Building Research Capacity of Medical Students and Health Professionals in Rural Communities: Leveraging a Rural Clinical School's Resources to Conduct Research Skills Workshops

Abstract

The paper reports on a project where the objective was for the Rural Clinical School, The University of Queensland, Australia, to design an acceptable model of research skills workshops for medical students and rural health professionals. Eight, interactive research skills workshops focused on skill development were conducted in rural Queensland, and attended by 62 undergraduate medical students and rural health professionals. The workshop learning objectives were to: provide an understanding of research methods and practise some basic research skills; and develop a greater understanding of the research process. Of the 53 participants who provided evaluations, more than two-thirds agreed that the learning objectives were met, and although health professionals evaluated the workshops most highly, two-thirds of the medical students also agreed. Consistent with the positive quantitative evaluations, participants reported valuing the knowledge acquired in the workshops, combined with the teaching methods. The study demonstrated that an interactive, skills-based workshop was an acceptable model for the medical students and rural health professionals who participated, and that better health outcomes for rural Australians could ultimately result from leveraging a Rural Clinical School's resources to increase research capacity through this approach.

Keywords:

• Australia
• education
• health
• medical students
• research
• rural health

Introduction

The health of rural Australians is generally poorer than that of city dwellers. The causes are complex; however, overall, they experience higher health risk factors and inferior access to health care services (Australian Government Department of Health and Ageing 2008; Australian Institute of Health and Welfare 2012; Health Workforce Australia 2012). Governments at all levels have developed policies and funded initiatives to address this issue with varying degrees of success (Alston 2007; Dunbar et al. 2007; Humphreys 2009; Humphreys, Wakerman, and Wells 2006; Humphreys et al. 2008; Wakerman, Curry, and McEldowney 2012). Studies have criticised ‘one size fits all’ approaches (Fraser et al. 2002) and highlighted the integral role of communities in forging local solutions (Humphreys 2009; O'Meara et al. 2012; Peake and Judd 2007; Stagg and Rosenthal 2012; Sutton, Maybery, and Moore 2011; Wakerman and Humphreys 2011).

Many health professionals understand the importance of conducting meaningful research into local issues; however, the barriers to their participation are well documented. These include a lack of time (Barnett et al. 2005), funding (Gunn, McCallum, and Sanci 2008; Yallop et al. 2006), research skills and confidence (Ried, Farmer, and Weston 2007), technological issues (Barnett et al. 2005; Liaw and Humphreys 2006) and limited access to research networks and infrastructure (Dunbar 2010). Despite these barriers, there are examples of successful research projects by rural primary health care professionals developed from the ground up which have investigated topics of local interest and value (Veitch, Heal, and Preston 2008). Funding and access to university researchers with the appropriate infrastructure and skills have assisted in overcoming barriers (Perkins et al. 2011).

The Australian Commonwealth government has funded programmes such as Primary Health Care Research, Evaluation and Development (PHCRED), Rural Clinical Schools (RCSs) and University Departments of Rural Health (UDRHs) to develop the rural health workforce and improve rural health. The Commonwealth expected a high level of engagement between these groups and local health professionals to increase rural research (Australian Department of Health and Ageing 2010; National Health and Hospitals Reform Commission, and Australian Department of Health and Ageing 2009). Recently the Commonwealth reinforced the importance of the translation of research to practice, and the role of research in workforce development (Australian Department of Health and Ageing 2011). The 2012 consultation paper summary of the Strategic Review of Health and Medical Research in Australia identified a general lack of research capacity amongst health professionals, recommended strategies for improvement and named rural and remote research as a priority area (Commonwealth Department of Health and Ageing 2012).

The RCS and UDRH programmes have a research role; however, it is more explicitly expressed in the objectives set by the Commonwealth for the UDRHs than those of the RCSs. There is an expectation of research productivity from the UDRHs: publications, grants and consultancies. The 2008 evaluation of the programmes, commissioned by the Department of Health and Ageing, recommended that the UDRHs build upon their achievements in facilitating research by rural health professionals (Department of Health and Ageing, and Urbis 2008). To date, measurement of the effectiveness of RCSs has focused on their success at attracting medical students and retaining them as health professionals (Eley et al. 2012). The evaluation found that RCS infrastructure such as library services enabled local clinicians with particular interests to undertake research and to contribute to the development of a research culture (Department of Health and Ageing, and Urbis 2008). The message for the RCSs was to turn their attention to research capacity building once the teaching programmes were established.

Despite the Commonwealth's view that research is critical to improved health outcomes, as well as evidence of some signs of improvement in rural research capacity, further advances will largely depend on the engagement of future health professionals. This is problematic, given the barriers to research participation outlined earlier, and a deficit of medical school graduates' research skills highlighted in the 2008 synthesis report of the Department of Education, Employment and Workplace Relations Review of Undergraduate Medical Education in Australia (Department of Education, Science and Training, and Urbis 2008). Junior doctors self-reported a lack of preparedness in research methodologies required for speciality training, a weakness also observed by specialists. Medical programmes in Australia are assessed according to the standards set by the Australian Medical Council which expect schools to have an active research programme, to emphasise the importance of research for the advancement of knowledge and to encourage student engagement with research (Australian Medical Council Limited 2010). This emphasis and encouragement is not producing graduates with strong research skills.

A review of the literature found that researchers have investigated this issue, not unique to Australia, asking questions related to medical students' perceptions of research and their skills and productivity. In addition, there are reports of strategies employed to improve education and engagement in this area. Investigations have been undertaken in the context of a worldwide shortage of clinical scientists or physician investigators, not limited to rural areas (Lander et al. 2010), and increasing difficulty for clinicians to find time for teaching and research (Commonwealth Department of Health and Ageing 2012; Joyce, Piterman, and Wesselingh 2009). Surveys of students in Australia, Canada, New Zealand, the United Kingdom and the United States of America have found that while they valued research and could see benefits, both personally and for the betterment of medicine, there were barriers to their involvement at medical school and beyond (Burgoyne, O'Flynn, and Boylan 2010; Chakraborti et al. 2012; Galletly et al. 2009; Hyde 2007; Murdoch-Eaton et al. 2010; Park, McGhee, and Sherwin 2010; Siemens et al. 2010). One Australian survey of students revealed that just over one half predicted they would have some involvement in research during their working life (Galletly et al. 2009), and in another, 40% of the respondents had not ruled out a research career, motivated to advance medicine (Hyde 2007). Overall, the medical students' interest in research was qualified. A common perception was that research was removed from clinical practice and patient contact, making it less attractive (Burgoyne, O'Flynn, and Boylan 2010; Hyde 2007). New Zealand medical students articulated plans to participate in related activities while at university and during their careers; however, their clinical role took precedence (Park, McGhee, and Sherwin 2010). For this group and others, debt incurred during studies and a desire to earn money was a reported barrier to students making a long-term research commitment (Park, McGhee, and Sherwin 2010; Vanasse et al. 2011). A lack of awareness of flexible pathways, of combining research with practice, was also reported (Hyde 2007).

In addition to research training within the standard curricula of some undergraduate programmes, strategies to inculcate knowledge, skills and interest have included dedicated project courses (Laidlaw, Guild, and Struthers 2009; Laskowitz et al. 2010), fellowships or summer scholarships (Cleland et al. 2010; Smith et al. 2009; Zorzi et al. 2005), pathways or ‘tracks’ (Hunskaar et al. 2009), mentoring (Zier and Coplit 2009), and learning activities such as workshops and lectures (Vujaklija et al. 2010). Disciplines aiming to bolster research numbers within their ranks have introduced programmes (Allen et al. 2009; Back et al. 2011; Smith et al. 2009). These studies reported the success of their strategies against measures such as students' participation, completion and satisfaction rates (Cleland et al. 2010; Dehaven et al. 2011; van Eyk et al. 2010; Zier and Coplit 2009), self-reported positive perception of research (Vujaklija et al. 2010), speciality selection (Allen et al. 2009), funding success, reported value to their studies, and long-term engagement and research productivity (Daniel, Michael Brooks, and Waterbor 2011; Hunskaar et al. 2009; Smith et al. 2009).

Despite these initiatives, the survey findings suggest that engagement with research while at medical school has been limited by students' perceptions and experiences. Although the UK cohorts were interested in gaining research skills, they required a more realistic understanding of the research process (Murdoch-Eaton et al. 2010) and the broader application of research in the clinical context (Burgoyne, O'Flynn, and Boylan 2010). Students at three medical schools in Canada reported low levels of engagement with research despite acknowledgement that it could facilitate selection into speciality training programmes, citing a lack of time, inadequate research training, insufficient mentors and concern their contribution would be downplayed (Siemens et al. 2010). Few students in the New Zealand study sought an intense research experience, such as an intercalated research degree, or thought research methods should be compulsory (Park, McGhee, and Sherwin 2010). American students highlighted the value of a research office to coordinate information and resources. Research training combined with awareness of local research activity and mentors increased chances of successful research (Chakraborti et al. 2012). The nature of the research training or exposure influenced students' attitudes to research, as expressed by the Australian students. It could encourage or deter future involvement (Galletly et al. 2009; Hyde 2007). Students who undertook research projects did not benefit when the project descriptions were vague and the skills they could develop were not made explicit (Murdoch-Eaton et al. 2010), or mentoring was considered inadequate and failed to deliver on-going role models (Galletly et al. 2009).

There are few studies which have investigated the research skills development of medical students undertaking their training in rural locations. One study reported positive outcomes from a summer research placement programme in rural communities in Canada (Zorzi et al. 2005). A comparison of research engagement of rural and urban origin medical students in Croatia found that students of rural background performed less well against the study outcome measures, including research involvement (Polasek and Kolcic 2006). Given that these students were more likely to return to practise in rural areas, and contribute to improving rural health indicators, a support programme was recommended.

The literature review revealed that trends in Australia reflected those in countries with comparable medical education systems. Informed by these studies and aware of the government priorities in relation to research and health workforce strategy, Research Skills Workshops were trialled by a librarian and postdoctoral research fellow at The University of Queensland, Rural Clinical School, commencing in 2010. Local drivers were also in play that led to student demand: anecdotal evidence of medical students' awareness of research experience as a competitive advantage for places on specialty training programmes. Demand existed locally for research training from health professionals who had particular studies they were involved with or wished to conduct.

The workshops complemented the existing research capacity building work undertaken by the postdoctoral research fellow and Rural Clinical School library staff at all locations who offered advice and assistance predominantly to students, but also to university staff and local health professionals. The library service was established with funding from the Commonwealth in 2002 to enhance access to information and related services for medical students and their clinical teachers in traditionally underserved areas (Lasserre and Lamb 2010).

When the workshop content and offering were developed the strengths and challenges of previous models of similar training were taken into account, and addressed where the RCS curriculum and structure permitted. The key challenges identified in the literature that were targeted, were creating a positive perception of research through demonstrating its application to clinical work and the clear identification of research skills, through naming and practising them. The workshops were scheduled to fit in with free time in the students' programme and as the students of interest were known to highly value interactive learning, this style of workshop approach was selected.

The theoretical framework that underpins the workshop design is problem-based learning, where the student learns by actively working through realistic problems (Yew and Schmidt 2012) hence the cycle of research was used, with participants using their own examples to work through the exercises in small groups. The students drew on prior knowledge, searched for new information and invested intellectually to construct solutions collaboratively with peers (Yew and Schmidt 2012). This model was selected primarily due to the students' familiarity with this approach, but also because it integrates adult learning theory (Onyon 2012) which promotes self-directed learning, an essential skill for independent research. Problem-based learning has been used successfully for research skills development training within medical education. Reports highlight the positive benefits to participants of a problem-based learning approach: active, collaborative, motivational and productive (Davis III et al. 2006). Due to much information being new to participants and time constraints, this approach was balanced with some lecture format sessions.

The workshop content and design was jointly developed by the author librarian and the postdoctoral research fellow author drawing on their respective skills and knowledge. The librarian brought expertise in literature searching and reference management, and experience in delivering training, undertaking research and publishing. To complement this, the postdoctoral research fellow's strengths were her skills and knowledge of research methodology, and experience running workshops, but she too had experience in conducting research projects, and reporting/publishing. Both had a grounded understanding, from experience, of the benefits of multi-disciplinary collaboration.

While transdisciplinary collaboration has the benefit of integrating diverse disciplinary approaches (Gehlert 2013), the strength of the collaboration for the workshop was that the librarian and postdoctoral research fellow brought complementary knowledge. It was their capacity to maintain their disciplinary lenses and so work within a multi-disciplinary framework that resulted in the breadth of the set of skills covered in the workshop. In Sullivan's (1998) continuum of collaborative interactive education models, the multi-disciplinary approach is most similar to the uni-disciplinary approach where activities and interactions are collaborative but maintain a strong disciplinary focus (Hoeman 2002). By comparison interdisciplinary and transdisciplinary approaches seek a level of integration of the disciplines. The multi-disciplinary approach has been characterised as doing one's own work but sharing results, being cost and time efficient but promoting limited discussion about differences and similarities, having no real sharing, just an exchange of information and no presumption of change or enrichment (MacRae and Dyer 2005). However, the multi-disciplinary approach is collaborative and consistent with Whitehouse (1951), where a team approach was advocated for education.

This collaboration was expanded to conduct the first four workshops (at Toowoomba, Hervey Bay, Bundaberg and Rockhampton), in accordance with the RCS sites where the librarians were based. A further two librarians were involved as co-presenters, with the postdoctoral research fellow and each librarian making minor adaptations to the Bundaberg and Rockhampton workshops to accommodate local requirements. While all three librarians already had working relationships, these were new collaborations for the postdoctoral research fellow. Following these workshops, using the principles of reflective practice (Kolb 1984; Schön 1983) the process and content of the workshops were reviewed by all presenters, by teleconference.

At later workshops the collaboration was expanded again. At the second Hervey Bay workshop a University of Southern Queensland librarian who provided librarian services to RCS students co-presented. At this workshop and at the final Toowoomba workshop a RCS research assistant also co-presented. In total there were four librarians involved (three from the RCS) and two research staff. The author librarian presented in five of the seven workshops offered at RCS sites and the one pre-conference workshop. The other author presented at all workshops. The remaining four workshops were reviewed by those who presented, on the completion of each workshop, in person.

This paper reports on the evaluation of the level of acceptability of a model of research skills workshops designed to provide an understanding of research methods and of the research process, to health professionals, and students undertaking undergraduate medical education in a rural setting.

Methods

Over a 2-year period 62 people participated in a total of eight research skills workshops that were conducted in five locations across Queensland. The workshops were conducted at each of The University of Queensland, Rural Clinical School sites – Toowoomba, Rockhampton, Hervey Bay and Bundaberg, and as a pre-conference workshop at the 2011 Rural Doctors Association of Queensland conference, Cairns. The learning objectives of the workshop were to:

1.	Provide an understanding of research methods and practise some basic research skills
2.	Develop a greater understanding of the research process

This four-hour interactive workshop focused on developing four skills, based on the cycle of research:

1.	Turning a research idea into a research question
2.	Searching the academic literature online
3.	Using EndNote with literature searches and when writing assignments/reports
4.	Critiquing a research article

At every workshop the postdoctoral research fellow led the presentation of skills 1 and 4, and the librarian with responsibility for each RCS site (Toowoomba, Hervey Bay, Bundaberg, Rockhampton) typically led the presentation of skills 2 and 3. While the target audience was the University of Queensland, Rural Clinical School, Year 3 and Year 4 medical students, most workshops were open to and attended by health professionals in the local community. Workshops were scheduled at times that were optimal for student attendance, with the exception of the workshop offered prior to the conference. Attendance was compulsory for students at one site.

This model of research skills workshops was evaluated using two approaches – by the participants and by the presenters. The workshops were evaluated by participants at the end of each workshop. Of the 62 people who attended the workshops 53 completed a one-page pen and paper evaluation. Participants identified their occupation/employer (e.g. student/ Queensland Health) from a list of options. The key question, ‘the workshop met the learning objectives’ was rated on a Likert-like scale (1 = Strongly disagree; 5 = Strongly agree). These data were analysed using IBM SPSS Statistics Version 19. The remaining questions were open-ended, asking participants to list the ‘best aspects’ of the workshop, the ‘worst aspects’ of the workshop, and ‘how the workshop could be improved’. These qualitative data were then thematically analysed.

Ethical clearance for this project was provided by the University of Queensland, Behavioural and Social Sciences Ethical Review Committee.

Results

Of the 62 who attended the workshops, the mean score for those 53 participants who evaluated the workshops was 3.65. In order to meet other learning commitments several participants did not complete the workshop. The five response categories were collapsed into three for analysis, with Strongly agreed and Agreed combined, and Strongly disagreed and Disagreed combined. Sixty-seven percent of participants (n = 34) Strongly agreed/Agreed that the learning objectives were met, 20% (n = 10) were Undecided and the remainder Strongly disagreed/Disagreed (13.7%; n = 7) that the learning objectives were met. When the types of participants were examined by collapsing into students, Queensland Health staff, Rural Clinical School/University of Queensland staff, and preceptors (medical practitioners who supervise medical students while doing clinical practice), a more refined analysis was possible.

The majority of participants who evaluated the workshop were students (71.7%; n = 38). Queensland Health staff were the next largest group (11.3%; n = 6) followed by Rural Clinical School/University of Queensland staff who were predominantly Rural Clinical staff (9.4%; n = 5), and finally preceptors (7.5%; n = 4). Of all participants, 17.7% (n = 9) had no Rural Clinical School affiliation. Thirty-four people completed evaluations in 2010 and 19 in 2011.

The mean score for the students was 3.44, with almost two-thirds (61.1%; n = 22) who Strongly agreed/Agreed that their learning objectives were met, almost a quarter (22.2%; n = 8) were Undecided and 16.7% (n = 6) Strongly disagreed/Disagreed that their learning objectives were met (Table 1). The Queensland Health staff had a mean of 4.17, with more than three-quarters (83.3%; n = 5) who Strongly agreed/Agreed that their learning objectives were met and the remainder (16.7%; n = 1) who Strongly disagreed/Disagreed that their learning objectives had been met. The Rural Clinical School/University of Queensland staff evaluated the workshop most positively, with a mean of 4.2. In this group more than three-quarters (80.0%; n = 4) Strongly agreed/Agreed that their learning objectives were met with one participant being Undecided. The preceptors' mean was 4.00. Three-quarters (75%; n = 3) Strongly agreed/Agreed that their learning objectives had been met and one was Undecided.

Table 1 Responses to the question ‘The workshop met the above learning objectives for me?’ on a scale of 1 to 5 (1 = Strongly agree; 5 = Strongly disagree), by type of participant (* = not students).

Participant type	Strongly agree/Agree % (n)	Undecided % (n)	Strongly disagree/Disagree % (n)	Mean score
Students	61.1 (22)	22.2 (8)	16.7 (6)	3.44
Qld Health staff*	83.3 (5)	–	16.7 (1)	4.17
RCS/UQ*	80.0 (4)	20.0 (1)	–	4.20
Preceptors*	75.0 (3)	25.0 (1)	–	4.00

When the learning objectives were analysed by RCS site it emerged that Toowoomba students were significantly more likely than Hervey Bay students or participants who were not students at RCS site workshops (health professionals) to Strongly agree /Agree that the workshop objectives were met, and Hervey Bay students were significantly more likely than those who were not students, or Toowoomba students to Strongly disagree/Disagree that the workshop objectives were met (χ² df 3, n = 51, p = 002). The highest mean score for workshops where there were predominantly student participants was in Toowoomba (4.24) (Table 2). The librarian author was based here and had daily contact with the student population; and the workshop was conducted at this location on three occasions. At this site, Toowoomba, almost all (94.1%; n = 16) participants Strongly agreed/Agreed that their learning objectives were met, with only one being Undecided. The site where the workshop was compulsory for students and only attended by students (Hervey Bay) is where the lowest mean was reported for a student group – 2.83. At Hervey Bay, while more than a third of participants (36.8%; n = 7) Strongly agreed/Agreed that their learning needs were met, almost the same proportion (31.6%; n = 6) Strongly disagreed/Disagreed that their learning needs were met, with a slightly smaller proportion (26.3%; n = 5) being Undecided. The workshop was conducted twice at Hervey Bay. The one workshop conducted at Rockhampton had the greatest diversity of participants (students; Queensland Health staff; preceptors) and had a mean of 3.88. Almost two-thirds (62.5%; n = 5) Strongly agreed/Agreed that their learning objectives were met and the remaining third (33.3%; n = 3) were Undecided.

Table 2 Responses to the question ‘The workshop met the above learning objectives for me?’ on a scale of 1 to 5 (1 = Strongly agree; 5 = Strongly disagree), by site of workshop, for all participants, students and those who were not students.

Site	Strongly agree/Agree % (n)	Undecided % (n)	Strongly disagree/Disagree % (n)	Mean score	Total evaluations per site
Toowoomba	94.1 (16)	5.90 (1)	–	4.24	17
Hervey Bay	36.8 (7)	26.3 (5)	31.6 (6)	2.83	18
Rockhampton	62.5 (5)	33.3 (3)	–	3.88	8
Cairns	100.0 (5)	–	–	4.80	5
Bundaberg	33.3 (1)	33.3 (1)	33.3 (1)	2.67	3

The two remaining workshops were attended predominantly by health professionals. At the pre-conference workshop in Cairns, the highest mean score by location, of 4.80 was reported. All participants indicated that they Strongly agreed/Agreed that their learning objectives had been met (n = 5). By contrast Bundaberg participants reported the lowest mean score of all the workshops for location with 2.67. Of the three participants, one Strongly agreed/Agreed that his learning objectives were met, one was Undecided and the last Strongly disagreed/Disagreed that his learning objectives were met.

The qualitative comments indicated that it was the content of the workshops in general, learning how to use referencing software, the small sized groups and the interactive nature of the workshop which were considered the best aspects. Examples of quotes highlighting each of these are: ‘Comprehensive overview of basic research skills’; ‘… a basic understanding of EndNote and how to export citations in to EndNote’; ‘Small group – more personal and able to ask questions freely’; ‘Interactive and flexible’. Participants reported that the worst aspects were having inadequate time and inaccurate targeting of participants' level of expertise. Quotes providing examples of these are: ‘Lack of time and a lot of information to digest’; ‘Too simplistic for people with advanced research skills’; ‘Probably a bit over my head – needed something more basic’. When asked how the workshop could be improved there were a range of suggestions, but most indicated that lack of time was an issue. Examples are: ‘Give the articles to peruse before the workshop for more time for discussion’; ‘Perhaps a little more time on conducting an online search and storing the data’.

Based on the participant evaluations and on the presenters' reflection on their practice, changes were made to the model of workshop delivery, both with the process of delivery and the content. The most significant change was doubling the time from an initial two-hour workshop, to four hours over a five-hour period. While this was well received by those who attended later workshops, a common issue in participant evaluations was inadequate time. The presenters determined that any future workshops while retaining the same length of four hours, would be best offered over two days either early in the morning or late afternoon. This would provide students with greater opportunity to re-organise their timetable and health professionals, particularly those in private practice who would potentially lose income through attending during usual working hours, easier access. A second change in the process dimension of the workshops was to increase the number of ‘change of state’ activities to maintain the energy levels and interest of participants. Changes here were made following most workshops with one example being the introduction of competitions which involved physical movement, and another where participants were required to conduct activities while standing instead of sitting. The third process change was to represent more closely the cycle of research by having the participants use their research topic of interest throughout the workshop, from developing the research question, in the online search practice and use of EndNote, then later in the mock research design component.

While the four skills remained the focus of all workshops, some content was changed. Two significant additions were the expansion of the section on literature reviews and a pre-workshop questionnaire to establish the skill base for literature searching and use of EndNote so the appropriate skill level could be targeted. While modifications were made, the model remained an interactive, skills-based workshop that engaged participants.

When the temporal dimension was considered, the mean score at the final workshop was higher than the first workshop, but there were decreases and increases within that period (Table 3). However when the linear trend was examined for responses categorised as Disagree, Undecided and Agree, the slope for those who Agreed was positive (Figure 1).

Table 3 The mean scores of each workshop, by location and the date the workshop was conducted.

Workshop location	Date of workshop	Mean score
Toowoomba	April 2010	4.29
Rockhampton	April 2010	3.88
Hervey Bay	April 2010	2.88
Bundaberg	April 2010	2.67
Toowoomba	August 2010	4.00
Hervey Bay	February 2011	2.80
Toowoomba	February 2011	4.50
Cairns	June 2011	4.80

Figure 1 Percentages of workshop participants who Strongly agreed/Agreed, were Undecided and who Strongly disagreed/Disagreed that the workshop met the learning objectives, in chronological order of the workshops being conducted.

Discussion

The study demonstrated that an interactive, skills-based workshop was an acceptable model for these participants – medical students and rural health professionals. This novel approach to increasing research capacity for students through running research skills workshops, but also making them available to locally based health professionals, met a need in each of the student cohorts and communities where it was offered. The results demonstrate clearly that the health professionals (Queensland Health staff, Rural Clinical School/University of Queensland staff and preceptors) received more benefit from the workshop than the medical students, as reflected by the mean scores. This is shown with each of the health professional participant groups having a mean score of four or above, out of a possible five, and medical students lowering the overall mean, with a score of 3.44. It should be noted, however, that more than one-third (37.7%) of all participants were students who were not given a choice about attending and it is hypothesised that the involuntary nature of attendance may be reflected in their evaluation. The high mean scores from the health professional participants may reflect a high value being placed on a scarce resource as indicated by previously reported barriers of a lack of research networks and infrastructure (Dunbar 2010) and contribute to addressing low levels of research skills and confidence (Ried, Farmer, and Weston 2007), and if so it would highlight the importance of this approach to enhancing research skills acquisition in rural communities.

Importantly almost two-thirds of the medical students reported the learning objectives were met, which shows substantial support for this model of delivery of research skills training. Amongst the predominantly student participant workshops it was participants at the location where the librarian author was based who gave the highest ratings with means of four or above. This may reflect the RCS quality assurance data which showed consistently that students at this site highly valued this librarian's contribution to their learning. The greatest difference by site, between highest and the lowest mean scores, is where only health professionals attended. These were substantially different groups, with the Bundaberg participants each having a research project they were about to undertake or had commenced (one a clinical trial) and the hope that this workshop would provide much needed knowledge and skill. The Cairns participants on the other hand were at the location to attend a conference and chose to attend this workshop and others, prior to the conference.

Consistent with the positive evaluations of learning needs being met, the open-ended comments indicate that it was both the knowledge acquired in the workshops that participants valued, combined with the teaching methods and activities used in the workshops. The evaluations endorsed the choice of the problem-based learning design. Participants appreciated learning about the process of conducting research, and in particular learning how to use referencing software (Endnote). They enjoyed the interactive, small group format.

Having reflective practice built into the workshop model assisted presenters to continually monitor and modify components, in concert with the participant feedback. There is some support indicated for the presenters' ability to use the feedback and their insights to effectively modify the workshops, demonstrated by the upward trajectory of the mean scores for those who Agreed that the learning needs were met, from the first to last workshop.

These results confirm earlier findings where medical students recognise the value of gaining research skills (Burgoyne, O'Flynn, and Boylan 2010; Galletly et al. 2009; Hyde 2007; Murdoch-Eaton et al. 2010; Park, McGhee, and Sherwin 2010; Siemens et al. 2010), with a mean of 3.44, even though the health professionals scored higher. Given these students are seen as potential rural health professionals, predominantly in primary care, their research capacity is important in facilitating the provision of evidence-based health care and improved rural health outcomes. This model, through using the cycle of the research process, with a skills focus, potentially contributes to students having a clear understanding of what fundamental research skills are, and a more realistic perception of the conduct of research, and so addressed these key short comings noted previously (Murdoch-Eaton et al. 2010). While specific research methods were not taught in the workshops, participants were exposed to the theory underlying methods which provides an introduction, so to a degree addresses another barrier found (Siemens et al. 2010). Including local health professionals in the workshops, provided the students with the opportunity to learn about local research projects and gain insights into the way research can be combined with practice, potentially preventing negative perceptions found earlier (Burgoyne, O'Flynn, and Boylan 2010; Hyde 2007). For health professionals interested in conducting their own research, or participating in research it contributed to addressing the lack of skills issue (Yallop et al. 2006), to some extent technological issues (Gunn, McCallum, and Sanci 2008; O'Meara et al. 2012) and access to research networks and infrastructure (Ried, Farmer, and Weston 2007).

While this model of research skills workshops was found acceptable by participants, there are some limitations. First, to effectively measure the impact of the workshop on research capacity building it would be necessary to enhance the evaluation process with additional surveying. Self-assessment of research knowledge and skills, as well as attitudes to research, pre- and post-workshop would provide more insights. Participants' stronger engagement could be measured by enrolment in research-based study, project initiation, publications, grants and increased use of research services such as the library or research advice. Second, apart from a pre-workshop questionnaire on database and EndNote experience, the baseline research knowledge and skills of the participants was not assessed. The research design would be strengthened by a pre- and post-test evaluation of knowledge and skills to provide a more objective measure than the self-report by the participants, in addition a longitudinal study would have the capacity to report on individual changes, over time and therefore the longer term impact. Finally, the small sample size only allows descriptive analysis and the non-probability sampling limits generalisation beyond this study.

The multi-disciplinary collaboration between the authors in developing the workshop, then expanding this to include other librarians and a research assistant in presenting the workshops, appears to have been effective. The challenges of multi-disciplinary teamwork such as competition for resources, discipline-specific turf issues, workloads and perceptions of power and control (Dyer 2003) were not apparent. While the impact of this team approach on the students' learning outcomes was not measured, some of Pounder's (1999) potential areas for enhanced work experience were realised. The on-going review of the workshops provided opportunities for colleagues to give feedback about work effort, which was invariably constructive. There was an increased level of work coordination between this group, on matters outside the workshops. Presenters attended each other's sections of the workshops and typically this resulted in increased skills, knowledge and instructional strategies. For the research staff who had the least student contact, their knowledge of the students and their total educational experience increased as a result of the workshops. At reviews of the workshops, a sense of satisfaction and professional commitment was often reported, even though the focus was always on how to improve.

Leveraging local resources, in particular, the combined skills sets of the librarians, postdoctoral research fellow, and research assistant, was effective. They lived in or knew the communities where the workshops were conducted, through their day-to-day work. This local knowledge gave an advantage over an external provider flying in for the day. However the challenge of institutionalising activities such as this with high staff turnover in rural communities (Australian Government Department of Health and Ageing 2008) is highlighted by a half of the presenters, which includes both authors, now living elsewhere.

Conclusion

An outcome of this project was that the majority of participating students and health professionals concluded that the learning objectives were met. So they developed a greater understanding of the research process, were provided with an understanding of research methods and practised some basic research skills. The research skills workshops therefore moved participants a step closer to being able to operate as independent researchers.

Therefore this study demonstrates that a small multi-disciplinary team can respond to interest in research and assist in scaling the barriers for primary health care providers in conducting research. While research skills are not part of all undergraduate medical curricula and not core business for rural clinical schools, this approach is an alternative for students and health professionals to commence the development of research skills. The optimal format of the workshop would be voluntary, and sufficiently long to spend more time on each skill. It was difficult for participants to commit a half day to the workshop, so it would be preferable to hold it over two days or evenings.

This unique approach, to offer an interactive, skills-based workshop to future and current rural health professionals through the leveraging of a multi-disciplinary local collaboration presents an effective model that addresses numerous previously identified barriers to current and future health professionals in rural communities conducting research. While the barriers to health professionals undertaking research are well documented, the potential positive benefits to rural health care and communities are considerable. This model of research skills workshops could potentially be replicated in other rural communities where Rural Clinical Schools operate.

Acknowledgements

The authors would like to thank Sarah Thorning, Margaret Lamb and Brenda Strachan, librarians who participated in the development and delivery of the workshops, and also Donna Rouse who assisted in the delivery of workshops.