were usually willing to increase teaching loads, the ability to do so depended on adequate additional resources and support, particularly in areas such as funding for teaching, practice subsidies and consulting space3.
There is capacity for rural general practices to increase engagement in education. For example, practices that do not host learners could be recruited as teaching practices, while practices that host one learner may have capacity to host several learners at different levels of training. To achieve this, educational and funding models that are attractive and sustainable for both practices and learners must be developed. For education to be considered as a core activity, the approach to funding, educational support and learner placement must be an integrated one22. Further, issues such as effective teacher orientation and professional development, physical space, infrastructure and internal organisational structures need to be considered22,24.
Elsewhere the authors have reported the advantages and challenges for rural general practices to host several learners at varying levels25. In that report, the perspective of the practice, the learners and the practice patient community was examined. This article addresses the research question, 'What considerations contribute to the development of a rural academic general practice?'
The rural academic general practice
To inform the development of a rural academic general practice, the model of the academic health sciences centre (AHSC) was explored for use in the context of a rural academic general practice. AHSCs are well established in the USA and the UK and are beginning to be acknowledged in Australia26. The AHCS model describes three complementary pillars of service, education and research. A principle of the AHCS model is fostering the 'discovery-care' continuum by bringing clinical services, education and research together in the one institution. AHSCs are characterised by their large scale, resulting in improved patient outcomes and cost efficiencies26. 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 