Today is a brief podcast about leaving theivory tower. As a PA or physician, we have to train at such a place but with time we will leave. Not all nurses, paramedics, or others in such settings will ever see the "ivory tower" and may have their education only in rural environments or at least not at a tertiary care center. The challenge for us becomes not only getting the medical knowledge, but also how to spread it.
We have an obligation to always be learning when it comes to providing medical care. Many of us choose to leave the "ivory tower" for different reasons, but rarely is it because we do not like to learn or teach. In fact, we sometimes gain more education opportunities because we can become involved in a different community once we leave urban academic centers.
There are limitations with working in a rural setting. For example, we are usually in a resource poor environment where we may lack specialists, equipment, or even certain medications. It is rare for a small critical access hospital to have a neurosurgeon or an ophthalmologist. There may not be a cardiac cath suite or anti-venom. Such limitations means we may have to provide the care we have access to and then transfer if it extends beyond our capabilities. Having access to training on how to manage the basics of conditions can help limit unnecessary or dangerous transfers or at a minimum provide safe care until the patient can receive more definitive care. In a rural setting we are truly "jack of all trades" types with us seeing everything with minor complaints to emergent resuscitation. Things that may be "farmed out" in an academic center such as reductions or complex laceration repairs but is rarely an option in a more rural setting. This can be a great environment to challenge the well experienced and capable provider. However, those who lack the experience will have a harder time growing since they may be left with transferring the patient. Most patients will be happy to stay at their home hospital so if we can take care of it in the rural setting we should try as much as possible. Outreach programs are vital. This is how we can learn from the major centers. The trick can sometimes being able to attend such classes. One easy way to fix this is offer multiple classes in a short timeframe to open access to more staff. Another important aspect is feedback. We are not talking enough between the tertiary care centers and their smaller "feeder" hospitals. Let us know what you think by giving us feedback here in the comments section or contacting us on Twitter or Facebook. Remember to look us up on Libsyn and on iTunes. If you have any questions you can also comment below, email at thetotalem@gmail.com, or send a message from the page. Please check our bandwidth sponsor, FunnyRx, too. We hope to talk to everyone again soon. Until then, continue to provide total care everywhere. 
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