Exploring how Australian general practice registrars define cultural safety with Aboriginal and Torres Strait Islander patients: a mixed method study.

BACKGROUND: Understanding how the general practice medical workforce defines cultural safety may help tailor education and training to better enable community-determined culturally safe practice. This project seeks to explore how Australian general practice registrars define cultural safety with Aboriginal and Torres Strait Islander patients and alignment with an Australian community derived definition of cultural safety. METHODS: This mixed method study involved a survey considering demographic details of general practice registrars, questionnaire, and semi-structured interviews to explore how general practice registrars defined cultural safety and a culturally safe consultation. RESULTS: Twenty-six registrars completed the survey. Sixteen registrars completed both the survey and the interview. CONCLUSION: This study shows amongst this small sample that there is limited alignment of general practice registrars' definitions of cultural safety with a community derived definition of cultural safety. The most frequently cited aspects of cultural safety included accessible healthcare, appropriate attitude, and awareness of differences.

Validating the knowledge represented by a self-organizing map with an expert-derived knowledge structure.

BACKGROUND: Professionals are reluctant to make use of machine learning results for tasks like curriculum development if they do not understand how the results were generated and what they mean. Visualizations of peer reviewed medical literature can summarize enormous amounts of information but are difficult to interpret. This article reports the validation of the meaning of a self-organizing map derived from the Medline/PubMed index of peer reviewed medical literature by its capacity to coherently summarize the references of a core psychiatric textbook. METHODS: Reference lists from ten editions of Kaplan and Sadock's Comprehensive Textbook of Psychiatry were projected onto a self-organizing map trained on Medical Subject Headings annotating the complete set of peer reviewed medical research articles indexed in the Medline/PubMed database (MedSOM). K-means clustering was applied to references from every edition to examine the ability of the self-organizing map to coherently summarize the knowledge contained within the textbook. RESULTS: MedSOM coherently clustered references into six psychiatric knowledge domains across ten editions (1967-2017). Clustering occurred at the abstract level of broad psychiatric practice including General/adult psychiatry, Child psychiatry, and Administrative psychiatry. CONCLUSIONS: The uptake of visualizations of published medical literature by medical experts for purposes like curriculum development depends upon validation of the meaning of the visualizations. The current research demonstrates that a self-organizing map (MedSOM) can validate the stability and coherence of the references used to support the knowledge claims of a standard psychiatric textbook, linking the products of machine learning to a widely accepted standard of knowledge.

Defining the Boundaries of Psychiatric and Medical Knowledge: Applying Cartographic Principles to Self-Organising Maps.

Biases in selection, training, and continuing professional development of medical specialists arise in part from reliance upon expert judgement for the design, implementation, and management of medical education. Reducing bias in curriculum development has primarily relied upon consensus processes modelled on the Delphi technique. The application of machine learning algorithms to databases indexing peer-reviewed medical literature can extract objective evidence about the novelty, relevance, and relative importance of different areas of medical knowledge. This study reports the construction of a map of medical knowledge based on the entire corpus of the MEDLINE database indexing more than 30 million articles published in medical journals since the 19th century. Techniques used in cartography to maximise the visually intelligible differentiation between regions are applied to knowledge clusters identified by a self-organising map to show the structure of published psychiatric evidence and its relationship to non-psychiatric medical domains.

Strategies for facilitating social work placements in general practice.

BACKGROUND: Hosting social work placements within general practice can provide opportunities to extend interdisciplinary skills, increase the ability to meet patient needs and improve understanding of social work as a discipline. OBJECTIVE: This paper is based on an Australian pilot project involving social work students being placed in general practice for their 500-hour placements. Collaboratively written by academics and practitioners from social work and general practice, it provides key strategies guiding practices to optimise implementing social work student placements. It identifies strategies to design the placement, select students and to prepare practices, supervisors and students to benefit student learning and the general practice. DISCUSSION: Preparing key stakeholders, providing targeted supervision, longer appointments for social work students and involving all stakeholders are key strategies to successfully facilitate social work placements in general practice. Hosting social work students effectively can further develop multidisciplinary practice, connecting general practices even more with best practice, research and community.

How does GP training impact rural and remote underserved communities? Exploring community and professional perceptions.

BACKGROUND: Substantial government funding has been invested to support the training of General Practitioners (GPs) in Australia to serve rural communities. However, there is little data on the impact of this expanded training on smaller communities, particularly for smaller rural and more remote communities. Improved understanding of the impact of training on underserved communities will assist in addressing this gap and inform ongoing investment by governments and communities. METHOD: A purposive sample of GP supervisors, GP registrars, practice managers and health services staff, and community members (n = 40) from previously identified areas of workforce need in rural and remote North-West Queensland were recruited for this qualitative study. Participants had lived in their communities for periods ranging from a few months to 63 years (Median = 12 years). Semi-structured interviews and a focus group were conducted to explore how establishing GP training placements impacts underserved communities from a health workforce, health outcomes, economic and social perspective. The data were then analysed using thematic analysis. RESULTS: Participants reported they perceived GP training to improve communities' health services and health status (accessibility, continuity of care, GP workforce, health status, quality of health care and sustainable health care), some social factors (community connectedness and relationships), cultural factors (values and identity), financial factors (economy and employment) and education (rural pathway). Further, benefits to the registrars (breadth of training, community-specific knowledge, quality of training, and relationships with the community) were reported that also contributed to community development. CONCLUSION: GP training and supervision is possible in smaller and more remote underserved communities and is perceived positively. Training GP registrars in smaller, more remote communities, matches their training more closely with the comprehensive primary care services needed by these communities.

COVID-19: General practice education in the 'new normal'.

COVID-19 has provided learning opportunities for medical students, supervisors and the public.

Design and Evaluation of a Professional Identity Development Program for Pharmacy Students.

Objective. To design and evaluate a professional identity program (PIP) based on self-determination theory (SDT) for entering Bachelor of Pharmacy (BPharm) students. Methods. The PIP, which featured autonomy-supportive teaching approaches, was delivered as 10 workshops that were integrated into existing pharmacy courses over the first four semesters (2 years) of the BPharm program. The program was evaluated using a student satisfaction survey and two previously validated tools for measuring professional identity (MCPIS-9) and motivation to study pharmacy (Pharm-S). Nonparametric statistical techniques were used to compare students' scores before and after introducing the PIP. Results. Students responded positively to the introduction of the PIP in the pharmacy program. Based on survey responses, the students valued opportunities to engage in activities and discussions related to professional development and identity formation. Student scores on the motivation-based tool (Pharm-S) increased by the end of the first year of participation in the PIP, indicating an increase in student autonomy levels. There was no change in students' scores on the professional identity measure (MCPIS-9) after the first year. Conclusion. The use of SDT-based instruction in professional identity education resulted in increased levels of autonomy in pharmacy students, indicating a transition to more intrinsic levels of motivation. This has the potential to positively impact student professional identity and future professional practice.

International approaches to rural generalist medicine: a scoping review.

BACKGROUND: Contemporary approaches to rural generalist medicine training and models of care are developing internationally as part of an integrated response to common challenges faced by rural and remote health services and policymakers (addressing health inequities, workforce shortages, service sustainability concerns). The aim of this study was to review the literature relevant to rural generalist medicine. METHODS: A scoping review was undertaken to answer the broad question 'What is documented on rural generalist medicine?' Literature from January 1988 to April 2017 was searched and, after final eligibility filtering (according to established inclusion and exclusion criteria), 102 articles in English language were included for final analysis. RESULTS: Included papers were analysed and categorised by geographic region, study design and subject themes. The majority of articles (80%) came from Australia/New Zealand and North America, reflecting the relative maturity of programmes supporting rural generalist medicine in those countries. The most common publication type was descriptive opinion pieces (37%), highlighting both a need and an opportunity to undertake and publish more systematic research in this area. Important themes emerging from the review were: Definition Existing pathways and programmes Scope of practice and service models Enablers and barriers to recruitment and retention Reform recommendations There were some variations to, or criticisms of, the definition of rural generalist medicine as applied to this review, although this was only true of a small number of included articles. Across remaining themes, there were many similarities and consistent approaches to rural generalist medicine between countries, with some variations reflecting environmental context and programme maturity. This review identified recent literature from countries with emerging interest in rural generalist medicine in response to problematic rural health service delivery. CONCLUSIONS: Supported, coordinated rural generalist medicine programmes are being established or developed in a number of countries as part of an integrated response to rural health and workforce concerns. Findings of this review highlight an opportunity to better share the development and evaluation of best practice models in rural generalist medicine.

Developing a general practice workforce for the future.

BACKGROUND: Australia continues to develop as a multicultural nation, with a population that is ageing and developing complex health needs. The world around us is changing, and the pace of change is increasing. These contextual changes pose challenges for general practice training. OBJECTIVE: This paper explores the potential impact of these changes on the general practice workforce. DISCUSSION: General practitioners (GPs) will continue to have a central role in coordinating continuous, comprehensive care but are more likely to act as managers of multi-source, continuous monitoring data that facilitate personalised medical care. GPs will need to adapt rapidly to change, seizing opportunities offered by disruptive technology in a globalised world affected by climate change. The nature and impact of change is difficult to predict, and more research is needed to explore how change will affect healthcare and healthcare professionals. Ideally, training for general practice should include preparation for managing continuous change.

Producing a general practice workforce: Let's count what counts.

BACKGROUND: Medical workforce problems still dominate headlines despite considerable investment in education, training and other initiatives. There is little consensus about what Australia's general practice workforce should look like or what training outcomes should be reported. OBJECTIVE: The aim of this paper was to explore a number of issues relevant to outcomes of workforce programs and offer suggestions for identifying and overcoming these issues. DISCUSSION: Social accountability literature highlights the importance of outcomes focusing on community needs. We suggest that evaluations should 'count what counts' and be careful what is counted. Numbers are only part of the story; not everything that counts is counted, and synergies and cooperation are key. Australia has many general practice workforce programs that are generally heading in the right direction. We believe that closer attention to appropriate outcome measures is important if we are to maximise return on investment and get the best outcomes for the community.

Training for general practice: How Australia's programs compare to other countries.

BACKGROUND: General practice in Australia and internationally has undergone a dramatic transformation over the past half century in terms of recognition, academic status, organisation and funding. Training pathways have also evolved in response to this changing environment. OBJECTIVES: This paper compares some of the features of Australian and international general practice training using the educational standards developed by the World Organization of Family Doctors' (WONCA) Working Party on Education as a framework. DISCUSSION: General practice training in Australia, particularly rural training, is strong by international standards, but more lessons can still be learnt from other settings. Local contextual factors mean there are substantial differences in training across jurisdictions, but there are a number of similarities. There is increasing attention being paid to the many roles of a general practitioner, and the importance of a formalised, structured and well-resourced training program. More needs to be done internationally to ensure high-level primary care is available to all people, particularly the underserved.

The Ethics of Medical Practitioner Migration From Low-Resourced Countries to the Developed World: A Call for Action by Health Systems and Individual Doctors.

Medical migration appears to be an increasing global phenomenon, with complex contributing factors. Although it is acknowledged that such movements are inevitable, given the current globalized economy, the movement of health professionals from their country of training raises questions about equity of access and quality of care. Concerns arise if migration occurs from low- and middle-income countries (LMICs) to high-income countries (HICs). The actions of HICs receiving medical practitioners from LMICs are examined through the global justice theories of John Rawls and Immanuel Kant. These theories were initially proposed by Pogge (1988) and Tan (1997) and, in this work, are extended to the issue of medical migration. Global justice theories propose that instead of looking at health needs and workforce issues within their national boundaries, HICs should be guided by principles of justice relevant to the needs of health systems on a global scale. Issues of individual justice are also considered within the framework of rights and social responsibilities of individual medical practitioners. Local and international policy changes are suggested based on both global justice theories and the ideals of individual justice.

Professionalization in Pharmacy Education as a Matter of Identity.

Little research exists on the formation of professional identity in higher education health programs. Such programs may approach the teaching, learning, and assessment of professionalism based upon a suite of attitudes, values, and behaviors considered indicative of a practicing professional. During this transition, professional identity formation can be achieved through student engagement with authentic experiences and interaction with qualified professionals. This paper examines the shift toward identity formation as an essential element of professional education and considers its implications for pharmacy curriculum design.

The psychosocial impacts of fly-in fly-out and drive-in drive-out mining on mining employees: a qualitative study.

OBJECTIVE: To explore how fly-in fly-out (FIFO) and drive-in drive-out (DIDO) mining affects the psychosocial well-being of miners resident in a rural north Queensland town as well as the sources of support miners identify and use in managing these effects. DESIGN: A descriptive qualitative study, using semistructured interviews. SETTING: Charters Towers, a rural town in north Queensland, and a remote north-western Queensland mine. PARTICIPANTS: Eleven people, resident in or near Charters Towers, currently or formerly employed in FIFO or DIDO mining. MAIN OUTCOME MEASURES: Self-reported effects on psychosocial well-being and sources of support. RESULTS: Participants reported positive and negative psychosocial impacts across domains including family life, relationships, social life, work satisfaction, mood, sleep and financial situation. Concerns about the impact on participants' partners were described. Awareness of onsite support, such as Employee Assistance Programs, varied. Other supports included administration staff and nurses or medics. Trusted friends or colleagues at the mine site were considered a preferred means of support. Some, but not most, had experienced coworkers discussing problems with them. A reluctance to seek support was described, with a number of barriers identified. Those having problems might not recognise their own stress and thus not seek support. CONCLUSIONS: This study identifies numerous psychosocial impacts on FIFO/DIDO miners and their partners, and provides insights into preferences regarding support. Employee Assistance Programs cannot be relied upon as the sole means of support. Further studies exploring the impact upon and supports for FIFO/DIDO workers and their partners will assist in better understanding these issues.