Professor Rod McClure recently joined UNE as the Head of the School of Rural Medicine.
Prof. McClure has extensive clinical experience in emergency medicine, a PhD in injury epidemiology and specialist training in public health medicine. He has been the director of several research institutes and has a long history of injury prevention research.
He spoke to UNE Corporate Communications writer Amanda Burdon about his desire to contribute to rural communities, trends in medicine and health, and UNE’s role in supporting health in rural communities.
On the rural experience
Prof. McClure has travelled widely since his intern days at Sydney’s Royal North Shore Hospital, and has taught medicine at the University of Queensland, Griffith University and Monash University. Most recently, he worked for the US Centres for Disease Control and Prevention in Atlanta, Georgia, but his roots have always been firmly in the bush, on his property at Cassilis.
“You get to the point where you ask yourself when do I stop seeking and start contributing,” Prof. McClure said. “At UNE I have the opportunity to pay back, to contribute to the success of rural communities. I would like to see increased access to quality health care in rural areas.”
“One of the chief indicators of the success of the School of Rural Medicine is an increase in the number of rural doctors, but this is part of a bigger goal. A university located in a rural area provides educational pathways that enable rural citizens to advance their wellbeing … I came specifically to this university to increase those educational opportunities for rural citizens and to improve the health of rural populations.
“There is a common feeling that rural areas have fewer resources, but I don’t believe this is true. Rural communities have a range of important strengths rarely found elsewhere. They are known for their resilience, their collective effort and their problem-solving approach. It’s a case of finding each community’s strengths and building on them. To improve health care, yes, but also to take on the challenge of preventive medicine.”
Medicine in rural areas is different
One of the things that attracted Prof. McClure to UNE is the fact that our School of Rural Medicine is situated within a comprehensive rural university. “Unlike most rural medical student training centres in Australia, which are small rural departments of city-based universities, the UNE School of Rural Medicine is self-sufficient within the context of its community,” he said.
“The school collaborates with diverse disciplines across the university and we have robust connections with the rural community itself; we are a living consequence of our rural networks and, as a result, students who come here become immersed immediately in the rural context. UNE is almost unique in that.”
“As a consequence, the workings under the bonnet are more evident here – the realities of health and how it is practised and constructed. It’s not book learning; it comes from being in a situation where you can see the dynamics of rural health-care delivery laid out before you. If you really want to get a sense of what rural medicine is about, then you have to train in a rural setting.”
Rural practitioners: quantity is important, but so is quality
While growing the number of rural practitioners is one of his ambitions, Prof. McClure said he is equally focused on the quality of those practitioners. “We have the highest quality students, many of whom see rural medicine as their calling. As a school, we aim to provide training equal to the best in the country, and graduate students that will become future leaders in their respective fields.
“Our school also has a very important role to play in encouraging the development of medical doctors that can be involved in their communities and address society’s significant health inequities, including those experienced by our Aboriginal and Torres Strait Islander population. The school is committed to supporting Aboriginal and Torres Strait Islander Australians in their choice of medicine as a career.
“My vision is that people in rural communities will have the same health status as their urban and metropolitan counterparts. To achieve this, we need to be able to maximise the access, efficiency, appropriateness, equity, and acceptability of the way health care is delivered in rural settings. We need to accept the importance of preventive medicine, and create the circumstances in rural Australia that support optimal health for all citizens.”
UNE and the future of medicine
UNE has a major contribution to make to the world of medicine, as much as it has to the local region, Prof. McClure said.
“As well as improving health in rural populations and increasing the chance for rural students to pursue academic careers in medicine and health, we need to be finding ways to take advantage of future thinking, rather than teaching students about what medicine used to be in the past.
“There is a lot of change in the medical profession just around the corner and we need our students to be able to cope with that change and maximise its benefits. Yesterday’s answer is probably not the right answer to tomorrow’s question. Doctors are not most effective when they see themselves as the expert.”
“We are most effective when we understand that we are adaptive learners in a complex world. Evidence is growing and changing, and it needs to be assessed and used and re-evaluated.”
UNE has a wonderful opportunity to be at the forefront of new developments in medical education that will prepare our students for future practice, according to Prof. McClure. “The doctors coming through now are going to be practising in a totally different way to the way I was trained,” he said.
“The digital medicine age is upon us; we have tremendous capabilities just starting to be applied in rural areas to address the needs of dispersed populations. Tele-medicine can bring the world’s leading experts to a patient’s bedside at the flick of a switch. Remote sensors can monitor a patient’s symptoms and enable a doctor and patient to communicate over vast distances. Doctors will need to be knowledge managers, able to synthesise and make judgements, and to translate information into something the patient can understand and work with.”
“They will also need to be able to develop partnerships and relationships with other members of the caring professions and a vast range of organisations that will become service industries in support of patient health.”
Partnering with patients
Professor McClure is a supporter of “patient-centred decision-making”, where individuals and their health practitioners are partners. “Dramatic advances in communications technology makes evidence available to anyone, wherever they are,” he said. “But how that evidence is applied depends on the relationships between individuals and their practitioners, and the community around them.
“To improve the health of populations we need to address more than just the technical challenges. It’s very easy to look up the back of the book and find an answer, but how do you apply that answer efficiently and appropriately and equitably and acceptably so there is maximum impact, that is the challenge.”
“In rural health we need to maximise the access and deliver health care in a way that encourages individuals to have a role in the decision-making process. If we do that, then we deliver health care to the individuals who need it, and maximise the preventive medicine impact for those who don’t yet have the condition.”
“Preventive health sits alongside diagnosis, medical care, health management and patient recovery as part of the health continuum. Doctors and other members of a rural community, both in the health and non-health areas – in workplaces, schools, councils – all have a role to play in maintaining the health of that community. Rural medicine is about understanding health not in isolation, but within the context of how people live their lives in rural settings.”
Some things never change
While future medicine will make different demands on practitioners, some things will not change.
“First and foremost, a practitioner works with patients and people,” Prof. McClure said. “Never more urgently is the need for the doctor-patient relationship to be secure, ongoing and trustful. Continuity of care produces a better result for the individual, the system and the population, especially in our increasingly fragmented world.”
“The human being hasn’t changed; we need to understand and have trust in the people giving us information to make the most use of that information. The relationship between the rural doctor and rural patient, rural doctor and rural community, and the sense that they belong to each other and have a deep level of commitment to one another is a very special feature of rural medicine.”