Sustaining Pediatrics in Rural and Underserved Communities

More pediatricians are needed in rural British Columbia (BC), but recruitment and retention remain a challenge. For those who practice pediatrics in rural areas, the role can be relatively isolated and disconnected from other pediatricians and pediatric resources. Sustaining Pediatrics in Rural and Underserved Communities (SPRUCe) is a clinical network that connects community pediatric providers with 

interest in supporting and sustaining excellence in pediatric care in rural and remote communities across BC. The goal of SPRUCe is to support those providing rural pediatric care so that provider care gaps are filled, education and mentorship supports are available, and pediatric residents have a structured mechanism for exposure and contact with rural pediatrics.     

Our Achievements

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Established structured rural pediatric locum supports

To enhance resident pediatricians’ use of available Rural Specialist Locum Program supports for vacation and vacancy allocations, SPRUCe recruited locum pediatricians who were matched to rural communities to provide oneweek locums at regularly scheduled intervals, based on host community needs. To date, four communities have been supported on a regular basis (Campbell River, Comox, Terrace, and Trail), with additional intermittent support provided to two additional rural communities (Port Alberni and Williams Lake), covering over 40 weeks of locum support throughout the calendar year.

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Established pediatric outreach clinic for Dawson Creek

Dawson Creek is a rural community that, to date, has been unable to recruit a permanent pediatrician and been served for many years by one pediatrician providing regular outreach clinics. Upon this physician’s retirement, the community was left without access to local pediatric consulting care. SPRUCe recruited a group of five urban pediatricians who committed to regular inperson outreach clinics in Dawson Creek and worked with the Northeast Medical Director and local team to establish needed infrastructure for a successful longterm pediatric outreach clinic. The clinic was launched in November 2021 and, to date, has completed six monthly outreach clinics.

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Established rural-focused pediatric accredited CME

Rural and remote pediatricians have unique educational needs, different than those practicing in urban centres with more readily available resources. Over the last year, SPRUCe organized and executed accredited continuing medical education (CME) learning sessions based on the needs identified and brought forward by rural pediatricians. In September 2021, Dr. Rose Hatala and Dr. Mary Bennett hosted a session, titled “Coaching Residents in the Era of Competency by Design”. The session highlighted teaching strategies and introduced the new evaluation system for University of British Columbia (UBC) pediatric residents to support rural pediatricians in having residents join them for electives in their practices and to confidently provide education and evaluations. In December 2021, SPRUCe hosted a presentation by Dr. Melissa Skaugset on “Point of Care Ultrasound (PoCUS) in Pediatrics”. This session was specifically meant as an introduction to PoCUS for pediatricians and provided ideas for rural pediatric providers to use PoCUS in their routine practice. This session stimulated significant discussion and has directed SPRUCe to further explore other PoCUS educational opportunities for rural pediatricians across BC. Finally, a presentation by a panel of pediatric subspecialists from BC Children’s Hospital gave a very timely session, titled “Multisystem Inflammatory Syndrome in Children, which was highly attended and generated great discussion.

Making a Difference

In just 18 short months, Sustaining Pediatrics in Rural and Underserved Communities (SPRUCe)—led by Dr. Kirsten Miller and Dr. Jennifer Retallack—has made great strides in connecting and supporting rural pediatricians.  

Feedback and participation from rural pediatricians involved in the SPRUCe clinical network over the course of the year has been encouraging. 

“Our CME session feedback has been positive—particularly through the Zoom chat when sessions come to a close,” says Dr. Miller. “Many participants have stayed online to chat and network after the formal sessions end.”   

SPRUCe is also increasing interest and requests for support for rural pediatric locum coverage.  

“One of the locum pediatricians who became connected to a rural community [Comox] through SPRUCe has now accepted a permanent position in that community,” explains Dr. Retallack. “And rural pediatricians have expressed appreciation for the logistical help provided by SPRUCe in securing locum coverage. Rural pediatricians regularly reach out to us when their need for locum coverage evolves.” 

SPRUCe has also sparked rural pediatric mentorship opportunities.  

“Two UBC pediatric residents established mentor/mentee relationships with rural pediatricians through the UBC Coaching and Mentoring Program (CAMP) over the past year, after SPRUCe presented about the CAMP program,” says Dr. Retallack.   

 The SPRUCe team also raised awareness about the state of rural pediatrics in BC by presenting research at several conferences.  

“We presented, ‘Pediatrics in Rural BC: How Are We Doing?’, at the BC Children’s Hospital/UBC Department of Pediatrics Grand Rounds last March, as well as data from SPRUCe’s rural pediatrician survey at RCCbc’s BC Rural Health Research Exchange and the Society of Rural Physicians of Canada Conference,” explains Dr. Miller.   

 In the upcoming fiscal year, plans for SPRUCe are just as ambitious.  

We’ll conduct a group discussion with rural pediatric locum physicians to determine how SPRUCe can most efficiently connect them to a rural community,” says Dr. Retallack. “We’ll also host another four-part accredited CME educational series, and explore opportunities to hold an in-person learning and networking opportunity for rural pediatricians.” 

“In addition, we plan to repeat our survey of rural pediatricians, enhance mentorship of trainees, disseminate data and information about the status of rural pediatrics in our province, and collaborate with other regions,” adds Dr. Miller. 

Team Members

Dr. Kirsten Miller
Dr. Kirsten Miller
Dr. Jenny Retallack
Dr. Jenny Retallack
Heather Gummow

Heather Gummow

Provincial Manager, RCME Community Program

Kirsten Quinlan

Kirsten Quinlan

Project Assistant