Applying principles of adult learning to rural health electives in a medical school curriculum | BMC Medical Education

The Rural Health Foundations course is designed for MD1 students interested in exploring rural health in Australia and those considering a future career in rural healthcare settings. To ensure broad accessibility, this subject is open to all students irrespective of their study location (metropolitan or rural) or whether they come from an urban or rural background.

Over an 18-week teaching period, with a total time commitment of 170 h, students engage in an in-depth exploration of healthcare within the rural context. The course introduces the unique demographics of rural populations, including at-risk groups within remote and rural communities across Australia. Students examine the benefits and challenges associated with healthcare practice in regional and remote Australia, addressing topics such as complexities in service delivery, disparities in access to care, and the impact of social determinants of health. This is done specifically in the rural context, as understanding the trends in health status and social determinants of health in capital cities and the remaining areas states and territories in Australia, and the distribution of health and social determinants between metropolitan, inner regional, outer regional, rural and remote areas is crucial if we are to reach health equity [4]. Special attention is given to the healthcare needs of different population groups, including First Nations Australians (Table 1). Cultural competence refers to the ability of healthcare providers and students to understand, respect, and effectively respond to the cultural needs and perspectives of First Nations peoples. In the context of the curriculum, this involves recognizing the historical, social, and health inequities faced by First Nations communities. The content emphasizes the importance of building trust, demonstrating cultural humility, and applying culturally safe practices. Students engage with real-world examples, case studies, and interactions with First Nations health professionals to deepen their understanding and develop skills for delivering equitable and respectful care.

To ensure both accessibility and engagement, the course employs a blend of interactive, activity-based learning, including synchronous and asynchronous online components, as well as independent study. The weekly learning activities are structured as follows:

During the asynchronous learning period, students access a range of pre-recorded interviews conducted by individuals within the rural health medical workforce, including clinicians and non-clinicians. These interviews align with the content theme for that given week and are followed by specific readings that scaffold onto the information discussed.

Asynchronous online learning plays a critical role in medical education by offering students the flexibility to access course content at their convenience, free from temporal and spatial constraints. This flexibility allows students to engage with the material in a way that fits their schedules, fostering self-discipline and autonomy in managing their learning. Research has demonstrated that asynchronous learning is effective in enhancing a wide range of professional competencies, including attitudes, knowledge, skills, and behaviours. It enriches the educational experience by overcoming logistical challenges posed by geographical distance and time constraints, providing a more adaptable learning environment [5]. This approach not only supports academic development but also ensures that medical education remains accessible and equitable, regardless of student location.

Given the rapid expansion of medical knowledge and the continuous production of new resources, it is essential that medical students develop lifelong learning skills. This includes the ability to navigate the vast amount of medical and scientific data and accurately identify and access scholarly resources. Independent learning activities (ILAs) are a proven strategy for cultivating these skills [6].

The diverse and complex nature of rural health requires students to be both adaptive and self-directed learners. By dedicating 2.5 h each week to independent activities, students can delve more deeply into topics that align with their personal interests and career goals within the context of Australian rural health. This approach fosters curiosity and empowers students to take ownership of their learning, allowing them to build a tailored knowledge base that complements the core curriculum. Encouraging self-directed exploration in this manner supports the development of essential skills for rural practice, where medical professionals often encounter unique challenges that require creative problem-solving and a broad understanding of diverse health issues.

The Rural Health Foundations subject is strategically designed to address the pressing need for medical professionals equipped to serve rural and remote communities. By providing students with a comprehensive understanding of the unique challenges and opportunities in rural healthcare, the course cultivates essential skills, such as critical thinking, adaptability, and self-directed learning. The integration of diverse teaching strategies, including problem-based learning, asynchronous content, and independent exploration, not only enhances engagement but also fosters professional development tailored to the realities of rural practice. This course stands out by offering students from all backgrounds the opportunity to explore and deepen their knowledge in rural health, ultimately contributing to a more informed and resilient future workforce.

Each week, students participate in an interactive online learning session led by a tutor with specialised knowledge and experience in rural health in Australia. Tutors include general practitioners, specialist medical professionals, epidemiologists, rural health researchers, and MD1 course facilitators who have lived and worked in rural communities. This ensures that students benefit from a wide range of perspectives from individuals who are deeply connected to rural health, which has been shown to demonstrate the value of rural doctors and the rural medical workforce [7].

Healthcare professionals must develop strong critical thinking abilities and work efficiently within teams as essential components of their competencies. To achieve this, educational programs should implement methods grounded in educational theory to ensure that learners acquire these skills. Team-based learning (TBL) is one such approach integrated into healthcare education, promoting critical thinking while encouraging collaboration in high-performing teams [8, 9]. To maximise engagement and efficiency, tutors employ active learning strategies designed to deepen students’ understanding of the content. A combination of problem-based learning (PBL) and TBL techniques is utilised. These approaches are recognised for promoting a deeper level of learning compared to traditional methods, as they place responsibility for learning on the students themselves, encouraging lifelong learning [10]. Importantly, TBL provides similar outcomes in face-to-face or online delivery modes [9].

The use of TBL strategies is particularly effective as it enhances active and collaborative learning. We utilise this by providing the students with pre-tutorial instructions and a framework around the tutorial activities to create an environment where TBL not only fosters deeper engagement with the material but also integrates the development of key professional skills, such as leadership, communication, and teamwork—attributes essential for medical professionals [11]. Additionally, each stage of TBL is closely linked to knowledge development in the following phase and overall learning performance, making it a critical component of the process [8], thus the ordering of the activities have been developed to maximize this association.