What Does Men's Health Education Look Like in Australian University Health Curricula? A Formative Evaluation and Future Enhancement Opportunities.

OBJECTIVES: Developing the capacity of the health system, and the practitioners within it, to provide quality gender responsive care to men and boys remains critical to advancing men's health, and reducing health inequities amongst men. The aim for this study was to undertake a formative evaluation of Australian university health curricula for men's health content and scope the opportunities for future enhancement. METHODS: A two-stage evaluation first involved a review of online course information for a sample of medicine (n = 10), nursing (n = 10), pharmacy (n = 10), clinical psychology (n = 10), social work (n = 12) and public health (n = 15) university curricula for men's health and gender content and opportunities for curricula enhancement. Secondly, university staff completed a survey on the coverage of men's health in their course(s), and receptivity, barriers and facilitators to curricula enhancement. RESULTS: The curricula review found no dedicated men's health courses, and men's health was referenced in the information for 10 of 1246 courses (0.8%) in 8 of 67 curricula. Gender was rarely referenced in course information, particularly for the disciplines of medicine, nursing, pharmacy, and clinical psychology. There was an average of 16 enhancement opportunities per curricula with 40% relating to communicating and engaging with men within healthcare. Seventy staff from 25 universities and all target disciplines validated the curricula review findings of limited dedicated men's health content. Eighty-three percent were receptive to curricula enhancement, facilitated by content integration into existing courses. CONCLUSION: This review provides clear evidence that there are gaps, opportunities, and educator receptiveness for improving and implementing content regarding men's health education and gender responsive care in Australian university health curricula.

Approaches to Engaging Men During Primary Healthcare Encounters: A scoping review.

Gender-responsive healthcare is critical to advancing men's health given that masculinities intersect with other social determinants to impact help-seeking, engagement with primary healthcare, and patient outcomes. A scoping review was undertaken with the aim to synthesize gender-responsive approaches used by healthcare providers (HCPs) to engage men with primary healthcare. MEDLINE, PubMed, CINAHL, and PsycINFO databases were searched for articles published between 2000 and February 2024. Titles and abstracts for 15,659 citations were reviewed, and 97 articles met the inclusion criteria. Data were extracted and analyzed thematically. Thirty-three approaches were synthesized from across counseling/psychology, general practice, social work, nursing, psychiatry, pharmacy, and unspecified primary healthcare settings. These were organized into three interrelated themes: (a) tailoring communication to reach men; (b) purposefully structuring treatment to meet men's health needs, and (c) centering the therapeutic alliance to retain men in care. Strength-based and asset-building approaches focused on reading and responding to a diversity of masculinities was reinforced across the three findings. While these approaches are recommended for the judicious integration into health practitioner education and practice, this review highlighted that the evidence remains underdeveloped, particularly for men who experience health inequities. Critical priorities for further research include intersectional considerations and operationalizing gender-responsive healthcare approaches for men and its outcomes, particularly at first point-of-contact encounters.

"I'd have no idea how to go about this " - a survey of Australian medical students' perspectives on their men's health education.

BACKGROUND: While there have been calls over the last 15 years for the inclusion of training in sex and gender-based medicine in medical school curricula and to sustain such improvements through a more gender responsive health system, little progress has been made. A related objective of the Australian National Men's Health Strategy (2020-30) is to improve practitioner core learning competencies in men's health as a critical step to reducing the burden of disease in men and disparities between men in health care access and outcomes. The aim of this study was therefore to obtain Australian medical student perspectives on the extent to which men's health and sex and gender-based medicine education is delivered in their curricula, their preparedness for engaging with men in clinical practice, and the men's health content they would have found useful during their training. METHODS: Eighty-three students (48% male) from 17 accredited medical schools, and in at least their fourth year of training, completed an online survey. The survey was co-designed by a multidisciplinary team of men's health researchers and clinicians, alongside a student representative. A mix of quantitative and qualitative survey items inquired about students' preparedness for men's health clinical practice, and coverage of men's health and sex- and gender-based medicine in their curricula. RESULTS: Most students reported minimal to no men's health coverage in their medical school education (65%). While few were offered optional men's health units (10.5%), the majority would have liked more formal training on the topic (78%). Accompanying qualitative findings substantiated a lack of preparedness among medical students to engage male patients, likely stemming from minimal coverage of men's health in their medical education. CONCLUSIONS: Australian medical students may feel underprepared for contemporary men's health clinical practice, as well as, albeit to a lesser extent, women's health clinical practice. There is a clear need and desire amongst medical students to enhance curricula with sex and gender-based medicine training.

The COVID-19-forced transformation of general practitioner training from face-to-face to online delivery: A qualitative study of participants' experiences.

BACKGROUND AND OBJECTIVES: Outside the clinical space, face-to-face education essentially stopped when the COVID-19 pandemic started, largely substituted by online education. This provided an opportunity to explore general practice registrar and educator views about the benefits, challenges and enablers of both types of educational delivery. METHOD: This qualitative study included 45 registrars and medical educators from across Queensland, Australia. Transcripts of five focus groups and 22 semi-structured interviews were analysed thematically using the Framework Method. RESULTS: Major themes focused on social connection, learning engagement, content delivery, and time and space in relation to education. Other themes included technology, unplanned learning, learning safety and pastoral care. Face-to-face education was viewed more positively than online education, but many suggested ways to enhance online education. DISCUSSION: The importance of social connection dominated and underpinned many other themes identified as central to achieving safe and effective vocational general practitioner education.

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.

The educational affordances of external clinician observation of GP trainee consultations.

AIM: There is widespread agreement about the importance of direct observation of trainee practice by clinical supervisors. Less is known about observation by observers external to the supervisory team. We explored the educational affordances of external observation of GP trainee consultations for educational and assessment purposes, from the perspectives of both observers and trainees. METHOD: GP medical educators, who were scheduled to observe sessions of GP trainee consultations, were recruited as participant observers. They completed field notes, reflective memos and a focus group discussion, and conducted post-observation interviews with trainees, focused on trainee experiences of accessing educational input from supervisors and observers during the sessions. Thematic analysis was guided by constructivist realism and socio-cultural theory. RESULTS: A total of 23 observation sessions (131 observed patient consultations), 33 trainee interviews and 23 observer reflections were completed. External observers embraced teaching, coaching and pastoral opportunities, rather than being 'flies on the wall', despite also having research and assessment roles. They gained useful insights into the challenges of obtaining and providing in-consultation supervisory assistance and provided some in-consultation guidance themselves. Both trainees and observers experienced the sessions as valuable and collegial. Trainees appreciated post-consultation feedback conversations: topics included consultation challenges, managing uncertainty and variation in clinical practice. Patient expectations and pre-existing relationships influenced the distinctive interpersonal dynamic of the externally observed consultation. CONCLUSIONS: The educational affordances and interpersonal dynamics of external observation differ from supervisor observation. We recommend wider use in clinical training of observers who cross between educator and clinician communities.

Flags for seeking help: making supervisor expectations of general practice trainee help-seeking explicit.

Timely supervisor input into patient care plays a key role in ensuring the safety of patients under the care of general practice trainees. Current models of clinical supervision for trainees in both hospital and general practice training have, however, been criticised for placing too much onus on the trainee to request assistance, despite the many known barriers for trainees to do so. An important barrier to general practice trainee help-seeking is trainee uncertainty about when and how their clinical supervisor expects them to seek this assistance. We introduce a tool, 'Flags for Seeking Help', which was modified from an existing checklist, to assist supervisors to tailor their input to the care of their trainee's patients. The tool aims to make supervisor expectations of trainees explicit, including when trainees should request assistance during consultations (rather than defer this until more convenient opportunities) and when this assistance should be face-to-face (rather than by phone or messaging systems). Our aim is to reduce the barriers for trainees to request in-consultation and face-to-face supervision, in particular, when it is indicated. We outline the evidence which informed the development of the tool, and present some preliminary findings from a pilot in Australian general practice training.

Getting good help: a guide for reflection, debriefing and feedback conversations about in-consultation supervision.

Timely supervisor input to the care of their trainees' patients plays a key role in ensuring the safety of patients under the care of general practice trainees. Supervisor responses to trainee calls for assistance are also important for trainee learning and professional identity formation. The in-consultation supervisory encounter in general practice training is, however, a complex social space with multiple trainee, supervisor and patient agendas. Trainee requests for assistance during their consultations are known to present general practitioner supervisors with a number of challenges. From the trainee's perspective, a safe learning environment is essential during these supervisory interactions. A number of factors may act as barriers to, or reduce the usefulness of, in-consultation assistance in particular, resulting in trainees being less likely to seek such assistance on future occasions. It is therefore important to improve both trainee and supervisor skills in safe, effective and efficient in-consultation supervision. Making time for trainee and supervisor conversations about their help-seeking and help provision may uncover opportunities for improving skills, aligning agendas and enhancing outcomes. Finding time for debriefing, reflection and effective feedback conversations may be challenging, however, and opportunities for trainees to provide feedback to their supervisors are known to be particularly limited. We introduce a Debriefing, Reflection and Feedback Guide which is designed to prompt reflection, and structure effective and efficient debriefing and reciprocal feedback conversations. We outline the evidence which informed the development of the Guides, and present some preliminary findings from a pilot in Australian general practice training.

Good help: a model for providing in-consultation supervision of general practice trainees.

Timely clinical supervision of trainee consultations plays a key role in ensuring the safety of patients under the care of general practice trainees, and in trainee learning and professional development. Trainee requests for assistance during their consultations present supervisors with a number of challenges, however, and a number of factors act as barriers to, or reduce the utility of, this in-consultation assistance from the trainee's perspective. Face-to-face supervision in the presence of the patient presents particular challenges and opportunities. It is important to address barriers to trainee help-seeking and improve both trainee and supervisor skills in promoting safe, effective and efficient in-consultation supervision. We introduce a model (ß-LACTAM) to assist supervisors in planning and delivering their face-to-face in-consultation supervision. The recent evidence which informed the development of this model is outlined, and some preliminary findings from a pilot of ß-LACTAM in Australian general practice training are presented.

Validation of a Driving Simulator Study on Driver Behavior at Passive Rail Level Crossings.

OBJECTIVE: The behavioral validation of an advanced driving simulator for its use in evaluating passive level crossing countermeasures was performed for stopping compliance and speed profile. BACKGROUND: Despite the fact that most research on emerging interventions for improving level crossing safety is conducted in a driving simulator, no study has validated the use of a simulator for this type of research. METHOD: We monitored driver behavior at a selected passive level crossing in the Brisbane region in Australia for 3 months ( N = 916). The level crossing was then replicated in an advanced driving simulator, and we familiarized participant drivers ( N = 54) with traversing this crossing, characterized by low road and rail traffic. RESULTS: We established relative validity for the stopping compliance and the approach speed. CONCLUSION: This validation study suggests that driving simulators are an appropriate tool to study the effects of interventions at passive level crossing with low road and rail traffic, which are prone to reduced compliance due to familiarity. APPLICATION: This study also provides support for the findings of previous driving simulator studies conducted to evaluate compliance and approach speeds of passive level crossings.

Esoteric Connective Tissue Therapy for chronic low back pain to reduce pain, and improve functionality and general well-being compared with physiotherapy: study protocol for a randomised controlled trial.

BACKGROUND: Low back pain causes more global disability than any other condition. Once the acute pain becomes chronic, about two-thirds of sufferers will not fully recover after 1-2 years. There is a paucity of effective treatments for non-specific, chronic low back pain. It has been noted that low back pain is associated with changes in the connective tissue in the affected area, and a very low-impact treatment, Esoteric Connective Tissue Therapy (ECTT), has been developed to restore flexibility in connective tissue. ECTT uses patterns of very small, circular movements, to the legs, arms, spine, sacrum and head, which anecdotally are effective in pain relief. In an unpublished single-arm phase I/II trial with chronic pain patients, ECTT showed a 56% reduction in pain after five treatments and 45% and 54% improvements at 6 months and 7-9 years of follow-up respectively. METHODS: The aim of this randomised controlled trial is to compare ECTT with physiotherapy for reducing pain and improving physical function and physical and mental well-being in patients with chronic low back pain. The trial will be held at two hospitals in Vietnam. One hundred participants with chronic low back pain greater than or equal to 40/100 on the visual analogue scale will be recruited and randomised to either ECTT or physiotherapy. Four weekly treatments will be provided by two experienced ECTT practitioners (Treatment Group, 40 minutes each) and hospital-employed physiotherapy nurses (Control Group, 50 minutes). The primary outcomes will be changes in pain, physical function per the Quebec Pain Functionality Questionnaire and physical and mental well-being recorded by the Short Form Health Survey (SF-36), with mixed modelling used as the primary statistical tool because the data are longitudinal. Initial follow-up will be at either 4 or 8 months, with a second follow-up after 12 months. DISCUSSION: The trial design has important strengths, because it is to be conducted in hospitals under medical supervision, because ECTT is to be compared with a standard therapy and because the assessor and analyst are to be blinded. The findings from this trial will provide evidence of the efficacy of ECTT for chronic low back pain compared with standard physiotherapy treatment. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12616001196437 . Registered on 30 August 2016.

Impact of case management on rural women's quality of life and substance use.

INTRODUCTION: It is widely accepted that women experience drug dependency in different ways from men, including a greater sense of social stigma, higher levels of shame and self-blame, and higher rates of psychological co-morbidity. There is also evidence that women's experience of substance dependency may be negatively affected by living in a rural area. Recognising the complex needs of rural drug dependent women, a community-based case management model (known as WRAP--women's referral and access program) was developed, which adopted a holistic approach and aimed to address the physical, social and psychological dimensions of women's lives. This article reports a study to determine if this model was effective in meeting the women's broader support needs; and specifically whether it improved women's quality of life, health and social circumstances. METHODS: Women were assessed at baseline, 3 and 6 months, using a semi-structured interview, the WHO Quality of Life brief version (WHOQoL-BREF), Rosenberg Self-Esteem Scale, and the Brief Treatment Outcome Measure (BTOM). RESULTS: Sixty-three women were recruited to case management. After 6 months, 62% of women recruited remained in case management, with older women and those with better self-reported health status at recruitment more likely to do so. Consistent with women's subjective experience, there were significant improvements in self-esteem; the psychological domain of the WHOQoL-BREF; severity of dependence, psychological wellbeing and social functioning (BTOM); with reductions in drug dependency and drug use. The model, linking women with services and some direct service provision, was generally well accepted by women. CONCLUSION: The WRAP case management model, with its holistic approach and focus on improving women's quality of life rather than on reducing drug use per se and/or trying to move women into drug treatment, was successful. The model is well suited to implementation within the constraints of a rural setting. There is strong evidence for improvement in many areas of women's lives over a 6 month period of case management, and a trend towards continued improvement beyond 3 months of case management in some areas. For women, the success of case management was a result of the consistency and continuity provided by having one person who provided much needed support and assistance.