The importance of continuous professional development for health care workers is widely acknowledged, but the identification of optimal implementation strategies remains a challenge, particularly in academically isolated rural areas.

We report the results of a qualitative study that evaluated the effect of an educational intervention aimed at rural doctors in the Western Cape Province, South Africa.

We also present a conceptual framework for developing best practice educational strategies to reverse the inverse performance spiral in academically isolated rural hospitals.

Doctors felt that participation in relevant learning activities improved their competence, increased the levels of job satisfaction they experienced, increased their willingness to stay in a rural environment, and impacted positively on the quality of services provided. However, the success of educational strategies is heavily dependant on the local environment (context), as well as the practical applicability and clinical relevance of the activities (process).

Successful educational strategies may help to reverse the inverse performance spiral previously described in academically isolated rural hospitals, however, this requires effective local leadership that creates a positive learning environment and supports clinically relevant learning activities.

The study findings also indicate the need for health care providers and institutions of higher education to join forces to improve the quality of rural health care.