This perspective article, based on personal experience, reflects on a family medicine residency in rural Portugal, across a small town and two villages characterized by aging populations, high dependency rates, low health literacy, and social isolation. Family medicine residency training in resource-limited rural settings offers unique learning opportunities, demonstrating that effective primary care extends beyond clinical decision-making and requires continuity of care, community engagement, and adaptability to local contexts. Daily practice involved addressing not only medical conditions but also the social, emotional, and logistical factors influencing health, while building trusting relationships with patients, families, healthcare teams, and the wider community. This experience highlights the essence of family medicine and underscores the importance of rural residency training in cultivating adaptable, community-oriented, and person-centered family physicians.
Introduction: In Italy, many facilities have started adopting telemedicine services since their regulation in 2020. Rural areas mainly benefit from telemedicine implementation due to their geographic features. We investigated the interests, attitudes, and perceptions of healthcare providers operating in the Italian Dolomites regarding the adoption of telemedicine. Furthermore, we explored the relationship between technostress and the intention to integrate telemedicine services during daily practices.Methods: We developed a structured interview protocol based on existing literature and following the key principles of constructivist grounded theory to investigate five areas of interest in telemedicine. After the interview, participants completed the Italian version of the Technostress Creators Scale (TCS) to evaluate the current technostress experienced in work activities, and a TCS-adapted version to measure technostress values generated through telemedicine services.Results: A content analysis of the interviews highlighted four main factors that can help communities more readily accept telemedicine services: the convenience of not having to travel, the ageing population, cost savings, and a sense of community. Regarding the scales, there were positive significant correlations between most of the subscales.Discussion: Our findings confirm that telemedicine fosters perceived security and service quality in rural settings. Despite moderate technostress, professionals remain supportive, highlighting the role of perceived usefulness. Key barriers include low digital literacy and reduced social contact, underscoring the need for strong patient-provider relationships and targeted digital training to ensure successful implementation.Conclusion: Telemedicine offers vital support in improving healthcare access in remote areas. Overcoming barriers like low digital skills and poor connectivity requires infrastructure investment and training. Evaluating technostress alongside digital readiness is essential for future research.
Introduction: People who have experienced sexual assault have many acute needs requiring timely attention. In New South Wales (NSW), Australia, reported sexual assault rates have been increasing over the past decade, with reported rates increasing at a higher rate outside metropolitan areas. These regional and rural areas experience chronic shortages of medical and forensic examiners able to deliver timely care. The aim of this study was to identify the motivations, barriers and facilitators affecting the recruitment and retention of examiners in regional and rural NSW, Australia.Methods: Doctors and sexual assault nurse examiners who have worked as examiners for NSW sexual assault services in a non-metropolitan area were recruited to participate in semi-structured interviews. Written informed consent was obtained, and interviews were recorded and transcribed. Data were coded using a combination of deductive and inductive approaches. Themes were developed according to Braun and Clarke's thematic analysis approach.Results: A total of 13 participants were interviewed, of whom 11 were female and 2 were male; 9 were doctors and 4 were nurses. Five key themes were identified: structural challenges of rural service delivery, near invisibility in the health system, isolation and missed connections with colleagues, inability to thrive, and sense of duty to patients, colleagues and community. While motivated by obligation to colleagues and community, barriers of travel time over large geographic areas and insufficient examinations to maintain skills were present. Potential facilitators such as peer support, contributing to policy and funded training opportunities were considered to be lacking.Conclusion: To ensure the sustainability of rural sexual assault medical workforces, change addressing isolation and invisibility is needed. Future changes to services should be considered from a rural lens, as rural examiners face unique barriers to workforce participation and are essential to service delivery.
Introduction: In remote areas and an increasingly aging society, patients with rheumatic diseases often experience delayed diagnoses due to limited access to specialists, which significantly impacts their quality of life. Effective training of primary care physicians is therefore essential to improve the quality of rheumatic disease care in these areas. Entrustable professional activities (EPAs) offer a robust framework for evaluating learners by defining specific, observable units of work. This study aimed to develop a consensus-based list of essential EPAs for young generalist physicians to enhance the quality of rheumatic care in underserved, remote settings.Methods: We employed a modified Delphi method to build consensus among an expert panel of 25 members, including specialists in rheumatology, internal medicine, and family medicine (21 of whom had direct remote medical experience). The research team synthesized an initial task list from national and international medical education and rheumatology curricula. Experts rated each task on a five-point Likert scale over four iterative rounds. Consensus was defined by an average score of ≥4.0, a standard deviation of <1.0, and ≥75% agreement.Results: Response rates were exceptionally high throughout the process (96-100%). The Delphi rounds culminated in a finalized list of 14 EPAs. Key refinements included narrowing technical procedures (eg joint aspiration) to the knee and rephrasing clinical tasks to emphasize the timing of specialist collaboration. Expert feedback underscored the necessity of early diagnosis, maintaining a broad differential diagnosis during initial assessments, and the indispensable nature of structured handover skills in resource-limited environments.Conclusion: This study successfully established a specialized EPAs framework for generalists in remote areas, addressing a critical gap between general residency training and subspecialty curricula. The list emphasizes managing rheumatic diseases within the constraints of limited resources while ensuring appropriate specialist synergy, ultimately aiming to improve patient outcomes in rural communities.
