Assessment in rural medicine: hHow to measure and motivate achievement of abilities

[Extract] The unique nature of rural and remote medicine is now well documented. As a result of its context, rural medicine is characterised by an expanded scope of clinical practice in the community and hospital setting, authentic multi-professional care, the necessity of a population health approach and an obligation to ration scarce resources. These are also global challenges: in high-income countries, governments are grappling with the health care demands of ageing populations and complex care; and in low-income countries, infectious and chronic disease increasingly co-exist in a predominantly rural context. A key driver in the emergence of rural medicine as a distinct discipline has been a divergence between metropolitan and rural general practice. Expansion of medical specialist numbers and increasing sub-specialisation in cities has led to more referral-oriented practice and ‘shared-care’ for GPs, less GP access to hospitals and a reduced involvement in procedural and emergency medicine. In contrast, in many rural and remote areas in Australia and around the world, rural contexts continue to require comprehensively-skilled doctors who can work across the primary and secondary care settings, including emergency and hospital in-patient services as well as in population health and community