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

Afterword

Learning from the past for a sustainable future

Professor Judi Walker

It has been an exciting and humbling experience to read about the evolution of the Monash University School of Rural Health over the past 20 years. It has reinforced for me the responsibility I carry in leading the school into its third decade. There is much to be learnt from the past for future sustainability.

The preface of this book provides an excellent summary of the story of the school from the perspective of a number of people, internal and external, who have played significant roles. From a small rural academic unit in Gippsland to one of the largest and most geographically dispersed schools in the Faculty of Medicine, Nursing and Health Science at Monash University, the School of Rural Health now has a footprint that extends across Victoria from Mildura in the west to Orbost in the east. While the school is represented as two distinct regions, the Office of the Head of School provides leadership and direction across these regions. The north-west constituency consists of the Bendigo and Mildura Regional Clinical Schools and the south-east includes the Gippsland and East Gippsland Regional Clinical Schools, the Gippsland Medical School and the Monash University Department of Rural and Indigenous Health. The Office of the Head of School houses a secretariat, rural health education programs and the research hub.

The Monash academic governance structure does not accommodate small schools (size determined by sustainable teaching and research income and outputs). For the School of Rural Health to be constant to its vision of better health outcomes for rural and regional communities through high quality education, training and research programs, it needs to act as a school with one voice to thrive in the Monash family. We are seeing, in other universities, unsustainable rural health units, including rural clinical schools and university departments of rural health, incorporated into larger schools of public health and health sciences. The Monash School of Rural Health is uniquely placed as the exemplar of academic rural health, nationally and internationally. It has a unique geographical distribution of regional clinical schools and the graduate entry medical program that are each responsive to their communities, delivering distinctive and innovative models of rural medical training; a university department of rural health that is carving a defined niche as an academic leader in rural mental health, population health and interprofessional programs; and a research hub with a centre of research excellence and a growing reputation for research training in rural health. The potential is limitless for these component parts of the school to sustain and thrive by drawing on and sharing experiences and expertise in, for example, simulated learning environments, or cultural safety. There is however a danger to guard against: that continuing fragmentation, internal competition and historical feuding might turn this strength to weakness.

The school’s first 10 years (1992–2001) stands as a pioneering era which saw development of a wide range of specific rural health education, workforce, research and community initiatives as well as multidisciplinary education for rural health practitioners. These provided the prototype for Australian initiatives which now fall under the banner of the Commonwealth Government’s Rural Clinical Training and Support and University Department of Rural Health funded programs. It saw extension to north-west Victoria and in 2001 the establishment of the Bendigo and Mildura Regional Clinical Schools and, in the south-east, the Gippsland and East Gippsland Regional Clinical Schools. The decade culminated in the formal creation of the School of Rural Health as a fully fledged school within the Faculty of Medicine, Nursing and Health Science.

The next five years (2002–2006) generated further expansion, growth and opportunistic endeavours with the dominance of and considerable increase in medical undergraduate clinical training through the regional clinical schools. Necessary to these successes were significant degrees of engagement with health services and communities and innovations in training models. In 2006, the Gippsland Medical School (graduate entry medical program, not within the School of Rural Health) and the Extended Rural Cohort program in the north-west were established. And finally, the Centre for Multi-Disciplinary Studies in Rural Health received University Department of Rural Health funding and became Monash University Department of Rural and Indigenous Health. One nagging issue has been addressed through the contribution to this book of the then Commonwealth Minister for Health. The reason why Monash was not successful in the first and competitive University Department of Rural Health funding round in 1997 was because ‘the consensus within my department was that the University of Melbourne bid for Shepparton was a better proposition’ and not because Monash already had the Centre for Rural Health, a belief widely held within the school.

An outsider looking in could be forgiven for thinking that by 2006 the school’s centre of gravity had shifted to the north-west at the expense of the south-east and that the employment of medical specialists was eroding the focus on primary care and a strong multidisciplinary culture. However, this shift reflects the remarkable evolution of the school. Its leaders had the ability to respond to openings afforded by the political environment to bid for new Commonwealth Supported Places for medical students and finance for capital infrastructure to support these places in rural and regional Victoria. The strength of the School of Rural Health was in seizing these opportunities as they arose and this is continuing today through the auspices of Health Workforce Australia. It will continue into the future as new trends emerge, such as the current move towards vertical integration in medical and health professions training.

The period 2007–2010 was an era of consolidation, with individual sites and regions building on successes and innovations by implementing distinctive training models, embedding rural health into the medical programs, and inroads into and breakthroughs in improving the health of Indigenous communities. The student voice was significant as students are the best advocates to promote rural clinical training.

Through the rigorous and systematic approach of the school’s Office of Research, Monash has played a significant role in generating new knowledge relating to overcoming rural health workforce shortages, developing innovative rural models of health care, and understanding the risk determinants that underpin rural health disadvantage. Monash is an international leader in rural health research. The strategic approach to research that was adopted has had a significant impact on the development of new knowledge as well as on national policies. The Monash University research strategy imperatives of excellence, relevance and impact provide the necessary framework for the future.

The current era (2011 and beyond) is seeing a process of renewal through a period of change and uncertainty. It should be remembered as a period when the school achieved full academic recognition through high quality, excellence and innovation; a period which embraced a whole-of-systems approach, through partnerships and collaborations, to harness precious resources in a shrinking financial environment.

On 1 January 2011 the Gippsland Medical School was amalgamated with the School of Rural Health. As originally conceived and established, Gippsland Medical School was in a conflicting position in relation to the regional clinical schools in Gippsland. Amalgamation relieved the tensions generated by different approaches to rural medical education and competition for clinical places in Gippsland, paving the way for the next era in the School of Rural Health’s development.

The current academic environment is highly competitive and the emphasis on strong national and international collaborations will require the School of Rural Health to continue to broaden its outlook and processes of engagement. In order to remain a leader in academic rural health, the school will need to build on the factors that have led to its present success. It will also be compelled to address new challenges including building stronger relationships across all units that constitute the school and responding speedily to the requirements of Monash, governments, policy makers and partner organisations.

Inevitably the initial rural health education and research pioneers are moving on. The focus must be on attracting and retaining the next generation of academic and clinical leaders who have passion and commitment to rural and regional practice and who recognise that embedding and integrating rural health training and research is integral to both the daily as well as the strategic culture of universities, health services and communities.

As a fully fledged member of the Monash family, the School of Rural Health is required to meet University requirements and expectations of its teaching and research and to succeed we must have staff adequately prepared to meet these expectations. The School of Rural Health must be indispensable to Monash medical and health professions training.

The next decade will be about balance and sustainability with a strong program of education, training, research and engagement across the school. We will see digital technologies harnessed for rural health care, education training and research and the expansion of non-traditional clinical training environments. We will see rural and regional medical and health professional training at the forefront of new models and trends, such as graduate training programs that are integrated across the training continuum. It will be imperative for the Monash School of Rural Health to keep ahead of the game in order to maintain currency and to respond to inevitable challenges, changes and opportunities.

Over 20 years the School of Rural Health has come full circle. The difference is that it is now operating as a fully fledged and recognised academic school within the largest faculty of Australia’s largest university. However, we must never lose sight of the main aim – better health outcomes for rural and regional communities through leadership in and integration of responsive, sustainable and high quality education, training and research programs.

The fact that we are celebrating the twentieth anniversary of the School of Rural Health is due to thousands of people we are not able to name – health professionals, patients, community members, students, faculty, professional colleagues, bureaucrats and politicians – in addition to the many people named in the pages of this commemorative publication. Thank you. We will do everything we can to chart a pathway into the future to continue, strengthen and sustain the academic rural health journey.

Walker, Judi. 2012. ‘Afterword: Learning from the past for a sustainable future’, in From a Broom Cupboard: 20 Years of Rural Health at Monash University, edited by Clough, Robert. Melbourne: Monash University Publishing. Pp. 146–150.

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

   by Robert Clough, editor