. Dzau et al. describe the value of extending this structure into primary care as an AHSC system where the emphasis is not so much a tertiary institution as a vertically integrated system spanning from community-based care through to tertiary hospitals and universities27. Dzau's model of extending the AHSC model to primary care may facilitate progression within the proposed rural academic practice framework, especially in enabling research activity. If rural general practices are enabled to develop internal research capacity, they will have the means to drive research agendas from the bottom up and in this way meaningfully engage local general practitioners to 'address questions relevant to local health needs'8.
The research question is best answered using a qualitative paradigm. An experienced researcher (TM) conducted semi-structured interviews. Six rural general practices in Victoria were recruited: three practices with multi-level learners, two practices with one learner group, and one practice without learners. This sample was selected to explore the diversity of rural general practice engagement in education. Within the practices purposive sampling of staff (GP supervisors, practice managers, senior administration staff, nurses), learners (registrars, interns, medical students) and patients was undertaken (Table 1). A topic guide was developed after reviewing relevant literature around general practice education and training to guide interviewing. Each respondent group had parallel questions and was designed to address the research question (Table 2 contains an example). Audio recordings of interviews were transcribed and checked against the original recording to ensure transcripts were accurate. Transcripts were not offered for respondent validation.
The data were analysed in several stages. Using an inductive thematic analysis28,29, all four members of the research team (TM, JB, MB, DN) independently coded transcripts. Key themes and subthemes were negotiated and all transcripts were analysed again using this thematic template30 with the unit of analysis by general practice. A deductive thematic approach was used to create the framework, revisiting the data for confirmation and for negative case analysis. The creation of the framework was informed further by the literature and the expertise of the research team.
Table 1: Interviewees categorised by role
Table 2: Interview topic guide for practice staff
Human research ethics approval was obtained from Monash University Human Research Ethics Committee, project number CF11/3006 - 2011001694.
Data were collected from 44 participants using a topic guide developed for each respondent group. Table 2 contains an example. Interviews ranged from 20 to 60 minutes and were audio-taped and transcribed verbatim. Table 3 summarises the characteristics of each general practice unit of analysis.
The results are presented in two parts: first, the thematic analysis representing the thematic template and, second, the resulting framework for a rural academic general practice. Like many classifications, there is some overlap between themes.
Table 3: General practice characteristics summary
The three major themes were organisational, educational and research considerations. Under each major theme, several subthemes were identified. These major and subthemes are detailed in Table 4 with example quotes from the data. In describing and discussing the analysis below, italics are used to highlight subthemes.
For organisational considerations, there were six subthemes. Prominent were the values, vision and culture of each practice. Business and service considerations were not always seen to align with educational considerations, hence the degree to which a practice engaged in education was associated with the value that the practice attached to education in relation to business and service: '[Teaching and its requirements] takes you away from your core business which is basically earning a living and keeping the place on the rails.' (Supervisor S2 - single-learner practice).
The patient popu