Rural parents' adherence to infant feeding guidelines to prevent allergy: a cross sectional study in New South Wales.

BACKGROUND: Responding to international research showing that early introduction of common food allergens can reduce the chance of developing allergies, in 2016 the Australasian Society of Clinical Immunology and Allergy (ASCIA) revised allergen introduction guidelines, recommending earlier introduction of allergens to infants in their first year. Australia has high food allergy rates, and limited understanding of adherence to allergen introduction guidelines, especially in rural areas. This project explored rural parent adherence to ASCIA guidelines. METHODS: This was a mixed method cross sectional study using an online survey including multiple-choice and qualitative short answer responses. The sample were 336 women from two rural health districts in New South Wales. All were aged 18 or over, and either pregnant or had delivered a baby since July 2018. Descriptive statistics were used to measure behavioural alignment with the recommended guidelines, thematic analysis was used to analyse attitudes and explanations. RESULTS: In 84.3% of children, feeding adhered to all four guidelines studied, including no elimination of allergens during pregnancy (98%), age of introduction of solids (97.7%), continuation of breast milk/cow's milk formula during introduction of solids (95%), and age of introduction of allergens (92.9%). Adherence was not significantly correlated with the education (X2 = 17.9, P = .056), prior history of allergy [neither mother (X2 = 0.945,P = .623) nor previous children (X2 = 0.401,P = .818)], or primary care received during pregnancy. More than 90% of participants agreed or strongly agreed that the guidelines are realistic, trustworthy, and important for the health of their child. However, thematic analysis revealed that parents' perceptions of a child's individual progress, and medical conditions or other circumstances, such as challenges with breastfeeding, will often take precedence over adherence to specific guideline recommendations. CONCLUSIONS: High rates of adherence with ASCIA guidelines found here are comparable with findings from metropolitan studies and encouraging for future population health. Participant comments on the guidelines imply to rural policymakers that there are multiple influences on parent decisions about infant feeding, often including parents' own intuition and experiences. Further studies to improve understanding of the role of information, carers, and other influences on parent decision-making concerning feeding attitudes and behaviours will be necessary to optimise adherence in rural areas.

Benefits and challenges of electronic prescribing for general practitioners and pharmacists in regional Australia.

OBJECTIVE: To explore the benefits and challenges of electronic prescribing (e-prescribing) for general practitioners (GPs) and pharmacists in regional New South Wales (NSW). METHODS: This qualitative study utilised semistructured interviews conducted virtually or in-person between July and September 2021. SETTING AND PARTICIPANTS: General practitioners and pharmacists practising in Bathurst NSW. MAIN OUTCOMES: Self-reported perceived and experienced benefits and challenges of e-prescribing. RESULTS: Two GPs and four pharmacists participated in the study. Reported benefits of e-prescribing included improvement in the prescribing and dispensing process, patient adherence, and prescription safety and security. The increased convenience for the patients was appreciated particularly during the COVID-19 pandemic. Challenges discussed were how the system was perceived to be unsafe and insecure, costs of messaging and updating general practice software, utilisation of new systems and patient awareness. Pharmacists reported the need for education to patients and staff to minimise the impact of inexperience with the novel technology on workflow efficacy. CONCLUSION: This study provided first insight and information on the perspectives of GPs and pharmacists 12 months after the implementation of e-prescribing. Further nationwide studies are required to consolidate these findings; provide comparisons with the system's progress since conception; determine whether metropolitan and rural health care professionals share similar perspectives; and shed light on where additional government support may be required.

Awareness and attitudes towards the revised National Cervical Screening Program amongst women in rural New South Wales: a cross-sectional study.

BACKGROUND: Research exploring awareness and attitudes towards the revised National Cervical Screening Program (NCSP) amongst rural Australian women is limited. Given the increased incidence and mortality from cervical cancer in rural Australian women, this gap needs attention. This study examined awareness and attitudes of women in rural New South Wales (NSW) towards the revised NCSP. METHODS: A cross-sectional survey was conducted with women aged 18-74years currently residing in the Western NSW Primary Health Network region. The anonymous survey was distributed online via social media and email to eligible women. RESULTS: In total, 309 rural women participated. The majority were 30-39years old (35.9%) and had completed tertiary education (73.1%), figures which are higher than average for this rural region. Of these, 51.8% (160/309) were aware there had been a change to the NCSP. This information most commonly came from their healthcare provider (57.5%; 82/160). Three-quarters reported being happy or neutral with the change (76.1%; 235/309). Those who were aware of the revised NCSP were more likely to have a positive attitude toward it (P =0.02). Fewer participants reported that they were never/unlikely to participate in screening under the revised NCSP (4.8%, 9/309) as compared to the previous program (15.5%, 48/309) after being provided with information about the revised NCSP. Women who reported an abnormal result under the previous NCSP were more likely to be concerned about the revised NCSP (P =0.037), in particular the starting age of 25years (P =0.007) and the 5-yearly screening interval (P =0.008). CONCLUSION: Awareness and knowledge levels play an important role in attitudes towards the revised NCSP in rural women. Strategies to increase participation rates should therefore target these areas. Healthcare professionals can take a central role in this information sharing process.

"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.

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.

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.

Staff perceptions of the management of mental health presentations to the emergency department of a rural Australian hospital: qualitative study.

INTRODUCTION: Current research demonstrates higher prevalence of mental health related emergency department (ED) presentations in rural areas, despite similar overall prevalence of these conditions in rural and metropolitan contexts. This stems from shortages in availability of specialised mental health professionals, greater stigma against mental illness, greater socioeconomic disadvantages, and access to means of self-harm in rural regions. Little is known, however, about the specific characteristics of mental health presentations to rural emergency departments (EDs) in Australia. Additionally, studies have shown that ED staff feel uncomfortable managing mental health presentations to ED due to factors such as lack of confidence and stigma against mental illnesses. AIM: This qualitative study sought to examine ED staff perceptions regarding the management of mental health presentations in a rural Australian ED. METHODS: A qualitative study design was used, incorporating semi-structured interviews of current ED staff. Ten interviews were conducted in person or over the phone by two researchers and thematically analysed to draw out key themes from the data. RESULTS: Staff perceived deficiencies in availability of mental health expertise, de-escalation, and referral pathways as major barriers to effective patient management. These factors contributed to increased retention of mental health patients in ED due to uncertainties regarding their definitive care. Despite acknowledging the value of practical experience with mental health presentations as the best way of increasing clinician confidence, staff expressed a desire for more face-to-face training to better equip them to respond to mental health presentations. CONCLUSION: A combination of departmental and hospital-wide issues in conjunction with individual staff attitudes regarding mental health conditions contributes to issues in mental health patient care in this ED. In particular, limited training in mental health and resources available to ED staff affects confidence in managing mental health presentations and contributes to prolonged time to definitive treatment.

Barriers and enablers to Aboriginal and Torres Strait Islander careers in health: A qualitative, multisector study in western New South Wales.

OBJECTIVE: Growing a strong Aboriginal and Torres Strait Islander health workforce is key to closing the gap in health outcomes between Indigenous and non-Indigenous Australians. This study sought to explore barriers and enablers to career development for Aboriginal health staff and potential strategies to enhance career pathways. DESIGN: Qualitative study, with data collected primarily through focus group discussions (yarning circles) at different health workplaces. SETTING: Western New South Wales. PARTICIPANTS: Aboriginal health staff (n = 54) from Aboriginal Community Controlled Health Services, a Local Health District and a Primary Health Network, and their managers (Aboriginal and non-Aboriginal; n = 28). MAIN OUTCOME MEASURES: Identified barriers and enablers and regional strategies for improving career pathways. RESULTS: Aboriginal people interested in pursuing a career in health face barriers in: pre-employment, recruitment, the workplace and further education and training. Being given practical and emotional support, as well as opportunities, makes a difference at every stage. Family and community are very influential in career decisions. Within the workplace, culturally appropriate human resource systems and management structures are vital. The ability to obtain employment and access education and training locally is important to rural and remote communities. CONCLUSION: To enhance health career pathways for Aboriginal people, strategies are needed at all levels: community, organisation, system and society. Aboriginal leadership and self-determination are crucial, as are partnerships within the health sector and between the health and the education and training sectors. Cultural safety is essential to expansion of the Aboriginal workforce, and to health care experiences and outcomes for Aboriginal community members.

User Perceptions and Experiences of a Handheld 12-Lead Electrocardiographic Device in a Clinical Setting: Usability Evaluation.

BACKGROUND: Cardiac arrhythmias are a leading cause of death. The mainstay method for diagnosing arrhythmias (eg, atrial fibrillation) and cardiac conduction disorders (eg, prolonged corrected QT interval [QTc]) is by using 12-lead electrocardiography (ECG). Handheld 12-lead ECG devices are emerging in the market. In tandem with emerging technology options, evaluations of device usability should go beyond validation of the device in a controlled laboratory setting and assess user perceptions and experiences, which are crucial for successful implementation in clinical practice. OBJECTIVE: This study aimed to evaluate clinician and patient perceptions and experiences, regarding the usability of a handheld 12-lead ECG device compared to a conventional 12-lead ECG machine, and generalizability of this user-centered approach. METHODS: International Organization for Standardization Guidelines on Usability and the Technology Acceptance Model were integrated to form the framework for this study, which was conducted in outpatient clinics and cardiology wards at Westmead Hospital, New South Wales, Australia. Each patient underwent 2 ECGs (1 by each device) in 2 postures (supine and standing) acquired in random sequence. The times taken by clinicians to acquire the first ECG (efficiency) using the devices were analyzed using linear regression. Electrocardiographic parameters (QT interval, QTc interval, heart rate, PR interval, QRS interval) and participant satisfaction surveys were collected. Device reliability was assessed by evaluating the mean difference of QTc measurements within ±15 ms, intraclass correlation coefficient, and level of agreement of the devices in detecting atrial fibrillation and prolonged QTc. Clinicians' perceptions and feedback were assessed with semistructured interviews based on the Technology Acceptance Model. RESULTS: A total of 100 patients (age: mean 57.9 years, SD 15.2; sex: male: n=64, female n=36) and 11 clinicians (experience acquiring ECGs daily or weekly 10/11, 91%) participated, and 783 ECGs were acquired. Mean differences in QTc measurements of both handheld and conventional devices were within ±15 ms with high intraclass correlation coefficients (range 0.90-0.96), and the devices had a good level of agreement in diagnosing atrial fibrillation and prolonged QTc (κ=0.68-0.93). Regardless of device, QTc measurements when patients were standing were longer duration than QTc measurements when patients were supine. Clinicians' ECG acquisition times improved with usage (P<.001). Clinicians reported that device characteristics (small size, light weight, portability, and wireless ECG transmission) were highly desired features. Most clinicians agreed that the handheld device could be used for clinician-led mass screening with enhancement in efficiency by increasing user training. Regardless of device, patients reported that they felt comfortable when they were connected to the ECG devices. CONCLUSIONS: Reliability and usability of the handheld 12-lead ECG device were comparable to those of a conventional ECG machine. The user-centered evaluation approach helped us identify remediable action to improve the efficiency in using the device and identified highly desirable device features that could potentially help mass screening and remote assessment of patients. The approach could be applied to evaluate and better understand the acceptability and usability of new medical devices.

A qualitative exploration of medical students' placement experiences with telehealth during COVID-19 and recommendations to prepare our future medical workforce.

BACKGROUND: Clinical practice is increasingly being digitalised. Little is known about how medical students learn and were exposed to telehealth during COVID-19. This is particularly important if we wish to further improve healthcare access and equity in rural areas and vulnerable populations. This formative study sought to explore the exposure and attitudes of medical students on telehealth and COVID-19 during their rural clinical placement in 2020 and provide recommendations. METHODS: Focus groups were held in August 2020 after completion of a 12-month rural placement. Questions centred around students' exposure and experiences with telehealth during COVID-19. Data was analysed using thematic analysis. RESULTS: There has been a clear shift in students now acknowledging the importance of telehealth and, more importantly, expressing a clear wish for telehealth to be embedded in the curriculum starting in their first year. In tandem with this, students expressed the need for their clinical supervisors or hospital teams to have the capability to practice telehealth efficiently as this will improve the telehealth experience and lead to better engagement for both staff and students. Furthermore, it was felt that rural clinicians should play a lead role in telehealth implementation given it is integral to rural practice. CONCLUSIONS: Medical students are more exposed to and more interested to learn about telehealth since COVID-19 and wish to see telehealth training built into their curriculum from the outset of medical school. Themes that emerged from this formative study can potentially assist in planning for telehealth education during and post COVID-19 and inform further telehealth research. Embedding telehealth skills training and guidelines into the medical program, and particularly rural medicine training programs, is essential to prepare the future medical workforce to ensure access and quality patient care during pandemics and also to improve access for rural Australians.

Interprofessional education in the rural environment to enhance multidisciplinary care in future practice: Breaking down silos in tertiary health education.

OBJECTIVE: Western Sydney University has implemented a rural interprofessional learning programme to promote collaborative care approaches to enhance cross-discipline communications, improve knowledge and clarity of roles and improve patient care and outcomes. DESIGN: Rural interprofessinal learning is an interprofessional educational approach, consisting of simulations of complex health events. Simulation methodology frames the study with a focus on human interaction. A mixed-methods evaluation has been conducted, incorporating pre- and post- event participant surveys along with semi-structured focus groups. SETTING: Simulations are conducted in the rural setting, including community settings, working farms and rural hospitals. MAIN OUTCOME MEASURES: Reflexive thematic analysis was used to identify themes measuring students' perceptions of interdisciplinary care, knowlede of other health discipline roles and skills and how they believe the exercise will influence their future practice. Facilitator feedback regarding the efficacy of the simulations was also recorded and analysed using reflexive thematic analysis. PARTICIPANTS: Care of simulated patient(s)/bystander(s) is primarily provided by paramedicine, nursing and medical students; however, increasing interest has expanded the programme to include students from a range of allied health professions. Simulations are facilitated by a multidisciplinary team of experienced practitioners and specialists. INTERVENTION: Four rural interprofessional learning events have been held. RESULTS: 120 students have participated in the evaluation. Findings include increased understanding of the contributions of other disciplines in enhancing patient care, team approaches, cross-discipline communication and a need to engage in collaborative care in future practice. CONCLUSION: Creating a collaborative learning environment creates a culture of multidisciplinary care, enhancing patient care and improving outcomes. The rural interprofessional learning model is an effective interprofessional educational approach, which can be repeated, refined and improved for continual professional development.

Incorporation of human papillomavirus self-sampling into the revised National Cervical Screening Program: a qualitative study of GP experiences and attitudes in rural New South Wales.

Human papillomavirus self-sampling is part of the revised Australian National Cervical Screening Program for eligible under- or never-screened women. Although research demonstrates self-sampling as an acceptable method from the perspective of women, little is known about GP experiences and perspectives of this new screening alternative. This study sought to explore the experiences and perspectives of rural GPs towards the revised National Cervical Screening Program and the new self-sampling option. Semistructured qualitative interviews were completed with 12 GPs in central west New South Wales. The study found that GPs had limited experience facilitating self-sampling. The limited provision of education, difficulty accessing testing kits, poor availability of accredited laboratories and unclear rebate guidelines hindered their capacity to offer self-sampling. GPs reported uncertainty around patient eligibility and the quality of self-collected samples. GPs explained that self-sampling could increase cervical screening participation among some women, but because it is only available to complete in a general practice, it would not benefit those who are disengaged from health services. Despite GPs' limited experience with facilitating self-sampling to date, they were optimistic about potential increases in cervical screening rates. Clearer articulation of specific program details and the evidence underpinning the program changes would reduce clinician uncertainty regarding the practicalities of how to incorporate patient-collected sampling into their daily practice, as well as the quality of patient-collected samples compared with clinician-collected samples. GPs must also be supported at a systems level to ensure there are processes in place to enable easy access to kits, laboratories, Medicare rebates and relevant support.

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.

'Re-placing' professional practice.

While preparation for professional practice is conceived as placeless, it is enacted in place. Consequently, many professionals find themselves working in conditions significantly different than those they were educated in and for. This is especially relevant for new professionals arriving in rural settings after preparation in urban programs, where metrocentric models of orientation to practice are implicitly privileged. The consequent dis-join between practice and place often results in new professionals feeling 'out of place' and questioning their professional competence. It also results in settings outside the metrocentric norm being viewed as less desirable practice contexts. Negative desirability hinders professional recruitment, while feeling out of place and incompetent hinders professional retention; both are longstanding issues in rural communities. Recent developments in professional education and practice standards emphasise adaptability to practise in specific contexts. However, 'context,' a primary focus to date for rural preparation is presented as a largely static backdrop that needs to be accommodated to engage in the 'real practice' one was trained for. Drawing on the spatial turn in social theory, we argue that place both shapes and is shaped by professionals and their practices and as such, must be engaged with deeply and dynamically. This conceptualisation of the relationship between place and practice has critical implications for professional preparation. As interdisciplinary practitioners and researchers working in diverse contexts, we examine 'place' from a social constructivist perspective as a focal point for professional preparation.

Exploring rural patients' understanding of the types, risk factors and measures to prevent healthcare-associated infections in Australia.

BACKGROUND: In Australia, there are approximately 165,000 healthcare-associated infections (HAIs) per year. Improving patient knowledge on HAIs and actively involving them in infection prevention is essential. This study assessed patient knowledge on types of and risk factors for HAIs and their perceptions of HAI information provision and hospital infection control practices in rural New South Wales, Australia. METHODS: Medical and surgical ward patients in three rural hospitals completed a questionnaire between February and March 2019. Open ended responses were grouped under categories, decided upon by two researchers, one of which is an infection prevention and control nurse. Descriptive analysis was completed. RESULTS: A total of 153 patients completed the survey. Most (n = 126, 82%) participants were previously aware of HAIs, with common sources of education/information being family/friends (n = 55, 36%), television (n = 28, 18%), newspapers (n = 27, 18%), and previous experience of a HAI (n = 20, 13%). Satisfaction with infection control measures and hospital cleanliness was high. Over half (n = 83, 54%) of participants thought they received too little information on HAIs, and only 35% (n = 21) of those that had surgery reported receiving information. Participants suggested that more education for the general public (n = 117, 76%) and patients (n = 110, 72%) in both written form and verbally from hospital staff, and education outside of the hospital in various mediums, could help reduce the risk and rates of HAI. CONCLUSION: Awareness of HAIs amongst respondents was high, however, education appeared to be lacking. More can be done to inform patient, family and general public education programs in rural and regional Australian hospitals.

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.

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.