Burnout, wellbeing and how they relate: A qualitative study in general practice trainees.

PURPOSE: Although research has explored burnout risk factors among medical trainees, there has been little exploration of the personal experiences and perceptions of this phenomenon. Similarly, there has been little theoretical consideration of trainee wellbeing and how this relates to burnout. Our study aimed to conceptualise both constructs. METHOD: We situated this study within a post-positivist epistemology using grounded theory to guide the research process. Participants were recruited from one Australian General Practice training organisation. Fourteen trainees completed interviews, while a further five focus groups explored the views of 33 supervisors, educators and training coordinators. Data collection and analysis occurred concurrently, drawing upon constant comparison and triangulation. Template analysis, using an iterative process of coding, was employed to generate conceptual models of the phenomena of interest. RESULTS: Participants described burnout as an insidious syndrome lying on a spectrum, with descriptions coalescing under seven themes: altered emotion, compromised performance, disengagement, dissatisfaction, exhaustion, overexertion and feeling overwhelmed. Wellbeing was perceived to comprise personal and professional domains that interacted and were fuelled by an underlying 'reservoir'. Both constructs were linked by the degree of a trainee's value fulfilment, with burnout occurring when a trainee's wellbeing reservoir was depleted. CONCLUSIONS: Participants in this study characterised burnout and wellbeing as multifaceted, connected constructs. Given the complexity of these constructs, preventive interventions should target both person and workplace-focused factors, with value fulfilment proposed as the basic change mechanism. A novel model that synthesises and advances previous research is offered based on these findings.

Promoting Wellbeing among Family Medicine Trainees: A Hermeneutic Review of Intervention Mechanisms of Change and their Delivery Methods.

PHENOMENON: Efforts to promote wellbeing and reduce burnout amongst postgraduate medical trainees have been hampered by little consideration of interventions' underlying mechanisms, as well as how interventions are delivered. The critical role of trainee specialty has also been overlooked, despite the unique personal and work-based stressors faced among subgroups - such as those completing Family Medicine/General Practice. A consolidation of intervention research can help to guide the design, implementation and evaluation of future targeted programs and potentially enhance their effectiveness. The present hermeneutic literature review addresses this gap. APPROACH: The Embase, Ovid Medline, and Ovid PsycINFO databases were searched for articles exploring wellbeing and related concepts of burnout and stress amongst Family Medicine/General Practice trainees. Thirty-one studies were identified through seven iterative rounds, with articles that offered novel insights and/or addressed knowledge gaps identified in each round and analyzed, followed by refinement of the overarching coding structure. Thematic analysis was conducted by two researchers. FINDINGS: Proposed and enacted wellbeing interventions typically involved a combination of individualistic (e.g., self-awareness), organizational (e.g., increasing policy flexibility), and cultural (e.g., leadership) strategies. Change mechanisms were interpersonal (e.g., comradery) and, to a greater extent, intrapersonal (e.g., normalizing and accepting feelings of insecurity). Key delivery methods included the need to ingrain trainee wellness into daily work life and the importance of contextualizing interventions to increase their relevance, acceptance, and effectiveness. INSIGHTS: The present review identifies and consolidates key mechanisms of change intrinsic to wellbeing-promotion interventions, alongside delivery methods. These findings provide guidance for practice and research to identify these attributes of interventions in the design and evaluation stages. This, in turn, will enhance the clarity of what is being evaluated, facilitating more informed comparisons between evaluations.Supplemental data for this article is available online at at www.tandfonline.com/htlm .

The impact of climate change on the risk factors for tuberculosis: A systematic review.

BACKGROUND: Tuberculosis (TB) continues to pose a major public health risk in many countries. The current incidence of disease exceeds guidelines proposed by the World Health Organisation and United Nations. Whilst the relationship between climate change and TB has surfaced in recent literature, it remains neglected in global agendas. There is a need to acknowledge TB as a climate-sensitive disease to facilitate its eradication. OBJECTIVE: To review epidemiological and prediction model studies that explore how climate change may affect the risk factors for TB, as outlined in the Global Tuberculosis Report 2021: HIV infection, diabetes mellitus, undernutrition, overcrowding, poverty, and indoor air pollution. METHODS: We conducted a systematic literature search of PubMed, Embase, and Scopus databases to identify studies examining the association between climate variables and the risk factors for TB. Each study that satisfied the inclusion criteria was assessed for quality and ethics. Studies then underwent vote-counting and were categorised based on whether an association was found. RESULTS: 53 studies met inclusion criteria and were included in our review. Vote-counting revealed that two out of two studies found a positive association between the examined climate change proxy and HIV, nine out of twelve studies for diabetes, eight out of seventeen studies for undernutrition, four out of five studies for overcrowding, twelve out of fifteen studies for poverty and one out of three studies for indoor air pollution. DISCUSSION: We found evidence supporting a positive association between climate change and each of the discussed risk factors for TB, excluding indoor air pollution. Our findings suggest that climate change is likely to affect the susceptibility of individuals to TB by increasing the prevalence of its underlying risk factors, particularly in developing countries. This is an evolving field of research that requires further attention in the scientific community.

Wellbeing Conceptualizations in Family Medicine Trainees: A Hermeneutic Review.

PHENOMENON: High levels of burnout have been widely reported among postgraduate medical trainees, however relatively little literature has examined what 'wellbeing' means for this group. Moreover, the literature that does exist has generally overlooked the potential role of specialty factors in influencing such conceptualizations. This is particularly true for family medicine and general practice trainees - a specialty considered to be unique due, in part, to its focus on community-based care. The present review sought to explore conceptualizations of wellbeing specifically within the context of family medicine and general practice training. APPROACH: The Embase, Ovid Medline, and PsycINFO databases were searched from inception to November 2019 for literature examining wellbeing in family medicine and general practice trainees. Literature was iteratively thematically analyzed through the process of a hermeneutic cycle. In total, 36 articles were reviewed over seven rounds, at which point saturation was reached. FINDINGS: The findings confirm the complex and multifaceted nature of wellbeing as experienced by family medicine and general practice trainees. An emphasis on psychological factors - including emotional intelligence, positive mental health, self-confidence and resilience - alongside positive interpersonal relationships, rewards, and balanced interactions between trainees' personal and professional demands were deemed critical elements. INSIGHTS: A model of wellbeing that emphasizes rich connections between trainees' personal and professional life domains is proposed. Further qualitative research will help to extend current understanding of wellbeing among medical trainees, including the individuality of each specialty's experiences, with the potential to enhance interventional efforts.

Identifying the at-risk General Practice trainee: a retrospective cohort meta-analysis of General Practice registrar flagging.

A central principle of programmatic assessment is that the final decision is not a surprise to the learner. To achieve this, assessments must demonstrate predictive and consequential validity, however, to date, research has only focussed on the former. The present study attempts to address this gap by examining the predictive and consequential validity of flagging systems used by Australian General Practice regional training organisations (RTOs) in relation to Fellowship examinations. Informed by unstructured interviews with Senior Medical Educators to understand the flagging system of each RTO, meta-analyses of routinely-collected flagging data were used to examine the predictive validity of flagging at various points in training and exam performance. Additionally, flagging system features identified from the interviews were used to inform exploratory subgroup analyses and meta-regressions to further assess the predictive and consequential validity of these systems. Registrars flagged near the end of their training were two to four times more likely to fail Fellowship exams than their non-flagged counterparts. Regarding flagging system features, having graded (i.e. ordinal) flagging systems was associated with higher accuracy, whilst involving the assigned medical educator in remediation and initiating a formal diagnostic procedure following a flag improved registrars' chances of passing exams. These results demonstrate both predictive and consequential validity of flagging systems. We argue that flagging is most effective when initiated early in training in conjunction with mechanisms to maximise diagnostic accuracy and the quality of remediation programs.

Workplace-based assessments in postgraduate medical education: A hermeneutic review.

OBJECTIVES: Since their introduction, workplace-based assessments (WBAs) have proliferated throughout postgraduate medical education. Previous reviews have identified mixed findings regarding WBAs' effectiveness, but have not considered the importance of user-tool-context interactions. The present review was conducted to address this gap by generating a thematic overview of factors important to the acceptability, effectiveness and utility of WBAs in postgraduate medical education. METHOD: This review utilised a hermeneutic cycle for analysis of the literature. Four databases were searched to identify articles pertaining to WBAs in postgraduate medical education from the United Kingdom, Canada, Australia, New Zealand, the Netherlands and Scandinavian countries. Over the course of three rounds, 30 published articles were thematically analysed in an iterative fashion to deeply engage with the literature in order to answer three scoping questions concerning acceptability, effectiveness and assessment training. As each round was coded, themes were refined and questions added until saturation was reached. RESULTS: Stakeholders value WBAs for permitting assessment of trainees' performance in an authentic context. Negative perceptions of WBAs stem from misuse due to low assessment literacy, disagreement with definitions and frameworks, and inadequate summative use of WBAs. Effectiveness is influenced by user (eg, engagement and assessment literacy) and tool attributes (eg, definitions and scales), but most fundamentally by user-tool-context interactions, particularly trainee-assessor relationships. Assessors' assessment literacy must be combined with cultural and administrative factors in organisations and the broader medical discipline. CONCLUSIONS: The pivotal determinants of WBAs' effectiveness and utility are the user-tool-context interactions. From the identified themes, we present 12 lessons learned regarding users, tools and contexts to maximise WBA utility, including the separation of formative and summative WBA assessors, use of maximally useful scales, and instituting measures to reduce competitive demands.

Adaptation and initial examination of the psychometric properties of the Short Supervisory Relationship Questionnaire (SSRQ) for use with general practice registrars.

The relationship between general practice (GP) registrars and their supervisors underpins the training experience for the next generation of medical practitioners. Building on recent research into the development and validation of a measure of the relationship between registrars and supervisors from the perspective of the supervisor, the current study focuses on the educational alliance from the perspective of the registrar. This paper presents an adaptation and initial validation of the clinical psychology supervisory relationship measure for GP registrars in an Australian context. Following an Expert Group review and adaptation of the items, 238 GP registrars completed the adapted tool. Using exploratory factor analysis and Procrustes confirmatory rotation, an optimal four factor model of the supervisory relationship was identified, reflecting measures of Safe base (α =.93), Supervisor investment (α =.96), Registrar professionalism (α =.90), and Emotional intelligence (α =.87). The general practice supervisory relationship measure for registrars (GP-SRMR) demonstrated excellent model fit, high internal consistency, and was theoretically consistent with the original tool. Implications for clinical education and future research are presented.

Entrustable professional activities for workplace assessment of general practice trainees.

OBJECTIVE: To assess whether entrustment levels for junior trainees with respect to entrustable professional activities (EPAs) increase over time; whether entrustment levels for senior trainees are higher than for junior trainees; and whether self-assessment of entrustment levels by senior trainees more closely matches supervisor assessment than self-assessment by junior trainees. DESIGN, SETTING, PARTICIPANTS: Observational study of 130 junior and 153 senior community-based general practice trainees in South Australia, 2017. MAIN OUTCOME MEASURES: Differences in entrustment levels between junior and senior trainees; change in entrustment levels for junior trainees over 9 months; concordance of supervisor and trainee assessment of entrustment level over 9 months. RESULTS: Senior trainees were 2.1 (95% CI, 1.66-2.58) to 3.7 times (95% CI, 2.60-5.28) as likely as junior trainees to be entrusted with performing clinical EPAs without supervision. The proportion of EPAs with which junior trainees were entrusted to perform unsupervised increased from 26% at 3 months to 35% at 6 months (rate ratio [RR], 1.37; 95% CI; 1.15-1.63), to 50% at 9 months (RR, 1.92; 95% CI, 1.64-2.26), and 69% at 12 months (RR, 2.68; 95% CI; 2.32-3.12). At 3 months, the mean differences in entrustment ratings between supervisors and trainees was 5.5 points (SD, 6.6 points) for junior trainees and 2.93 points (SD, 2.8 points) for senior trainees (P < 0.001). CONCLUSIONS: EPAs are valid assessment tools in a workplace-based training environment.

Prevalence of Helicobacter pylori infection in newly arrived refugees attending the Migrant Health Service, South Australia.

BACKGROUND: To determine the prevalence of Helicobacter pylori infection in the refugee population attending the Migrant Health Service, South Australia, identify demographic factors associated with infection and compare prevalence of infection in refugees with that of the nonrefugee population in Australia. MATERIALS AND METHODS: Cross-sectional study conducted between October 2010 and August 2013. Monoclonal stool antigen testing for H. pylori infection is performed as part of a comprehensive health assessment for newly arrived refugees. The sample population included 922 adults and children. Outcome measures were (i) prevalence of H. pylori infection (ii) association between demographic factors such as sex, ethnicity and age, and H. pylori infection. RESULTS: H. pylori infection was detected in 198 (21.5%) participants (95% CI 18.9%-24.3%). The odds of infection were lower in females OR 0.71 (95% CI 0.51-0.98) compared to males. Compared to Middle Eastern participants, the odds of infection were 1.75 (95% CI 1.17-2.62) times higher in African and 1.90 (95% CI 1.10-3.26) times higher in Burmese participants. Infection was not associated with age. DISCUSSION AND CONCLUSION: H. pylori infection is common among newly arrived refugees. The long latency of infection to development of complications and the availability of testing and relatively effective eradication regimens all add weight to a decision to screen in this population.

Newly arrived refugee children with Helicobacter pylori are thinner than their non-infected counterparts.

The hypothesis of this study was that those refugee children with Helicobacter pylori are thinner than their non-infected counterparts. This cross-sectional study investigated the height and weight of newly arrived refugee children up to age 19 years, who were screened for H. pylori using a stool antigen test at the Migrant Health Service in Adelaide between August 2010 and October 2013. Of 460 children, 21% were infected with H. pylori. After adjusting for vitamin B12 and iron levels, ethnicity, age and sex, the odds of being thin in the 10- to 19-year-old age group was 4.28-fold higher (95% CI 1.48-12.4) if they were H. pylori positive compared with those who were H. pylori negative. The difference between the two groups is statistically significant (P=0.01). Screening and treatment for H. pylori in the general population in developed countries is not recommended unless there are symptoms such as dyspepsia or risk of peptic ulcer, duodenal ulcer or gastric cancer. Given the findings of this study, a recommendation could be made that newly arrived refugee children who are thin should be tested for H. pylori. Thinness in children may influence their cognitive ability, school performance, physical endurance and hence their ability to successfully settle into their new country.

Age determination in refugee children: A narrative history tool for use in holistic age assessment.

AIM: To present the rationale for using a narrative history tool as part of a holistic age assessment of accompanied refugee children with age uncertainty by exploring cultural narratives of age. METHODS: Seven small group, semi-structured interviews with 24 humanitarian entrants (10 male, 14 female) recruited from Afghan, Bhutanese and Burundian communities in Adelaide, Australia were conducted. Interviews were performed with interpreters present, audio-recorded, transcribed verbatim and thematically analysed. RESULTS: Four themes emerged: the significance of age; ways of remembering age; the refugee experience and its effect on age recall; and the reliability and permissibility of documentation. Age was significant, but understood and remembered differently with knowledge of an exact date of birth not required for functioning in participants' home societies. Information regarding age was embedded in narrative accounts, related to events and other people. Birth was not always registered, with birth and age-containing documentation obtained later in life. These documents often reflected cultural ideas regarding age, rather than recording true chronological age. The refugee experience profoundly affected the ability of people to remember their age by disrupting methods used to recall specific events, including birth. CONCLUSION: Narrative history provides valuable information regarding age in accompanied refugee children with age uncertainty, and allows for age to be located within a range that approximates true chronological age when age documentation is absent or clearly erroneous. The Age Assessment Tool questionnaire provides health professionals with a framework for conducting age assessment interviews.

A holistic approach to age estimation in refugee children.

AIM: Many refugee children arriving in Australia have an inaccurately documented date of birth (DOB). A medical assessment of a child's age is often requested when there is a concern that their documented DOB is incorrect. This study's aim was to assess the accuracy a holistic age assessment tool (AAT) in estimating the age of refugee children newly settled in Australia. METHODS: A holistic AAT that combines medical and non-medical approaches was used to estimate the ages of 60 refugee children with a known DOB. The tool used four components to assess age: an oral narrative, developmental assessment, anthropometric measures and pubertal assessment. Assessors were blinded to the true age of the child. Correlation coefficients for the actual and estimated age were calculated for the tool overall and individual components. RESULTS: The correlation coefficient between the actual and estimated age from the AAT was very strong at 0.9802 (boys 0.9748, girls 0.9876). The oral narrative component of the tool performed best (R = 0.9603). Overall, 86.7% of age estimates were within 1 year of the true age. The range of differences was -1.43 to 3.92 years with a standard deviation of 0.77 years (9.24 months). CONCLUSIONS: The AAT is a holistic, simple and safe instrument that can be used to estimate age in refugee children with results comparable with radiological methods currently used.

A brief experience for medical students in a remote Aboriginal community.

BACKGROUND: Aboriginal and Torres Strait Islander peoples, particularly those in remote communities, have lower access to health services when compared with the rest of the Australian population. This research examined the expectations and outcomes of medical students who went on a 2-day trip to a remote Aboriginal community. METHODS: Activities were organised by community members, ground staff and fly-in fly-out health professionals. Students wrote about their expectations and post-trip reflections on personal, medical and cultural themes. RESULTS: Twenty-three students participated in this study. Themes included complex, different and increased illnesses; how culture affects day-to-day life and health; personal growth; administrative, health delivery and advocacy skills; learning cultural awareness first-hand; and future career options. DISCUSSION: The 2-day trip gave students a profound learning experience. To build a culturally appropriate and dedicated workforce for Aboriginal and Torres Strait Islander peoples, medical schools should consider incorporating short trips to remote Aboriginal and Torres Strait Islander communities into their curriculum.

Low levels of vitamin B12 can persist in the early resettlement of refugees: symptoms, screening and monitoring.

BACKGROUND: Many refugees have vitamin B12 (B12) deficiency. It has been assumed that deficiency would be predictable from macrocytosis or symptoms, and borderline levels would improve after a period of resettlement in countries rich with animal-source foods. We explored B12 levels and symptoms soon after the refugees' arrival and 4-8 months after settlement in Australia. METHODS: Newly arrived refugees aged >18 years (n = 136) were tested for vitamin B12 and haematological indices. They also completed a language-validated questionnaire, which they repeated 4-8 months after arrival. B12 levels were reassessed in patients with levels ≤240 pmol at baseline. RESULTS: We found that 21 participants (15%) had low levels of B12 (≤150 pmol/L) and 65 (48%) had borderline B12 levels (151-240 pmol/L). There was no relationship between B12 level and mean corpuscular volume, ferritin or symptoms. Borderline B12 levels persisted in 64% of participants at follow-up and deficiency developed in 11%. CONCLUSION: B12 levels cannot be predicted from macrocytosis or symptoms, and may not 'self-correct' after resettlement. Health assessments for newly arrived refugees should include B12 measurement and those with borderline levels should be followed up.

Extreme heat and cultural and linguistic minorities in Australia: perceptions of stakeholders.

BACKGROUND: Despite acclimatisation to hot weather, many individuals in Australia are adversely affected by extreme heat each summer, placing added pressure on the health sector. In terms of public health, it is therefore important to identify vulnerable groups, particularly in the face of a warming climate. International evidence points to a disparity in heat-susceptibility in certain minority groups, although it is unknown if this occurs in Australia. With cultural diversity increasing, the aim of this study was to explore how migrants from different cultural backgrounds and climate experiences manage periods of extreme heat in Australia. METHODS: A qualitative study was undertaken across three Australian cities, involving interviews and focus groups with key informants including stakeholders involved in multicultural service provision and community members. Thematic analysis and a framework approach were used to analyse the data. RESULTS: Whilst migrants and refugees generally adapt well upon resettlement, there are sociocultural barriers encountered by some that hinder environmental adaptation to periods of extreme heat in Australia. These barriers include socioeconomic disadvantage and poor housing, language barriers to the access of information, isolation, health issues, cultural factors and lack of acclimatisation. Most often mentioned as being at risk were new arrivals, people in new and emerging communities, and older migrants. CONCLUSIONS: With increasing diversity within populations, it is important that the health sector is aware that during periods of extreme heat there may be disparities in the adaptive capacity of minority groups, underpinned by sociocultural and language-based vulnerabilities in migrants and refugees. These factors need to be considered by policymakers when formulating and disseminating heat health strategies.

Communicating medical information with Aboriginal patients: lessons learned from GPs and GP registrars in Aboriginal primary health care.

BACKGROUND: Aboriginal culture stands as the oldest continuous culture in the world. It gives paramount importance to a harmonious balance between personal connections to the body, spirit, and mind, as well as collective relationships with family, land, and community, integral to the wellbeing of Aboriginal people. However, obstacles can emerge for patients due to language barriers, cultural differences, or a historical lack of trust in the healthcare system. The establishment of Aboriginal Community Controlled Health Organisations (ACCHOs) has undoubtedly improved the healthcare experience for Aboriginal patients, yet there is limited research on the specific approaches utilised by general practitioners (GPs) working in these clinics. METHODS: Twelve semi-structured interviews were conducted with two groups of GPs working in Aboriginal health. Each GP was presented with three scenarios and asked questions related to each scenario. Braun and Clarke's method of thematic analysis was applied to transcribed interviews. RESULTS: Patient-doctor relationship, health literacy, and engagement with the health system emerged as key factors influencing communication with Aboriginal patients. Experienced GPs, despite differing clinical backgrounds, shared concise yet similar ideas to their less experienced counterparts. Notably, experienced GPs prioritised non-medical conversations and mindful body language, emphasising the importance of building strong patient relationships over other consultation aspects. CONCLUSIONS: This research provides initial insights for GPs in Aboriginal health, comparing experienced GPs with more than 10years experience to novices. However, further research involving Aboriginal patients is needed to validate GP strategies and understand their significance from the patients' perspective.

'Being in a place where it matters': GPs who do and do not work in Aboriginal Health Services.

BACKGROUND: Few general practitioners (GPs) pursue a career in Aboriginal and Torres Strait Islander health. This research examined factors motivating Australian General Practice Training Program (AGPT) graduates to remain in, or leave, Aboriginal Medical Services (AMSs). METHODS: AGPT graduates who remained (n =11) and left (n =9) AMSs after placements participated in semi-structured interviews across two studies. Thematic analysis informed by grounded theory was employed. RESULTS: Both participant groups highlighted similar motivations for requesting an AMS placement, particularly their interest in Aboriginal health or culture. Participants enjoyed organisational structures and relationships, and faced similar barriers to working in AMSs. Those who left placed greater emphasis on the politics and bureaucracy, and unpredictability, and also faced the barrier of ties to their current practice. Those who remained in Aboriginal health more proactively addressed barriers and had a more external view of barriers. CONCLUSIONS: Factors influencing career decisions of GPs in Aboriginal health overlap with those for GPs in rural and other under-served areas. Training providers can better prepare (e.g. more comprehensive orientations) and support registrars during their placements (e.g. greater mentoring). Registrars' perceptions of, and reactions to, barriers may be pivotal in determining whether they remain in Aboriginal health. This article provides guidance for training providers to better support AMS registrars and encourage more GPs to work in this sector.

Family medicine and general practitioner supervisor wellbeing: a literature review.

BACKGROUND: Research examining general practice supervisor wellbeing has often been conducted within the context of trainee wellbeing and educational outcomes. AIM: To consolidate the current literature regarding the wellbeing of GP supervisors through a 'supervisor-wellbeing' lens. DESIGN & SETTING: Literature review of original research studies on Embase, Ovid MEDLINE, and Ovid PsycINFO from inception to December 2022. METHOD: The Embase, Ovid MEDLINE, and Ovid PsycINFO databases were systematically searched from inception to December 2022. Original research studies were eligible if they explored any aspect of wellbeing or burnout (that is, construct conceptualisations, risk and protective factors, implications, or interventions) among GPs involved in educating GP trainees. Reporting quality of included studies was assessed using the QualSyst tool. Results from included studies were narratively synthesised. RESULTS: Data from 26 independent samples were reviewed. Burnout was generally conceptualised using the Leiter and Maslach model. Wellbeing was poorly defined in the literature, largely being conceptualised in personal psychological terms and, to a lesser extent, professional satisfaction. Risk and protective factors were identified and grouped as individual (for example, satisfaction with capacity to teach) and external (for example, autonomy, collegial relationships, resource availability) factors. GP supervisors' wellbeing appeared to affect their job performance and retention. This review identified only two studies evaluating interventions to support GP supervisors' wellbeing. CONCLUSION: The present review highlights a lack of conceptual clarity and research examining interventions for GP supervisor wellbeing. It provides guidance for future research designed to maximise the wellbeing of GP supervisors and support the wellbeing of trainees.

'A sense of self, empowerment and purposefulness': professional diversification and wellbeing in Australian general practitioners.

BACKGROUND: Burnout and workforce shortages comprise a vicious cycle in medicine, particularly for Australian general practitioners (GPs). Professional diversification, whereby individuals work multiple roles across their week, may help address this problem, but this strategy is under-studied. METHODS: We surveyed 1157 Australian GPs using qualitative and quantitative questions examining professional diversification, values, autonomy, and wellbeing. Quantitative data were analysed using inferential statistics, whilst qualitative data were analysed using inductive thematic analysis. We triangulated the data by using the qualitative findings to inform further quantitative testing. RESULTS: Approximately 40% of the sample had diversified. Although diversifying was not significantly associated with wellbeing, the qualitative data indicated that diversification supported GPs' wellbeing by enhancing career sustainability, accomplished through various pathways (e.g. value fulfilment, autonomy, variety). Subsequent quantitative analyses provided evidence that these pathways mediated the relationship between diversification and wellbeing. To diversify, GPs needed particular personal qualities, external supports, flexibility, and serendipity. Barriers to diversifying mirrored these factors, spanning individual (e.g. skillset) and situational levels (e.g. autonomy, location). CONCLUSIONS: Diversification can support GPs' wellbeing if it meets their needs. Organisations should focus on publicising opportunities and accommodating requests to diversify.

Burnout and wellbeing in the Australian general practice training context: Stakeholder-informed guidelines

METHOD: This study forms part of a larger evaluation of general practice registrar burnout and wellbeing. Feedback on preliminary guidelines developed from this evaluation was sought through two rounds of consultation within one regional training organisation. Qualitative data were thematically analysed. RESULTS: Themes focused on enhancing participants' awareness of resources, providing practical guidance and prioritising burnout prevention. A refined list of strategies and preliminary conceptual framework for registrars, practices, training organisations and the broader medical system were developed. DISCUSSION: Principles of communication, flexibility and knowledge were endorsed, as was the need to prioritise wellbeing and enhance trainee support. These findings provide an important step to developing contextualised, preventive interventions for Australian general practice training.