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Introduction: Victoria, Australia commenced its first Rural Community Internship Training program in 2012 to support the development of rural generalist (RG) doctors. These general practitioners have additional skills to work at a broad scope to deliver the range of primary care and additional specialist services that communities need. Unlike most internships, which are wholly hospital-based and delivered mostly within larger metropolitan and regional centres, this RG internship training model involves completing general practice experience in smaller rural communities working with RGs and visiting specialists. This study aimed to explore the characteristics and satisfaction of doctors who participate in RG internship training in Victoria and their workforce outcomes. Methods: Between October and November 2021, a retrospective 10-minute anonymous survey invitation was sent to all contactable interns (n=222) who had completed/were completing the RG internship training (2012--2021). The survey was co-designed with RG internship managers and other stakeholders of a statewide evaluation advisory group, informed by the latest evidence regarding RG medicine and rural training predictors, and outcomes of interest. Participants completed the survey using Microsoft Forms, with three invitations circulated to an up-to-date email address maintained by the internship program. Collected data were analysed descriptively, by subgroup, to explore training pathway outcomes by region, training stage and specialty choice. Workforce distribution outcomes were defined in line with objectives of the program and predetermined indicators of RG scope. Results were compared with the benchmarks of rural workforce training outcomes in Australia using recent research. Results: There were 59 participants (27% response rate); 81% were in postgraduate years 3--7. Respondents included 54% male, 17% rurally bonded, 39% of rural origin, 34% having had more than 3 months rural undergraduate training and 48% doing RG training where they previously did undergraduate training. All were satisfied/very satisfied with the RG training and 61% were working in general practice (excluding the prevocational group). Overall, 40% were currently working in the same rural region as their internship (including three who were currently interns), 56% continued to complete some prevocational training in the same region as their RG internship, while 20% had gone on to be currently based in smaller rural communities (Modified Monash Model locations 4--7) and 44% to be working part-time in smaller rural communities. Overall, 42% self-identified as working as an RG and nearly all (97%) met at least one of the key indicators of extended (RG) scope. In all areas the RG internship outcomes were better than the national benchmarks from published evidence about rural training. Conclusion: This study provides evidence from doctors up to 9 years after completing their RG internship. Compared with industry benchmarks, the RG internships attract rurally intentioned and rurally experienced doctors who may be likely to remain in the same rural region as their undergraduate rural medical training and continue their postgraduate training in the same region. They were all satisfied with RG internship training, had high propensity to follow a general practice career and work at broad scope in smaller communities. Importantly, they intended to stay in the region where they trained. This suggests RG internship programs are a positive intervention for promoting an RG workforce. [ABSTRACT FROM AUTHOR]

An expansion of Commonwealth-supported medical student places is required in rurally located end-to-end medical school programs, rather than a reliance solely on redistribution, to ensure that each state has at least one rural medical school program that provides remote or rural training from the start to the completion of the medical degree. Highlight rural medicine in medical school curricula Showcase diverse rural contexts Medical curricula and assessments shape students' views of rural career options.[30] Traditional medical school teaching is predominantly metropolitan focused and specialist led. Invest in rural training pathways Immerse students in a rural place Immersive rural training remains a cornerstone for producing more rural doctors. Keywords: Rural health services; Healthcare disparities; Education, medical; Resource allocation EN Rural health services Healthcare disparities Education, medical Resource allocation S8 S13 6 08/08/23 20230803 NES 230803 Rural communities across Australia face an ongoing shortage of doctors, which reduces access to care and leads to poorer health outcomes for people living in rural areas. [Extracted from the article]

Introduction: Little is known about how medical school placements in rural areas impact key stakeholders such as patients, host organisations and the wider rural community. With engagement from rural communities crucial to the success of rural medical training, this case study sought to demonstrate the benefit that rural clinical placements can have on rural general practices (systems) and likely impacts on communities (health outcomes). Specifically, we describe how a series of consecutive short-term student placements in a single rural practice were the drivers of a series of clinical audits and interventions resulting in improved management of chronic disease. Methods: Data for this project were obtained from student research reports completed as part of a rural and remote medicine rotation at an Australian medical school. For this series of projects, eight consecutive students were based at the same rural medical centre, with each attending for 6 weeks across a 15-month period, completing a report for a quality improvement activity and evaluating the outcomes. Each project related to chronic kidney disease (CKD), with CKD chosen based on the needs of the medical centre and the higher burden of this disease in rural areas. Each project was developed and delivered in consultation with the practice, taking into account student interest and skills, and related projects completed prior or concurrently. Projects were related to database management (n=2), alignment between CKD management and best-practice guidelines (n=3), patient health literacy (n=3), and a summary and staff perceptions of the preceding quality improvement activities (n=1). Results: The combination of student projects led to tangible improvements in CKD management at a rural general practice. All doctors at the medical centre (n=4) reported using the database management tools implemented by the students and felt the interventions were sustainable, long-term solutions for ensuring clinical investigations are not being delayed or missed. Following the various interventions completed by the students, clinician knowledge and implementation of best-practice CKD management increased, and some patients became more aware of their condition and how to manage it. Conclusion: This case study provides evidence that short-term rural clinical placements for medical students have the potential to greatly improve health care and clinical practice in rural and remote communities, when designed around a consistent topic within a medical practice. Outcomes of the student projects in combination demonstrate that addressing CKD management longitudinally led to improvements in administrative processes, clinical practices, and patient awareness and accountability, despite each student only being at the medical centre for a short period of time. Similar approaches to structuring rural clinical placements and defining community projects for medical students should be considered more broadly. [ABSTRACT FROM AUTHOR]

Introduction: Despite substantial investment in rural workforce support, sustaining the necessary recruitment and retention of general practitioners (GPs) in rural areas remains a challenge. Insufficient medical graduates are choosing a general/rural practice career. Medical training at postgraduate level, particularly for those 'between' undergraduate medical education and specialty training, remains strongly reliant on hospital experience in larger hospitals, potentially diverting interest away from general/rural practice. The Rural Junior Doctor Training Innovation Fund (RJDTIF) program offered junior hospital doctors (interns) an experience of 10 weeks in a rural general practice, aiming to increase their consideration of general/rural practice careers This study aimed to evaluate the educational and potential workforce impact of the RJDTIF program. Methods: Up to 110 places were established during 2019-2020 for Queensland's interns to undertake an 8-12-week rotation (depending on individual hospital rosters) out of regional hospitals to work in a rural general practice. Participants were surveyed before and after the placement, although only 86 were invited due to the disruption caused by the COVID-19 pandemic. Descriptive quantitative statistics were applied to the survey data. Four semi-structured interviews were conducted to further explore the experiences post-placement, with audio-recordings transcribed verbatim. Semi-structured interview data were analysed using inductive, reflexive thematic analysis. Results: In total, 60 interns completed either survey, although only 25 were matched as completing both surveys. About half (48%) indicated they had preferenced the rural GP term and 48% indicated strong enthusiasm for the experience. General practice was indicated as the most likely career option for 50%, other general specialty 28% and subspecialty 22%. Likelihood to be working in a regional/rural location in 10 years was indicated as 'likely' or 'very likely' for 40%, 'unlikely' for 24% and 'unsure' for 36%. The two most common reasons for preferencing a rural GP term were experiencing training in a primary care setting (50%) and gaining more clinical skills through increased patient exposure (22%). The overall impact on pursuing a primary care career was self-assessed as much more likely by 41%, but much less by 15%. Interest in a rural location was less influenced. Those rating the term poor or average had low pre-placement enthusiasm for the term. The qualitative analysis of interview data produced two themes: importance of the rural GP term for interns (hands-on learning, skills improvement, influence on future career choice and engagement with the local community), and potential improvements to rural intern GP rotations. Conclusion: Most participants reported a positive experience from their rural GP rotation, which was recognised as a sound learning experience at an important time with respect to choosing a specialty. Despite the challenges posed by the pandemic, this evidence supports the investment in programs that provide opportunities for junior doctors to experience rural general practice in these formative postgraduate years to stimulate interest in this much-needed career pathway. Focusing resources on those who have at least some interest and enthusiasm may improve its workforce impact. education, postgraduate, workforce. [ABSTRACT FROM AUTHOR]

Objective: To examine associations between extended medical graduates' rural clinical school (RCS) experience and geographic origins with practising in rural communities five and eight years after graduation. Design, participants: Cohort study of 2011 domestic medical graduates from ten Australian medical schools with rural clinical or regional medical schools. Main outcome measures: Practice location types eight years after graduation (2019/2020) as recorded by the Australian Health Practitioner Regulation Agency, classified as rural or metropolitan according to the 2015 Modified Monash Model; changes in practice location type between postgraduate years 5 (2016/2017) and 8 (2019/2020). Results: Data were available for 1321 graduates from ten universities; 696 were women (52.7%), 259 had rural backgrounds (19.6%), and 413 had extended RCS experience (31.3%). Eight years after graduation, rural origin graduates with extended RCS experience were more likely than metropolitan origin graduates without this experience to practise in regional (relative risk [RR], 3.6; 95% CI, 1.8–7.1) or rural communities (RR, 4.8; 95% CI, 3.1–7.5). Concordance of location type five and eight years after graduation was 92.6% for metropolitan practice (84 of 1136 graduates had moved to regional/rural practice, 7.4%), 26% for regional practice (56 of 95 had moved to metropolitan practice, 59%), and 73% for rural practice (20 of 100 had moved to metropolitan practice, 20%). Metropolitan origin graduates with extended RCS experience were more likely than those without it to remain in rural practice (RR, 2.0; 95% CI, 1.3–2.9) or to move to rural practice (RR, 1.9; 95% CI, 1.2–3.1). Conclusion: The distribution of graduates by practice location type was similar five and eight years after graduation. Recruitment to and retention in rural practice were higher among graduates with extended RCS experience. Our findings reinforce the importance of longitudinal rural and regional training pathways, and the role of RCSs, regional training hubs, and the rural generalist training program in coordinating these initiatives. [ABSTRACT FROM AUTHOR]

The purpose of this research is to investigate the extent to which Australia's northern cities have become increasingly important mediators of migration of nurses and general practitioners (GPs) to the regional north since the 1980s. Over that period, national and provincial policy has focused on 'regionalisation' of health workforce development, including creating education and training infrastructure outside of metropolitan areas. This paper hypothesises that the effectiveness of regionalisation in northern Australia should be reflected in an increased net flow of GPs and nurses from northern cities (which are the hubs of education and training) to the regional north. Data from the seven Australian Census between 1986 and 2016 are used to model changing patterns of migration. Overall, there was limited evidence of substantial change in migration patterns, although for GPs there was a reduction in migration from the key metropolitan source markets (Brisbane and Adelaide) matching an increase in supply from northern cities. Northern cities have consistently been the source of about one quarter of new nurse and GP migrants to the regional north, but the regional north has become a much less favoured destination for professionals leaving northern cities as cities' populations have grown much faster than regional populations. Net flows have remained small and for nurses have favoured the cities while for GPs favoured the regional north. The paper concludes that, while there is limited evidence of increased 'spillover' of labour from the cities to the regional north, there is also no evidence of the cities increasingly 'spongeing' regional labour. Cities and regional migration systems may be increasingly disconnected as labour demands diverge, but new connections are being created with the rest of non-metropolitan Australia. The research is the first to analyse health professional migration over such a long period, and contributes to the debates about the roles of cities in sparsely populated areas in the development of their rural and remote hinterlands. • There is no evidence of increasing 'sponge' or 'spillover' relationships between northern cities and the regional north. • Large investment in 'regionalisation' of workforce development has not led to an increase in intra-northern migration. • There is evidence of increasing net loss of health professionals from the regional north to other regional Australia. • Regionalisation may be an ineffective strategy for growing the health professional workforce in the regional north. [ABSTRACT FROM AUTHOR]

Objective: To assess differences in the demographic characteristics, professional profile and professional satisfaction of rural and metropolitan junior physicians and physician consultants in Australia. Design, setting and participants: Cross-sectional, population level national survey of the Medicine in Australia: Balancing Employment and Life longitudinal cohort study (collected 2008-2016). Participants were specialist physicians from four career stage groups: pre-registrars (physician intent); registrars; new consultants (<5years since Fellowship); and consultants. Main outcome measures: Level of professional satisfaction across various job aspects, such as hours worked, working conditions, support networks and educational opportunities, comparing rural and metropolitan based physicians. Results: Participants included 1587 pre-registrars (15% rural), 1745 physician registrars (9% rural), 421 new consultants (20% rural) and 1143 consultants (13% rural). Rural physicians of all career stages demonstrated equivalent professional satisfaction across most job aspects, compared with metropolitan physician counterparts. Some examples of differences in satisfaction included rural pre-registrars being less likely to agree they had good access to support and supervision from qualified consultants (odds ratio [OR], 0.6; 95% CI, 0.3-0.9) and rural consultants being more likely to agree they had a poorer professional support network (OR, 1.9; 95% CI, 1.2-2.9). In terms of demographics, relatively more rural physicians had a rural background or were trained overseas. Although most junior physicians were women, female consultants were less likely to be working in a rural location (OR, 0.6; 95% CI, 0.4-0.8). Conclusion: Junior physicians in metropolitan or rural settings have a similar professional experience, which is important in attracting future trainees. Increased opportunities for rural training should be prioritised, along with addressing concerns about the professional isolation and poorer support network of those in rural areas, not only among junior doctors but also consultants. Finally, making rural practice more attractive to female junior physicians could greatly improve the consultant physician distribution. [ABSTRACT FROM AUTHOR]

Chapter 1: Characterising Australia's rural specialist physician workforce: the professional profile and professional satisfaction of junior doctors and consultants Objective: To assess differences in the demographic characteristics, professional profile and professional satisfaction of rural and metropolitan junior physicians and physician consultants in Australia. Design, setting and participants: Cross‐sectional, population level national survey of the Medicine in Australia: Balancing Employment and Life longitudinal cohort study (collected 2008–2016). Participants were specialist physicians from four career stage groups: pre‐registrars (physician intent); registrars; new consultants (< 5 years since Fellowship); and consultants. Main outcome measures: Level of professional satisfaction across various job aspects, such as hours worked, working conditions, support networks and educational opportunities, comparing rural and metropolitan based physicians. Results: Participants included 1587 pre‐registrars (15% rural), 1745 physician registrars (9% rural), 421 new consultants (20% rural) and 1143 consultants (13% rural). Rural physicians of all career stages demonstrated equivalent professional satisfaction across most job aspects, compared with metropolitan physician counterparts. Some examples of differences in satisfaction included rural pre‐registrars being less likely to agree they had good access to support and supervision from qualified consultants (odds ratio [OR], 0.6; 95% CI, 0.3–0.9) and rural consultants being more likely to agree they had a poorer professional support network (OR, 1.9; 95% CI, 1.2–2.9). In terms of demographics, relatively more rural physicians had a rural background or were trained overseas. Although most junior physicians were women, female consultants were less likely to be working in a rural location (OR, 0.6; 95% CI, 0.4–0.8). Conclusion: Junior physicians in metropolitan or rural settings have a similar professional experience, which is important in attracting future trainees. Increased opportunities for rural training should be prioritised, along with addressing concerns about the professional isolation and poorer support network of those in rural areas, not only among junior doctors but also consultants. Finally, making rural practice more attractive to female junior physicians could greatly improve the consultant physician distribution. Chapter 2: General physicians and paediatricians in rural Australia: the social construction of professional identity Objective: To explore the construction of professional identity among general physicians and paediatricians working in non‐metropolitan areas. Design, setting and participants: In‐depth qualitative interviews were conducted with general physicians and paediatricians, plus informants from specialist colleges, government agencies and academia who were involved in policy and programs for the training and recruitment of specialists in rural locations across three states and two territories. This research is part of the Training Pathways and Professional Support for Building a Rural Physician Workforce Study, 2018–19. Main outcome measures: Individual and collective descriptors of professional identity. Results: We interviewed 36 key informants. Professional identity for general physicians and paediatricians working in regional, rural and remote Australia is grounded in the breadth of their training, but qualified by location — geographic location, population served or specific location, where social and cultural context specifically shapes practice. General physicians and paediatricians were deeply engaged with their local community and its economic vulnerability, and they described the population size and dynamics of local economies as determinants of viable practice. They often complemented their practice with formal or informal training in areas of special interest, but balanced their practice against subspecialist availability, also dependent on demographics. While valuing their professional roles, they showed limited inclination for industrial organisation. Conclusion: Despite limited consensus on identity descriptors, rural general physicians and paediatricians highly value generalism and their rural engagement. The structural and geographic bias that preferences urban areas will need to be addressed to further develop coordinated strategies for advanced training in rural contexts, for which collective identity is integral. Chapter 3: Sustainable rural physician training: leadership in a fragile environment Objectives: To understand Royal Australasian College of Physicians (RACP) training contexts, including supervisor and trainee perspectives, and to identify contributors to the sustainability of training sites, including training quality. Design, setting and participants: A cross‐sectional mixed‐methods design was used. A national sample of RACP trainees and Fellows completed online surveys. Survey respondents who indicated willingness to participate in interviews were purposively recruited to cover perspectives from a range of geographic, demographic and training context parameters. Main outcome measures: Fellows' and trainees' work and life satisfaction, and their experiences of supervision and training, respectively, by geographic location. Results: Fellows and trainees reported high levels of satisfaction, with one exception — inner regional Fellows reported lower satisfaction regarding opportunities to use their abilities. Not having a good support network was associated with lower satisfaction. Our qualitative findings indicate that a culture of undermining rural practice is prevalent and that good leadership at all levels is important to reduce negative impacts on supervisor and trainee availability, site accreditation and viability. Trainees described challenges in navigating training pathways, ensuring career development, and having the flexibility to meet family needs. The small number of Fellows in some sites poses challenges for supervisors and trainees and results in a blurring of roles; accreditation is an obstacle to provision of training at rural sites; and the overlap between service and training roles can be difficult for supervisors. Conclusion: Our qualitative findings emphasise the distinctive nature of regional specialist training, which can make it a fragile environment. Leadership at all levels is critical to sustaining accreditation and support for supervisors and trainees. Chapter 4: Principles to guide training and professional support for a sustainable rural specialist physician workforce Objective: To draw on research conducted in the Building a Rural Physician Workforce project, the first national study on rural specialist physicians, to define a set of principles applicable to guiding training and professional support action. Design: We used elements of the Delphi approach for systematic data collection and codesign, and applied a hybrid participatory action planning approach to achieve consensus on a set of principles. Results: Eight interconnected foundational principles built around rural regions and rural people were identified: FP1, grow your own "connected to" place; FP2, select trainees invested in rural practice; FP3, ground training in community need; FP4, rural immersion — not exposure; FP5, optimise and invest in general medicine; FP6, include service and academic learning components; FP7, join up the steps in rural training; and FP8, plan sustainable specialist roles. Conclusion: These eight principles can guide training and professional support to build a sustainable rural physician workforce. Application of the principles, and coordinated action by stakeholders and the responsible organisations, are needed at national, state and local levels to achieve a sustainable rural physician workforce. [ABSTRACT FROM AUTHOR]

This finding is consistent with broader evidence supporting the quality and safety of distributed general practice training.[[6]] General practice training in remote areas provides equivalent opportunities for learning and progression toward the fellowship, justifying the national strategy to offer general practice training in more remote locations.[8] Whether the results are also equivalent in later years of general practice training or in other states should be investigated. Keywords: General practice; Education, medical, continuing; Rural health services EN General practice Education, medical, continuing Rural health services 408 409 2 05/17/23 20230515 NES 230515 General practice training is provided in geographically diverse locations across Australia to promote the development of the rural and remote medical workforce. [Extracted from the article]

Introduction: Access to medical services for rural communities is poorer than for metropolitan communities in many parts of the students. This study explores the workforce outcomes of one model of such placements – the longitudinal integrated clerkship (LIC) – delivered in year 4, the penultimate year of the medical course, as part of the rural programs delivered by a medical school in Victoria, Australia. The LIC involved student supervision under a parallel consulting model with experienced rural generalist doctors for a whole year in small community rural general practices. Methods: This study aimed to compare the work locations (regional or more rural), following registration as a medical practitioner, of medical students who had completed 1 year of the LIC, with, first, students who had other types of rural training of comparable duration elsewhere, and second, students who had no rural training. Study participants commenced their medical degree after 2004 and had graduated between 2008 and 2016 and thus were in postgraduate year 1–9 in 2017 when evaluated. Information about the student training location(s), and duration, type and timing of training, was prospectively collected from university administrative systems. The outcome of interest was the main work location in 2017, obtained from the Australian Health Practitioner Regulation Agency’s public website. Results: Students who had undertaken the year 4 LIC along with additional rural training in years 3 and/or 5 were more likely than world. One of the strategies to improve rural medical workforce has been rural clinical placements for undergraduate medical all other groups to be working in smaller regional or rural towns, where workforce need is greatest (relative risk ratio (RRR) 5.62, 95% confidence interval (CI) 2.81–11.20, compared with those having metropolitan training only). Non-LIC training of similar duration in rural areas was also significantly associated, but more weakly, with smaller regional work location (RRR 2.99, 95%CI 1.87–4.77). Students whose only rural training was the year 4 LIC were not significantly associated with smaller regional work location (RRR 1.72, 95%CI 0.59–5.04). Overall, after accounting for both LIC and non-LIC rural training exposure, rural work after graduation was also consistently positively associated with rural background, being an international student and having a return of service obligation under a bonded program as a student. Conclusion: This study demonstrates the value of rural LICs, coupled with additional rural training, in contributing to improving Australia’s medical workforce distribution. Whilst other evidence has already demonstrated positive educational outcomes for doctors who participate in rural LIC placements, this is the first known study of work location outcomes. The study provides evidence that expanding this model of rural undergraduate education may lead to a better geographically distributed medical workforce. [ABSTRACT FROM AUTHOR]

Introduction: In Australia, about one in five medical specialist doctors travel away from their main practice to provide regular outreach services in rural communities. A consistent policy question is whether video consultations (VC) are used as part of rural outreach service provision and the degree to which they partly or wholly substitute outreach visits. This study aimed to explore how commonly specialists providing rural outreach services also use VC to provide clinical service at the outreach site, the aspects of outreach clinical services they consider suitable for VC delivery, whether VC use reduces outreach travel frequency and, if used, has the potential to improve the sustainability of outreach. Methods: The study involved 390 specialists in Victoria being invited to participate in an online survey between December 2016 and March 2017. Invited specialists were those travelling to provide rural outreach services in areas of need, already subsidised by the Australian government’s outreach policy. Analysis included basic frequency counts and proportions and Pearson χ tests for associations. Qualitative free text responses were analysed and grouped thematically. Results: Of 65 respondents, who were travelling to provide rural outreach services on average 11 times per year, 57% (95% confidence interval (CI) 44–69%) used VC to provide aspects of clinical services to the outreach site. They used VC for a median of 12 sessions per year, mainly for one patient per session. VC was used for non-complicated health care, to support rural GPs, undertake clinical reviews or see urgent new patients expediently. Key restrictions were the inability to conduct physical examinations and complex assessments. VC reduced the frequency of outreach travel for 50% of those using it (95%CI 29–63%) although 43% (95%CI 27–61%) reported that providing outreach clinical services via VC took more time than providing face-to-face consultations. Use was not associated with increased intention to continue rural outreach services for 5 or more years (56% v 62%; p=0.70) Conclusion: More than half of specialist doctors complemented their rural outreach services with VC. However, VC was used infrequently, mainly for one patient per session, for restricted clinical scenarios. Although VC use reduced outreach travel frequency for half of providers, 43% responded that VC takes more time than face-to-face clinical service provision. In conclusion, VC is a potentially useful adjunct to outreach service models, but it is unlikely to replace the utility of face-to-face rural specialist services, particularly for complex care, and may not influence outreach service sustainability in the manner in which it is currently used. [ABSTRACT FROM AUTHOR]

Objective: To investigate associations between general practitioner vocational training location and subsequent practice location, including the effect of rural origin.Design and Participants: Annual panel survey of GPs (from the MABEL study) who completed their vocational training and transitioned to independent practice, 2008-2014.Main Outcome Measures: Rural practice location in the 5 years after vocational registration for participants in four primary cohorts: (1) rural origin/rural training; (2) metropolitan origin/rural training; (3) rural origin/metropolitan training; and (4) metropolitan origin/metropolitan training.Results: During the study period, 610 doctors completed GP vocational training and commenced independent practice. 74-91% of rural origin/rural training cohort GPs remained in rural areas during their first 5 years after completing training, with 61-70% remaining in the same community. Conversely, 87-95% of metropolitan origin/metropolitan training cohort GPs remained in metropolitan areas. GPs from the other two cohorts initially remained in their training location type, but gradually moved towards their origin type. Generalised estimating equation logit models identified a highly significant association between rural training pathways and subsequent rural practice that was sustained for 5 years after vocational registration; it was substantially strengthened when combined with rural origin (cohort 2 v cohort 4: odds ratio [OR], 24; 95% CI, 13-43; cohort 1 v cohort 4: OR, 52; 95% CI, 24-111).Conclusion: This study provides new quantitative evidence of strong associations between rural GP vocational training location and subsequent rural practice location, which is strengthened when combined with rural origin. This evidence supports current government policy supporting rural GP vocational training and quotas for medical student selection based on rural origin. [ABSTRACT FROM AUTHOR]

Cultural desire is considered to be a prerequisite for developing cultural competence. This study explored cultural desire among student nurses towards Aboriginal peoples and its association with participation in a one-semester unit on Aboriginal health through a cross-sectional survey. Our main outcome, cultural desire, was measured using two items level of agreement with Aboriginal health being an integral component of the nursing curriculum and an expressed interest in Aboriginal health. 220 (74.58%) student nurses completed the survey. Completing the Aboriginal Health and wellbeing unit did not influence students’ opinions on inclusion of the unit as part of the nursing curriculum (odds ratio OR 0.73, 95% CI 0.43–1.29) or their overall cultural desire (mean difference = −0.69, 95% CI −1.29 to −0.08, p = 0.026). Students who completed the unit reported a higher understanding of Aboriginal health (OR = 2.35, 95% CI = 1.35–4.08) but lower interest levels in the subject (OR = 0.45, 95% CI: 0.24–0.84). Further research is necessary to explore how and when cultural desire might develop in nurses who are trained in cultural competence particularly in the contexts of post-colonial disparities and political conflict. [ABSTRACT FROM AUTHOR]

CHAPTER 1: CHARACTERISING AUSTRALIA'S RURAL SPECIALIST PHYSICIAN WORKFORCE: THE PROFESSIONAL PROFILE AND PROFESSIONAL SATISFACTION OF JUNIOR DOCTORS AND CONSULTANTS: Objective: To assess differences in the demographic characteristics, professional profile and professional satisfaction of rural and metropolitan junior physicians and physician consultants in Australia.Design, Setting and Participants: Cross-sectional, population level national survey of the Medicine in Australia: Balancing Employment and Life longitudinal cohort study (collected 2008-2016). Participants were specialist physicians from four career stage groups: pre-registrars (physician intent); registrars; new consultants (< 5 years since Fellowship); and consultants.Main Outcome Measures: Level of professional satisfaction across various job aspects, such as hours worked, working conditions, support networks and educational opportunities, comparing rural and metropolitan based physicians.Results: Participants included 1587 pre-registrars (15% rural), 1745 physician registrars (9% rural), 421 new consultants (20% rural) and 1143 consultants (13% rural). Rural physicians of all career stages demonstrated equivalent professional satisfaction across most job aspects, compared with metropolitan physician counterparts. Some examples of differences in satisfaction included rural pre-registrars being less likely to agree they had good access to support and supervision from qualified consultants (odds ratio [OR], 0.6; 95% CI, 0.3-0.9) and rural consultants being more likely to agree they had a poorer professional support network (OR, 1.9; 95% CI, 1.2-2.9). In terms of demographics, relatively more rural physicians had a rural background or were trained overseas. Although most junior physicians were women, female consultants were less likely to be working in a rural location (OR, 0.6; 95% CI, 0.4-0.8).Conclusion: Junior physicians in metropolitan or rural settings have a similar professional experience, which is important in attracting future trainees. Increased opportunities for rural training should be prioritised, along with addressing concerns about the professional isolation and poorer support network of those in rural areas, not only among junior doctors but also consultants. Finally, making rural practice more attractive to female junior physicians could greatly improve the consultant physician distribution. CHAPTER 2: GENERAL PHYSICIANS AND PAEDIATRICIANS IN RURAL AUSTRALIA: THE SOCIAL CONSTRUCTION OF PROFESSIONAL IDENTITY: Objective: To explore the construction of professional identity among general physicians and paediatricians working in non-metropolitan areas.Design, Setting and Participants: In-depth qualitative interviews were conducted with general physicians and paediatricians, plus informants from specialist colleges, government agencies and academia who were involved in policy and programs for the training and recruitment of specialists in rural locations across three states and two territories. This research is part of the Training Pathways and Professional Support for Building a Rural Physician Workforce Study, 2018-19.Main Outcome Measures: Individual and collective descriptors of professional identity.Results: We interviewed 36 key informants. Professional identity for general physicians and paediatricians working in regional, rural and remote Australia is grounded in the breadth of their training, but qualified by location - geographic location, population served or specific location, where social and cultural context specifically shapes practice. General physicians and paediatricians were deeply engaged with their local community and its economic vulnerability, and they described the population size and dynamics of local economies as determinants of viable practice. They often complemented their practice with formal or informal training in areas of special interest, but balanced their practice against subspecialist availability, also dependent on demographics. While valuing their professional roles, they showed limited inclination for industrial organisation.Conclusion: Despite limited consensus on identity descriptors, rural general physicians and paediatricians highly value generalism and their rural engagement. The structural and geographic bias that preferences urban areas will need to be addressed to further develop coordinated strategies for advanced training in rural contexts, for which collective identity is integral. CHAPTER 3: SUSTAINABLE RURAL PHYSICIAN TRAINING: LEADERSHIP IN A FRAGILE ENVIRONMENT: Objectives: To understand Royal Australasian College of Physicians (RACP) training contexts, including supervisor and trainee perspectives, and to identify contributors to the sustainability of training sites, including training quality.Design, Setting and Participants: A cross-sectional mixed-methods design was used. A national sample of RACP trainees and Fellows completed online surveys. Survey respondents who indicated willingness to participate in interviews were purposively recruited to cover perspectives from a range of geographic, demographic and training context parameters.Main Outcome Measures: Fellows' and trainees' work and life satisfaction, and their experiences of supervision and training, respectively, by geographic location.Results: Fellows and trainees reported high levels of satisfaction, with one exception - inner regional Fellows reported lower satisfaction regarding opportunities to use their abilities. Not having a good support network was associated with lower satisfaction. Our qualitative findings indicate that a culture of undermining rural practice is prevalent and that good leadership at all levels is important to reduce negative impacts on supervisor and trainee availability, site accreditation and viability. Trainees described challenges in navigating training pathways, ensuring career development, and having the flexibility to meet family needs. The small number of Fellows in some sites poses challenges for supervisors and trainees and results in a blurring of roles; accreditation is an obstacle to provision of training at rural sites; and the overlap between service and training roles can be difficult for supervisors.Conclusion: Our qualitative findings emphasise the distinctive nature of regional specialist training, which can make it a fragile environment. Leadership at all levels is critical to sustaining accreditation and support for supervisors and trainees. CHAPTER 4: PRINCIPLES TO GUIDE TRAINING AND PROFESSIONAL SUPPORT FOR A SUSTAINABLE RURAL SPECIALIST PHYSICIAN WORKFORCE: Objective: To draw on research conducted in the Building a Rural Physician Workforce project, the first national study on rural specialist physicians, to define a set of principles applicable to guiding training and professional support action.Design: We used elements of the Delphi approach for systematic data collection and codesign, and applied a hybrid participatory action planning approach to achieve consensus on a set of principles.Results: Eight interconnected foundational principles built around rural regions and rural people were identified: FP1, grow your own "connected to" place; FP2, select trainees invested in rural practice; FP3, ground training in community need; FP4, rural immersion - not exposure; FP5, optimise and invest in general medicine; FP6, include service and academic learning components; FP7, join up the steps in rural training; and FP8, plan sustainable specialist roles.Conclusion: These eight principles can guide training and professional support to build a sustainable rural physician workforce. Application of the principles, and coordinated action by stakeholders and the responsible organisations, are needed at national, state and local levels to achieve a sustainable rural physician workforce. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the geographical mobility of general practitioners in the rural areas of Australia. Details about the design and participants of the study are offered, along with the main outcome measures and the study's importance. Result identified general practitioners who work in small communities and in rural location for less than three years as the most at risk of departing rural practice.

The article discusses the crucial period of rural general practice (GP) in Australia including the distribution of GPs, occurrence of extensive range of policy and increasing undergraduate medical education and training

The article presents a study which aimed to examine whether community size and location are factors that affect the levels of professional satisfaction experienced by Australian general practitioners (GPs). The study was conducted to discover the reasons for the shortage of medical practitioners in rural and remote areas of Australia from 1990 to 2010. It concludes that GPs express similar levels of satisfaction with most aspects of their professional work regardless of community size and suggests a more active marketing of rural medicine.

Summary: Publication rates are a vital measure of individual and institutional performance, yet many nurse academics publish rarely or not at all. Despite widespread acceptance of the need to increase academic publication rates and the pressure university faculty may experience to fulfil this obligation, little is known about the effectiveness of practical strategies to support academic writing. In this small cohort study (n=8) comprising nurses and other professionals involved in university education, a questionnaire survey was used to evaluate the effectiveness of a one-week ¿Writing for Publication¿ course combined with a monthly writers support group to increase publication rates. Two year pre and post submissions increased from 9 to 33 articles in peer-reviewed journals. Publications (in print) per person increased from a baseline of 0.5¿1.2 per year. Participants reported increased writing confidence and greater satisfaction with the publishing process. Peer support and receiving recognition and encouragement from line managers were also cited as incentives to publish. Writing for publication is a skill that can be learned. The evaluated model of a formal writing course, followed by informal monthly group support meetings, can effectively increase publication rates. [Copyright &y& Elsevier]

Abstract: Study Objective: The objective of the study was to compare intranasal fentanyl (INF) with intravenous morphine (IVM) for prehospital analgesia. Methods: This was a randomized, controlled, open-label trial. Consecutive adult patients (n = 258) requiring analgesia (Verbal Rating Score [VRS] >2/10 noncardiac or >5/10 cardiac) were recruited. Patients received INF 180 μg ± 2 doses of 60 μg at ≥5-minute intervals or IVM 2.5 to 5 mg ± 2 doses of 2.5 to 5 mg at ≥5-minute intervals. The end point was the difference in baseline/destination VRS. Results: Groups were equivalent (P = not significant) for baseline VRS [mean (SD): INF 8.3 (1.7), IVM 8.1 (1.6)] and minutes to destination [mean (SD): INF 27.2 (15.5), IVM 30.6 (19.1)]. Patients had a mean (95% confidence interval) VRS reduction as follows: INF 4.22 (3.74-4.71), IVM 3.57 (3.10-4.03); P = .08. Higher baseline VRS (P < .001), no methoxyflurane use (P < .01), and back pain (P = .02) predicted VRS reduction. Safety and acceptability were comparable. Conclusions: There was no significant difference in the effectiveness of INF and IVM for prehospital analgesia. [Copyright &y& Elsevier]

It was a World Bank exemplar of health workforce data collection internationally,18 and continues to guide the distribution of over $1 billion funding to regional health care through its use in the design of the Modified Monash Model (used to classify which geographical areas are eligible to receive increased funding), as well as supporting the design of rural health workforce programs. Keywords: Health personnel; Health planning; Health policy EN Health personnel Health planning Health policy 252 252 1 04/06/21 20210401 NES 210401 Challenges with data infrastructure are affecting medical workforce research and access to medical care Access to high quality medical care can save lives and help reduce the consequences of the growing burden of chronic disease. [Extracted from the article]

This article focuses on a research program into the patterns of rural and remote outreach work by specialists in Australia, and discusses factors affecting participation, distribution and sustainability of specialist outreach services, and the participation of female specialists in rural outreach.

Objective: To explore the characteristics of specialists who provide ongoing rural outreach services and whether the nature of their service patterns contributes to ongoing outreach.Design, Participants and Setting: Specialist doctors providing rural outreach in a large longitudinal survey of Australian doctors in 2008, together with new entrants to the survey in 2009, were followed up to 2011.Main Outcome Measures: Providing outreach services to the same rural town for at least 3 years.Results: Of 953 specialists who initially provided rural outreach services, follow-up data were available for 848. Overall, 440 specialists (51.9%) provided ongoing outreach services. Multivariate analysis found that participation was associated with being male (odds ratio [OR], 1.82; 95% CI, 1.28-2.60), in mid-career (45-64 years old; OR, 1.44; 95% CI, 1.04-1.99), and working in mixed, mainly private practice (OR, 1.73; 95% CI, 1.18-2.53). Specialists working only privately were less likely to provide ongoing outreach (OR 0.51; 95% CI, 0.32-0.82), whereas metropolitan and rural-based specialists were equally likely to do so. Separate univariate analysis showed travelling further to remote towns had no effect on ongoing service provision. Outreach to smaller towns was associated with improved stability.Conclusions: Around half of specialists providing rural outreach services continue to visit the same town on an ongoing basis. More targeted outreach service strategies should account for career stage and practice conditions to help sustain access. Financial incentives may increase ongoing service provision by specialists only working privately. There is some indication that outreach services delivered to smaller communities are more stable. [ABSTRACT FROM AUTHOR]