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BackgroundTelehealth appears to be an ideal mechanism for assisting rural patients and doctors and medical students/registrars in accessing specialist services. Telehealth is the use of enhanced broadband technology to provide telemedicine and education over distance. It provides accessible support to rural primary care providers and medical educators. A telehealth consultation is where a patient at a general practice, with the assistance of the general practitioner or practice nurse, undertakes a consultation by videoconference with a specialist located elsewhere. Multiple benefits of telehealth consulting have been reported, particularly those relevant to rural patients and health care providers. However there is a paucity of research on the benefits of telehealth to medical education and learning. ObjectiveThis protocol explains in depth the process that will be undertaken by a collaborative group of universities and training providers in this unique project. MethodsTraining sessions in telehealth consulting will be provided for participating practices and students. The trial will then use telehealth consulting as a real-patient learning experience for students, general practitioner trainees, general practitioner preceptors, and trainees. ResultsResults will be available when the trial has been completed in 2015. ConclusionsThe protocol has been written to reflect the overarching premise that, by building virtual communities of practice with users of telehealth in medical education, a more sustainable and rigorous model can be developed. The Telehealth Skills Training and Implementation Project will implement and evaluate a theoretically driven model of Internet-facilitated medical education for vertically integrated, community-based learning environments

While 'public health medicine' is a specialised field, most medical practitioners practice 'public health' to some extent, e.g., undertaking preventative screening tests or advising individuals about lifestyle interventions. While requirements to demonstrate capability in public health are common to medical education around the world, medical programs face a challenge to integrate public health education and promote health advocacy in an environment where the doctor: patient relationship is at the core of learning. Students who spend part of their medical education working within general practice or community settings have an opportunity to observe and identify issues of public health importance, and to see how they impact at both a personal and a population level. This paper aims to illustrate how a year-long research project can provide an opportunity for medical students to learn about public health issues and methods to investigate them. Analysis was undertaken of the research topics chosen by eight successive cohorts of medical students, representing 519 students, who successfully completed a research project. Over half of the student research projects (51.8%) directly related to Australian national health priority areas of dementia, obesity, arthritis and musculoskeletal conditions, asthma, diabetes, mental health, injury prevention and control, cardiovascular health and cancer control, and a further 28.5% of projects had a specific public health focus, within domains that include lifestyles and health, communicable disease, and healthy growth and development. Researching public health topics in the community setting represents a practical way to engage medical students in learning about public health, and can help to develop their potential to become 'clinician researchers', investigating and understanding issues relevant to their communities.

Background Acute kidney injury (AKI) is common. An AKI episode may disrupt the normal mineral bone balance maintained by normal kidney function, thereby modifying the risk of developing bone fractures. However, it remains unclear whether an AKI episode is associated with the risk of bone fractures. Methods Using retrospective cohort study from an Australian Local Health District, we examined the association between an AKI episode and bone fractures using patient data between 2008 and 2017. Time-varying Cox proportional hazards and propensity-matched analysis were used to examine the association. Sensitivity analyses were undertaken to capture the impact of confirmed AKI status and AKI severity. Results Of 123 426 included patients, 14 549 (12%) had an AKI episode and 12 505 (10%) had a bone fracture. In the unadjusted analysis, AKI was associated with bone fractures [hazard ratio (HR) 1.99, 95% confidence interval (CI) 1.88–2.11]. This association persisted in the adjusted analysis (HR 1.50, 95% CI 1.41–1.59) and propensity-matched dataset (HR 1.71, 95% CI 1.59–1.83). The sensitivity analysis yielded similar results, with the AKI patients having a higher risk of fractures compared with no AKI patients in the adjusted analysis (HR 1.34, 95% CI 1.25–1.43) and in the propensity-matched dataset (HR 1.44, 95% CI 1.33–1.55). Similar results were seen in the subsidiary sensitivity analysis excluding patients without baseline creatinine. We did not find an increased risk of bone fractures with increasing AKI severity (P = .7). Interaction tests demonstrated a significant association between sex and age category with AKI status and fractures, but not CKD stage or osteoporosis. Conclusions AKI is associated with a greater risk of bone fractures. This could have implications for managing and screening for bone disease in patients post-AKI episode. This association should be examined in other cohorts and populations for verification. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine changes in the demographics and regions of work of Australian doctors over a period of 9 years. Methods: A retrospective study of Australian Health Practitioner Regulation Agency (AHPRA) registration data was performed. Data were sourced from the Health Workforce Dataset Online Data Tool which was derived from annual registration data from AHPRA for 2013–2022. The demographic factors analysed were gender, age, and origin of qualification. Regions of work were defined using the Modified Monash (MM) model. Results: The number of registered doctors increased from 82,408 in 2013 to 111,908 in 2022 but mean hours worked per week decreased from 41 to 39 leading up to 2020. Trends in age and origin of qualification remained stable, but the proportion of female workers increased from 38.5% in 2013 to 44.5% in 2022. While female hours per week (~37) were consistent from 2013 to 2020, male hours per week decreased from 43 to 41. The number of registrations and total full-time equivalent (FTE) outcomes increased consistently in metropolitan (MM1) and rural (MM2–5) regions but did not increase for remote and very remote (MM6–7) regions. Conclusion: The Australian medical workforce both grew and changed between 2013 and 2022. An overall decrease in mean hours worked appears to be driven by a decline in hours worked by male workers and the increased proportion of female workers. While increased gender parity and a decrease in hours worked per week were positive outcomes, a lack of growth in the medical workforce was noted in remote and very remote regions of Australia. What is known about the topic? Changes in the medical workforce over time are likely to impact health service delivery. What does this paper add? This paper examined changes in the gender, age, origin of qualification, and the region of work of Australia's medical workforce from 2013 to 2022. What are the implications for practitioners? An increase in gender parity and a decrease in the mean hours worked suggests improvements in workforce participation and sustainability, but lack of growth in medical workforce was noted in remote and very remote regions of Australia. [ABSTRACT FROM AUTHOR]

Aim: People with chronic kidney disease experience high rates of cardiovascular disease. Cholesterol‐lowering therapy is a mainstay in the management but there is uncertainty in the treatment effects on patient‐important outcomes, such as fatigue and rhabdomyolysis. Here, we summarise the updated CARI Australian and New Zealand Living Guidelines on cholesterol‐lowering therapy in chronic kidney disease. Methods: We updated a Cochrane review and monitored newly published studies weekly to inform guideline development according to international standards. The Working Group included expertise from nephrology, cardiology, Indigenous Health, guideline development and people with lived experience of chronic kidney disease. Results: The guideline recommends people with chronic kidney disease (eGFR ≥15 mL/min/1.73 m2) and an absolute cardiovascular risk of 10% or higher should receive statin therapy (with or without ezetimibe) to reduce the risk of cardiovascular events and death (strong recommendation, moderate certainty evidence). The guidelines also recommends a lower absolute cardiovascular risk threshold (≥5%) for Aboriginal and Torres Strait Islander Peoples and Māori with chronic kidney disease to receive statin therapy (with or without ezetimibe) (strong recommendation, low certainty evidence). The evidence was actively surveyed from 2020–2023 and updated as required. No changes to guideline recommendations were made, with no new data on the balance and benefits of harms. Conclusions: The development of living guidelines was feasible and provided the opportunity to update recommendations to improve clinical decision‐making in real‐time. Living guidelines provide the opportunity to transform chronic kidney disease guidelines. Summary at a glance: In people >30 with chronic kidney disease not requiring dialysis and a 5‐year cardiovascular risk ≥10% cholesterol‐lowering therapy is effective at preventing death and cardiovascular events with minimal harms. Indigenous populations should receive cholesterol‐lowering therapy at a lower absolute cardiovascular risk (≥5%) due to a higher burden of cardiovascular disease. [ABSTRACT FROM AUTHOR]

After receiving negative feedback from students and tutors about their group work experiences in a health subject, strategies to resolve these collaborative learning issues were considered. The objectives were to facilitate student ability to resolve group work issues, highlight group work as an important graduate attribute and to improve perceptions of the benefits of group work. A literature review assisted in identifying several strategies that had been used elsewhere to resolve issues similar to those raised by the students in this study. Consequently a number of support resources were designed for the revised delivery of the subject to the next cohort of students. These included a structured introduction to elements of group work and several strategies to improve the group work experience. At the conclusion of the subject students indicated that the group work experience was of value. The overall response suggested that active tuition in the elements of group work contributes positively to student understanding of both the process and group dynamics.

Research skills are fundamental to the building of the evidence basis of professional practice, are at the core of lifelong professional learning and are the keys to discovery, innovation and knowledge transfer. Research competency is thus increasingly recognised as an important educational goal for graduates in many professions. This paper describes a flexible program, adaptable to any professional course of study that allows students to engage in meaningful, scholarly and authentic research. Students are supported to undertake a research activity that spans the research continuum from development of a research question through to dissemination of findings, and strategic points in-between.

Introduction: The shortfall in medical workers in rural and remote Australia has led to health discrepancies in these regions. The University of Wollongong's medical program was designed to encourage graduates to work in these regions to address this shortfall. Objective: To compare rural and regional locations of work and choices of speciality between University of Wollongong's graduates and graduates from all Australian universities. Design: We conducted a longitudinal analysis on data available from the Medical Schools Outcome database, with graduate exit surveys linked to registrations of location and speciality. Rural and remote locations were identified as MM2‐7 regions using the Modified Monash Model. In total, 716 graduates from the University of Wollongong and 26 915 graduates from all Australian medical schools completed the MSOD exit survey in 2010‐2021 and registered with the Australian Health Practitioner Regulation Agency in 2022. The main outcome was the relative likelihood (relative risk) of cohorts working in rural and regional areas and of cohorts choosing general practice as their speciality. Findings: University of Wollongong's medical graduates were 1.51 times or 51% more likely to work in regional or rural areas (RR 1.51, 95% CI 1.34 to 1.71, p < 0.0001). Respondents who were 10 or more years post graduation were 1.57 times or 57% more likely to specialise in general practice than all other Australian medical graduates (RR 1.57 95% CI: 1.40 to 1.79, p < 0.0001). Discussion: The University of Wollongong's medical school is producing graduates to meet Australia's rural health workforce needs. This may be due to a higher intake of rural students, and a higher percentage of students taking rural placements. Conclusions: Rural health workforce needs can be addressed through rural‐focussed education strategies. [ABSTRACT FROM AUTHOR]