Exploration of rural physicians’ lived experience of practising outside their usual scope of practice to provide access to essential medical care (clinical courage): an international phenomenological study

Objectives Rural doctors describe consistent pressure to provide extended care beyond the limits of their formal training in order to meet the needs of the patients and communities they serve. This study explored the lived experience of rural doctors when they practise outside their usual scope of p...

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Main Authors:	David Campbell, Lucie Walters, Jill Konkin, Laura Grave, Ella Cockburn, Ian Couper, Ruth Alison Stewart
Format:	Article
Language:	English
Published:	BMJ Publishing Group 2020-08-01
Series:	BMJ Open
Online Access:	https://bmjopen.bmj.com/content/10/8/e037705.full

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record_format	Article
spelling	doaj-b83252f846f94c1683b778e40de517a52021-05-28T12:32:01ZengBMJ Publishing GroupBMJ Open2044-60552020-08-0110810.1136/bmjopen-2020-037705Exploration of rural physicians’ lived experience of practising outside their usual scope of practice to provide access to essential medical care (clinical courage): an international phenomenological studyDavid Campbell0Lucie Walters1Jill Konkin2Laura Grave3Ella Cockburn4Ian Couper5Ruth Alison Stewart65 Australian College of Rural and Remote Medicine, Lakes Entrance, Victoria, Australia 4 Rural Health, Flinders University, Adelaide, South Australia, Australia 1 Office of Rural and Regional Health, University of Alberta, Edmonton, Alberta, Canada2 Flinders Rural Health South Australia, Flinders University, Mount Gambier, South Australia, Australia2 Flinders Rural Health South Australia, Flinders University, Mount Gambier, South Australia, Australia3 Ukwanda Centre for Rural Health, Stellenbosch University, Stellenbosch, South Africa4 Rural Medicine, College or Medicine and Dentistry, James Cook University Faculty of Medicine Health and Molecular Sciences, Thursday Island, Queensland, AustraliaObjectives Rural doctors describe consistent pressure to provide extended care beyond the limits of their formal training in order to meet the needs of the patients and communities they serve. This study explored the lived experience of rural doctors when they practise outside their usual scope of practice to provide medical care for people who would otherwise not have access to essential clinical services.Design A hermeneutic phenomenological study.Setting An international rural medicine conference.Participants All doctors attending the conference who practised medicine in rural/remote areas in a predominantly English-speaking community were eligible to participate; 27 doctors were recruited.Interventions Semi-structured interviews were conducted. The transcripts were initially read and analysed by individual researchers before they were read aloud to the group to explore meanings more fully. Two researchers then reviewed the transcripts to develop the results section which was then rechecked by the broader group.Primary outcome measure An understanding of the lived experiences of clinical courage.Results Participants provided in-depth descriptions of experiences we have termed clinical courage. This phenomenon included the following features: Standing up to serve anybody and everybody in the community; Accepting uncertainty and persistently seeking to prepare; Deliberately understanding and marshalling resources in the context; Humbly seeking to know one’s own limits; Clearing the cognitive hurdle when something needs to be done for your patient; Collegial support to stand up again.Conclusion This study elucidated six features of the phenomenon of clinical courage through the narratives of the lived experience of rural generalist doctors.https://bmjopen.bmj.com/content/10/8/e037705.full
collection	DOAJ
language	English
format	Article
sources	DOAJ
author	David Campbell Lucie Walters Jill Konkin Laura Grave Ella Cockburn Ian Couper Ruth Alison Stewart
spellingShingle	David Campbell Lucie Walters Jill Konkin Laura Grave Ella Cockburn Ian Couper Ruth Alison Stewart Exploration of rural physicians’ lived experience of practising outside their usual scope of practice to provide access to essential medical care (clinical courage): an international phenomenological study BMJ Open
author_facet	David Campbell Lucie Walters Jill Konkin Laura Grave Ella Cockburn Ian Couper Ruth Alison Stewart
author_sort	David Campbell
title	Exploration of rural physicians’ lived experience of practising outside their usual scope of practice to provide access to essential medical care (clinical courage): an international phenomenological study
title_short	Exploration of rural physicians’ lived experience of practising outside their usual scope of practice to provide access to essential medical care (clinical courage): an international phenomenological study
title_full	Exploration of rural physicians’ lived experience of practising outside their usual scope of practice to provide access to essential medical care (clinical courage): an international phenomenological study
title_fullStr	Exploration of rural physicians’ lived experience of practising outside their usual scope of practice to provide access to essential medical care (clinical courage): an international phenomenological study
title_full_unstemmed	Exploration of rural physicians’ lived experience of practising outside their usual scope of practice to provide access to essential medical care (clinical courage): an international phenomenological study
title_sort	exploration of rural physicians’ lived experience of practising outside their usual scope of practice to provide access to essential medical care (clinical courage): an international phenomenological study
publisher	BMJ Publishing Group
series	BMJ Open
issn	2044-6055
publishDate	2020-08-01
description	Objectives Rural doctors describe consistent pressure to provide extended care beyond the limits of their formal training in order to meet the needs of the patients and communities they serve. This study explored the lived experience of rural doctors when they practise outside their usual scope of practice to provide medical care for people who would otherwise not have access to essential clinical services.Design A hermeneutic phenomenological study.Setting An international rural medicine conference.Participants All doctors attending the conference who practised medicine in rural/remote areas in a predominantly English-speaking community were eligible to participate; 27 doctors were recruited.Interventions Semi-structured interviews were conducted. The transcripts were initially read and analysed by individual researchers before they were read aloud to the group to explore meanings more fully. Two researchers then reviewed the transcripts to develop the results section which was then rechecked by the broader group.Primary outcome measure An understanding of the lived experiences of clinical courage.Results Participants provided in-depth descriptions of experiences we have termed clinical courage. This phenomenon included the following features: Standing up to serve anybody and everybody in the community; Accepting uncertainty and persistently seeking to prepare; Deliberately understanding and marshalling resources in the context; Humbly seeking to know one’s own limits; Clearing the cognitive hurdle when something needs to be done for your patient; Collegial support to stand up again.Conclusion This study elucidated six features of the phenomenon of clinical courage through the narratives of the lived experience of rural generalist doctors.
url	https://bmjopen.bmj.com/content/10/8/e037705.full
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Exploration of rural physicians’ lived experience of practising outside their usual scope of practice to provide access to essential medical care (clinical courage): an international phenomenological study

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