Developing clinical courage in rural generalist registrars: a qualitative study

Clinical courage underpins the ability of rural doctors to work at the full extent of their scope to provide their patients with access to clinical care not otherwise available in rural areas. Clinical courage develops over time and has been associated with sustained clinical work in rural areas. The aim of this study was to explore the development of clinical courage in Australian Rural Generalist (RG) registrars. Participants were recruited from Australian College of Rural and Remote Medicine (ACRRM) RG registrars, rural clinical supervisors, and medical educators. A semi-structured interview schedule for each group explored how registrars understand clinical courage and how experience and training influence the development of clinical courage. Interviews were undertaken via zoom, recorded, transcribed and analysed using a combination of inductive and deductive coding to identify key themes. Mezirow’s theory of transformative learning was used as a guide for exploratory deductive coding. We identified several themes related to RG experiences in developing clinical courage: ‘ registrars’ understanding of clinical courage’ , ‘ developing rural generalist clinical expertise’ , and ‘ community engagement increases motivation’ . A further theme ‘ adapting practise to prioritise patient values and ties to place’ describes a shift in perspective to adapt best practice care to prioritise the patient-in-place. Trainees move from being primarily accountable to their supervisor or consultant toward shared decision making with patients. Clinically courageous practice can attract censure from outsiders who do not understand the rural context, and the final theme, ‘ managing judgement , ’ is an integral part of developing clinical courage. Supervisors and educators play a crucial role in supporting registrars throughout this transformational learning journey. The findings describe the registrar journey of clinical courage development toward community engaged practice. These insights may be transferable to support the development of clinical courage in registrars training for rural medicine in other countries. We advocate that clinical courage should be made explicit throughout RG registrar training, and that documenting clinically courageous management plans could facilitate teaching and learning for RG registrars.