A taste of country practice

From being first on the scene of a car crash to attending a birth, medical students on a new rural medical programme have had everything thrown at them – and thrived.

The University’s inaugural Rural Medical Immersion Programme launched in 2025 and has involved a dozen fifth-year medical students flatting, working and learning together in a rural community for the full academic year.

One group has lived in a large Wellsford house, owned by Coast to Coast Health Care.

Phoebe Wilson is only half-joking when she says free rent was one of her motivations for joining the scheme. More seriously, she saw an opportunity to hone a range of skills.

“It’s been helpful, especially for our clinical examination skills and confidence with patients,” says Phoebe.

“We will be the first one to see the patient. We get to ask all the questions, do an exam, and then often we’ll present to the doctors.

“So, we get to practise our presentations, which is definitely one of my weak points.

“Then the doctor will do another consult and send through the plan. We can see how accurate we were and what we missed. It’s instant feedback.”

The biggest challenge has been the variety of medical conditions she has seen.

“You have to be ready to tackle anything. And over the year you really do build up your skills.”

Dr Neil Anderson is an honorary senior lecturer in general practice at the University and a GP and clinical director at Coast to Coast Health Care. As academic coordinator of the Wellsford RMIP site, he holds a weekly tutorial with the students, which offers them an opportunity to debrief complex cases.

Usually, fifth-year students cover their curriculum in blocks through a series of hospital placements. But that had to be adapted for the rural medical immersion students.

“We soon realised that is not how medicine presents in general practice; it very much comes through the door in any order. It can be a mental-health case, followed by a child case or a complicated obstetric-related case,” says Neil.

“So, we have had to build those key relationships with providers in our community, as well as visiting specialists.”

He found they were keen to support the students.

Dr Tim Malloy, a specialist GP at Coast to Coast Health Care, has been a long-time supporter of student training.

“For those of us who practise in rural New Zealand, you actually learn to make it up as you go along,” says Tim. “I think we’ve had to learn to do that in this particular domain.”

Associate Dean (Rural) Dr Kyle Eggleton says the students will have the same, if not better, learning outcomes than those who undertook traditional hospital-based placements.

“There is also significant evidence that rural medical immersion programme students are up to six times more likely to return to work as rural clinicians compared to students who don’t do a rural medical immersion programme,” says Kyle.

Another of the Wellsford students, Raphaella Rae, was attracted to the programme for the opportunity to enjoy living in a rural community, after spending her early years in Tasman. Flatting with the other students on the immersion programme was also an attraction.

“I’ve never lived with medical students before, so it’s been a new experience. It has been good being able to come home and discuss cases or teaching and have that moral support at home,” says Raphaella.

Ryan Semmens grew up in Northland and came to medical school through its Regional Rural Admission Scheme. So he knew about the programme and was keen to be part of the first Auckland intake.

While on the programme, Ryan had an alarming experience that, in hindsight, was tinged with black humour.

He was working in the emergency care resuscitation area, known as ‘resus’, taking a patient’s history. Ryan noticed they were on a common asthma medication and asked whether they had the condition. The patient didn’t reply, so he asked again if they had an allergy or an inhaler.

There was still no response, so he glanced over, only to see the patient was unconscious. Ryan wondered how long the person had been in that state and whether they had had an asthma attack.

He commenced chest rubs, and the person started to come around. A nurse arrived to assist and it transpired the patient occasionally had episodes of fainting.

Nonetheless, for Ryan, it provided a valuable lesson: “You have to make sure you are watching them,” he says.

Ryan also found it a positive experience, albeit traumatic for all involved, to be early at the scene of a serious car crash and able to help.

Phoebe was pleased to discover a heart arrhythmia in a patient while checking their vital signs as part of a routine visit.

“I put my finger on their pulse, and to me it was irregular, but I’ve got a terrible sense of rhythm, absolutely horrible.”

The doctor trusted Phoebe’s ‘terrible sense of rhythm’ and ordered an ECG, which a cardiologist then confirmed was a heart arrhythmia, albeit one that was unlikely to cause problems in the foreseeable future.

The other groups of three students on the programme were based in Thames, Te Kuiti and Hāwera. They’ve similarly reported enjoying the wide variety of medical training experiences and being part of the community, from being invited onto the local marae for a special occasion, to joining the local quiz night.

Meanwhile, the Wellsford students say they gained an appreciation of rural communities’ culture, meaning they would treat patients from the country differently in future.

“I feel like connection and rapport building is much more important, because of the community values,” says Ryan.

“And, if you are trying to risk-manage someone, you need to think about things like how far they are from a hospital, how long would an ambulance take to reach them, and do they have mobile coverage or live alone? You have to think about these things.”

Jodi Yeats