Self-efficacy and planning strategies can improve physical activity levels in women with a recent history of gestational diabetes mellitus

INTRODUCTION

Regular physical activity can reduce the risk of developing diabetes in high risk populations including in women with gestational diabetes mellitus (GDM). This study applied the Health Action Process Approach (HAPA) to determine the motivational and volitional factors important in increasing physical activity among women with previous GDM.

METHODS

Women with GDM receiving obstetric care at a teaching hospital in Sri Lanka were invited to participate in a survey 6-36 months post-delivery. At baseline and 8 weeks later, 152 women completed postal and telephone surveys that collected socio-cognitive and physical activity data. The study hypotheses were tested using structural equation modelling.

RESULTS

The modified model fit the data well (CFI = .95, TLI = .94, RMSEA = .057) and explained 11% of the variance in behaviour. Action self-efficacy was the only important predictor of intention to be physically active. Intention as well as maintenance self-efficacy predicted planning, which, in turn, predicted physical activity. Planning mediated the effect of intention and self-efficacy (maintenance and recovery) on physical activity.

CONCLUSION

This study has identified predictors of physical activity among women with previous GDM that can inform intervention studies. Interventions targeting this population need to include planning strategies and enhance self-efficacy.

Acceptability, technological feasibility and educational value of remotely facilitated simulation based training: A scoping review

Although remote teaching and learning is not new to medical education, the Covid-19 pandemic has heightened its importance as a mode of education delivery. This scoping review aims to provide a narrative/iterative summary of the current literature in assessing the acceptability, educational value and technological feasibility of remotely facilitated (RF) simulation-based training (SBT) - 'telesimulation', for medical students and facilitators. The review was conducted using the method described by Arksey and O'Malley. A systematic process was followed to search multiple electronic databases supplemented with a general internet search to identify any relevant grey literature. The search strategy was developed in collaboration with medical students and educators familiar with SBT. Nine articles were identified as fitting the review inclusion criteria. The results indicated that RF SBT was positively viewed by participants but may not be viewed as equivalent to locally facilitated SBT. Participants of RF SBT felt confident to deal with common acute scenarios, believed it could expand their knowledge and skills and in turn would improve patient care in the clinical setting. Facilitators found RF SBT to be technologically feasible, promoting the acquisition of desired learning outcomes. Future research should assess the reaction to, and learning acquired during RF SBT, particularly, the perception and attitudes of facilitators. A clear research gap was identified in literature assessing the role of RF SBT in behavioural change and improved clinical care outcomes. Addresing these gaps will clarify the role of RF SBT in medical education.

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.

Analysis of agriculture-related life-threatening injuries presenting to emergency departments of rural generalist hospitals in Southern Queensland

OBJECTIVE

Agricultural industries are among the most dangerous in Australia posing significant public health risks. This study analyses the nature and management of agriculture-related injuries presenting to EDs in selected hospitals in Southern Queensland.

METHODS

Data on agricultural injury presentations over a 6 month period was collected at four rural hospitals by a dedicated onsite hospital data coordinator. Additionally, in two of the participating hospitals all injury presentations over the same 6 month period were recorded. A pre-tested survey instrument, modified for rural settings and designed and developed to export the abstracted data using an iPad application was used as the survey tool.

RESULTS

The incidence of agriculture-related injuries was 11% of all injuries, most were males (73%), averaging 40 years. On presentation, 66.5% (n = 234) were categorised as imminently or potentially life threatening with 44% of those patients presenting to hospital ED >3 h after the injury. Large animals were more commonly reported as involved in the aetiology of the presenting injury, particularly using horses and handling cattle.

CONCLUSIONS

Agricultural injuries are a significant group of primary care presentations to rural hospitals and training and resourcing for rural hospitals should reflect this. A better understanding of common injury types can lead to efficient allocation of available resources in rural hospitals and potentially improve ED practices. The delay in presentation must be considered in response planning both by farmers and hospital EDs.

Managing behavioural and developmental paediatric conditions in rural outpatient clinics: An insight to the challenge ahead

AIM

The aim of this study is to characterise the nature and caseload of general paediatric outpatient clinics in rural Queensland and to compare the findings with national data.

METHODS

A retrospective clinical audit of medical records in paediatric clinics at two rural hospitals was undertaken over a 6-month period. Data extracted included demographics, diagnostic category and onward referral outcomes. The same diagnostic categories were used as the national Children Attending Paediatricians Study (CAPS) to facilitate comparison.

RESULTS

A total of 346 records were reviewed, 56 (16.2%) documented Aboriginal and Torres Strait Islander descent. Compared to national data, significantly more children with behavioural/developmental diagnoses were seen in the rural clinics (CAPS 33.8%; rural 59.2%; P < 0.001). In contrast, children presenting with medical conditions (CAPS 48.2%; rural 28.6%; P < 0.001) and mixed medical/developmental conditions (CAPS 17.9%; rural 12.1%; P = 0.006) were seen less frequently in the rural clinics. Referral rates from the rural sites were lower than the rates reported by CAPS for children with behavioural/developmental diagnoses (CAPS 35.9%, rural 24.9%; P = 0.002) and mixed diagnoses (CAPS 40.6%, rural 19.0%; P = 0.005), while there was no difference in referral rates for children with medical diagnoses (CAPS 16.1%, rural 18.2%; P = 0.575).

CONCLUSIONS

Rural paediatricians' caseloads are dominated by developmental/behavioural conditions, however children with these conditions are less likely to be referred to allied health and psychology services. The reasons for lower referral rates and specific pressures upon rural health services need to be investigated in future studies to provide better health services for rural children.

Video capsule endoscopy in patients with iron deficiency anaemia: experience at a regional Australian service

OBJECTIVE

The objective of this study was to identify the diagnostic performance of video capsule endoscopy (VCE) among patients presenting with iron deficiency anaemia (IDA) and negative bidirectional endoscopy to a gasteroendoscopy practice in regional Australia. The secondary objectives were to identify the distribution of findings and factors predictive of positive findings in a regional setting.

RESULTS

In total 123 procedures were included in the study. Mean age of the patients was 67.9 years. Females made up 60.2% (n = 74) of the study population. Mean haemoglobin and ferritin levels were 93.3 g/L and 11.9 ug/L, respectively. Positive findings were present in 67 procedures (54.5%) with the most frequent finding being small bowel angiodysplasia (53.7%, n = 36/67), followed by ulceration/significant erosion (26.8%, n = 18/67), fresh blood (20.8%, n = 14/67) and tumour/polyp (16.4%, n = 11/67). Haemoglobin level was the only variable associated with positive findings (p = 0.005) in the study population. Of the procedures reporting positive findings outside the small bowel, the majority (80%) were within reach of conventional upper endoscopy and may have implications for future practice, particularly when allocating health resources in a rural setting.

Assessing health literacy of Aboriginal and Torres Strait Islander peoples presenting to general practice

BACKGROUND

Health literacy is a social determinant of health, with lower levels linked to suboptimal health outcomes. There is a gap in the literature regarding the value of health literacy assessment among Aboriginal and Torres Strait Islander peoples and best methods with which to perform such assessments in general practice.

OBJECTIVE

Literature was reviewed to determine what is known regarding health literacy of Aboriginal and Torres Strait Islander peoples, the availability of assessment tools and the implications for general practice.

DISCUSSION

Despite its effect on health outcomes, the health literacy of Aboriginal and Torres Strait Islander peoples is poorly understood, with no validated assessment tools specifically tailored to this population. Culturally insensitive screening of health literacy has potentiality to disaffect; thus, practitioners should consider assessments aligned with Indigenous methodologies such as conversational or yarning approaches or the use of a small number of screening questions. Practitioners are encouraged to adopt a universal precautions approach and use culturally appropriate conversational styles to optimise communication and healthcare outcomes.

Physical Activity Tracking Among Sri Lankan Adults: Findings From a 7-Year Follow-up of the Ragama Health Study

Limited data are available on physical activity tracking among adults in low- and middle-income countries. Using a longitudinal design, we assessed trends and correlates of physical activity among Sri Lankan adults. Individuals selected through age-stratified random sampling, were screened initially in 2007 (n = 2986) and reevaluated in 2014 (n = 2148). On both occasions, structured interviews and clinical measurements were completed. Approximately 40% of the participants engaged in recommended levels of physical activity both at baseline and follow-up. One-fifth reported increased physical activity at follow-up, a similar proportion reported being persistently inactive or a reduction in physical activity. In the adjusted analysis, being persistently active was associated with male sex, a lower educational level and income, being free of any chronic disease conditions, better self-rated health, and sitting time <8 hours. Our findings support public health interventions to help maintain recommended physical activity levels over time, particularly for subgroups at high-risk of physical inactivity.

Connectivity is the key to longer rural placement: Retaining students on rural longitudinal integrated clerkships

PURPOSE

Recruitment and retention of medical practitioners to rural practice is an ongoing global issue. Rural longitudinal integrated clerkships (LIC) are an innovative solution to this problem, which are known to increase rural workforce. Crucially this association increases with time on rural placement. This study examines factors that promote retention in a Rural LIC.

METHODS

A two-phased, sequential design qualitative study in a cohort of students enrolled in a rural LIC at Griffith University, Queensland, Australia. Phase I consisted of an open-ended questionnaire and phase II follow-up focus groups from the same cohort. Data was transcribed and analysed using an iterative, six-step thematic analysis process to identify salient themes.

RESULTS

Twenty-four students were invited to participate, of which eight respond in phase I and thirteen participated in phase II. Participants described retention being driven by connectivity within three broad themes: current practice, future practice (immediate internship and career intention), and social networks. Participant proposals to increase connectivity were also suggested including peer-led solutions and short rotations in metropolitan hospitals.

CONCLUSION

Connectivity is key to retention on rural longitudinal integrated clerkships. Programs which enhance connectivity with current practice, future practice, and social networks will increase retention on rural medical programs.

A cross-sectional study of skin cancer secondary prevention in rural general practice

BACKGROUND AND OBJECTIVES

As a result of the lack of evidence of reduction in mortality, secondary prevention of melanoma and keratinocyte skin cancers (KSCs) with active screening is not recommended except for individuals at high risk. Limited access to medical professionals for diagnosis and specialised treatment of skin cancers are related to poorer health outcomes for Australians living in rural areas. The aim of this study was to evaluate the secondary prevention of skin cancer in general practice.

METHOD

A clinical audit of 317 melanomas and 5463 KSCs was conducted, examining the nature of consultation and stage of cancer at diagnosis.

RESULTS

It was more common for an uncomplicated melanoma ≤1 mm in size to be identified by a general practitioner (GP) during a planned whole-body skin examination than to be the presenting complaint found by the patient (χ2 = 4.2, P <0.05). Half (49%) of KSCs found were the presenting complaint, with 21% an incidental diagnosis during another presentation and 30% found during whole-body skin examinations. Half of all squamous cell carcinomas found were at the intra-epidermal stage.

DISCUSSION

Secondary prevention of skin cancer by GPs is a value proposition for rural populations.

Determining the cultural safety of chronic disease interventions for Aboriginal and Torres Strait Islander Australians: a scoping review

Objectives

To assess how the cultural safety of primary care-based chronic disease interventions for Aboriginal and Torres Strait Islander Australians is determined.

Methods

Scoping review of peer-reviewed evaluations of chronic disease interventions for Aboriginal and Torres Strait Islander patients, in which cultural safety is an outcome. Searches included Scopus, Informit, OVID Medline, Emcare and CINAHL including all articles published until September 2023.

Results

Searches identified 2,225 articles. 1,854 articles underwent title and abstract screening, with 97 progressing to full text review. Twenty articles met the inclusion criteria. 75% (n = 15) of articles determined cultural safety based solely on Aboriginal and Torres Strait Islander peoples' perspectives, with community acceptance as the most common means of determining cultural safety. In the analysed studies, elements contributing to cultural safety included practitioner behaviour (n = 15), knowledge (n = 6), skills (n = 1) and attitudes (n = 4), partnership with community (n = 4) and culturally safe services (n = 5), and graphics and artwork (n = 6). The inconsistent terminology and lack of definitions made comparison of studies challenging.

Conclusion

This review underscores the importance of adopting the Australian Health Practitioner Regulation Agency (AHPRA) definition of cultural safety to standardise terminology and explore the many elements of cultural safety. It is recommended that cultural safety is defined by the community targeted by the intervention. Identification of elements of cultural safety will guide future interventions and reduce reliance on community acceptance as an indirect measure of cultural safety. If chronic diseases interventions are to effectively impact health equity, it is vital to understand cultural safety within these settings.

Prevalence and predictors of default with tuberculosis treatment in Sri Lanka

The objectives of this study were to determine the default rate and predictors for default in patients undergoing antituberculosis treatment. All consenting patients with a confirmed diagnosis of tuberculosis admitted to a unit of the Chest Hospital, Welisara, Sri Lanka from April 2001 to April 2002 were recruited into the study. Personal and follow-up data were recorded on a pre-tested questionnaire and data sheet, respectively. A defaulter was defined as a patient who interrupted treatment for more than two consecutive months before the end of the course of treatment. Of the 892 patients recruited, 770 were new cases and 122 were relapses. The default rates were 10.3% (95% CI: 8.3-12.6) and 30.3% (95% CI: 22.7-38.1) among new cases and retreatment cases, respectively, during the intensive phase of treatment and 10.9% (95% CI:8.7-13.3) and 16.5% (95% CI:9.7-25.5), respectively, during the continuation phase. Ninety percent of new cases and 94% of retreatment cases were sputum positive for acid-fast bacilli at diagnosis. Two hundred five patients (22.9%) defaulted on treatment (95% CI: 20.3-25.8). Using logistic regression analysis, regular smokers (OR = 1.9), smear positive patients who were previous defaulters (OR = 2.4) and patients having involvement of less than 3 zones of the lung on chest x-ray (OR = 0.5) were more likely to default compared to patients who did not smoke regularly, smear positive patients who had relapsed after taking the full course of treatment and patients with less lung involvement. Skilled and unskilled laborers were the most likely occupation to default (OR = 2.03) followed by sales personnel (OR = 2.00), compared to the unemployed or home-bound. A high default rate of 23% was observed among the study participants. Smoking status, occupation, history of treatment compliance of the patient, and extent of lung involvement were predictors for defaulting.

Finding what works-Patients' long-term experiences of weight maintenance post bariatric surgery: A systematic review and thematic synthesis of qualitative studies

Individuals with obesity can attain significant weight loss in a relatively short timeframe following bariatric surgery; however, new healthy behaviors must be sustained in perpetuity to maintain weight loss. This study investigates patients' views on the facilitators and barriers to long-term weight loss maintenance following bariatric surgery. Systematic searches of Medline, PsycINFO, and CINAHL databases identified 403 studies with 15 fitting the study inclusion criteria. Included studies were independently appraised using Critical Appraisal Skills Program (CASP). Data extraction and thematic synthesis generated three themes: changing food relationships, navigating inter- and intrapersonal influences, and caring health professionals. These appeared across six organizing sub-themes: building new food relationships, creating healthy habits, relationships with others, internalized stressors, finding and defining success, and ongoing patient education. Patients experienced a variety of barriers and facilitators to weight loss maintenance, with some facilitators diminishing over time. The findings demonstrate the importance of considering patients' perspectives and individual contexts to assist them to negotiate and overcome challenges to long-term weight loss maintenance post-bariatric surgery.

Colorectal polyps in young adults: a retrospective review of colonoscopy data from Toowoomba and the Darling Downs

BACKGROUND

Polyps are the predominant precursors of colorectal cancer. In the past three decades, the incidence and mortality rates of colorectal cancer have been increasing in adults younger than 50 years.

AIMS

The aim of this clinical audit was to evaluate the prevalence, characteristics and clinical associations of polyps in adults aged 18-49 years presenting to an established private gastroenterology clinic in the Toowoomba Darling Downs region.

METHODS

The audit included data from 353 patient records held by the Toowoomba Gastroenterology Clinic. Data extracted from patient medical records through the Medical Director program software contained structured endoscopy/colonoscopy and histology reports of excised lesions of patients presenting to the clinic. The extract involved identifying all patients aged 18-49 years in the database from January 2019 to March 2022. Patients were screened based on audit inclusion and exclusion criteria. Patients were risk stratified for recommended surveillance intervals as per Australian Clinical Guidelines.

RESULTS

Of the sample population, 33.4% were identified with polyps and 22.4% were identified with neoplastic polyps (NPs). A total of 6.7% of 18- to 29-year-old patients were identified with intermediate risk for colorectal cancer (CRC) screening, and 19.8% and 19.3% of 30- to 39-year-old and 40- to 49-year-old patients identified with intermediate or high risk for CRC screening respectively. Increased age, greater size of polyps and surveillance of previous polyps were associated with increased NP prevalence.

CONCLUSIONS

Data from this audit supported the temporal trend of increasing prevalence of polyps in adults younger than 50 years. Patient cohorts aged 30-39 and 40-49 years may benefit from earlier first colonoscopies. Findings could be the impetus for future research in young adults presenting for colonoscopy.

Appropriateness of antibiotic prescribing for patients with sepsis in rural hospital emergency departments

DESIGN/PARTICIPANTS

This was a multicentre retrospective cohort study of adult patients (≥18 years) presenting with a process associated International Classification of Diseases code (ICD-AM-10) pertaining to sepsis between January 2017 and July 2020 to rural Emergency Departments.

MAIN OUTCOME MEASURES

Our primary outcome was antibiotic appropriateness as defined by the Australian Therapeutic Guidelines (for antibiotic selection relative to infecting source) and the National Antimicrobial Prescribing Survey tool. Our secondary outcome was in-hospital mortality.

METHODS

Relevant clinical and non-clinical, physiological and laboratory data were collected retrospectively. Multivariate logistic regression was used to estimate the odds of both inappropriate antibiotic prescribing and in-hospital mortality based on clinical and non-clinical factors.

RESULTS

A total of 378 patients were included who primarily presented with sepsis of unknown origin (36.8%), a genitourinary (22.22%) or respiratory (18.78%) source. Antibiotics were appropriately prescribed in 59% of patients. A positive Quick Sequential Organ Failure Assessment score (qSOFA) (odds ratio [OR] = 0.49; 95% confidence interval [CI], 0.29-0.83), a respiratory infection source (OR = 0.5; 95% CI, 0.29-0.86) and documented allergy (OR = 0.42; 95% CI, 0.25-0.72) were associated with a lower risk of appropriate prescribing in multivariate analysis. Forty-one percent of patients received antibiotics within 1 h of presentation. Inappropriate antibiotic prescribing was not associated with in-hospital mortality.

CONCLUSION

The rates of appropriate antibiotic prescribing in rural Emergency Departments for patients presenting with sepsis is low, but comparable to other referral metropolitan centres.

Exploring the learning environment afforded by an Aboriginal Community Controlled Health service in a rural longitudinal integrated clerkship

OBJECTIVES

Despite the extensive literature regarding longitudinal integrated clerkships (LICs), there is very little evidence about this model in non-traditional settings, such as Aboriginal Community Controlled Health Organisations (ACCHOs). This study explored the key elements of the learning experience in a rural LIC programme, within an ACCHO from the perspective of multiple stakeholders including medical students, the general practice supervisory team, Aboriginal health workers (AHWs) and cultural mentors.

METHODS

The study was conducted using a qualitative case-study design. Participants included Year 3 medical students and the health care team (general practitioners, practice nurse, AHWs, and a practice manager in the role of cultural mentor) from an ACCHO in regional Queensland. Data was collected through semi-structured interviews and analysed using inductive thematic analysis.

RESULTS

Three key features were identified within the learning experience of students undertaking an LIC in the ACCHO setting. This study showed it was a safe context for learners to learn about 'culturally safe practice', 'putting relationships at the centre', and to 'try new things', reinforcing ACCHO as an invaluable site for learning.

CONCLUSION

The extended clinical placement in an ACCHO setting afforded an increase in the number of opportunities to develop students' cultural safety, communication skills and relationships with patients and the supervisory team, including AHWs and cultural mentors.

Beyond the Written Reflection: A Systematic Review and Qualitative Synthesis of Creative Approaches to Reflective Learning Amongst Medical Students

Introduction

In medical curricula, reflective learning (RL) mostly consists of writing and small-group discussion, yet accommodating diverse learning preferences is a key factor in developing lifelong reflective practitioners. Medical education uses a number of creative approaches to RL which cater to more diverse learning preferences; however, the overarching benefits of creative RL to students' development is unknown. To understand how creative RL approaches contribute to students' holistic development we performed a qualitative systematic review and synthesis.

Methods

Systematic searches of PubMed, PsycINFO, and EMBASE databases identified 4986 unique records, with 15 studies meeting inclusion criteria. Included studies specifically assessed the impact of RL on medical students and utilized creative approaches to RL. Creative approaches were defined as those not predominantly focused on reflective writing or group discussion. Studies were appraised using the Critical Appraisal Skills Programme and the Checklist for Quasi-Experimental Studies.

Results

We identified five distinctive RL methods: viewing, performing, creating, imagining, and mind-body. Thematic analysis generated three themes: building and maintaining relationships, personal development, and sense of belonging. These themes incorporated eight sub-themes: recognizing multiple perspectives, empathizing with others, two-way communication skills, patient centered care, processing thoughts and emotions, self-care, interacting positively with peers, and developing trust and commonality.

Discussion

Creative RL approaches may foster students' sense of belonging and support interpersonal skills and personal development. In addition, creative RL activities may contribute to medical graduate's holistic development, while providing opportunities to address diverse student needs using innovative, non-conventional methods.

Exploring recent trends (2014-21) in preferencing and accepting Queensland medical internships in rural hospitals

BACKGROUND

Medical internship is a key transition point in medical training from student to independent (junior) doctor. The national Regional Training Hubs (RTH) policy began across Australia in late 2017, which aims to build medical training pathways for junior doctors within a rural region and guide students, interns and trainees towards these. This study aims to explore preferencing and acceptance trends for rural medical internship positions in Queensland. Moreover, it focuses on internship preference and acceptance outcomes prior to and following the establishment of RTHs, and their association with key covariates such as rural training immersions offered by medical schools.

METHODS

Data from all applicants to Queensland Health intern positions between 2014-2021 were available, notably their preference order and location of accepted internship position, classified as rural or metropolitan. Matched data from Queensland's medical schools were added for rural training time and other key demographics. Analyses explored the statistical associations between these factors and preferencing or accepting rural internships, comparing pre-RTH and post-RTH cohorts.

RESULTS

Domestic Queensland-trained graduates first preferencing rural intern positions increased significantly (pre-RTH 21.1% vs post-RTH 24.0%, p = 0.017), reinforced by a non-significant increase in rural acceptances (27.3% vs 29.7%, p = 0.070). Rural interns were more likely to have previously spent ≥ 11-weeks training in rural locations within medical school, be rurally based in the year applying for internship, or enrolled in the rural generalist pathway.

CONCLUSIONS

The introduction of the RTH was associated with a moderate increase of graduates both preferencing and accepting a rural internship, though a richer understanding of the dominant reasons for and against this remain less clear. An expansion of graduates who undertook longer periods of undergraduate rural training in the same period did not diminish the proportion choosing a rural internship, suggesting there remains an appetite for these opportunities. Overall, domestic graduates are identified as a reliable source of intern recruitment and retention to rural hospitals across Queensland, with entry to the rural generalist pathway and extended rural placement experiences enhancing uptake of rural practice.

Recruiting students to rural longitudinal integrated clerkships: a qualitative study of medical educationists' experiences across continents

INTRODUCTION

Many health systems struggle in the provision of a sustainable and an efficient rural health workforce. There is evidence to suggest that Longitudinal Integrated Clerkships (LIC) placing student learners in rural community settings have positively impacted the provision of rural health care services The recruitment and engagement of students in rural LIC have significant challenges. This study explored best practice methods of recruiting and supporting the transition of medical students into rural LIC.

METHODS

The study took place during the 2021 Consortium of Longitudinal Integrated Clerkships Conference, a virtual event hosted by Stellenbosch University, South Africa. Participants consisted of delegates attending the Personally Arranged Learning Session (PeArLS) themed 'Secrets to success'. The session was recorded with the participants' consent and the recordings were transcribed verbatim. Data was uploaded to NVivo software and coded and analyzed using constant comparative analysis. Salient themes and patterns were identified.

RESULTS

Thirteen attendees participated in the PeArLS representing a range of countries and institutions. Strategically marketing the LIC brand, improving the LIC program profile within institutions by bridging logistics, and the need to scaffold the transition to the rural LIC learning environment emerged as key themes for success. The attendees highlighted their experiences of using peer groups, early exposure to rural LIC sites, and student allocation strategies for promotion. Unique learning styles adopted in LIC models, student anxiety and the importance of fostering supportive relationships with stakeholders to support students in their transition to the LIC environment were discussed.

DISCUSSION

This PeArLS highlighted successful systems and processes implemented in rural settings across different countries to recruit and manage the transition of medical students to rural LIC. The process proved to be a quick and efficient way to elicit rich information and may be of benefit to educationists seeking to establish similar programs or improve existing rural LIC.

Enhancing Reflective Practice Using Prompts in Online Submission of Case Reports (OSCAR): An Exploratory Study Among Medical Students in Rural Longitudinal Integrated Clerkships

Introduction

Medical students learn to reflect to gain new insights into self and practice; however, allowing for reflection within a busy curriculum is challenging. In this study we embedded reflective writing prompts (RWP) into an existing assessment item, Online Submission of Case Reports (OSCAR), to investigate whether this minimalistic scaffolding intervention could develop students' reflective capacity and increase their exposure to rural social determinants of health.

Methods

This study is framed by ontological realism and informed by an interpretivist stance. Focus group transcripts (medical students and educators) were inductively analysed using thematic analysis. Written OSCAR reflections were analysed in a deductive top-down method to provide a contrasting perspective and triangulation.

Results

Focus groups included 27 students, 10 educators, and 52 OSCAR reflections. Inductive analysis generated three themes: Scaffolded Learning, Affording Diverse Responses, and Maximising Learning Opportunities. Deductive analysis indicated that most students (87%) demonstrated lower-order thinking.

Discussion

Most participants valued the impact of RWP on students' learning. Though the RWP did not assist students to demonstrate higher-order thinking, they did increase the breadth of rural social determinants of health topics reflected upon by students, thereby increasing student knowledge of the impact of rural context on patient care.

Fostering links, building trust, and facilitating change: connectivity helps sustain longitudinal integrated clerkships in small rural and remote communities

BACKGROUND

Maldistribution of medical professionals presents a significant challenge globally and leads to inequitable healthcare access, particularly in remote areas. Longitudinal integrated clerkships (LICs) in rural areas can improve workforce distribution and may be an innovative contributor to solving maldistribution issues. However, to align with healthcare needs, LICs must be sustainable in small communities, which often have a limited medical workforce. This study investigates the key elements underpinning LIC sustainability in small communities.

METHODS

This study adopted a constructivist research paradigm in which participants' constructions of their experiences supporting LICs in small rural communities were explored. Participants were conveniently sampled from the LIC community of practice attending the 2021 virtual annual conference of the Consortium of Longitudinal Integrated Clerkships. Data were collected through video recording and thematically analysed to identify barriers and enablers to running sustainable LIC programmes.

RESULTS

Eleven participants fulfilling key roles within LICs, including clinical school directors, program coordinators, and clinical educators, were recruited for the study. Thematic analysis indicated that it is Connectivity, expressed through three subthemes, Fostering Links, Building Trust, and Facilitating Change, which underpins sustainable LICs in small communities.

CONCLUSIONS

Connectivity is a strong mediator for sustainability of LICs and may be the central defining theme of LICs. Increasing connectivity through prioritizing community engagement, trust-building, and strategic investment enhances the sustainability of rural LICs, ensuring their continued positive contribution to medical workforce distribution in underserved areas.