Understanding rural practice: implications for occupational therapy education in Canada.

INTRODUCTION Currently Canadians living in rural communities tend to have a poorer health status than those living in urban settings. This is contributed to by the shortage of health professionals choosing work in rural and remote areas. Over the past decade there has been much research into the recruitment and retention of rural health professionals. However little has been done to identify the actual nature of rural practice and whether graduates have been adequately prepared for the diversity of rural work. The present study sought to identify the rewards and challenges of rural occupational therapy practice in western Canada. Participants' were also asked about their preparedness for rural practice after graduation, and specifically about the usefulness of course work and practical skills taught as undergraduates. METHODS Participants were occupational therapists working in rural communities in the Canadian provinces of Alberta and Saskatchewan. The quantitative approach employed a self-administered survey with closed- and open-ended questions. Data were entered into SPSS v14 (http://www.spss.com.au) for frequency data and percentages. RESULTS The participants (n = 59) worked mainly in full-time community healthcare positions with clients who had physical health issues. More than half worked in sole therapy positions. The average length of time in their current position was 5 years. Most participants reported that they were receiving informal professional support, with some receiving a formal support as well. Participants more frequently identified the rewards of rural practice (n = 214) than its challenges (n = 112). Perceived rewards included team work, autonomy, diversity and flexible work schedule, increased client contact, job satisfaction, experiences gained and the rural lifestyle. The most frequently mentioned challenges included staff shortages, the generalist nature of rural occupational therapy practice, excess time spent travelling, coping with inappropriate referrals and the need for more professional support. Regarding participants' perceptions about the course work and practical skills taught during their training that best prepared them for actual practice, some highlighted additional valuable resources such as actual hands-on experience during rural fieldwork placement, personal characteristics, working in an urban setting prior to embarking on a rural career, coming from a rural background and locating a mentor prior to working rurally. Some recommended increasing management and organisational skills content in the curriculum because these were considered essential skills for effective rural practice. The return of unanswered questionnaires by participants who did not consider themselves to be rural therapists because of access to online and telehealth resources suggests further research is warranted into the changing nature of rural practice. CONCLUSION Characteristics of current rural occupational therapy practice in western Canada were identified. Overall, rural occupational therapy practice appeared to be rewarding, and few had difficulty in accessing professional support. While on the whole the participants believed their training prepared them adequately for rural practice, the acquisition of increased management and organisational skills during training was seen as necessary to effectively manage their typically large and diverse caseloads. Participants' access to online and telehealth resources appears to have markedly changed the nature of rural practice and further research is recommended to determine the impact of such technologies.