Ensuring an appropriately trained and resourced medical workforce for regional, rural, and remote areas is critical to enhancing the welfare of rural Australians, as it is for the welfare of rural and remote communities globally [1]. Australian medical schools frequently arrange for some (or all) of their medical students to undertake part of their training away from major metropolitan areas with the aim of producing practitioners capable of, and motivated to, practice in regional, rural, and remote locations [2]. There is evidence that this approach results in sound educational outcomes [3,4]. In addition, this approach—together with targeted recruitment of graduates from rural areas—is highly important in creating a sustainable rural medical workforce [5].

Both a cause and effect of an inadequate rural medical workforce is lack of timely access to specialist advice for onsite rural health practitioners and patients [6,7]. One potential strategy for assisting rural patients and doctors who would benefit from specialist access is telehealth. Telehealth has been defined as the “use of telecommunication techniques for the purpose of providing telemedicine, medical education, and health education over a distance” [8]. For the purposes of providing support to rural primary care providers and patients, a telehealth consultation is where a patient at a general practice, with the assistance of the general practitioner (GP) or practice nurse, undertakes a consultation by videoconference with a specialist located elsewhere [9]. While telehealth consulting is reported to be underused in Australia [10], there is evidence that telehealth consulting can result in improved access to specialized health services for rural patients [11,12], upskill of rural GPs [13], improved rural workforce retention [13], significant health gains [12], and financial savings [12]. The recent Australian government-funded “Connecting Health Services with the Future” initiative was designed to address this issue by providing Medicare rebates and financial incentives for video consultations with specialists for patients outside of major metropolitan areas [9], supported by telehealth consulting standards set by the Royal Australian College of General Practitioners [14] and Australian College of Rural and Remote Medicine [15].

However, until recently, technical restrictions including requirements for necessary bespoke hardware, video cameras, and integrated services digital network (ISDN) connectivity [16] have limited most applications of telehealth in Australia, limiting access and scalability [16]. For example, most professional quality video consulting applications, up until recently, have used fully featured Web-based medical video consulting software. These applications, including Skype, provide encryption for data transmission security and Medicare Australia standards level audit trails [17]. While there is evidence that exposure to telehealth consulting improves physician attitudes to its use [18], there are many reasons for the low rates of adoption, namely insufficient training as a barrier to the uptake and use of this technology [19]. Other barriers to adoption of telehealth have been identified including lack of adequate equipment, poor connectivity, lack of telehealth consulting skills, scheduling difficulties, inadequate reimbursement schemes, and patient reluctance [20-26]. Therefore, what is required is training for health professionals to optimize the video consultation care provided [27], supported networks of health professionals using the technology [27], stakeholder involvement in implementation, and well-developed business models.

A further challenge to a sustainable rural workforce in Australia is securing sufficient clinical placement sites for the numbers of rural undergraduate, prevocational, and vocational trainees required by the health system [2]. A number of factors, including reduced hospital in-patient stay times, increased use of medical technology, expanding training numbers, and a recognition of the need for generalist medical exposure, have resulted in an increase in the demand for community clinical placements [28-30]. Of particular concern in Australia is the capacity of rural clinical schools to accommodate increased training numbers [2]. Thus, new paradigms of health care professional training are required as it is now not unusual for a general practice to host medical and nursing students, pre-vocational doctors in training, and vocational GP trainees.

To manage this number of learners without exhausting the clinician teachers (and while still providing quality medical care and educational training), innovative models of teaching are required. One such model is vertically integrated teaching where all levels of learner, from undergraduate to vocational, contribute to a learning environment [31]. One way of conceptualizing vertically integrated learning environments is as communities of practice (CoPs). CoPs can be defined as “groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly” [32]. There is strong evidence from business literature that CoPs can be effective in workplace training with measureable improvements in outcomes [33]. Geographically dispersed learners may also be connected by information technology tools to form virtual communities of practice (VCoPs) [34]. In medical education, VCoPs have been shown to be perceived by GP trainees to be useful in overcoming the isolation that can accompany training in rural areas [35].

Telehealth consulting has been reported to facilitate peer communication and reduce isolation for rural and remote doctors [11]. It has also been demonstrated that rurally relevant continuing medical education is effective in increasing practitioners’ confidence to practice in a rural location, reducing isolation and increasing intention to continue to work in a rural area [36]. There is also evidence that VCoPs can be effective in fostering information sharing and reducing professional isolation in GP training [37]. With the above evidence in mind, the Telehealth Skills Training and Implementation Project (TSTIP), funded through the Australian government’s Broadband Enabled Education, Skills and Services (BEES) program, aims to evaluate the introduction of two broadband Internet-based interventions in rural medical training. The first is the training of telehealth skills in medical schools coupled with the use of telehealth consulting as a teaching medium for undergraduate medical students. The second is the use of broadband-enabled “virtual clinics” to support high-quality medical education and promote vertically integrated teaching and VCoPs in rural general practice.

To guide the development of virtual communities of practice, with a view to improving knowledge sharing and overcoming medical professional isolation, the Health VCoP Framework has been developed [34]. This framework has been used in previous studies on GP training and covers the seven steps to be considered when implementing a VCoP. The steps include (1) organizing facilitation, both administrative and professional, (2) ensuring an ongoing champion and support from stakeholders, (3) establishing clear goals, (4) involving a “broad church” of users, (5) establishing a supportive environment, (6) measuring activity and progress against goals, and providing feedback to participants and opportunities for benchmarking, and (7) considering technical factors such as ease of use and access, synchronous and asynchronous interactions, and considering community factors such as providing high-quality content, building trust online, self-selection of membership, and encouragement of active and passive users.

The Health VCoP Framework will be used to help inform the project’s activities and also provide a template for assessing the success (or otherwise) of the project in fostering CoPs and VCoPs among the project’s participants. While creation of CoPs and VCoPs are aims of the project, there are other educational, technical, and administrative components of the trial that require evaluation. To aid conceptualization of the use of the Health VCoP framework for the project’s implementation and evaluation, the project plan is discussed in entirety under the Health VCoP headings in the following sections, recognizing that several measures are not relevant to the framework.