Rural Education route

Community and Rural Education Route

Training the next generation of doctors via the Rural Education Route (RER) – Llwybr Addysg Wledig (LLAW)

The Rural Education Route (RER) – Llwybr Addysg Wledig (LLAW) is an innovative pathway on offer for the third-year Cardiff medical students. Similar year-long placements, referred to as Longitudinal Integrated Clerkship studies, have been implemented around the world for fifteen years. Feedback demonstrates that they effectively prepare the students for their future careers, whatever area of Medicine they wish to settle in.

The successful candidates live for a year by the sea in two seaside resorts, Aberystwyth in Mid-Wales and Bangor in North Wales. Both university towns have a buzzing student life and are ideal locations to practice outdoor activities, such as hiking, running, surfing, canoeing, mountaineering, caving, photography, birdwatching, etc.

The students undertake a year-long placement in GP practices where they become an integral part of the medical teams. Each student is based in a local GP surgery of their choice where they ultimately see patients by themselves under the supervision of a designated GP tutor. In Mid and North Wales, the patients, doctors and nurses in the GP practices and in the local hospitals have been very supportive and have welcomed this opportunity to train the next generation of doctors.

The medical students are given the responsibility of performing consultations and presenting their findings to their GP tutors with whom they discuss potential treatments and any referral for further investigation.

As part of their training, they also complete 20 days placement in the local hospitals and learn about the acute management of medical and surgical conditions. During the COVID19 pandemic, Hywel Dda University Health Board employed the students as health care support workers in A&E and in several wards in Bronglais hospital. They gained a first-hand experience on the ground; delivering care to patients in hospital.

The medical students study one day a week on Aberystwyth University campus. Dr Sue Fish is a local GP and the Clinical Senior Lecturer in rural practice who supervises their studies in Aberystwyth. The students watch recordings of the lectures delivered to their peers at Cardiff medical school, have local tutorials delivered by local medical practitioners, as well as attend conferences held at the Centre for Excellence in Rural Health Research at Aberystwyth University. They also research in depth a topic of their choice one day a week based on healthcare in a rural area.

The third-year students based in Cardiff complete successive blocks of eight weeks placements mainly based in hospitals, interspaced with some blocks of teaching delivered at medical school. While the Rural Education route offers a more in-depth experience to the students in general practice who can follow patients over a longer period. They are working towards the same learning as their peers on the C21 pathway under the guidance of a small dedicated team of experts. They simultaneously sit the same examinations as the Cardiff medical students in some exam rooms at Aberystwyth Universities.

From March 2020, Cardiff medical school teaching switched to online provision and Dr Sue Fish has delivered her weekly teaching via Microsoft Teams since then too. Most chose to stay in Aberystwyth during lockdown During lockdown where they have been working both in their GP surgeries and as Healthcare Support Workers at Bronglais General Hospital. They have continued to receive weekly teaching from Dr Sue Fish, the local Clinical Senior Lecturer and GP Tutor at Borth Surgery remotely via Microsoft Teams. Some have also been taking part in video consultations with patients.

Francesca Saleh spent lockdown with her family in Portsmouth and used the Attend Anywhere Platform and the GP clinical system Remote Access platform to take the patient histories online and get access to their medical records. She presented her findings to Dr Fish with whom she discussed the treatments and further examinations before delivering their joint conclusions to the patients online. This proved a successful way of consulting patients while protecting everybody from the spread of COVID19.

Learn more about Francesca's experience doing video consultations.

The CARER students are immersed for a year living and working in rural communities in Wales.

This gives them an invaluable insight into the daily life of patients living in rural areas. They get involved with the community and follow the evolution of some patients’ cases over a significant period.

As a result, the medical students develop a holistic and a patient centred approach to medicine which benefits their training and gives them essential skills for their upcoming career, whatever path they choose to take.

These longitudinal integrated clerkship studies also encourage medical staff to choose careers in GP practices and settle in some rural areas which could be at risk of being deprived of medical care in the future.

Find out about student life in Aberystwyth on the next page.

Find out more about the Rural Education Route.

Read about the "once in a lifetime" experiences of the medical students who have undertaken the Rural education route on the CARER blog.

To get more information about the Rural Education Route and medical studies, contact:

Cambrian Primary Care

Borth Surgery,
High Street,


SY24 5JE

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