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Background: Accessible and contextually relevant healthcare research programs and networks for rural physicians are exceedingly rare, which hinders the development of social capital in an already isolating profession. This study aims to examine the impact of the Rural Health Research Capacity Building (RRCB) Program on enhancing cognitive, structural, and relational social capital through comprehensive research skills training, supported by professional teams and resources., Methods: This study uses a mixed-methods approach with utilization of qualitative and quantitative data and pre-post quasi-experimental design. Data were collected prior and after completion of the program by means of surveys, focus group, and observation. Thirty-five rural physicians participated in this study from 2014 to 2021., Results: The results show a significant increase in cognitive (pre-program = 0.37 vs. post-program = 0.61, p < .001), structural (pre-program = 0.58 vs. post-program = 0.81, p < .001), and relational (pre-program = 0.49 vs. post-program 0.69, p < .001) components of social capital. Focus group discussions and observation data supported these findings, particularly highlighting that research capacity-building programs tailored to the needs of rural physicians can enhance collective values, improve the quality of relationships, and foster communities of research-focused practice., Conclusions: Being equipped with a shared system of meanings and interpretations, research knowledge and resources, and a professional research network appears to play a critical role in enhancing social capital in rural health research. The RRCB program effectively improves social capital among rural and remote physicians., Competing Interests: Declarations. Ethics approval and consent to participate: All research was performed in accordance with the Declaration of Helsinki. All methods were carried out in accordance with relevant guidelines and regulations. The study was approved by the provincial Health Research Ethics Board and informed consent was obtained from all participants prior to study start. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

We conducted a scoping review to determine incidence and risk factors for postpartum haemorrhage (PPH) in rural Indigenous women. We systematically searched PubMed (Medline), EMBASE, and CINAHL for all peer-reviewed articles and grey literature regarding Indigenous ethnicity, rural settings, and PPH incidence, risk factors, or maternal outcomes published from inception to 11 January 2021. Eleven articles were deemed relevant after screening and quality assessment using the National Institutes of Health scoring system for mixed study reviews. Of these, 3 articles were good quality, 1 was fair, and 7 were poor. Nine possible risk factors were recorded. The outcomes studied were transfusion, hysterectomy and mortality. PPH research in rural Indigenous women is scarce, mostly low quality and fails to represent most Indigenous cultures and countries. Women from Indigenous groups in rural Canada, Australia and the USA are at higher risk for PPH but specific risk factors are unknown. While widely differing populations made the data difficult to synthesise, this inaugural scoping review highlights a need for further research and increased obstetrical resources in areas where rural Indigenous women reside.

Overwhelming issues and barriers often prevent rural and remote physicians (RRPs) from pursuing the many socially accountable research questions they encounter on a daily basis. Although research training programs can empower RRPs to rise to these challenges, there is a lack of evidence on how they should be developed and refined. At Memorial University, a faculty development program (FDP) called 6for6 has been helping RRPs surmount their research quagmires and engage in scholarship since 2014. After an initial three-year (2014-17) pilot, we prepared a detailed plan to evaluate the 6for6 research FDP for RRPs and inform future years of delivery. Using a modified Delphi method and participatory action model a group of program team members, stakeholders and evaluation experts developed an evaluation plan including a logic model and an evaluation matrix addressing five key themes. To our knowledge, this is the first evaluation plan for a research-focused FDP targeting RRPs. While this plan was developed specifically for the 6for6 FDP, our approach to its development may be useful to any institution interested in evaluating an FDP with limited resources., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: To assess the effect of a training programme called 6for6 (the programme) on research competency and productivity amongst rural physicians. The programme develops the research skills of six rural physicians over six weekends. Physicians learn about various research methods and writing techniques through blended learning components., Methods: We conducted a quasi-experimental study, comparing research competency and productivity between intervention and non-equivalent control groups and over time through a repeated measures design. Generalized linear mixed model (GLMM), ANOVA, and Cochran Q tests were conducted. The intervention was provided to five groups of 6 rural physicians each between 2014 and 2019. Main outcome measures: self-assessed research competency (knowledge, attitudes and skills) and productivity (publications, grants and presentations of research-related work at conferences) were our primary and secondary outcomes, respectively. We measured the outcomes before, during and after the programme. Controls: Rural physicians who expressed interest in the programme and later enrolled., Results: This study shows that, amongst its thirty participants, overall research competency was significantly different between intervention and control groups (65.7% ± 37.6% and 58.6% ± 14.4%, P < 0.05 for GLMM). The percentage of participants who were productive before, during and after the programme was 26.7%, 16.7% and 50.0%, respectively. Overall, productivity rates were significantly different between intervention and control groups (rate difference was 72.2/100 person-years, P < 0.05 for GLMM)., Conclusion: This study suggests that the programme improves research competency and productivity for rural physicians. Rural physicians who wish to improve their research competency would benefit from participating in similar programmes., Competing Interests: None

Rural physicians face many challenges with providing rural health care, which often leads to innovative solutions. Despite their creativity with overcoming barriers, there is a lack of support for rural health research - an area of health care where research makes great impacts on small communities. Rural research capacity building (RRCB) is essential to support rural physicians so that they can conduct relevant research, but RRCB programs are sparse. Thus, our team at Memorial University of Newfoundland, Canada, has created an RRCB ecosystem through the 6for6 and Rural360 programs, which outline a pathway for rural physicians to make meaningful contributions to their communities through research. This article describes the RRCB ecosystem and explains how the 6for6 and Rural360 programs address the need for RRCB. Designed to train six rural physicians over six sessions per year, 6for6 fosters learning of research practices through a conceptual framework that envelops complexity science, systems thinking, and anchored instruction. The use of this framework allows the learning to be grounded in issues that are locally relevant for each participant and follows guiding principles that enable many types of learning. Rural360 continues the pathway by providing an in-house funding opportunity with an iterative review process that allows participants to continue developing their research skills and, ultimately, secure funding for their project. This anchored delivery model of RRCB programming is made possible through many support systems including staff, librarians, instructors, the university, and other stakeholders. It has successfully helped form communities of practice, promotes collaboration both between learners and with third parties, encourages self-organization with flexibility for learners outside of the in-house sessions, and ultimately drives social accountability in addressing local healthcare issues.

People in Northern Newfoundland and Coastal Labrador (NNCL), Canada, face major challenges obtaining accessible and contextually-relevant healthcare. Rural 360 is a socially accountable research incubator that provides funding for NNCL physicians to research solutions to these issues. NNCL graduates of the adjoined 6 for 6 research training program for rural physicians are invited to submit the research project they have conceptualised as part of that initiative as a letter of intent, and subsequently as a research proposal, to Rural 360. These submissions are reviewed by relevant subject matter experts as part of the Rural 360 adjudication process. This process is iterative and strives to guide and assist participants in refining their submission. The overarching objective of Rural 360 is to collaborate with rural physicians to conduct, disseminate or otherwise catalyze unsupported community-based research in NNCL. In so doing, it is highly socially accountable, empowering participants to become change-makers who investigate contextually important health issues that emerge from NNCL communities.

Introduction: Canadian emergency departments (ED) are struggling to provide timely emergency care. Very few studies have assessed attempts to improve ED patient flow in the rural context. We assessed the impact of SurgeCon, an ED patient-management protocol, on total patient visits, patients who left without being seen (LWBS), length of stay for departed patients (LOSDep), and physician initial assessment time (PIA) in a rural community hospital ED., Methods: We implemented a set of commonly used methods for increasing ED efficiency with an innovative approach over 45 months. Our intervention involved seven parts comprised of an external review, Lean training, fast track implementation, patient-centeredness approach, door-to-doctor approach, performance reporting, and an action-based surge capacity protocol. We measured key performance indicators including total patient visits (count), PIA (minutes), LWBS (percentage), and LOSDep (minutes) before and after the SurgeCon intervention. We also performed an interrupted time series (ITS) analysis., Results: During the study period, 80,709 people visited the ED. PIA decreased from 104.3 (±9.9) minutes to 42.2 (±8.1) minutes, LOSDep decreased from 199.4 (±16.8) minutes to 134.4(±14.5) minutes, and LWBS decreased from 12.1% (±2.2) to 4.6% (±1.7) despite a 25.7% increase in patient volume between pre-intervention and post-intervention stages. The ITS analysis revealed a significant level change in PIA - 19.8 minutes (p<0.01), and LWBS - 3.8% (0.02), respectively. The change over time decreased by 2.7 minutes/month (p< 0.001), 3.0 minutes/month (p<0.001) and 0.4%/month (p<0.001) for PIA, LOSDep, and LWBS, after the intervention., Conclusion: SurgeCon improved the key wait-time metrics in a rural ED in a country where average wait times continue to rise. The SurgeCon platform has the potential to improve ED efficiency in community hospitals with limited resources., Competing Interests: Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. Funding was received from the Canadian Institutes for Health Research Rewarding Success Phase II Grant. There are no conflicts of interest or sources of funding to declare.

Introduction: Hepatobiliary iminodiacetic acid (HIDA)-radionuclear scans are used to diagnose biliary dyskinesia, the treatment for which is a laparoscopic cholecystectomy (LC). However, the predictive value of the HIDA scan for LC candidacy is debated., Case: A physical, ultrasound, and blood test for a 53-year-old woman with biliary dyskinesia-like symptoms were normal, contradicting a textbook history. A HIDA-scan was ordered but the results suggested she was not eligible for a LC. The patient insisted on receiving the procedure and gave informed consent to undergo an elective LC., Results: Six-weeks post-surgery, the patient's symptoms had ceased besides one short episode of abdominal pain., Conclusion: A LC relieved the patient's symptoms, suggesting that negative HIDA-scans can mislead correct decisions to perform a LC. Surgeons who receive inconclusive HIDA scan results should consult their patients, and when necessary and agreed-upon, take an informed risk together in an attempt to improve the patient's quality of life., Competing Interests: None

Introduction: The Canadian island of Newfoundland has a long history of fishing; however, no study to date has developed a regional profile of fishhook injuries on its east coast., Methods: To this end, we conducted a retrospective review of fishhook injuries at all Newfoundland East coast emergency departments from 2013 to 2015. Patient presentations were reviewed for the date of arrival, sex of the patient, location of fishhook injury, tetanus immunisation status, anaesthetic utilisation, diagnostic imaging, antibiotic management and technique of removal., Results: Information was retrieved for 165 patients. Most injuries occurred to the hand (80.6%), and out of five documented techniques, "advance and cut" was the most common extraction method (55.5%). There was a high percentage of prophylactic oral antibiotics prescribed (57%) and X-ray imaging (20%) utilised. Consultation was required for 4.2% of the fishhook injuries including consultation to a local fire department service., Conclusions: On the east coast of Newfoundland, fishhook injuries are addressed inconsistently, with potentially suboptimal methods for removal, coupled with unnecessary imaging and antibiotics. We believe that there is a role for education and other initiatives to improve the care delivered., Competing Interests: None

Problem Addressed: To address barriers challenging the engagement of rural and remote family physicians (RRFPs) in research, Memorial University of Newfoundland in St John's has developed a longitudinal faculty development program (FDP) called 6for6., Objective of Program: To establish and evaluate a longitudinal FDP that promotes a foundation of research activity. Program description Informed by a needs assessment in phase 1, phase 2 saw the 6for6 curriculum designed, developed, and implemented to reflect the unique needs of RRFPs. Preliminary evaluations have been conducted and results will be presented after year 1 of the program., Conclusion: The 6for6 FDP has been positively received by participants, and it is evident that they will serve as champions of rural research capacity building. It is anticipated that by April 2017, 18 RRFPs will be equipped with the research and leadership skills required to foster research networks within and outside their communities.

Problem Addressed: Rural and remote family physicians (RRFPs) face greater barriers to research engagement than their urban colleagues and have access to fewer faculty development programs (FDPs) to foster their research skills., Objective of Program: To identify and prioritize skills and services that RRFPs need to engage in research., Program Description: Memorial University of Newfoundland in St John's used a needs assessment as the foundation for developing an FDP for RRFPs. The assessment comprised a systematic literature review and environmental scan, key informant interviews (n = 10), a focus group with RRFPs (n = 15), expert group meetings (n = 2), and needs assessment surveys (n = 19)., Conclusion: The assessment identified barriers to RRFPs engaging in research, priority considerations for the development of a research FDP for RRFPs, and research areas to be included in the program curriculum. This information was used to inform phases 2 and 3 of program development, which are further discussed in a companion article.