Medical students on long-term rural clinical placements and their perceptions of urban and rural internships : a qualitative study

Background: There is some anecdotal evidence that anxiety about the responsibility of an intern influences rural future intentions. Additionally, research has shown that urban interns have reported that they are worried about being 'forced' to work in non-metropolitan hospitals in their first year after graduation. This study sought to explore rural medical students' perceptions and expectations of a rural internship and how local health services and/or their medical school can prepare them best for a rural intern position. Methods: Four focus groups were conducted with 62 final-year medical students upon completion of a 12-month rural clinical school placement. Focus groups were audio-recorded and transcribed verbatim for thematic analysis to identify key themes. Results: Most students have high levels of anxiety around starting work but they acknowledge that this may be exaggerated. They believe that in rural areas they get higher quality supervisory support than in urban hospitals as people know you better, whereas in the city you are more anonymous. However, the level of responsibility placed on rural interns was considered to be a double-edged sword. While rural interns were allowed to do more than be a 'paper-pusher' this level of responsibility means they are more accountable. The majority felt that doing your first training years in a metropolitan hospital can be crucial to getting on a training program in your chosen speciality. Conclusions: There appears to be a relatively high level of anxiety about rural internships amongst final-year medical students. Students need more targeted information around specialisation, particularly around regional training hubs, if we want to achieve higher levels of interns choosing a rural career path

Sun safety knowledge, practices and attitudes in rural Australian farmers : a cross-sectional study in Western New South Wales

Background: Rates of skin cancer in Australia are amongst the highest in the world, with Western New South Wales (NSW) exhibiting very high prevalence. There is a large proportion of outdoor workers, including farmers, in Western NSW who have high levels of sun exposure and hence are at greater risk of developing skin cancer. Aims: To characterise the current sun safety practices of farmers in Western NSW and explore their knowledge, attitudes and perceived barriers towards sun safety and its implementation. Methods: A cross-sectional survey study was conducted using a self-directed questionnaire. Participants were recruited at field days held in Western NSW and through surveys distributed at general practices, local stores and online. Eligibility criteria were aged 18 years and over and currently working on a farm in the study region. Results: Of the 144 participants, 89 (61.8%) were male with a mean age of 49 years. Knowledge of sun safety was relatively high with most questions answered correctly by greater than 80% of participants. Risk of developing skin cancer was underestimated in 58 (40.3%) participants. Of all participants, 89 (62.2%) identified one or more barriers to practicing sun safety. The most common barrier was forgetfulness in 62 (43.4%) participants. The identification of barriers was significantly associated with reduced engagement of sun safety practices (p = 0.009). Conclusions: Knowledge of sun safety among farmers was high. There was, however, underestimation of risk of developing skin cancer. Addressing perceived barriers to implementing sun safety could improve sun safety practices in this cohort

Impact of COVID-19 on lifestyle and mental wellbeing in a drought-affected rural Australian population

INTRODUCTION: The SARS-CoV-2 (COVID-19) pandemic has caused unprecedented social and economic disruption, accompanied by the enactment of a multitude of public health measures to restrain disease transmission. These public health and social measures have had a considerable impact on lifestyle and mental wellbeing, which has been well studied with metropolitan populations. However, limited literature concerning such effects on a selectively rural population is presently available. Additionally, the use of a standardised scoring system for lifestyle may be valuable for an overall assessment of lifestyle that may be incorporated into clinical practice. METHODS: This study examined the associations between psychological distress and changes in SNAPS health behaviours (smoking, nutrition, alcohol, physical activity, sleep) since the onset of COVID-19 in Australia. A cross-sectional anonymous survey was distributed online to adults in the Western New South Wales Primary Health Network in August 2020 and included measures of psychological distress, income, disposition and lifestyle factors during the pandemic as well as changes to lifestyle due to COVID-19. A novel Global Lifestyle Score (GLS) was generated as a holistic assessment of lifestyle across multiple domains. RESULTS: The survey was completed by 304 individuals (modal age group 45-54 years, 86.8% female). High distress on the Kessler-5 scale was present in over one-third of participants (n=95, 33.7%). Detrimental change was reported for sleep (22.7%), nutrition (14.5%), alcohol (16.7%), physical exercise (34.0%) and smoking (24.7%) since the onset of the pandemic. Changes in sleep, nutrition, physical activity and smoking were associated with distress. Participants with a poor lifestyle (GLS) during the pandemic were significantly more distressed. Perceived COVID-19 impact was associated with high distress, drought impact and loss of income. Participants who reported negative impact from both COVID-19 and drought were significantly more distressed than those reporting a negative impact from drought alone or neither event. CONCLUSION: High rates of distress among rural Australians during the COVID-19 pandemic was linked to low GLS, worsening lifestyles and loss of income. Healthy lifestyle strategies should be considered by health professionals for the management of crisis-related distress. Further research may explore the impact of COVID-19 on a larger study population with a greater proportion of male participants and to examine the effect of modifying lifestyle factors in reducing distress in the context of a stressor such as this pandemic

Uptake and acceptability of human papillomavirus self-sampling in rural and remote Aboriginal communities : evaluation of a nurse-led community engagement model

Background: Aboriginal women experience disproportionately higher rates of cervical cancer mortality yet are less likely to participate in screening for early detection. This study sought to determine whether a community-based HPV self-sampling service model can effectively recruit never-screened and under-screened Aboriginal women to participate in cervical cancer screening; assess the clinical outcomes; and explore the acceptability of the model from the perspective of the participants. Methods: Aboriginal women aged 25–69 years of age were recruited from eight rural and remote communities in New South Wales, Australia to participate in HPV self-sampling via a community-based service model. Outcome measures were: number of women screened by HPV self-sampling, their prior cervical screening status (under-screened or never-screened), clinical outcomes and participation in follow-up pathways of care, and satisfaction with the service model. Results: In total, 215 women conducted a HPV self-sampling test and 200 evaluation surveys were completed. One-fifth of participants (n = 46) were never-screened and one-third (n = 69) were under-screened. Many were unsure of their screening status. Nine women were HPV 16/18 positive and eight had completed all follow up by the conclusion of the study. A further 30 women tested positive for a high risk type other than HPV 16/18 (HPV other), of which 14 had completed follow up at the conclusion of the study. Satisfaction with the HPV self-sampling kit, the process of self-sampling and the service model was high (> 92% satisfied on all items). Many women had difficulty understanding their official HPV results and placed high importance on the nurse explaining it to them. Conclusions: A community-based service model that respects Aboriginal Women’s Business can effectively recruit under-screened and never-screened Aboriginal women to complete cervical cancer screening. Furthermore, this service model supports them to complete recommended follow-up care and engage with their local existing health services

An Australian national survey of First Nations careers in health services

A strong First Nations health workforce is necessary to meet community needs, health rights, and health equity. This paper reports the findings from a national survey of Australia’s First Nations people employed in health services to identify enablers and barriers to career development, including variations by geographic location and organisation type. A cross-sectional online survey was undertaken across professions, roles, and jurisdictions. The survey was developed collaboratively by Aboriginal and non Aboriginal academics and Aboriginal leaders. To recruit participants, the survey was promoted by key professional organisations, First Nations peak bodies and affiliates, and national forums. In addition to descriptive statistics, logistic regression was used to identify predictors of satisfaction with career development and whether this varied by geographic location or organisation type. Of the 332 participants currently employed in health services, 50% worked in regional and remote areas and 15% in Aboriginal Community-Controlled Health Organisations (ACCHOs) with the remainder in government and private health services. All enablers identified were associated with satisfaction with career development and did not vary by location or organisation type. “Racism from colleagues” and “lack of cultural awareness,” “not feeling supported by their manager,” “not having role models or mentors,” and “inflexible human resource policies” predicted lower satisfaction with career development only for those employed in government/other services. First Nations people leading career development were strongly supported. The implications for all workplaces are that offering even a few career development opportunities, together with supporting leadership by Aboriginal and Torres Strait Islander staff, can make a major difference to satisfaction and retention. Concurrently, attention should be given to building managerial cultural capabilities and skills in supporting First Nations’ staff career development, building cultural safety, providing formal mentors and addressing discriminatory and inflexible human resources policies

"You're actually part of the team" : a qualitative study of a novel transitional role from medical student to doctor

Background Optimizing transitions from final year of medical school and into first post graduate year has important implications for students, patients and the health care system. Student experiences during novel transitional roles can provide insights into potential opportunities for final year curricula. We explored the experiences of medical students in a novel transitional role and their ability to continue learning whilst working as part of a medical team. Methods Novel transitional role for final year medical students were created in partnership by medical schools and state health departments in 2020 in response to the COVID-19 pandemic and the need for a medical surge workforce. Final year medical students from an undergraduate entry medical school were employed as Assistants in Medicine (AiMs) in urban and regional hospitals. A qualitative study with semi-structured interviews at two time points was used to obtain experiences of the role from 26 AiMs. Transcripts were analyzed using deductive thematic analysis with Activity theory as a conceptual lens. Results This unique role was defined by the objective of supporting the hospital team. Experiential learning opportunities in patient management were optimized when AiMs had opportunities to contribute meaningfully. Team structure and access to the key instrument, the electronic medical record, enabled participants to contribute meaningfully, whilst contractual arrangements and payments formalized the obligations to contribute. Conclusions The experiential nature of the role was facilitated by organizational factors. Structuring teams to involve a dedicated medical assistant position with specific duties and access to the electronic medical record sufficient to complete duties are key to successful transitional roles. Both should be considered when designing transitional roles as placements for final year medical students

Tracking Australian health and medical research expenditure with a PubMed bibliometric method

Objective: To assess Australian health and medical research (HMR) investment returns by measuring the trends in HMR expenditure and PubMed publications by Australian authors. Methods: Bibliometric analysis collating Australian HMR expenditure reported by the Australian Institute of Health and Welfare and Australian HMR publications indexed in PubMed. Similar methods were applied to data from the United Kingdom and New Zealand. Results: From financial year 2000/01 through 2011/12, HMR investment increased by 232% from $1.49 to$4.94 billion (current prices adjusted for inflation), while PubMed publications increased by 123% from 10,696 to 23,818. The average HMR investment required for a single PubMed publication rose by 49% from $139,304 in 2000/01 to$207,364 in 2011/12. Quality analyses showed an increase in systematic reviews, cohort studies and clinical trials, and a decrease in publications in PubMed's core clinical journal collection. Comparisons with New Zealand and the United Kingdom showed that Australia has had the greatest overall percentage increase in gross publication numbers and publications per capita. Conclusions: Our analyses confirm that increased HMR expenditure is associated with an increase in HMR publications in PubMed. Implications: Tracking HMR investment outcomes using this method could be useful for future policy and funding decisions at a federal and specific institution level

Supporting staff childcare needs can be an adjunct to an effective recruitment and retention strategy : a short report

Globally, rural areas continue to struggle with the recruit-ment and retention of their rural health care workforce. In Australia, the Government has responded to this need by implementing the Rural Health Multidisciplinary Training Program to provide rural immersion experiences to health students to increase the likelihood of rural prac-tice on graduation.1Whilst this and other initiatives provide an avenue for increasing recruitment of health care staff, they do not specifically address retention of the rural health work-force. Retention is a multifaceted issue, with an individ-ual's experience of their workplace situation/conditions, their perception of career development and advancement opportunities, as well as personal and community factors influencing their decisions in this space.2,3 For each indi-vidual, these factors can act as either push or pull factors, driving them to leave their rural post (push) or influencing them to stay (pull).2,4 These retention drivers are neatly captured in the ‘Whole-of- Person Retention Improvement Framework’ suggested by Cosgrave.5 This framework broadly categorises the influencers of retention into 3 domains: workplace/organisational, role and personal.5Whilst workplace/organisational and role- related influ-encers have been researched extensively, there is a need to examine more closely the personal factors that influence an individual's turnover intention.5 Hospital employees are generally required to work long hours and undertake shift work, which does not fit in with traditional childcare opening hours. Anecdotal evidence from a regional centre suggests that the limited availability of suitable childcare and out of school care is negatively impacting hospital staff well- being, recruitment and retention; however, pub-lished evidence is scant. The aim of this pilot study, there-fore, was to examine the childcare needs of hospital staff in a regional centre and the perceived impact this has on staff availability, recruitment and retention

Respiratory presentations and admissions at Bathurst Base Hospital emergency department : exploring the impacts of the recent bushfire crisis

Objective: To examine respiratory-related ED admissions and presentations at Bathurst Base Hospital during the 2019–2020 New South Wales bushfire crisis. Methods: A retrospective clinical audit was undertaken. Publicly available data on air quality were also examined. Results: Poorer air quality (measured by PM10 levels) was correlated with increased presentations to the ED (R = 0.228, P = 0.012). ED patients with respiratory diagnoses were more likely to be admitted for inpatient care in 2019–2020 (n = 234, 49.3%) compared with 2018–2019 (n = 165, 39.6%). Conclusion: The impact of bushfire smoke needs to be considered in the allocation of resources in this area in future, but further research is warranted to understand the full extent of impact at the local level