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. | INTRODUCTIONFeedback is often regarded as having a mostly positive influence on learning, but in some cases, it can lead to demotivation, defensiveness and deflection. 1 Recent literature suggests that strong supervisor-trainee relationships can improve engagement with, and subsequent action from, feedback information. [2][3][4] It has been suggested that these types of feedback relationships need to take place in a 'psychologically safe' environment, in order to support the type of learner vulnerability and risk-taking required for open feedback and

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.

SUMMARYBackground: With vertical integration, registrars and medical students attend the same educational workshops. It is not known whether these learners have similar or different learning styles related to their level of education within the medical training schema. This study aims to collect information about learning styles with a view to changing teaching strategies. If a significant difference is demonstrated this will impact on required approaches to teaching.

ObjectiveTo assess the prevalence of overweight and obese women in the antenatal and perinatal periods, in rural hospitals; and to evaluate neonatal and maternal outcomes, including transfer to larger birthing centres.DesignA retrospective clinical chart audit.SettingRural maternity services in five Queensland rural hospitals.ParticipantsData were collected from 250 women presenting to participating rural hospitals, with an estimated due date in 2016.Main outcome measuresObstetric and neonatal data, whether transfer occurred, mode of delivery and any complications, and neonatal outcomes including birth weight and complications were collected. Demographic information collected included maternal age, gravidity and parity, race, smoking status and pre‐pregnancy body mass index. The main outcome measures of interest were birth weight, Caesarean rate, transfer rate and diagnosis of gestational diabetes in relation to the body mass index.ResultsOver 50% of women were overweight or obese while entering pregnancy, with 5.2% of mothers in the morbidly obese category. There was an increase in the birth weight of mothers with a body mass index of more than 25. The increasing body mass index was associated with an increased likelihood of transfer, diagnosis of gestational diabetes, elective and, especially, emergency Caesareans performed at the hospital. Twenty‐four percent of women continued to smoke throughout pregnancy.ConclusionA high prevalence of obesity was found in the rural obstetric population. As the body mass index increases, so too does birth weight, gestational diabetes, transfer rate and Caesarean section rate. The rates of smoking throughout pregnancy were higher than the average metropolitan rates. These findings have implications not just for rural hospital operation and resources, but also for preventive health activities in rural communities.

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.

Background Assessment of cultural safety in general practice consultations for Indigenous patients is a complex notion. Design and development of any assessment tool needs to be cognizant that cultural safety is determined by Indigenous peoples and incorporates defined components of cultural safety and current educational theory. Consideration of how social, historical, and political determinants of health and well-being impact upon the cultural safety of a consultation is also important. Given this complexity, we assume that no single method of assessment will be adequate to determine if general practice (GP) registrars are demonstrating or delivering culturally safe care. As such, we propose that development and assessment of cultural safety can be conceptualised using a model that considers these variables. From this, we aim to develop a tool to assess whether GP registrars are conducting a culturally safe consultation, where cultural safety is determined by Aboriginal and Torres Strait Islander peoples. Methods This protocol will be situated in a pragmatic philosophical position to explore cultural safety primarily from the Australian Aboriginal and Torres Strait Islander patients’ perspective with triangulation and validation of findings with the GP and GP registrar perspective, the Aboriginal and Torres Strait Islander community, and the medical education community. The study will integrate both quantitative and qualitative data through three sequential phases. Data collection will be through survey, semi-structured interviews, an adapted nominal group technique, and a Delphi questionnaire. We aim to recruit approximately 40 patient and 20 GP participants for interviews, conduct one to five nominal groups (seven to 35 participants) and recruit fifteen participants for the Delphi process. Data will be analysed through a content analysis approach to identify components of an assessment of cultural safety for GP registrars. Discussion This study will be one of the first to explore how cultural safety, as determined by Indigenous peoples, can be assessed in general practice consultations. This protocol is shared to stimulate awareness and discussion around this significant issue and prompt other studies in this area.

BackgroundAs The Royal Australian College of General Practitioners (RACGP) introduces alternatives to the Objective Structured Clinical Examination, it is imperative that standards are continually set for a culturally safe general practice workforce. Assessments have many functions and should be continually reviewed to ensure that they require general practitioners (GPs) to demonstrate genuine cultural safety.

This scoping review aims to explore how cultural safety is defined in the Australian literature with health professional learners in clinical interactions. It maps how the components of the Australian Health Practitioner Regulation Agency definition of cultural safety align with this evidence. Databases were systematically searched for original, peer-reviewed research that included Australian Aboriginal and Torres Strait Islander peoples, health professional learners who were eligible for registration in Australia, teaching and assessment. Many elements of cultural safety lacked Indigenous input and had no patient involvement. General consultation and communications skills were key components of culturally safe interactions. The Australian Health Practitioner Regulation Agency consensus statement on cultural safety provides a consistent definition for teaching and learning cultural safety within health professions in Australia. The findings suggest that developing an approach for cultural safety requires incorporation of Indigenous voices, patient-centred care metrics, patient feedback, learner self-assessment and attitude measures.