Profs Sarah & Roger Strasser - Adventures in Rural Health Education & Research

Prof Sarah Strasser and Prof Roger Strasser, a trailblazing couple in the world of rural health, rural health research and rural medical education. 

 

Episode summary:

01.15  Sarah and Roger share how they became interested in rural health and some key highlights from their careers

15.30  What did they find most rewarding about living and working in rural areas and what was challenging?

20.50  How did they balance all their different roles with their family life?

29.30  What have been the most important research projects that they have worked on?

51.30  What is NOSM and what makes it different from other medical schools?

59.45  What were the enablers for the development of NOSM?

1:05.00  What has it been like to be a woman and trailblazer in the rural health space over time?

1:11.15  What do they see as being the research focus in rural health in the next 5 to 10 years?

 

Key Messages: 

They have lived and worked in different countries and in different rural and remote communities. They both share a passion for rural communities and rural health. 

In 1991 the first National Rural Health Conference inspired a lot of activity around rural health in Australia.  Monash University developed rural training pathways and the Monash School of Rural Health.  Roger became the first Professor of Rural Health in Australia.

Roger acted as the Founding Dean of the Northern Ontario School of Medicine in Canada for 17 years.  This is a multi-site rural based full medical school.

Sarah started her academic journey in Canada by teaching nurses about whole person medicine.  She then became regional director of general practice training in Australia and then became the national director of rural health and covered Indigenous health. Sarah later became dean of Health Sciences at the University of Otago New Zealand.

Most enjoyed:

The sense of space and being part of the community. Having a very privileged role which lets you get to know the deep issues within the community.  Using that privilege in an appropriate way and making a difference for the better.

Relationships with the people and the community. Community connectedness.  

Challenges:

Lack of child care that works for you.  Lack of resources.  Realizing how frustrating it is when things that you need on a daily basis run out or are not working, this can be a quick way to get burnout.  

Balancing their careers, different professional roles, and raising a family was challenging.  

Work-life balance gives the impression that work is not part of life. Roger prefers the concepts of work-style  life-style mix.

Research and teaching are integral to clinical practice.  In the daily interaction with patients there are often questions that come up, occasionally there is not an answer in the literature or when asking a colleague.  This can be part of a new research question to pursue.  It is all woven together.  

It has been wonderful to see how things have changed over time.  On one hand some things seem to stay the same, on the other side everything has changed.  Over the last couple of years has been going to conferences that are full of people she does not know.  

Two threads of research. One was a series of studies asking people in rural and remote communities about their needs.  They have a security need, they need to feel that there is a safety net. They first need a doctor and a hospital.  Then looking at the sustainability of rural and remote services - 22 in depth case studies.  Found that the ones that were doing well had active community participation in the running of the health service.  

Looked at issues of recruitment and retention of healthcare professionals.  Explored contributing to factors of success and developed a rural workforce stability framework with 5 country partners.  Active community participation again came up as a strong factor for success.  

The second thead was education and training for rural practice.  Recognizing that there is a better chance of medical graduates going into rural practice with early exposure to rural contexts.  Rural upbringing, positive rural clinical experiences and postgraduate training that prepares clinicians for rural practice are the three factors that have been shown to be most important. Immersive community engaged education.  

Seeking out the disconnects and trying to prove alternative ways of doing things.  Don’t accept things as they are, go and investigate and find out what needs to be done.  Communication and dissemination is an important part of research, share what you find with the relevant people. 

Encourage community engagement and recognize the importance of patients as teachers.

Rural practitioners are naturally effective teachers.  Doctors more generally after time in practice through their interaction with patients develop a lot of skill in teaching.  

Importance of having contracts - doctors and the community knew how long they would be there and gave them an opportunity to renegotiate their position.  

WHO has published updated policy guidelines in 2021 for the recruitment and retention of the rural health workforce.  Their research has been adapted for this document.

NOSM came into existence because the community recognized that they needed their own medical school to have a sustainable health workforce. It is the first medical school in Canada with a social accountability mandate.  This is about improving the health of the people and communities of Northern Ontario.  

NOSM has a full  immersive learning experience based in local communities.  All students have a year long integrated longitudinal clerkship, living and learning in one community.  77% of NOSM graduates are in general practice, 14% are in other general specialties like pediatrics or general surgery - a very different outcome to other medical schools in Canada. 

Politics is a large part of establishing a medical school.  NOSM has support from the Mayors of the 5 main municipalities, government support and community support.  Everything aligned to enable it to happen.  

Say “Yes And” to opportunities, then add some of your own suggestions or boundaries. If you find that it does not work, let it go.  

Be aware of the existing rural health research and undertake research which builds and contributes to that.  Future research can enable connection of rural communities across countries.  It should be undertaken in rural communities, by rural communities and for rural communities.  

Use frameworks that have already been established so that the research can add value to and build on what has already been done.  The Partnership Pentagram or Partnership Pentagram Plus is an example of a possible framework which could be used in this way.    

 

Thank you for listening to the Rural Road to Health!

Rural Health Compass