Continuity of care; a final year medical student’s professional and personal experience in rural Australia on a longitudinal placement in Broken Hill, New South Wales.

The article is available online or in volume 11, 2022, of the Australian Medical Student Journal.

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