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From a broom cupboard: 20 years of rural health at Monash University

Ch 05. Collaboration in northern Victoria

Embedding education in regional health services and communities

Professor Geoff Solarsh

A mere 10 years ago, the only trace of Monash University activity in the Loddon Mallee region were a small and struggling primary care clinic in a slightly dilapidated weatherboard building opposite the Bendigo Hospital, and a fledgling Centre for Rural Mental Health, recently established as a joint venture between the School of Psychiatry and Psychology at Monash and Bendigo Health.

Today, in mid-2012, the Monash School of Rural Health occupies large and well-appointed clinical schools on the regional hospital campuses in Bendigo and Mildura. Our Bendigo Regional Clinical School is an integral part of a new health education and research precinct shared with the La Trobe University Rural Health School and the Bendigo Primary Care Centre. Bendigo is the Monash hub of the NVRMEN (Northern Victoria Regional Medical Education Network), a collaborative innovation in medical education with the University of Melbourne that places over 200 medical students each year in north-west Victorian educational sites. Bendigo is also the La Trobe University hub for a regional education program for large numbers of students from nursing, allied health and dentistry within the same geographical footprint. Together these three universities, with their many health service partners and distributed rural communities, constitute a major health workforce intervention; they sustain the supply of health professionals from all disciplines and improve health status in these and other rural and remote communities in Australia.

Foundations

Rural clinical schools

The NVRMEN story has its start in 2001 with the federal funding of rural clinical schools in Australia. These schools provided the infrastructure and support for the placement and education of medical students in regional, rural and remote health services and communities. A condition of this funding was that all participating medical schools must place at least 25 per cent of their government-funded students – the vast majority of students at most universities – in these rural schools for at least one of the clinical years of the medical course. By selectively enrolling students from rural communities and by returning them to the same or similar communities for prolonged periods of education during their formative clinical years, it was expected that a good number of these students would return to practise in these areas after their graduation. This expectation was largely based on published evidence from rural medical education programs in other countries. The rural clinical school strategy provides an opportunity, on an unprecedented national scale, to apply these principles and to reproduce these results in Australian rural settings.

The Monash School of Rural Health

Between 2001 and 2002 Monash established four regional clinical schools, two in Mildura and Bendigo in the Loddon Mallee region in north-west Victoria, and two in Traralgon and Bairnsdale in the Gippsland region in south-east Victoria. These four schools, in their respective sub-regions, proceeded to recruit local health service providers in hospitals, general practices and other health agencies as key partners and future placement venues for their students. They also began to recruit and appoint small teams of clinical tutors and administrators to work with the central faculty to design and run rural medical education programs that were fully aligned with the Monash medical curriculum while, at the same time, providing essential rural context and content. Together with their staff and multiple health services and community partners, these four regional clinical schools provided the initial configuration for the Monash School of Rural Health.

The first cohort of clinical students entered the Monash School of Rural Health in 2004 in the first clinical year – Year 3 – of the medical course. By the end of 2006 the school, at all its sites, had demonstrated its capacity to successfully place students in all three clinical years – Years 3 to 5 – to meet all their respective learning objectives in rural settings and to achieve assessment results that were at least equivalent to those achieved in metropolitan clinical schools. The Monash School of Rural Health had passed its initial viability test and was, with its counterparts elsewhere in Australia, considered to be fully launched as part of a national innovation in medical education and health workforce development.

The School of Rural Health was the overarching governance structure for all rural programs and activities at Monash, including: the regional clinical schools; the Centre for Multi-Disciplinary Studies in Rural Health – soon to become the Monash University Department of Rural and Indigenous Health; a whole-of-school rural research program; and many smaller rural projects and programs over the school’s entire footprint. As a formally constituted school in the Faculty of Medicine, Nursing and Health Sciences, it had the same status, privileges and obligations as all other schools in the faculty.


School of Rural Health teaching sites in 2006.

 

Expansion of medical education programs in Australia

In 2006, after much discussion and analysis, the dominant view in universities, professional colleges and government was that Australia faced a medical and health workforce crisis. Its reliance on overseas-trained medical graduates was neither viable as a future health workforce strategy nor morally defensible, given the parlous state of health services in donor countries. Faced with this reality and a clear federal commitment to fund a national expansion of medical training, the state government in Victoria announced the creation of 220 new medical training places. Proposals were quickly received and approved for Deakin University to set up a new graduate entry medical school in western Victoria with 120 places, centred on Geelong, and for Monash to set up a new graduate entry medical school in Gippsland with 40 places, centred on its existing Gippsland campus. The remaining 60 places in northern Victoria were contested by La Trobe University (which wanted to establish a graduate entry medical school in Bendigo, centred on its existing Bendigo campus), and a collaborative bid by the rural clinical schools at Monash and the University of Melbourne (centred on their respective rural campuses in Bendigo and Shepparton).

In northern Victoria the options offered by La Trobe University and the Monash University–University of Melbourne consortium were starkly different in their approach. While the La Trobe University bid was to establish a new graduate entry regional medical school, Monash and the University of Melbourne proposed a model built around their existing rural clinical schools that enhanced rural enrolment and allowed students to spend much longer and continuous periods in rural clinical training. The Monash University–University of Melbourne bid was ultimately successful, so by the end of 2006 the ‘educational scramble for Victoria’ was over, and the educational landscape was significantly transformed. In parallel with the expansion in medical education, there was a similar if not greater expansion in nursing, allied health and dentistry education programs in Victoria.

Since this expansion has occurred, almost exclusively, in regional rather than metropolitan education programs, it has required the participation of virtually all health services, sizeable general practices and health-related agencies in Victoria. The rapid incorporation of partners, in many cases with very little past involvement or experience in health professions education, has posed some challenges for both governance and effective delivery of large-scale distributed health professions education in Victoria. It has, at the same time, provided an important opportunity to involve almost every health professional in the state in the clinical education of the next generation of health practitioners; by providing support for students in this role, professionals enhance the standard of their own clinical practice. Seen in this way these expanded programs represent not only a significant educational and health workforce intervention but also a very significant strategy for improving health services in Victoria.


By the end of 2006 the medical educational landscape in Victoria was split into distinct regions with NVRMEN covering the northern and central parts of the state.

The NVRMEN model

In opting to build this expansion around existing rural clinical schools rather than to create a new regional medical school, Monash and the University of Melbourne were able to retain their current educational focus on the clinical years while more effectively addressing the health workforce imperatives of their rural clinical school programs. They were also able to redevelop many of their existing facilities, to extend their partner base to include many new small health services, community-based practices and other community health agencies, and to recruit a new cohort of students. They were predominantly from rural areas, with a pre-enrolment commitment to extended placement in northern Victorian rural education sites for over 80 per cent of their clinical training. This new cohort of 60 students – 30 at each university, enrolled under the umbrella of the NVRMEN collaboration – is referred to as the ‘Extended Rural Cohort’ at both universities.

Collaboration with the University of Melbourne

Both universities saw in their collaboration the opportunity to align their medical education programs across two adjacent rural regions that together constitute a third of the land mass of Victoria. This brought the academic resources of two leading Group of Eight universities to bear on a well-circumscribed rural population of 600,000 people. It also provided the unusual opportunity to tackle, in concert, the health workforce and health service priorities and thereby improve the health status of these communities.


Opening of the Bendigo Regional Clinical School redevelopment 2010: left to right – Georgia von Guttner (University of Melbourne), Peter Disler (Bendigo Health), Dawn DeWitt (University of Melbourne), Jacinta Allan (Victorian Minister for Regional and Rural Development), Geoff Solarsh, and Graham Allardice (Monash University).

The two universities signed a memorandum of agreement which provided for ongoing management by each university of its existing sites, and catered for the placement of University of Melbourne students in prescribed numbers at Monash’s Bendigo Regional Clinical School and its affiliated regional hospital. At the outset both universities recognised the special challenges of aligning two different curricula and meeting their separate academic requirements at sites where students from both universities were placed. They also recognised the leverage that could be obtained by working together, as demonstrated by the considerable infrastructural resources secured by this consortium for the NVRMEN initiative in northern Victoria.

Infrastructure development

A total of $25 million dollars of new funding was obtained to develop the physical infrastructure for the NVRMEN initiative. This allowed each university to improve facilities in their respective regional centres. Monash built a new regional clinical school on the Bendigo Health campus and significantly extended our regional clinical school in Mildura. Funding also allowed Monash to establish three rural hubs in the Loddon Mallee region, centred on Kyneton, Castlemaine and Swan Hill. Each hub was provided with dedicated educational facilities and resources to support a distributed model of community-based medical education in multiple general practices and health-related community agencies. Additional funding was obtained for the development of student consulting suites and small educational precincts in each of the participating general practices.

Selection and enrolment

The universities agreed to run a joint process to recruit the first cohort of students in 2007. The shared goal was to recruit as many rural-origin students as possible from the Loddon Mallee and Hume districts in northern Victoria. Failing that, the following recruits were sought, in descending order of priority: rural-origin students from elsewhere in Victoria; rural-origin students from elsewhere in Australia; and, finally, metropolitan students. The usual definition for rural-origin students was used. Information sessions were run at every small rural centre in northern Victoria and publicity campaigns for this new stream of education were launched by both universities through their usual recruitment channels at high schools across Australia. A new Extended Rural Cohort enrolment code was created at the Victorian Tertiary Admissions Centre so that students could pre-select this option in preference to the standard stream at both universities. All students finally selected for the Extended Rural Cohort stream at Monash were expected to sign a contractual agreement that they would be based at regional and rural clinical education sites in northern Victoria in their clinical years.

Pre-clinical education

NVRMEN continues to rely on its Melbourne campuses – the University of Melbourne in Parkville and Monash in Clayton – for the first two years of largely pre-clinical education. This decision allows Extended Rural Cohort students to benefit from the rich resources the central campuses provide in the basic biomedical, social and population sciences, and to enjoy the formative social experience of large campus life. The strong, active presence of the Monash rural health club, Wildfire, on the Clayton campus has provided a vehicle for Extended Rural Cohort student involvement in rural health initiatives during their two-year stay on the metro campus. Short-term rural placements in the early years also provide opportunities for Extended Rural Cohort students to be placed in Bendigo and Mildura and to develop early links with staff and clinical Extended Rural Cohort students based in these schools.

Educational philosophy

Student cohorts on long-term placement in a single circumscribed educational system provide opportunities for learning that are not available in less continuous learning environments. Educational access to the same students over time makes it possible to plan and facilitate sequenced and incremental learning, to have much greater control over educational inputs and to assume greater educational responsibility – with its attendant satisfaction – for distal learning outcomes. However, in NVRMEN, this commitment to educational continuity goes beyond that of the curriculum. Regional systems of care with well-defined primary care systems that have clear, bi-directional referral relationships with more sophisticated, specialised levels of care provide opportunities to understand continuity of care and its effect on the health of both individuals and whole populations. Students in this program move between large regional hospitals, small community hospitals, general practices, community health agencies and households at different points in their three-year clinical training. Our hope is that they will develop well-balanced biomedical, social and population perspectives on the many conditions they encounter, and a good understanding of how health systems at all levels of care make appropriate contributions to their management. Such broad perspectives are particularly important for chronic diseases which represent an ever-increasing proportion of the disease burden in Australia.

Curriculum development

At the inception of NVRMEN, both Monash University and the University of Melbourne already had well-established rural medical education programs in their respective regions and, therefore, considerable pooled experience in customising medical curricula for rural contexts.

Clinical year 1

It had been agreed that students from both universities would do their foundation clinical year in internal medicine, general surgery and their related sub-disciplines together in Bendigo. Since the core curriculum content and hospital-based format were very similar at both universities, it was further agreed that the foundation year would be delivered as a single integrated year-long program for all students, irrespective of their university of origin. In preparation for the first clinical year in 2009, educational teams from Monash and the University of Melbourne, with the assistance of an external consultant, met repeatedly to analyse the two curricula, to map learning objectives and content, and to develop appropriate learning methods that would meet the assessment needs of both universities. This task was complicated by the fact that the two programs had commencement times that were six months apart and that there was a strong likelihood that the University of Melbourne would introduce a totally new curriculum in a few years time. In the end, agreement was reached on a hybrid model that incorporated some of the best elements of both curricula and could be feasibly implemented until clarity about future changes to the University of Melbourne medical course could be provided.

Clinical year 2

The other large curriculum development exercise tackled under the NVRMEN banner was the implementation of a longitudinal community-based model for the disciplines of women’s health, children’s health, psychiatry and general practice in the second clinical year. Monash and the University of Melbourne briefly considered taking this on as a combined and integrated exercise for all Extended Rural Cohort students at both universities and across both regions. Given the complexity of integrating these four discipline-specific curricula, the number of large and small health services and community agencies that would need to be engaged in each region, and the significant mismatch between curriculum content at the two universities, Monash and the University of Melbourne decided to implement this model separately in their respective regions. At Monash, this exercise was preceded by a protracted community engagement process with rural and regional general practices over a two-year period. The process included an in-depth survey of specialist and general practitioner beliefs about who should teach which parts of the curriculum. Based on the survey, on a detailed mapping of the four component curricula, and on an analysis of individual site capacity for student placements, a final model was determined. It also met our pre-set goals for community-basing, disciplinary integration and year-long educational continuity.

In this year-long model students are expected to cover the children’s health, women’s health psychiatry and general practice curricula through the course of the year in both regional and rural practice settings. Their time is thus divided equally between semester-long rural and regional rotations which are supervised by generalists and specialists respectively. The detailed mapping of the content of all four curricula and a careful allocation of defined components of this content to rural or regional rotations for generalist or specialist delivery provides year-long continuity and, where appropriate, integration of disciplinary perspectives.

In the rural rotations students are based in a single general practice in one of the rural hubs for 18 weeks, during which they see their own booked patients for two days a week under the supervision of a clinical GP tutor. Another two days are spent linking with multiple community agencies in the same rural primary care system in which their general practices are based and in following selected patients with chronic health conditions through their multiple contacts with other health professionals at different levels in this system. The remaining day of the week is a learning day devoted to tutorials conducted by generalist tutors, and self-directed study.

In the regional rotations students move between three discipline-specific and largely hospital-based blocks in women’s health, children’s health and psychiatry on four days of the week, and the fifth day is spent in a regional general practice. Discipline-specific tutorials, largely from specialist tutors, are run after 4.00 pm on four days of the week so that they do not interfere with clinical clerkships in the hospital.

Semesters 1 and 2 alternate, with 17 weeks of GP consulting at the regional hubs of Bendigo and Mildura, and 17 weeks at the rural hub undertaking procedural practice, plus one week of admin in Bendigo at the start of each semester
Chart 5.1 The NVRMEN Year 4 integrated, community-based model launched in 2009.

 

Clinical year 3

The final year of the Monash medical course comprises a series of hospital-based six-week block rotations that are intended to prepare students for their upcoming internship. There are four core block rotations that include internal medicine, general surgery, aged care and emergency medicine; there is also a Monash selective from a wide range of traditional and non-traditional specialist and generalist options; and, finally, an elective block at any medical school inside or outside Australia.

Monash Extended Rural Cohort students are expected to spend a minimum of two rotations in Bendigo or Mildura. There is anecdotal evidence to suggest that student choices about future career directions and locations are influenced by the exposure they receive in the year before graduation. At a minimum these exposures seem to influence their choices about where to do their internship, which in turn, influences decisions about training programs and their location. Given these observations, and the considerable investment already made in extended rural immersion during the preceding clinical years, it was considered important to base students for some time in the same regional and rural settings in clinical year 3.

It was equally necessary to give our students some exposure to large metropolitan sub-specialist hospitals to round off their clinical training. Not only are there critical perspectives about patient care to be gained, but many Extended Rural Cohort students will spend significant periods of training in these hospitals. Understanding the principles and contribution of sub-specialist services to patient care and the culture of practice in these hospitals is essential for graduates, irrespective of the individual decisions they make about their further medical vocation.

Steps to a regional academic health complex in Bendigo

The Monash Primary Care Clinic

Monash established a primary care clinic in Bendigo in the early 1990s long before the advent of the rural clinical school. This initiative of the Monash Department of General Practice was intended to provide a GP service to disadvantaged communities in Bendigo and to create an exemplar of best practice from which vocational GP training of the highest quality could be conducted. This clinic came to fill a specific niche in Bendigo by providing episodic care for those patients who, for multiple reasons, were not or could not be registered with established general practices. It also provided cover for patients of these other practices when their GPs were away. When the Bendigo Regional Clinical School was established, it took over management of the Primary Care Clinic in 2001.

The Primary Care Clinic has struggled, throughout its existence, to achieve full financial viability. Monash was advised that, unless the Primary Care Clinic significantly increased its patient base and developed service and business models similar to those of other private general practices in Bendigo, the financial issues were unlikely to be reversed. It was also the University’s view that the Primary Care Clinic was rightfully a public health asset of the City of Greater Bendigo and that, unless broad-based support could be demonstrated for its continuation, it might need to be closed. In 2007, at much the same time that NVRMEN was established, steps were taken to mobilise a broad-based consortium that would take collective responsibility for further developing the Primary Care Clinic as an ongoing primary health care facility for the people of Bendigo. The consortium was made up of Bendigo Health, Bendigo Community Health Services, Monash University, La Trobe University, Central Victorian General Practice Network, Beyond Medical Education – a GP vocational training provider – and the City of Greater Bendigo. This consortium of seven education and service providers, representing the key players in the primary care space in Bendigo, went on to secure $8.4 million of combined federal GP Super Clinic and state funding that finally enabled the Bendigo Primary Care Centre to be completed in October 2011.

Bendigo Primary Care Centre

Beyond its obvious value as a new purpose-built primary care provider for the people of Bendigo, the Bendigo Primary Care Centre has had a foundational role in building the next phase of health partnerships in the Loddon Mallee region. The shared aspiration for an integrated primary health care service for the City of Greater Bendigo kept the consortium of seven key institutions working together over an intense four-year period, with many ups and downs. It resulted in a protracted and in-depth conversation that has produced a future vision for a city-wide management strategy for chronic non-communicable diseases. It also cemented a set of trusted institutional relationships on which future collaborations could be built.

La Trobe University Rural Health School

La Trobe University has always been an important education provider to the nursing and allied health workforce in Victoria. The La Trobe University response to the expansion of health professions education in Australia has been to establish a new regional dental school in Bendigo and, thereafter, to reconceptualise and expand their nursing and allied health program through the establishment of a rural health school in Bendigo. This school serves as the hub for a distributed health professions education program and student placement strategy that has largely the same geographical footprint, educational philosophy and health workforce goals as the medical education programs run by Monash University and the University of Melbourne under the NVRMEN collaboration. The decision to build part of the La Trobe University Rural Health School adjacent to the Monash regional clinical school and the Bendigo Primary Care Centre has consolidated the health education and research precinct on the Bendigo campus.

Health education and research precinct

This precinct is now home to the Monash Bendigo Regional Clinical School, the coordinating hub for a distributed medical education program in the Loddon Mallee region with links to the adjacent Hume region through the NVRMEN collaboration with the University of Melbourne. It is also home to the La Trobe University Rural Health School, the clinical teaching building for nursing, allied health and dentistry. Finally, it is home to the Bendigo Primary Care Centre, an academic primary care clinic providing comprehensive primary health care to the people of Bendigo. It is a focal point for integrated management of chronic non-communicable diseases in Bendigo and, in time, models of interprofessional education for Monash and La Trobe University students from medical, nursing and allied health backgrounds.

The future influence of this precinct on health professions education, health workforce expansion and health services development in Bendigo and northern Victoria is potentially very large. It provides a concentration of resources and institutional relationships in Bendigo and the region that can now begin to systematically address some of the key health challenges in this region. Established research groups in public health, health services research, health professions education and rural mental health already exist at Monash University and La Trobe University. The next important step will be to build the necessary collaborations between these institutions and research groups, and to develop a shared population platform to support this combined research strategy.

Redevelopment of the Bendigo Hospital

In parallel with these developments there has been an ongoing campaign by Bendigo Health for the redevelopment of its ageing regional hospital. In 2010 the Victorian Government confirmed that $640 million would be set aside for this purpose. It is anticipated that the new hospital will be completed in 2016. With its co-located health education and research precinct, the new regional hospital will constitute one of the largest regional academic health complexes in Australia. Key challenges for the future will be to develop a shared vision for this complex and to understand what distinguishes its mandate from similar academic health complexes in metropolitan centres. An essential guiding principle in defining this mandate will be to insist that, ultimately, it measurably improves the health status of its defined catchment population. For this to occur, the complex will need to have close links with smaller health services in the region and be committed to working with them to address what are known to be the health priorities for its regional populations. It will also need to rely on its academic partners to develop a future workforce for the region and to assist with the many research activities that underpin an ambitious mandate of this kind.

A regional health and workforce strategy

Health Workforce Australia

Following its announcement of expanded health professions education programs for professional entry students in 2006, the federal government began to prepare for the new demands that this expansion would make on health service and education providers. In 2010, after extensive deliberations and stakeholder consultations, a new statutory body, Health Workforce Australia, was established through a Council of Australian Governments agreement and with a starting budget of $1.6 billion. Its brief was to provide a skilled, flexible and innovative health workforce that meets the needs of the Australian community. Since its inception, Health Workforce Australia has distributed considerable financial resources through the various state governments to meet this mandate. In Victoria, 11 clinical placement networks have been established to provide an accountable governance framework to distribute, manage and evaluate the effectiveness of these new funding streams.

Clinical placement networks

In the Loddon Mallee region, clinical placement networks were recognised early as natural and very valuable extensions to the many strategies and programs that were already in place in this region. They provide a formal organisational framework for multiple health service and education providers to convene at a regional level and to transparently discuss their respective health workforce and training needs and how these might be met using the many new streams of available funding. A critical success factor in these networks is goodwill and trust between their members. The well-established collaborations and relationships already in place in the Loddon Mallee region allowed the clinical placement network to be set up very quickly and to become functional within a very short period of time. While many of the larger health institutions in both Bendigo and Mildura were already linked through existing agreements, it was recognised that similar links with smaller health services and community agencies were less well developed. The clinical placement network provided a well-funded vehicle to bring smaller services into these collaborations and to provide them with a fair share of the resources for their important roles in widely distributed health professions education programs in the region. In addition, the clinical placement network provided a new opportunity to establish a shared vision for health professions education throughout the region and for all stakeholders to engage, on an ongoing basis, around a health workforce strategy for the region. Some specific projects illustrate the broad vision and specific directions that emerged through this process.

Whole of system placements

An important feature of the NVRMEN community-based educational model is the immersion of students for extended periods of time in rural primary health care systems. It is in these systems, tasked with providing comprehensive health care in close proximity to patients’ homes, that a special opportunity exists to understand holistic patient-centred care. This is especially true for chronic conditions that require multi-professional inputs at different levels of the health care system. While provision had been made in our previous model for students to spend two of their five days each week exploring these systems, we have struggled to fully demonstrate the link between the patients they see in their GP consulting sessions and the somewhat disconnected visits they make to other local health agencies.

Strategic project funding through the Loddon Mallee Clinical Placement Network has allowed us to reconceptualise this model in collaboration with the La Trobe University Rural Health School. We are currently piloting an alternative model – involving students from medicine, nursing and relevant allied health disciplines – in which students identify patients with chronic conditions in a range of practice environments. They then track the journeys of these patients and the various contacts they make with care providers from multiple disciplines at different levels of the local health care system. These case studies are discussed and developed by multi-professional student groups with a brief to explore the biomedical, social and population perspectives generated by patient journeys. Case studies have the potential to shed light not only on student learning but also on the ways that the health service functions – or does not function – with benefits for both the academy and the service itself. This project is ongoing.

A distributed simulated learning environment

The Loddon Mallee Clinical Placement Network has recently been successful in obtaining over $2 million to develop a distributed simulated learning environment for the region. This project establishes a primary simulation education hub in Bendigo and a secondary hub in Mildura. It significantly supplements the simulation resources held by Monash and La Trobe University on the health education and research precinct in Bendigo and those held by Monash at its regional clinical school in Mildura. A condition of this funding is that La Trobe University and Monash University – at the regional clinical schools in Bendigo and Mildura – provide regular access to these facilities for other health education and health service providers through so-called ‘in-reach’ and ‘out-reach’ simulation education programs. The in-reach program makes specific time and space allocations for other institutions to train their learners in these hub facilities, while the outreach program requires simulation education teams from Bendigo and Mildura to visit designated smaller health services on a regular, rostered basis, to service their needs for clinical education using simulation as the main modality.

This project requires Monash University and La Trobe University to conduct a careful educational needs analysis in all smaller centres and to work with local clinical educators to design and implement educational sessions that meet these needs. These are important new responsibilities for regional education providers. The project will improve their understanding of the educational needs of health professional students and practitioners at all stages in their career and pinpoint the opportunities for the use of simulation education. It is also an investment by these providers in the development of a health workforce for the region as a whole. Finally it locks providers into ongoing relationships with every small health service in the Loddon Mallee region.

The future

The 10-year establishment of rural medical education programs for Monash in northern Victoria has seen many phases of growth and development. Programs and perspectives have shifted from institution-specific and discipline-specific to an increasingly complex tapestry of cross-institutional collaborations and new alignments. Health professions education is now the business of all large and small education and health service providers, and related agencies in northern Victoria. It is no longer restricted to professional entry students but also includes health graduates from every profession across the continuum of pre-vocational, vocational and continuing education.

This learning platform straddles large regional hospitals, smaller community hospitals, general practices, community health services, mental health services, maternal and child health services and aged care, providing access through them to the entire patient population in the region. We are now well placed to design, implement and measure the impacts of region-wide health service and health workforce interventions using some or all parts of this platform. Analogous platforms have been established in other regions of Victoria and in other states in Australia. The development of such platforms is, in our view, the next natural step for health workforce and health services research in this region and potentially elsewhere in Australia.

Solarsh, Geoff. 2012 ‘Collaboration in northern Victoria: Embedding education in regional health services and communities’, in From a Broom Cupboard: 20 Years of Rural Health at Monash University, edited by Clough, Robert. Melbourne: Monash University Publishing. Pp. 72–89.

From a broom cupboard: 20 years of rural health at Monash University

   by Robert Clough, editor