Reimagining rural clinical education from lessons learnt during COVID.

BACKGROUND: Securing access to sufficient and focussed learning experiences is a perennial challenge for medical trainees. This challenge was accentuated during the COVID-19 pandemic lockdowns and with physical isolation processes that decreased in-person patient presentations and a shift to telehealth consultations. This situation has prompted the need to optimise the available experiences and educational responses to overcome the limitations in the number, quantum and range of available clinical learning experiences. METHODS: Semi-structured interviews were conducted with medical practice teams in four rural general practices to understand how medical trainees' education in rural general practices can be sustained in such circumstances. FINDINGS: Key considerations included optimising the available experiences to assist medical trainees to generate the kinds of mental models needed by trainees to conduct medical work, and particularly, when it became even more restricted through remote or physically distanced consultations. It also identified lessons learnt during COVID-19 pandemic lockdowns to inform and improve the provision of trainees' experiences in such practices. DISCUSSION: Providing experiences for trainees to participate fully in clinical activities is imperative. A sequenced set of experiences was proposed to incrementally prepare trainees to engage in and conduct clinical consultations remotely using digital technologies. CONCLUSION: Such an approach may not always be easy or possible to enact but offers a pathway of experiences most likely to lead to positive outcomes for the trainees whilst maintaining patient care and safety considerations.

The influence of psychological safety on feedback conversations in general practice training.

INTRODUCTION: Fostering trainee psychological safety is increasingly being recognised as necessary for effective feedback conversations. Emerging literature has explored psychological safety in peer learning, formal feedback and simulation debrief. Yet, the conditions required for psychologically safe feedback conversations in clinical contexts, and the subsequent effects on feedback, have not been explored. METHODS: We conducted a qualitative study using interviews and longitudinal audio-diaries with 12 rural general practice trainees. The data were analysed using framework thematic analysis to identify factors across the data and as individual participant case studies with illustrative vignettes of dynamic interleaving of factors in judgements about feedback conversations. FINDINGS: Findings identify the influence of intrapersonal (e.g. confidence and comfort to seek help), interpersonal (e.g. trust and relationship) and sociocultural factors (e.g. living and working in a rural community) that contribute to psychological safety in the context of everyday feedback conversations. Multiple factors interplayed in feedback conversations where registrars could feel safe and unsafe within one location and even at the one time. DISCUSSION: Participants felt psychologically safe to engage their educators in sanctioned systems of conversation related to the immediate care of the patient and yet unsafe to engage in less patient related performance conversations despite the presence of multiple positive interpersonal factors. The concept of a safe 'container' (contained space) is perhaps idealised when it comes to feedback conversations about performance in the informal and emergent spaces of postgraduate training. More research is needed into understanding how clinical environments can sanction feedback conversations in clinical environments.

Chronic Disease and Health Risk Behaviors Among Rural Agricultural Workforce in Queensland.

INTRODUCTION: Little is known of the lifestyle behaviors and prevalence of chronic disease in the Australian agricultural workforce. This study aimed to assess behavioral risk factors and the prevalence of chronic disease among attendees of agricultural events in rural Queensland. METHODS: Data on lifestyle risk factors and prevalence of diabetes and cardiovascular diseases were collected from participants in four separate cross-sectional studies in rural southern Queensland. Anthropometric measures, blood pressure, serum cholesterol, and glucose levels of consenting participants were assessed by trained medical students under the supervision of rural clinicians. Data were analyzed using SPSS 22 statistical software package and t-tests and chi-square tests were used to compare differences between groups. RESULTS: A total of 702 attendees participated; the majority were agricultural workers (n = 393). Greater psychological distress was reported among participants from these rural communities (42%) than in the Australian population (31%); however, levels of psychological distress was similar between agricultural workers and others in the sample. Fewer people in these agricultural communities reported smoking (10%), and they reported being more active (86%) than the average Australian, but a greater proportion reported high-risk alcohol consumption (53%) and were found to be hypertensive (31%). These findings were accentuated among agricultural workers. CONCLUSION: This method of investigation both raises awareness in the community and identifies health risks for further management in a group that has otherwise been poorly defined. Resident agricultural workers have different health risks and behaviors, though psychological distress appears to be borne across these communities.