Experiences of pursuing an intensivist career in regional and rural Australia: An interview study.

The regional and rural intensivist workforce is vital to delivering high standards of healthcare to all Australians. Currently, there is an impending workforce disaster, with higher senior medical officer vacancy rates among regional and rural intensive care units, with these units being staffed by junior doctors who are in earlier stages of their training, which in turn increases supervisory burden. There is a lack of comprehensive literature on the barriers and enablers of training, recruiting and retaining regional and rural intensivists. To address this gap, a qualitative study was conducted, involving 13 in-depth, structured interviews with full-time and part-time intensivists from eight Australian regional and rural hospitals. Content analysis of the interview data resulted in the identification of four major categories: unique practice context, need for a broad generalist skill set, perks and challenges of working in a regional/rural area and workforce implications. The study findings revealed that regional and rural intensive care practice offers positive aspects, including work satisfaction, supportive local teams and an appealing lifestyle. However, these benefits are counterbalanced by challenges such as a heavier burden of on-call work, a higher proportion of junior staff which increase supervisory burden and limited access to subspecialist services. The implications of these findings are noteworthy and can be utilised to inform government policies, hospitals, the College of Intensive Care Medicine and the Australian and New Zealand College of Anaesthetists in developing strategies to enhance the provision of intensive care services and improve workforce planning in regional and rural areas.

Can digital innovation transform rural primary health care? A systematic review protocol.

INTRODUCTION: Digital technology is increasingly being adopted within primary healthcare services to improve service delivery and health outcomes; however, the scope for digital innovation within primary care services in rural areas is currently unknown. This systematic review aims to synthesise existing research on the use and integration of digital health technology within primary care services for rural populations across the world. METHODS AND ANALYSIS: A systematic approach to the search strategy will be conducted. Relevant medical and healthcare-focused electronic databases will be searched using key search terms between January 2013 and December 2023. Searches will be conducted using specific inclusion and exclusion criteria. A systematic study selection and data extraction process will be implemented, using standardised templates. Outcomes will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses- Protocol statement guidelines. Quality assessment and risk of bias appraisal will be conducted using the Mixed Methods Appraisal Tool. ETHICS AND DISSEMINATION: Ethical approval will not be required because there is no individual patient data collected or reviewed. The finding of this review will be disseminated through peer-reviewed publications and conference presentations. Outcomes will help to understand existing knowledge and identify gaps in delivering digital healthcare services, while also providing potential future practice and policy recommendations. PROSPERO REGISTRATION NUMBER: CRD42023477233.

Australian rural service learning student placements: a national survey.

This preliminary national study is the first of its kind to investigate how service learning placements are implemented in real world settings in rural Australia and what factors enable or hinder their implementation. An anonymous survey was distributed to 17 University Departments of Rural Health (UDRH) in Australia. Numerical data were analysed descriptively. Textual data were analysed using a hybrid content analysis approach. Thirty seven respondents provided data representing 12 UDRHs. Responding UDRHs reported facilitating service learning programs, with experience in this context ranging from 3 months to 21 years. Service learning placements predominantly occurred in schools and aged care facilities. Occupational therapy, physiotherapy, and speech pathology were the most frequently involved professions in service learning. Enablers and barriers identified were categorised into: People, Partnerships, and Place and Space. This national-scale study provides a springboard for more in-depth investigation and implementation research focused on development of a conceptual model to support service learning across rural and remote Australia.

The rural and interprofessional education and collaborative practice interface: Findings from a qualitative study.

While rural health-care settings are said to be ideal places for the facilitation of interprofessional education and collaborative practice (IPECP) in students, little is known about the rural-IPECP interface. This study explored this interface through student and clinical educator experiences following implementation of a structured IPECP student placement model. Data were gathered through 11 focus groups with 34 students and 24 clinical educators. Content analysis was used to analyze data and two categories were developed for reporting. The power of place and space, highlighting the importance of flexibility, co-location, and lack of hierarchy in promoting IPECP, as well as the role of shared accommodation in enhancing social connectedness within and outside placement were highlighted. This study unpacks the characteristics of rural health-care settings that make it ideal for IPECP despite the resource constraints. Future studies can investigate the rural-IPECP interface through a patient lens.

Nature and extent of disruptions to staff clinical supervision practices in health care settings due to COVID-19: A survey study.

OBJECTIVE: To investigate the impact of the COVID-19 pandemic on clinical supervision practices of health care workers in health care settings in one Australian state. METHOD: A bespoke survey was developed and administered online using Qualtrics™. The survey consisted of Likert scale and closed questions, with options for free text comments. Numerical data were analysed descriptively and using Chi-Square tests. Textual data were analysed through content analysis. RESULTS: Of the 178 survey respondents, 42% were from allied health disciplines, 39% from nursing and midwifery, and 19% from medicine. The type and mode (i.e., face-to-face, telesupervision) of clinical supervision prior to the pandemic and at the time of survey completion (i.e., July-August 2021) were similar. Eighteen percent of respondents had a change in supervision arrangements but only 5% had a change in supervisor. For the 37% who changed roles due to COVID-19, 81% felt their current supervisor was still able to support them, 69% were still having their supervisory needs met. Analyses of textual data resulted in the development of two categories: Supervision deteriorating, and some clinical supervision functions (i.e., formative and restorative) being more impacted than others (i.e., normative). CONCLUSION: There were substantial disruptions to several parameters of clinical supervision due to COVID-19, that may pose a threat to high quality supervision. Health care workers reported pandemic-induced stress and mental health challenges that were not always addressed by effective restorative supervision practices.

Addressing the GP vocational training crisis in remote Australia: Lessons from the Northern Territory.

OBJECTIVE: GP vocational training enrolments are declining Australia-wide and, in the Northern Territory (NT), considered by some as '…the litmus test for the national scene' the decline is precipitous. This research investigates the drivers of declining GP training uptake in the NT and identifies and ranks potential solutions. SETTING: NT, Australia. PARTICIPANTS: Ten senior medical students, 6 junior doctors, 11 GP registrars, 11 GP supervisors and 31 stakeholders. DESIGN: Mixed methods: scoping review of Australian literature mapping key concepts to GP training pathway stages and marketing/communications; secondary data analyses; key informant interviews; and a stakeholder validation/prioritisation workshop. Interview data were thematically analysed. Workshop participants received summarised study findings and participated in structured discussions of potential solutions prior to nominating top five strategies in each of five categories. RESULTS: Highly prioritised strategies included increasing prevocational training opportunities in primary care and selecting junior doctors interested in rural generalism and long-term NT practice. Also ranked highly were: [Medical School] ensuring adequate infrastructure; [Vocational Training] offering high quality, culturally sensitive, flexible professional and personal support; [General Practice] better remunerating GPs; and [Marketing] ensuring positive aspects such as diversity of experiences and expedited GP career opportunities were promoted. CONCLUSION: Multifaceted strategies to increase GP training uptake are needed, which target different stages of GP training. Effective action is likely to require multiple strategies with coordinated action by different jurisdictional and national key stakeholder agencies. Foremost amongst the interventions required is the urgent need to expand primary care training opportunities in NT for prevocational doctors.

Characteristics of perceived effective telesupervision practices: A case study of supervisees and supervisors.

INTRODUCTION: Many healthcare workers have switched from face-to-face clinical supervision to telesupervision since the onset of the COVID-19 pandemic. Given the rise in prevalence of telesupervision and continuing remote working arrangements, telesupervision is no longer only limited to rural areas. As this remains an under-investigated area, this study aimed to explore supervisor and supervisee first hand experiences of effective telesupervision. METHODS: A case study approach combining in-depth interviews of supervisors and supervisees, and document analysis of supervision documentation was used. De-identified interview data were analysed through a reflective thematic analysis approach. RESULTS: Three supervisor-supervisee pairs from occupational therapy and physiotherapy provided data. Data analysis resulted in the development of four themes: Benefits vs limitations and risks, not often a solo endeavour, importance of face-to-face contact, and characteristics of effective telesupervision. DISCUSSION: Findings of this study have confirmed that telesupervision is suited to supervisees and supervisors with specific characteristics, who can navigate the risks and limitations of this mode of clinical supervision. Healthcare organisations can ensure availability of evidence-informed training on effective telesupervision practices, as well as investigate the role of blended supervision models to mitigate some risks of telesupervision. Further studies could investigate the effectiveness of utilising additional professional support strategies that complement telesupervision, including in nursing and medicine, and ineffective telesupervision practices.

Rural medical workforce pathways: exploring the importance of postgraduation rural training time.

BACKGROUND: Inadequate distribution of the medical workforce in rural regions remains a key global challenge. Evidence of the importance of postgraduation (after medical school) rural immersion time and subsequent rural practice, particularly after accounting for other key factors, remains limited. This study investigated the combined impact of three key training pathway factors: (1) rural background, (2) medical school rural immersion, and (3) postgraduation rural immersion, and duration time of each immersion factor on working rurally. METHODS: Data from a cross-sectional national survey and a single university survey of Australian doctors who graduated between 2000 to 2018, were utilised. Key pathway factors were similarly measured. Postgraduation rural training time was both broad (first 10 years after medical school, national study) and specific (prevocational period, single university). This was firstly tested as the dependent variable (stage 1), then matched against rural practice (stage 2) amongst consultant doctors (national study, n = 1651) or vocational training doctors with consultants (single university, n = 478). RESULTS: Stage 1 modelling found rural background, > 1 year medical school rural training, being rural bonded, male and later choosing general practice were associated with spending a higher proportion (> 40%) of their postgraduation training time in a rural location. Stage 2 modelling revealed the dominant impact of postgraduation rural time on subsequent rural work for both General Practitioners (GPs) (OR 45, 95% CI 24 to 84) and other specialists (OR 11, 95% CI 5-22) based on the national dataset. Similar trends for both GPs (OR 3.8, 95% CI 1.6-9.1) and other specialists (OR 2.8, 95% CI 1.3-6.4) were observed based on prevocational time only (single university). CONCLUSIONS: This study provides new evidence of the importance of postgraduation rural training time on subsequent rural practice, after accounting for key factors across the entire training pathway. It highlights that developing rural doctors aligns with two distinct career periods; stage 1-up to completing medical school; stage 2-after medical school. This evidence supports the need for strengthened rural training pathways after medical school, given its strong association with longer-term decisions to work rurally.

Medical student interest and participation in research at one rural clinical school: Insights from the last six years.

INTRODUCTION: Limited evidence is currently available relating to research acitivity of medical students training in regional or rural areas. OBJECTIVE: To describe medical student interest and participation in research at The University of Queensland Rural Clinical School (UQRCS). DESIGN: Annual student expression of interest surveys were collated with records of student research participation maintained at UQRCS from 2017-2022. Additionally, a systematic search was conducted to identify student outputs not captured in internal records. Frequencies and proportions were calculated for all descriptive data along with proportions of students who engaged with a project, and projects that led to a peer-reviewed publication. FINDINGS: At UQRCS commencement, 55% of research-interested students reported having basic research skills. Thirty-nine percent of research-interested students engaged with a project, most commonly literature reviews (47%) or audits (29%). Thirty-three percent of completed projects led to a peer-reviewed manuscript. DISCUSSION: Students who engage with a project are unlikely to receive a project in their preferred clinical area and should be informed about the transferrability of research skills. Most students have basic research skills when commencing a project and therefore require ongoing support and mentorship from staff/supervisors. CONCLUSION: Publication rates of medical students in regional/rural areas are comparable to those reported by metropolitan medical schools (~30%).

Impact of the COVID-19 pandemic on student supervision and education in health care settings: A state-wide survey of health care workers.

OBJECTIVE: To investigate student supervisor experiences of supervising students on clinical placements since the onset of the COVID-19 pandemic. BACKGROUND: Studies on the impact of COVID-19 on student clinical placements have focused largely on student reports and have been specific to individual professions or topic areas. There is a need to investigate student supervisor experiences. This study was conducted in Queensland (Australia) in four regional and rural public health services and four corresponding primary health networks. METHODS: The anonymous, mixed methods online survey, consisting of 35 questions, was administered to student supervisors from allied health, medicine, nursing and midwifery between May and August 2021. Numerical data were analysed descriptively using chi-square tests. Free-text comments were analysed using content analysis. RESULTS: Complete datasets were available for 167 respondents. Overall trends indicated perceived significant disruptions to student learning and support, plus mental health and well-being concerns for both students and supervisors. Extensive mask wearing was noted to be a barrier to building rapport, learning and teaching. Some positive impacts of the pandemic on student learning were also noted. CONCLUSIONS: This study has highlighted the perceived impact of the pandemic on supervisors' mental health, and on the mental health, learning and work readiness of students. This study provides evidence of the pandemic impacts on student clinical placements from a supervisor point of view. Findings can assist in future-proofing clinical education and ensuring that students continue to receive learning experiences of benefit to them, meeting curriculum requirements, in the event of another pandemic.

Comparing outcomes of an innovative interprofessional student placement model to standard placement models in rural healthcare settings.

This unique study investigated the educational and service delivery impacts of a team-based, innovative model of interprofessional education (IPE) namely the Rural Interprofessional Education and Supervision (RIPES) model on participating students, clinical educators, and their workplaces, in rural Australian healthcare settings. Participating professions included dietetics, occupational therapy, physiotherapy, and speech pathology. Outcomes from the RIPES model were compared with regular uni-professional placement models. A multi-site, pre-post, comparative design was used. The main data collection measures included were the Students Perceptions of Interprofessional Clinical Education - Revised scale, the Interprofessional Socialization and Valuing Scale, and time-usage data. The RIPES model resulted in significant improvement in students' beliefs, behaviors, and attitudes that underpin interprofessional socialization and collaborative practice in healthcare settings. Importantly, students were able to benefit from the RIPES learning activities without compromising their contact time with patients. Clinical educators spent significantly more time in non-patient contact activities than the uni-professional group. This important work was undertaken in response to previous calls to address a gap in IPE models in rural areas. It involved students from multiple professions and universities, measured impacts on multiple stakeholders, and followed international best practice interprofessional education research recommendations.

Understanding the non-professional needs of early career doctors: An interview-based study.

Speciality colleges and health services are often well attuned to professional factors, but non-professional needs are less acknowledged and are the focus of this study. This likely relates to limited research about the non-professional needs of early career doctors. This study aimed to describe the non-professional needs of doctors in their early postgraduate career, including how they intersect with career and training experiences. Semi-structured interviews were conducted with 32 male and female medical graduates working across all Australian states and territories, spanning a variety of speciality areas and early career stages. Participants were asked about their career journey to date including non-professional factors related to their experiences. This study identified important non-professional needs, that strongly interplayed with career and training experiences, including: children's education; partner's career needs; family stability; major life stages; proximity to the extended family; and spending time with immediate family. Results suggested clear gender differences, with female doctor's needs orientated to partner work and carer responsibilities, while male doctor's needs were oriented to spending time with family and meeting the family's needs. Non-professional needs should be considered as legitimate needs within health service employment and speciality training arrangements enabling early career doctors to realise their full potential.

Impact of the COVID-19 pandemic on student experiences during rural placements in Australia: findings from a national multi-centre survey.

BACKGROUND: The aim of this national study was to explore the learning experiences of Australia's medical students who trained rurally during the COVID-19 pandemic in 2020. METHODS: A cross-sectional, national multi-centre survey was conducted in 2020, through the Federation of Rural Australian Medical Educators (FRAME). Participants were medical students who had completed an extended Rural Clinical School (RCS) training placement (≥ 12 months). A bespoke set of COVID-19 impact questions were incorporated into the annual FRAME survey, to capture COVID-19-related student experiences in 2020. Pre-pandemic (2019 FRAME survey data) comparisons were also explored. RESULTS: FRAME survey data were obtained from 464 students in 2020 (51.7% response rate), compared with available data from 668 students in 2019 (75.6% response rate). Most students expressed concern regarding the pandemic's impact on the quality of their learning (80%) or missed clinical learning (58%); however, students reported being well-supported by the various learning and support strategies implemented by the RCSs across Australia. Notably, comparisons to pre-pandemic (2019) participants of the general RCS experience found higher levels of student support (strongly agree 58.9% vs 42.4%, p < 0.001) and wellbeing (strongly agree 49.6% vs 42.4%, p = 0.008) amongst the 2020 participants. Students with more than one year of RCS experience compared to one RCS year felt better supported with clinical skills learning opportunities (p = 0.015) and less affected by COVID-19 in their exam performance (p = 0.009). CONCLUSIONS: This study has provided evidence of both the level of concern relating to learning quality as well as the positive impact of the various learning and support strategies implemented by the RCSs during the pandemic in 2020. RCSs should further evaluate the strategies implemented to identify those that are worth sustaining into the post-pandemic period.

A Rapid Review of the Factors That Influence Service User Involvement in Interprofessional Education, Practice, and Research.

Service user involvement in interprofessional education and collaborative practice remains limited despite the increasing push for this by governments and grant funding bodies. This rapid review investigated service user involvement in interprofessional education, practice, and research to determine factors that enable or hinder such involvement. Following the Cochrane and the World Health Organization's rapid review guidelines, a targeted search was undertaken in four databases. Subsequent to the screening processes, included papers were critically appraised, and extracted data were synthesized narratively. Sixteen studies met inclusion criteria. Most studies were related to interprofessional collaborative practice, as opposed to education and research. Service user involvement was more in the form of consultation and collaboration, as opposed to consumer-led partnerships. Enablers and barriers to service user involvement in IPECP were identified. Enablers included structure, the valuing of different perspectives, and relationships. Barriers included time and resources, undesirable characteristics, and relationships. This rapid review has added evidence to a swiftly expanding field, providing timely guidance. Healthcare workers can benefit from targeted training. Policy makers, healthcare organizations, and governments can investigate strategies to mitigate the time and resource challenges that impede service user involvement in IPECP.

A Novel Interprofessional Education and Supervision Student Placement Model: Student and Clinical Educator Perspectives and Experiences.

Interprofessional student placements can not only cater to the added pressures on student placement numbers but can also enhance the work readiness of new graduates. For rural areas, there is a potential for interprofessional student placements to attract the future healthcare workforce. However, tried and tested models of interprofessional placements in rural areas backed up by rigorous evaluation, remain scarce. The Rural Interprofessional Education and Supervision (RIPES) model was developed, implemented, and evaluated across four rural health services in Queensland to address this gap. Students from two or more professions undertook concurrent placements at RIPES sites, with a placement overlap period of at least five weeks. Eleven focus groups (n = 58) with clinical educators (CEs) and students were conducted to explore student and clinical educator experiences and perspectives. Content analysis of focus group data resulted in the development of the following categories: value of the RIPES placement model, unintended benefits to CEs, work units and rural areas, tension between uni-professional and IPE components, and sustainability considerations. Students and CEs alike valued the learning which arose from participation in the model and the positive flow-on effects to both patient care and work units. This unique study was undertaken in response to previous calls to address a gap in interprofessional education models in rural areas. It involved students from multiple professions and universities, explored perspectives and experiences from multiple stakeholders, and followed international best practice interprofessional education research recommendations. Findings can inform the future use and sustainability of the RIPES model.

A rapid review of the impact of COVID-19 on clinical supervision practices of healthcare workers and students in healthcare settings.

AIMS: To synthesize available data on the impact of the COVID-19 pandemic on clinical supervision practices of healthcare workers and students in healthcare settings. DESIGN: A quantitative rapid review of the literature. DATA SOURCES: A search of MEDLINE, Embase, PsycINFO, the Cochrane Library and Scopus for English language papers published between December 2019 (initial onset of the pandemic) to March 2021. REVIEW METHODS: Using the World Health Organization and Cochrane guidelines for rapid reviews, following an identification of relevant papers and data extraction, a narrative synthesis approach was used to develop themes. RESULTS: Eight studies met the inclusion criteria. Four themes identified from data synthesis were nature and extent of disruptions to clinical supervision, unmet need for psychological support, supervisors also need support and unpacking telesupervision. Findings highlight the extent and nature of disruption to clinical supervision at the point of care. Further information on factors that facilitate high-quality telesupervision have come to light. CONCLUSION: The COVID-19 pandemic has placed tremendous burden on healthcare workers compromising their own health and well-being. It is essential to restore effective clinical supervision practices at the point of care, so as to enhance patient, healthcare worker and organizational outcomes into the post-COVID-19 pandemic period. IMPACT: This review has provided initial evidence on the adverse impacts of the COVID-19 pandemic on clinical supervision of healthcare workers and students at the point of care. Available evidence indicates the urgent need to restore effective and high-quality clinical supervision practices in health settings. The review has highlighted a paucity of studies in this area, calling for further high-quality studies.

Title-blended supervision models for post-graduate rural generalist medical training in Australia: an interview study.

BACKGROUND: Expanding rural training is a priority for growing the rural medical workforce, but this relies on building supervision capacity in small towns where workforce shortages are common. This study explored factors which support the use of blended supervision models (consisting of on- and offsite components) for postgraduate rural generalist medical training (broad scope of work) in small rural communities. METHODS: Data were collected between June and August 2021 through semi-structured, in-depth interviews with medical training stakeholders experienced in blended supervision models for rural generalist training. Interviews were audio-recorded, transcribed verbatim and analysed using an inductive thematic analysis process. RESULTS: Fifteen participant interviews provided almost 13 h of audio-recorded data. Four themes were developed: governance, setting, the right supervisor and the right supervisee. Blended supervision models may be effective if selectively applied including where the model is well-planned, the setting has local team supports and supervisor and supervisee characteristics are appropriate. CONCLUSIONS: Understanding factors involved in the application of blended supervision models can help with expanding rural generalist training places in distributed communities. Blended supervision models can be effective for rural generalist training if the model is planned, and the context is suitable.

Impact of the COVID-19 Pandemic on Clinical Supervision of Healthcare Students in Rural Settings: A Qualitative Study.

The COVID-19 pandemic has caused significant disruptions to healthcare student placements worldwide, including already challenged rural areas in Australia. While accounts are emerging of student experiences in larger centers and from a student perspective, there is a need for in-depth exploration of student supervisor experiences in rural areas at the onset of the pandemic. This study aims to address this gap through 23 individual, semi-structured interviews with healthcare workers from ten health professions who were either direct student supervisors or in roles supporting student supervisors A reflexive thematic analysis approach was used to develop four themes, namely compounding stress, negative impacts on student learning, opportunity to flex and innovate, and targeted transitioning support strategies. The findings indicate that healthcare workers with student supervision responsibilities at the onset of the pandemic experienced high levels of stress and wellbeing concerns. This study sheds light on the importance of supporting student supervisors in rural areas, and the need for implementing targeted support strategies for new graduates whose placements were impacted by the pandemic. This is not only essential for supporting the rural healthcare workforce but is also imperative for addressing inequalities to healthcare access experienced in rural communities.

Rebooting effective clinical supervision practices to support healthcare workers through and following the COVID-19 pandemic.

The importance of clinical supervision, a professional support and clinical governance mechanism, to patients, healthcare workers and organizations has been well documented. Clinical supervision has been shown to support healthcare workers during challenging times, by reducing burnout, enhancing mental health and wellbeing at work, and improving job satisfaction. However, clinical supervision participation and effectiveness are pre-requisites for realising these benefits. During times of stress and increased workloads (e.g. during the Coronavirus pandemic), healthcare workers tend to prioritise clinical duties and responsibilities over clinical supervision. Effective supervision practices can be restored, and healthcare workers can be better supported in their roles during and in the post-pandemic period only if healthcare workers, policy makers, healthcare organizations, clinical supervision trainers and researchers join forces. This paper sheds light on this important topic and offers a number of practical recommendations to reboot effective clinical supervision practices at the point of care.

Impact of the COVID-19 pandemic on medical student placements in rural Queensland: A survey study.

OBJECTIVE: The COVID-19 pandemic has adversely impacted medical students' learning experiences. Students in one Australian Rural Clinical School were surveyed to investigate the impact of disruptions to clinical placements and satisfaction with educational changes implemented as a result of the pandemic. DESIGN: Cross-sectional survey. SETTING: The University of Queensland Rural Clinical School. METHODS: Students undertaking one or two years of study at the participating Rural Clinical School in November 2020. MAIN OUTCOME MEASURE: A 20-item anonymised survey with questions on personal health and safety, quality of clinical training experience, response to changes in learning and student environment, and progression to completion of the medical degree. RESULTS: The survey was completed by 124 students (76% response rate). Students were satisfied with the changes made to their learning to accommodate the disruptions to health service delivery and placements. Final year students were more satisfied with their learning experiences compared to their third-year counterparts. CONCLUSIONS: The Rural Clinical School implemented a range of academic and psychological support strategies which appear to have helped with mitigating mental health concerns experienced by students completing rural placements, who are already prone to experiencing social isolation. Strengthening communication between the academic and health service sectors can improve the quality of learning for medical students on placements.