The right care in the right place: a scoping review of digital health education and training for rural healthcare workers.

BACKGROUND: Digital health offers unprecedented opportunities to enhance health service delivery across vast geographic regions. However, these benefits can only be realized with effective capabilities and clinical leadership of the rural healthcare workforce. Little is known about how rural healthcare workers acquire skills in digital health, how digital health education or training programs are evaluated and the barriers and enablers for high quality digital health education and training. OBJECTIVE: To conduct a scoping review to identify and synthesize existing evidence on digital health education and training of the rural healthcare workforce. INCLUSION CRITERIA: Sources that reported digital health and education or training in the healthcare workforce in any healthcare setting outside metropolitan areas. METHODS: We searched for published and unpublished studies written in English in the last decade to August 2023. The databases searched were PubMed, Embase, Scopus, CINAHL and Education Resources Information Centre. We also searched the grey literature (Google, Google Scholar), conducted citation searching and stakeholder engagement. The JBI Scoping Review methodology and PRISMA guidelines for scoping reviews were used. RESULTS: Five articles met the eligibility criteria. Two case studies, one feasibility study, one micro-credential and one fellowship were described. The mode of delivery was commonly modular online learning. Only one article described an evaluation, and findings showed the train-the-trainer model was technically and pedagogically feasible and well received. A limited number of barriers and enablers for high quality education or training of the rural healthcare workforce were reported across macro (legal, regulatory, economic), meso (local health service and community) and micro (day-to-day practice) levels. CONCLUSIONS: Upskilling rural healthcare workers in digital health appears rare. Current best practice points to flexible, blended training programs that are suitably embedded with interdisciplinary and collaborative rural healthcare improvement initiatives. Future work to advance the field could define rural health informatician career pathways, address concurrent rural workforce issues, and conduct training implementation evaluations. REVIEW REGISTRATION NUMBER: Open Science Framework: https://doi.org/10.17605/OSF.IO/N2RMX .

Australian rural service learning student placements: a national survey.

This preliminary national study is the first of its kind to investigate how service learning placements are implemented in real world settings in rural Australia and what factors enable or hinder their implementation. An anonymous survey was distributed to 17 University Departments of Rural Health (UDRH) in Australia. Numerical data were analysed descriptively. Textual data were analysed using a hybrid content analysis approach. Thirty seven respondents provided data representing 12 UDRHs. Responding UDRHs reported facilitating service learning programs, with experience in this context ranging from 3 months to 21 years. Service learning placements predominantly occurred in schools and aged care facilities. Occupational therapy, physiotherapy, and speech pathology were the most frequently involved professions in service learning. Enablers and barriers identified were categorised into: People, Partnerships, and Place and Space. This national-scale study provides a springboard for more in-depth investigation and implementation research focused on development of a conceptual model to support service learning across rural and remote Australia.

The rural and interprofessional education and collaborative practice interface: Findings from a qualitative study.

While rural health-care settings are said to be ideal places for the facilitation of interprofessional education and collaborative practice (IPECP) in students, little is known about the rural-IPECP interface. This study explored this interface through student and clinical educator experiences following implementation of a structured IPECP student placement model. Data were gathered through 11 focus groups with 34 students and 24 clinical educators. Content analysis was used to analyze data and two categories were developed for reporting. The power of place and space, highlighting the importance of flexibility, co-location, and lack of hierarchy in promoting IPECP, as well as the role of shared accommodation in enhancing social connectedness within and outside placement were highlighted. This study unpacks the characteristics of rural health-care settings that make it ideal for IPECP despite the resource constraints. Future studies can investigate the rural-IPECP interface through a patient lens.

Efficacy of a student-led interprofessional health clinic in regional Australia for preventing and managing chronic disease.

Increasing chronic disease rates in regional Australian communities necessitates innovative models of healthcare. We evaluated the efficacy of an interprofessional chronic disease program, delivered within a regional student-led nursing and allied health clinic in Southern Queensland, Australia. Changes to anthropometric, aerobic fitness and strength, and quality of life outcomes were examined at four time points spanning 16 months: intake, program transition (4 months), 6 and 12 months (post-transition). Our primary aim was to investigate whether the health improvements achieved during the program were sustained at 12 months in a subset of participants who provided complete data. Significant improvements were found in 6 of 11 measures, including the 6-minute walk test, grip strength, and self-reported quality of life across physical and psychosocial dimensions, with these improvements maintained to final review. No significant changes were found in body mass index (BMI), waist circumference, fat mass, or muscle mass. This is the first health clinic in regional Australia to deliver a student-led model of interprofessional and collaborative service to tackle the increasing burden of chronic disease in the community. The cost-effectiveness of this service and other potential clinical and social benefits remain to be investigated.

Rural medical workforce pathways: exploring the importance of postgraduation rural training time.

BACKGROUND: Inadequate distribution of the medical workforce in rural regions remains a key global challenge. Evidence of the importance of postgraduation (after medical school) rural immersion time and subsequent rural practice, particularly after accounting for other key factors, remains limited. This study investigated the combined impact of three key training pathway factors: (1) rural background, (2) medical school rural immersion, and (3) postgraduation rural immersion, and duration time of each immersion factor on working rurally. METHODS: Data from a cross-sectional national survey and a single university survey of Australian doctors who graduated between 2000 to 2018, were utilised. Key pathway factors were similarly measured. Postgraduation rural training time was both broad (first 10 years after medical school, national study) and specific (prevocational period, single university). This was firstly tested as the dependent variable (stage 1), then matched against rural practice (stage 2) amongst consultant doctors (national study, n = 1651) or vocational training doctors with consultants (single university, n = 478). RESULTS: Stage 1 modelling found rural background, > 1 year medical school rural training, being rural bonded, male and later choosing general practice were associated with spending a higher proportion (> 40%) of their postgraduation training time in a rural location. Stage 2 modelling revealed the dominant impact of postgraduation rural time on subsequent rural work for both General Practitioners (GPs) (OR 45, 95% CI 24 to 84) and other specialists (OR 11, 95% CI 5-22) based on the national dataset. Similar trends for both GPs (OR 3.8, 95% CI 1.6-9.1) and other specialists (OR 2.8, 95% CI 1.3-6.4) were observed based on prevocational time only (single university). CONCLUSIONS: This study provides new evidence of the importance of postgraduation rural training time on subsequent rural practice, after accounting for key factors across the entire training pathway. It highlights that developing rural doctors aligns with two distinct career periods; stage 1-up to completing medical school; stage 2-after medical school. This evidence supports the need for strengthened rural training pathways after medical school, given its strong association with longer-term decisions to work rurally.

Understanding the non-professional needs of early career doctors: An interview-based study.

Speciality colleges and health services are often well attuned to professional factors, but non-professional needs are less acknowledged and are the focus of this study. This likely relates to limited research about the non-professional needs of early career doctors. This study aimed to describe the non-professional needs of doctors in their early postgraduate career, including how they intersect with career and training experiences. Semi-structured interviews were conducted with 32 male and female medical graduates working across all Australian states and territories, spanning a variety of speciality areas and early career stages. Participants were asked about their career journey to date including non-professional factors related to their experiences. This study identified important non-professional needs, that strongly interplayed with career and training experiences, including: children's education; partner's career needs; family stability; major life stages; proximity to the extended family; and spending time with immediate family. Results suggested clear gender differences, with female doctor's needs orientated to partner work and carer responsibilities, while male doctor's needs were oriented to spending time with family and meeting the family's needs. Non-professional needs should be considered as legitimate needs within health service employment and speciality training arrangements enabling early career doctors to realise their full potential.

Comparing outcomes of an innovative interprofessional student placement model to standard placement models in rural healthcare settings.

This unique study investigated the educational and service delivery impacts of a team-based, innovative model of interprofessional education (IPE) namely the Rural Interprofessional Education and Supervision (RIPES) model on participating students, clinical educators, and their workplaces, in rural Australian healthcare settings. Participating professions included dietetics, occupational therapy, physiotherapy, and speech pathology. Outcomes from the RIPES model were compared with regular uni-professional placement models. A multi-site, pre-post, comparative design was used. The main data collection measures included were the Students Perceptions of Interprofessional Clinical Education - Revised scale, the Interprofessional Socialization and Valuing Scale, and time-usage data. The RIPES model resulted in significant improvement in students' beliefs, behaviors, and attitudes that underpin interprofessional socialization and collaborative practice in healthcare settings. Importantly, students were able to benefit from the RIPES learning activities without compromising their contact time with patients. Clinical educators spent significantly more time in non-patient contact activities than the uni-professional group. This important work was undertaken in response to previous calls to address a gap in IPE models in rural areas. It involved students from multiple professions and universities, measured impacts on multiple stakeholders, and followed international best practice interprofessional education research recommendations.

Addressing the GP vocational training crisis in remote Australia: Lessons from the Northern Territory.

OBJECTIVE: GP vocational training enrolments are declining Australia-wide and, in the Northern Territory (NT), considered by some as '…the litmus test for the national scene' the decline is precipitous. This research investigates the drivers of declining GP training uptake in the NT and identifies and ranks potential solutions. SETTING: NT, Australia. PARTICIPANTS: Ten senior medical students, 6 junior doctors, 11 GP registrars, 11 GP supervisors and 31 stakeholders. DESIGN: Mixed methods: scoping review of Australian literature mapping key concepts to GP training pathway stages and marketing/communications; secondary data analyses; key informant interviews; and a stakeholder validation/prioritisation workshop. Interview data were thematically analysed. Workshop participants received summarised study findings and participated in structured discussions of potential solutions prior to nominating top five strategies in each of five categories. RESULTS: Highly prioritised strategies included increasing prevocational training opportunities in primary care and selecting junior doctors interested in rural generalism and long-term NT practice. Also ranked highly were: [Medical School] ensuring adequate infrastructure; [Vocational Training] offering high quality, culturally sensitive, flexible professional and personal support; [General Practice] better remunerating GPs; and [Marketing] ensuring positive aspects such as diversity of experiences and expedited GP career opportunities were promoted. CONCLUSION: Multifaceted strategies to increase GP training uptake are needed, which target different stages of GP training. Effective action is likely to require multiple strategies with coordinated action by different jurisdictional and national key stakeholder agencies. Foremost amongst the interventions required is the urgent need to expand primary care training opportunities in NT for prevocational doctors.

Medical student interest and participation in research at one rural clinical school: Insights from the last six years.

INTRODUCTION: Limited evidence is currently available relating to research acitivity of medical students training in regional or rural areas. OBJECTIVE: To describe medical student interest and participation in research at The University of Queensland Rural Clinical School (UQRCS). DESIGN: Annual student expression of interest surveys were collated with records of student research participation maintained at UQRCS from 2017-2022. Additionally, a systematic search was conducted to identify student outputs not captured in internal records. Frequencies and proportions were calculated for all descriptive data along with proportions of students who engaged with a project, and projects that led to a peer-reviewed publication. FINDINGS: At UQRCS commencement, 55% of research-interested students reported having basic research skills. Thirty-nine percent of research-interested students engaged with a project, most commonly literature reviews (47%) or audits (29%). Thirty-three percent of completed projects led to a peer-reviewed manuscript. DISCUSSION: Students who engage with a project are unlikely to receive a project in their preferred clinical area and should be informed about the transferrability of research skills. Most students have basic research skills when commencing a project and therefore require ongoing support and mentorship from staff/supervisors. CONCLUSION: Publication rates of medical students in regional/rural areas are comparable to those reported by metropolitan medical schools (~30%).

Nature and extent of disruptions to staff clinical supervision practices in health care settings due to COVID-19: A survey study.

OBJECTIVE: To investigate the impact of the COVID-19 pandemic on clinical supervision practices of health care workers in health care settings in one Australian state. METHOD: A bespoke survey was developed and administered online using Qualtrics™. The survey consisted of Likert scale and closed questions, with options for free text comments. Numerical data were analysed descriptively and using Chi-Square tests. Textual data were analysed through content analysis. RESULTS: Of the 178 survey respondents, 42% were from allied health disciplines, 39% from nursing and midwifery, and 19% from medicine. The type and mode (i.e., face-to-face, telesupervision) of clinical supervision prior to the pandemic and at the time of survey completion (i.e., July-August 2021) were similar. Eighteen percent of respondents had a change in supervision arrangements but only 5% had a change in supervisor. For the 37% who changed roles due to COVID-19, 81% felt their current supervisor was still able to support them, 69% were still having their supervisory needs met. Analyses of textual data resulted in the development of two categories: Supervision deteriorating, and some clinical supervision functions (i.e., formative and restorative) being more impacted than others (i.e., normative). CONCLUSION: There were substantial disruptions to several parameters of clinical supervision due to COVID-19, that may pose a threat to high quality supervision. Health care workers reported pandemic-induced stress and mental health challenges that were not always addressed by effective restorative supervision practices.

Impact of the COVID-19 pandemic on student supervision and education in health care settings: A state-wide survey of health care workers.

OBJECTIVE: To investigate student supervisor experiences of supervising students on clinical placements since the onset of the COVID-19 pandemic. BACKGROUND: Studies on the impact of COVID-19 on student clinical placements have focused largely on student reports and have been specific to individual professions or topic areas. There is a need to investigate student supervisor experiences. This study was conducted in Queensland (Australia) in four regional and rural public health services and four corresponding primary health networks. METHODS: The anonymous, mixed methods online survey, consisting of 35 questions, was administered to student supervisors from allied health, medicine, nursing and midwifery between May and August 2021. Numerical data were analysed descriptively using chi-square tests. Free-text comments were analysed using content analysis. RESULTS: Complete datasets were available for 167 respondents. Overall trends indicated perceived significant disruptions to student learning and support, plus mental health and well-being concerns for both students and supervisors. Extensive mask wearing was noted to be a barrier to building rapport, learning and teaching. Some positive impacts of the pandemic on student learning were also noted. CONCLUSIONS: This study has highlighted the perceived impact of the pandemic on supervisors' mental health, and on the mental health, learning and work readiness of students. This study provides evidence of the pandemic impacts on student clinical placements from a supervisor point of view. Findings can assist in future-proofing clinical education and ensuring that students continue to receive learning experiences of benefit to them, meeting curriculum requirements, in the event of another pandemic.

Rebooting effective clinical supervision practices to support healthcare workers through and following the COVID-19 pandemic.

The importance of clinical supervision, a professional support and clinical governance mechanism, to patients, healthcare workers and organizations has been well documented. Clinical supervision has been shown to support healthcare workers during challenging times, by reducing burnout, enhancing mental health and wellbeing at work, and improving job satisfaction. However, clinical supervision participation and effectiveness are pre-requisites for realising these benefits. During times of stress and increased workloads (e.g. during the Coronavirus pandemic), healthcare workers tend to prioritise clinical duties and responsibilities over clinical supervision. Effective supervision practices can be restored, and healthcare workers can be better supported in their roles during and in the post-pandemic period only if healthcare workers, policy makers, healthcare organizations, clinical supervision trainers and researchers join forces. This paper sheds light on this important topic and offers a number of practical recommendations to reboot effective clinical supervision practices at the point of care.

A rapid review of the impact of COVID-19 on clinical supervision practices of healthcare workers and students in healthcare settings.

AIMS: To synthesize available data on the impact of the COVID-19 pandemic on clinical supervision practices of healthcare workers and students in healthcare settings. DESIGN: A quantitative rapid review of the literature. DATA SOURCES: A search of MEDLINE, Embase, PsycINFO, the Cochrane Library and Scopus for English language papers published between December 2019 (initial onset of the pandemic) to March 2021. REVIEW METHODS: Using the World Health Organization and Cochrane guidelines for rapid reviews, following an identification of relevant papers and data extraction, a narrative synthesis approach was used to develop themes. RESULTS: Eight studies met the inclusion criteria. Four themes identified from data synthesis were nature and extent of disruptions to clinical supervision, unmet need for psychological support, supervisors also need support and unpacking telesupervision. Findings highlight the extent and nature of disruption to clinical supervision at the point of care. Further information on factors that facilitate high-quality telesupervision have come to light. CONCLUSION: The COVID-19 pandemic has placed tremendous burden on healthcare workers compromising their own health and well-being. It is essential to restore effective clinical supervision practices at the point of care, so as to enhance patient, healthcare worker and organizational outcomes into the post-COVID-19 pandemic period. IMPACT: This review has provided initial evidence on the adverse impacts of the COVID-19 pandemic on clinical supervision of healthcare workers and students at the point of care. Available evidence indicates the urgent need to restore effective and high-quality clinical supervision practices in health settings. The review has highlighted a paucity of studies in this area, calling for further high-quality studies.

Title-blended supervision models for post-graduate rural generalist medical training in Australia: an interview study.

BACKGROUND: Expanding rural training is a priority for growing the rural medical workforce, but this relies on building supervision capacity in small towns where workforce shortages are common. This study explored factors which support the use of blended supervision models (consisting of on- and offsite components) for postgraduate rural generalist medical training (broad scope of work) in small rural communities. METHODS: Data were collected between June and August 2021 through semi-structured, in-depth interviews with medical training stakeholders experienced in blended supervision models for rural generalist training. Interviews were audio-recorded, transcribed verbatim and analysed using an inductive thematic analysis process. RESULTS: Fifteen participant interviews provided almost 13 h of audio-recorded data. Four themes were developed: governance, setting, the right supervisor and the right supervisee. Blended supervision models may be effective if selectively applied including where the model is well-planned, the setting has local team supports and supervisor and supervisee characteristics are appropriate. CONCLUSIONS: Understanding factors involved in the application of blended supervision models can help with expanding rural generalist training places in distributed communities. Blended supervision models can be effective for rural generalist training if the model is planned, and the context is suitable.

Impact of the COVID-19 pandemic on student experiences during rural placements in Australia: findings from a national multi-centre survey.

BACKGROUND: The aim of this national study was to explore the learning experiences of Australia's medical students who trained rurally during the COVID-19 pandemic in 2020. METHODS: A cross-sectional, national multi-centre survey was conducted in 2020, through the Federation of Rural Australian Medical Educators (FRAME). Participants were medical students who had completed an extended Rural Clinical School (RCS) training placement (≥ 12 months). A bespoke set of COVID-19 impact questions were incorporated into the annual FRAME survey, to capture COVID-19-related student experiences in 2020. Pre-pandemic (2019 FRAME survey data) comparisons were also explored. RESULTS: FRAME survey data were obtained from 464 students in 2020 (51.7% response rate), compared with available data from 668 students in 2019 (75.6% response rate). Most students expressed concern regarding the pandemic's impact on the quality of their learning (80%) or missed clinical learning (58%); however, students reported being well-supported by the various learning and support strategies implemented by the RCSs across Australia. Notably, comparisons to pre-pandemic (2019) participants of the general RCS experience found higher levels of student support (strongly agree 58.9% vs 42.4%, p < 0.001) and wellbeing (strongly agree 49.6% vs 42.4%, p = 0.008) amongst the 2020 participants. Students with more than one year of RCS experience compared to one RCS year felt better supported with clinical skills learning opportunities (p = 0.015) and less affected by COVID-19 in their exam performance (p = 0.009). CONCLUSIONS: This study has provided evidence of both the level of concern relating to learning quality as well as the positive impact of the various learning and support strategies implemented by the RCSs during the pandemic in 2020. RCSs should further evaluate the strategies implemented to identify those that are worth sustaining into the post-pandemic period.

Impact of the COVID-19 pandemic on medical student placements in rural Queensland: A survey study.

OBJECTIVE: The COVID-19 pandemic has adversely impacted medical students' learning experiences. Students in one Australian Rural Clinical School were surveyed to investigate the impact of disruptions to clinical placements and satisfaction with educational changes implemented as a result of the pandemic. DESIGN: Cross-sectional survey. SETTING: The University of Queensland Rural Clinical School. METHODS: Students undertaking one or two years of study at the participating Rural Clinical School in November 2020. MAIN OUTCOME MEASURE: A 20-item anonymised survey with questions on personal health and safety, quality of clinical training experience, response to changes in learning and student environment, and progression to completion of the medical degree. RESULTS: The survey was completed by 124 students (76% response rate). Students were satisfied with the changes made to their learning to accommodate the disruptions to health service delivery and placements. Final year students were more satisfied with their learning experiences compared to their third-year counterparts. CONCLUSIONS: The Rural Clinical School implemented a range of academic and psychological support strategies which appear to have helped with mitigating mental health concerns experienced by students completing rural placements, who are already prone to experiencing social isolation. Strengthening communication between the academic and health service sectors can improve the quality of learning for medical students on placements.

Developing supervision capacity for training rural generalist doctors in small towns in Victoria.

INTRODUCTION: Rural generalist (RG) doctors are broadly skilled to provide comprehensive primary care, emergency and other specialist services in small, distributed communities where access is otherwise limited because of distance, transport and cost limitations. In Victoria, Australia, the Victorian Rural Generalist Pathway (VRGP) represents a significant state-wide investment in training and growing the next generation of RGs. The first step of the VRGP is well established through the Rural Community Internship Training program, which commenced in Victoria in 2012-2015; however, the second step (RG2) requires expansion by growing supervised learning in small rural communities where RGs will eventually work. This project aimed to explore enablers and barriers to the supervision of RG2 learners across a core generalist curriculum in distributed towns in three rural Victorian regions. METHODS: Data were collected between June and August 2021 through semistructured, in-depth interviews conducted via Zoom or telephone with general practitioners (GPs) and health service executives from small and big health services in the Hume, Loddon Mallee and Barwon South West regions. Interview questions were shared prior to the interview to support reflective responses. Interviews were an hour in length and data were transcribed verbatim and analysed using an inductive thematic analysis process. The research team met regularly throughout the analysis process to refine theme development, test assumptions, and reduce any subjective biases. This study had ethical approval from Monash University. RESULTS: Thirty-one participants, including 13 GPs working at RG scope in MMM 4-7 and 18 health service executives, engaged with RGs consented and participated. The supervision of RG2s was affected by multilayer enablers and barriers. Enablers that emerged were having a critical mass of fellowed doctors using viable models to supervise RG2s, funding for the supervision of RG2s, generalist learning opportunities, and coordination and case management. Barriers included insufficient doctors to supervise, the cost and risk of supervising RG2s, developing rural training but finding it was unattractive to trainees, and a reliance on rotational staff, which limited supervision on the ground. Different regions experienced enablers and barriers to different degrees. CONCLUSION: Building supervised training for RG2 learners across a generalist scope in distributed rural communities is a complex undertaking, with multilayered enablers and barriers at play. A range of issues are beyond the control of the VRGP and rely on advocacy and collaboration with stakeholders. The major themes suggest that supervised learning should be addressed at multiple levels of the system, the community, clinical settings, and clinicians. Expanding supervision of RG2s across core generalist curriculum in small rural communities will also require a regionally guided long-term vision and stepwise planning. With ongoing commitment to RG-led care, it is possible to achieve high-quality supervision at the RG2 stage, retain RGs on the pathway, and produce skilled RG trainees to serve Victoria into the future.

Rural competencies in emerging medical practitioners: Beyond clinical skills.

PROBLEM: Recruitment and retention of rural doctors remains a challenge in Australia. The Queensland Rural Generalist Program was developed to address this challenge and provides a range of tailored professional development opportunities to support rural medical training, recruitment and retention. The Rural Generalist Vocational Preparation Workshop was developed to maintain connection with trainees during a known attrition risk period and address a gap in training that focused on competencies required for rural practice. DESIGN: The Rural Generalist Vocational Preparation Workshop, designed using adult learning principles, includes an optimal balance between theory, scenario-based learning and facilitated group discussions. A cross-sectional survey design was employed to evaluate the workshops delivered between 2015 and 2017. SETTING: The workshops were attended by Queensland Rural Generalist Program trainees in the year prior to undertaking a vocational training position in a rural hospital or general practice. Participants were from 10 Hospital and Health Services in the Queensland public health sector at the time of attendance. KEY MEASURES FOR IMPROVEMENT: An evaluation survey captured participant feedback about the workshop, its value, impact and their intention to implement changes in practice. STRATEGIES FOR CHANGE: Fifty-one trainees attended the workshops across four locations. EFFECTS OF CHANGE: Eight-eight per cent of participants reported intentions to implement changes to practice in: pursuit of career options and enhanced team work, leadership skills and networking. LESSONS LEARNT: Evaluation results indicated that Rural Generalist Vocational Preparation Workshop was a highly valued opportunity. It provided future rural medical practitioners with professional support and networking opportunities, promoted identity formation and stimulated rural career planning.

Oceans apart, yet connected: Findings from a qualitative study on professional supervision in rural and remote allied health services.

OBJECTIVE: Improving the quality and safety of health care in Australia is imperative to ensure the right treatment is delivered to the right person at the right time. Achieving this requires appropriate clinical governance and support for health professionals, including professional supervision. This study investigates the usefulness and effectiveness of and barriers to supervision in rural and remote Queensland. DESIGN: As part of the evaluation of the Allied Health Rural and Remote Training and Support program, a qualitative descriptive study was conducted involving semi-structured interviews with 42 rural or remote allied health professionals, nine operational managers and four supervisors. The interviews explored perspectives on their supervision arrangements, including the perceived usefulness, effect on practice and barriers. RESULTS: Themes of reduced isolation; enhanced professional enthusiasm, growth and commitment to the organisation; enhanced clinical skills, knowledge and confidence; and enhanced patient safety were identified as perceived outcomes of professional supervision. Time, technology and organisational factors were identified as potential facilitators as well as potential barriers to effective supervision. CONCLUSIONS: This research provides current evidence on the impact of professional supervision in rural and remote Queensland. A multidimensional model of organisational factors associated with effective supervision in rural and remote settings is proposed identifying positive supervision culture and a good supervisor-supervisee fit as key factors associated with effective arrangements.