Program
A PDF version of the program is now available here:
Keynote speakers

Lara Fuller
Associate Professor Lara Fuller, MBBS (Hons), FRACGP, GCME, AMusA, is Director of Rural Medical Education and the Rural Community Clinical School at Deakin University, Victoria. As an academic general practitioner, her teaching and research interests are in curriculum design for rural medical education, learning in longitudinal integrated clerkships, rural clinical training pathways and rural workforce outcomes. She is an active member of the Federation of Rural Australian Medical Educators (AusFRAME) and the International Consortium of Longitudinal Integrated Clerkships (CLIC).
Portland District Health services a community of almost 20,000 people. Compared to the rest of Victoria, Portland has greater socioeconomic disadvantage, a higher proportion of people of Indigenous status, and higher rates of hypertension, smoking, alcohol consumption, obesity and psychological distress.
The hospital has 69 registered inpatient beds with a 24-hour, seven-days-a-week Urgent Care Centre (UCC). The UCC is deemed one of the busiest in Victoria, per population.
On 14 June 2018, Professor Paul Worley, the then National Rural Health Commissioner, visited Portland. Portland’s shortage of general practitioners (now critical) was a familiar issue confronting him.
As a result of this visit, Portland decided to ‘grow its own’ rural workforce using the already existing infrastructure, beginning with longitudinal medical student training and ending with advanced skills training posts, eventually producing rural generalist general practitioners to meet the needs of the community.
With the hospital adversely affected, with limited access to International Medical Graduate Hospital Medical Officers due to the COVID-19 pandemic, the timing was opportune.
The outcome of this process is an innovative and collaborative rural generalist pathway with the achieved steps as follows:
- Novel longitudinal internship program. In 2021, interns commenced working for six months in ‘medicine’ and six months in ‘surgery’, but each week begins with a day in the UCC and finishes with a day in general practice. The intern may see a patient in UCC with a FACEM on Monday, follow up care in the general ward Tuesday to Thursday with a physician or surgeon and review or admit patients in general practice with their GP supervisor on Friday.
- PMCV accreditation for a Rural Generalist Year 2 stream. The program comprises a six-month blended community paediatric and obstetric experience, with placements within the hospital, general practice and Aboriginal Medical Service, followed by six months in UCC with support to enrol in ACEM Emergency Certificate and Anaesthetic experience in a JCCA-approved training position.
- Advanced skills training posts in anaesthetics and paediatrics accredited and in emergency currently under development. Partnerships established with Barwon Health and Western Health and South West Healthcare.
- The development of posts that facilitate rural generalist consolidation for each of the above disciplines
The significant beneficiaries of this integrated approach to rural generalist pathways will be the Portland community.

Margaret Garde
In 1985 Margaret Garde arrived in Portland, Victoria, to join her partner, now husband. Being the only female GP, and the youngest by at least 10 years, brought with it a sense of professional isolation.
The disciplines in which she worked included family planning, occupational health, Aboriginal health, public health, forensic medicine, adolescent health and mental health. Now she has a strong interest in teaching and supporting students and doctors who wish to live and work in a rural location, with a strong emphasis on giving them the preparation they need to feel confident and secure.
Thus followed the hosting of a string of medical students, John Flynn Scholars, and cousins, children of friends or anyone else who was remotely interested in medicine as a career.
As is now well recognised, none of these wonderful people returned to Portland to work.
In 2012 the opportunity to work in Portland’s GP SuperClinic presented and, together with this, the ability to host Deakin University students from a rural background who reside in Portland for their 12-month placement.
This, together with a visit from Paul Worley, the then National Rural Health Commissioner, provided the inspiration for our longitudinal rural vocational experience.
Portland District Health services a community of almost 20,000 people. Compared to the rest of Victoria, Portland has greater socioeconomic disadvantage, a higher proportion of people of Indigenous status, and higher rates of hypertension, smoking, alcohol consumption, obesity and psychological distress.
The hospital has 69 registered inpatient beds with a 24-hour, seven-days-a-week Urgent Care Centre (UCC). The UCC is deemed one of the busiest in Victoria, per population.
On 14 June 2018, Professor Paul Worley, the then National Rural Health Commissioner, visited Portland. Portland’s shortage of general practitioners (now critical) was a familiar issue confronting him.
As a result of this visit, Portland decided to ‘grow its own’ rural workforce using the already existing infrastructure, beginning with longitudinal medical student training and ending with advanced skills training posts, eventually producing rural generalist general practitioners to meet the needs of the community.
With the hospital adversely affected, with limited access to International Medical Graduate Hospital Medical Officers due to the COVID-19 pandemic, the timing was opportune.
The outcome of this process is an innovative and collaborative rural generalist pathway with the achieved steps as follows:
- Novel longitudinal internship program. In 2021, interns commenced working for six months in ‘medicine’ and six months in ‘surgery’, but each week begins with a day in the UCC and finishes with a day in general practice. The intern may see a patient in UCC with a FACEM on Monday, follow up care in the general ward Tuesday to Thursday with a physician or surgeon and review or admit patients in general practice with their GP supervisor on Friday.
- PMCV accreditation for a Rural Generalist Year 2 stream. The program comprises a six-month blended community paediatric and obstetric experience, with placements within the hospital, general practice and Aboriginal Medical Service, followed by six months in UCC with support to enrol in ACEM Emergency Certificate and Anaesthetic experience in a JCCA-approved training position.
- Advanced skills training posts in anaesthetics and paediatrics accredited and in emergency currently under development. Partnerships established with Barwon Health and Western Health and South West Healthcare.
- The development of posts that facilitate rural generalist consolidation for each of the above disciplines
The significant beneficiaries of this integrated approach to rural generalist pathways will be the Portland community.

Christine Giles
Chris Giles is a senior executive with considerable experience leading and managing regional, rural and remote health services.
Chris has a strong clinical background as a nurse then midwife, which has proven very valuable in her recent executive roles. These executive roles include working in healthcare organisations in Western Australia, Victoria and Queensland.
Most recently, Chris has worked as the Chief Executive Officer of Portland District Health in south-west Victoria. Prior to this she spent three years living in the Torres Strait, working as a District CEO for Queensland Health.
Chris has a passion for finding solutions to wicked problems, often challenging the normal by finding innovative solutions to improve health service access and quality for rural and remote communities. Some of these solutions include extending scope of practice for clinicians, training cohorts of nurse practitioners and using technology such videoconferencing and electronic health records to overcome distance.
As a sideline, Chris is on the Board of the local catchment management authority, keen to ensure land and water resources are managed to ensure future generations can enjoy them as we do.
Portland District Health services a community of almost 20,000 people. Compared to the rest of Victoria, Portland has greater socioeconomic disadvantage, a higher proportion of people of Indigenous status, and higher rates of hypertension, smoking, alcohol consumption, obesity and psychological distress.
The hospital has 69 registered inpatient beds with a 24-hour, seven-days-a-week Urgent Care Centre (UCC). The UCC is deemed one of the busiest in Victoria, per population.
On 14 June 2018, Professor Paul Worley, the then National Rural Health Commissioner, visited Portland. Portland’s shortage of general practitioners (now critical) was a familiar issue confronting him.
As a result of this visit, Portland decided to ‘grow its own’ rural workforce using the already existing infrastructure, beginning with longitudinal medical student training and ending with advanced skills training posts, eventually producing rural generalist general practitioners to meet the needs of the community.
With the hospital adversely affected, with limited access to International Medical Graduate Hospital Medical Officers due to the COVID-19 pandemic, the timing was opportune.
The outcome of this process is an innovative and collaborative rural generalist pathway with the achieved steps as follows:
- Novel longitudinal internship program. In 2021, interns commenced working for six months in ‘medicine’ and six months in ‘surgery’, but each week begins with a day in the UCC and finishes with a day in general practice. The intern may see a patient in UCC with a FACEM on Monday, follow up care in the general ward Tuesday to Thursday with a physician or surgeon and review or admit patients in general practice with their GP supervisor on Friday.
- PMCV accreditation for a Rural Generalist Year 2 stream. The program comprises a six-month blended community paediatric and obstetric experience, with placements within the hospital, general practice and Aboriginal Medical Service, followed by six months in UCC with support to enrol in ACEM Emergency Certificate and Anaesthetic experience in a JCCA-approved training position.
- Advanced skills training posts in anaesthetics and paediatrics accredited and in emergency currently under development. Partnerships established with Barwon Health and Western Health and South West Healthcare.
- The development of posts that facilitate rural generalist consolidation for each of the above disciplines
The significant beneficiaries of this integrated approach to rural generalist pathways will be the Portland community.

Stan Grant
Stan Grant is the International Affairs Editor for the Australian Broadcasting Corporation (ABC), a multi-award-winning current affairs host, an author and an adventurer.
Well known for having brought the former Prime Minister Malcolm Turnbull to tears when interviewed about Indigenous affairs on The Point, Stan’s keynotes are insightful, engaging, always professional and, at times, controversial.
Stan’s Aboriginal heritage has shaped his dynamic, resilient personality. Born in Griffith in south-west New South Wales (NSW) in 1963, Stan Grant’s mother is from the Kamilaroi people and his father is of the Wiradjuri.
Stan spent most of his childhood on the road living in small towns and Aboriginal communities across outback NSW. His father was an itinerant saw-miller who worked when and where he could. Stan moved so often he attended 12 different schools before he was in his teens.
The early travelling gave Stan a love of adventure and stories. He grew up listening to the tales of his grandfather and uncles and aunts. Despite poverty and an early sporadic education, the security of his family and the larger Aboriginal community gave him a strong platform for life.
After attending university, Stan won a cadetship with the Macquarie Radio Network, launching a career in journalism that has spanned more than 30 years and more than 70 countries. In that time Stan has travelled the world covering the major stories of our time from the release of Nelson Mandela, the troubles in Northern Ireland, the death of Princess Diana, war in Iraq, the second Palestinian intifada, the war on terror, the South Asia tsunami, the Pakistan earthquake and the rise of China.
Stan has hosted major news and current affairs programs on Australian commercial and public television. He has been a political correspondent for the ABC, a Europe correspondent for the Seven Network based in London and a senior international correspondent for the international broadcaster CNN based in Hong Kong and Beijing.
Returning to Australia in 2013, Stan continued to cover international events for Sky News Australia and reignited his passion for telling the stories of his own Indigenous people. He has worked as the Indigenous editor for The Guardian Australia, managing editor for National Indigenous Television and international editor for Sky News. In 2016 Stan was appointed as special adviser to the then Prime Minister Malcolm Turnbull on Indigenous constitutional recognition.
Stan has won many major awards including an Australian TV Logie, a Columbia University Du-Pont Award (the broadcast equivalent of the Pulitzer Prize) and the prestigious United States Peabody Award. He is a four-time winner of the highly prized Asia TV Awards including reporter of the year.
Stan has written The Tears of Strangers and Talking To My Country (Harper Collins), and has published numerous articles and opinion pieces for The Sydney Morning Herald and The Australian.
Stan Grant is passionate about justice and humanity. His years of international reporting have given him a deep understanding of how the world works. He is deeply immersed in the politics and history of Asia and the Middle East. He can link the importance of leadership and the impact of history and, above all, believes in the power and resilience of people.
Stan is married to ABC Sports broadcaster, Tracey Holmes, and has four children. He lives in Sydney.
Booked through: Celebrity Speakers www.celebrityspeakers.com.au

Mark Howden
Professor Mark Howden is Director of the Institute for Climate, Energy and Disaster Solutions at The Australian National University.
He is also an Honorary Professor at Melbourne University, a Vice Chair of the Intergovernmental Panel on Climate Change (IPCC) and the Chair of the ACT Climate Change Council. He was on the US Federal Advisory Committee for the Third National Climate Assessment, was a member of the Australian National Climate Science Advisory Committee and contributes to several major national and international science and policy advisory bodies.
Mark has worked on climate variability, climate change, innovation and adoption issues for over 30 years, in partnership with many industry, community and policy groups via both research and science-policy roles. Issues he has addressed include agriculture and food security, the natural resource base, ecosystems and biodiversity, energy, water and urban systems.
Mark has over 420 publications of different types. He helped develop both the national and international greenhouse gas inventories that are a fundamental part of the Paris Agreement and has assessed sustainable ways to reduce emissions. He has been a major contributor to the IPCC since 1991, with roles in the Second, Third, Fourth, Fifth and now Sixth Assessment Reports, sharing the 2007 Nobel Peace Prize with other IPCC participants and Al Gore.

Gabrielle O'Kane
Gabrielle O’Kane is Chief Executive Officer of the National Rural Health Alliance, the peak body for rural health in Australia. She is an Adjunct Associate Professor with the University of Canberra and Charles Sturt University. Gabrielle has extensive experience in the private and public health sector, which has contributed to her deep understanding of the need for collaborative partnerships to support the rural health workforce and achieve positive health outcomes for rural communities. She promotes solutions to the Australian Government to address the needs of rural communities and health professionals, through her position on many pertinent steering groups and committees.

Roland Sapsford
The Climate and Health Alliance’s new Chief Executive Officer, Roland Sapsford, has been working to respond to the challenge of climate change and the task of reducing emissions through public policy and activism for much of his professional life.
This work has ranged from being involved in New Zealand’s first study of the impacts of carbon taxes and work on energy efficiency and home insulation policy, through to getting solar panels installed on a local community centre and campaigning against major road projects.
Roland once completed four years of a medical degree and was a senior manager in public health for five years. He has also studied economics and systems ecology to postgraduate level, and has a strong commitment to Indigenous rights.

Rabia Siddique
Rabia Siddique is a history-making humanitarian, best-selling author and multi-award-winning international keynote speaker. She is a sought after transformational coach and mentor and speaks English, French, Spanish and Arabic.
Current work
Rabia’s powerful and engaging presentations on leadership, resilience, equality and diversity draw on her personal story of strength, courage and forgiveness, in addition to her legal, military and psychology training. Surviving a hostage crisis in Iraq, Rabia garnered global attention for making the British military accountable for silencing her about her ordeal and role as a military lawyer in releasing captured Special Forces soldiers. Standing up for justice in the face of public ridicule, Rabia’s brave action in suing the British Government for sexism and racism became a catalyst for policy change to ensure a fairer workplace for women and cultural minorities in the British military.
Rabia is an expert commentator, regularly appearing in newspapers and magazines, and on television, radio and online media in Australia and around the globe, including The Guardian, 60 Minutes and ABC television.
With her best-selling memoir Equal Justice also the focus of a feature film, she is now writing her second book.
Rabia is an Ambassador for 100 Women, Angelhands, Esther Foundation, Inner Ninja (mental health support) and Ishar (multicultural health service). She is a Board Member of the International Foundation of Non-Violence, Museum of Freedom and Tolerance, Wesley College and Calan Williams Racing.
Previous experience
Law: Rabia’s extensive career as a criminal, terrorism, war crimes and human rights lawyer has taken her to Europe, the Middle East, South America, South East Asia and Australia.
Military: Her military career includes serving as a British Army officer in England, Northern Ireland and the Middle East. Rabia was one of England’s first Armed Forces Employment Law Officers – a role which took her to Royal Military Academy Sandhurst where she ran equality and diversity training. Among her charges was Prince William, the Duke of Cambridge.

Keith Suter
Dr Keith Suter is considered one of Australia’s most influential global futurists and media commentators in national and foreign affairs. He has also held many strategic leadership roles. Dr Suter is an experienced, professional and awarded presenter renowned for explaining complex global and business issues in a way his audiences can digest and understand. He is in demand as an MC and conference facilitator. Keith’s tailored keynotes, workshops and facilitated sessions are entertaining, highly compelling and always captivating.
In 2019 Keith was proudly appointed as a Member (AM) of the Order of Australia (General Division), for significant service to international relations and to the Uniting Church in Australia.
Previous experience
Academic expert: Dr Keith Suter has achieved three doctorates. The first of these was about the international law of guerrilla warfare (University of Sydney), the second about the social and economic consequences of the arms race (Deakin University) and a third doctorate on scenario planning (University of Sydney).
Leadership roles: He has been appointed to many prestigious roles throughout his career, including Chairperson of the International Commission of Jurists (NSW), Director of Studies at the International Law Association (Australian Branch) and Managing Director of the Global Directions think tank. After 25 years, Keith recently retired from the role of Chairperson of the International Humanitarian Law Committee of the Australian Red Cross (NSW).
Global recognition: He has also been a member of the prestigious Club of Rome since 1993. The Club is ‘an informal association of independent leading personalities from politics, business and science, men and women who are long-term thinkers interested in contributing in a systemic, interdisciplinary and holistic manner to a better world. The Club of Rome members share a common concern for the future of humanity and the planet.’ The club has only 100 members, with Mikhail Gorbachev among them.
Keith is a Life Member of the United Nations Association of Australia in recognition of his service. At various times from 1978 to 1999, he served as the National President of the organisation and took on the roles of WA and NSW State President.
Strategic roles: Keith was the President of the Centre for Peace and Conflict Studies (1991–98) at the University of Sydney, and was a consultant on social policy with the Wesley Mission for 17 years. In addition, he served as a consultant for a number of other organisations with a focus on local and international issues. He is also an active member of the Australian Institute of Company Directors.
Media roles: He frequently appears on radio and television discussing politics and international affairs. He has been, for many years, the foreign affairs editor on Channel 7’s Sunrise program.
Renowned author: Among Keith’s many books are All about Terrorism: Everything you were afraid to ask, as well as Global Order and Global Disorder: Globalization and the Nation-State and 50 Things You Want to Know About World Issues … But Were Too Afraid to Ask.

Susan Wearne
Susan Wearne is a general practitioner (GP) and senior adviser to the Australian Government Department of Health and Aged Care regarding rural health and health professional education. She trained at Southampton University in England and completed general practice training in Northamptonshire and back home in Cheshire. She owned a practice in York, England, and worked at the Aboriginal Medical Service in Alice Springs and for the Royal Flying Doctor Service at Ayers Rock Medical Centre. She has extra qualifications in child health, women’s health, family planning, primary health care and medical education and now works as a GP in Canberra.
Susan is a Clinical Associate Professor at Australian National University and has published over 40 peer-reviewed articles on general practice and medical education. The fourth edition of her textbook Clinical Cases for General Practice Exams was published in 2019. She held educational leadership positions in the Northern Territory before taking on national roles for the Royal Australian College of General Practitioners and General Practice Education and Training. She works in the Health Workforce Division which manages general practice training and other programs that promote Australians’ access to qualified health professionals. She was medical lead for the soon to be released Australian National Medical Workforce Strategy.
Susan’s husband, Tim Henderson, is the eye surgeon at Alice Springs Hospital. Their daughter and her family live in England and their son works in Adelaide. Between flights home to Alice, Susan swims, makes clothes and enjoys the scenery on the lake as she learns to row.

Justin Yeung
Justin is a consultant emergency physician by training. He has had a number of leadership positions in WA Health – director roles in emergency medicine (Royal Perth Hospital, Albany Health Campus and WA Country Health Service) and medical services (Great Southern region of Western Australia). He is currently Medical Director of the WA Country Health Service Command Centre, which incorporates a number of 24/7 clinical streams in acute telehealth – emergency, inpatient medicine, mental health, obstetrics and midwifery, palliative care and acute patient transfer coordination. Justin splits his time between Perth and Albany, and still maintains clinical exposure working in the Emergency Telehealth Service and locums in regional Western Australia. To add some spice to the year, Justin has started postgraduate studies in health care leadership. He’s also an oft-stung beekeeper.
From humble beginnings as a limited-hours, weekend-only, single-doctor emergency consultation service for a handful of small country hospitals in Western Australia (WA), the WA Country Health Service Command Centre is approaching a 10-year milestone of providing specialist-led clinical consultation directly to rural patients using video-enabled technology. The Emergency Telehealth Service (ETS) has grown into a 24/7 virtual emergency department, managing more than 27,000 consultations in 2021. The range of clinical services available to support our regional clinicians using telehealth has expanded to include inpatient care (2018) and mental health (2019), obstetric and midwifery, palliative care and, most recently, transfer coordination (all commenced in 2022). We will present an overview of our 10-year journey, highlight areas of innovation and success, as well as outline challenges we have and continue to face.
Plenary sessions
Opening Session:
Julieanne Gilbert MP
Assistant Minister for Health and Regional Health Infrastructure, Queensland – Welcome to Brisbane
Emma McBride MP
Federal Member for Dobell, Assistant Minister for Rural and Regional Health
Plenary Session 1:
Russell Roberts
Australian Journal of Rural Health
Editor in Chief 2017–21 – AJRH 30 Years
Jason Waterford
HESTA Australia Ltd
Plenary Session 4:
Helen Haines MP
Independent Federal Member for Indi
Closing remarks:
Stephen Gourley
Deputy Chair, National Rural Health Alliance
Concurrent presenters
Karen Nicholls
No biography provided.
Cultural safety in rural health
The Australian Indigenous Doctors’ Association (AIDA) is the peak body representing Aboriginal and Torres Strait Islander doctors and medical students. AIDA’s core business is to grow the Aboriginal and Torres Strait Islander workforce, and to improve the health of Aboriginal and Torres Strait Islander peoples across Australia. AIDA aims to inform and support a culturally safe health system for all Aboriginal and Torres Strait Islander medical students, doctors and patients.
This presentation will outline the factors in developing culturally safe care for Aboriginal and Torres Strait Islander patients, and the role of AIDA’s cultural safety training in closing the gap in health outcomes for rural Aboriginal and Torres Strait Islander peoples.
In 2019, AIDA launched its cultural safety training. Aboriginal and Torres Strait Islander Health in Clinical Practice is clinically focused and designed to assist medical practitioners to integrate cultural safety into their practices to improve health care for Aboriginal and Torres Strait Islander patients. Developed and delivered by Aboriginal and Torres Strait Islander doctors for doctors, the one-day training is enhanced by the unique insights of AIDA members and a range of clinical case studies that have been experienced first-hand by Aboriginal and Torres Strait Islander doctors.
Content in the program affects doctors in all regions, including rural locations. Many of AIDA’s members work in rural locations and bring a unique knowledge about cultural safety care for Indigenous patients. Research shows that racism makes Indigenous peoples sick, and that cultural safety improves the health outcomes of Aboriginal and Torres Strait Islander patients.
Given the greater burden of disease and consequent increased need for healthcare services, it is imperative that all health services provide accessible, appropriate and responsive services and programs. Provision of culturally safe services and care is an evidence-based strategy to reduce morbidity and mortality among Aboriginal and Torres Strait Islander peoples.
Aboriginal and Torres Strait Islander peoples in rural areas are more likely to access, and will experience better outcomes from, services that are respectful and culturally safe places. Likewise, Aboriginal and Torres Strait Islander doctors in rural locations are more likely to stay and thrive in learning and working environments that consistently demonstrate cultural safety.
Specialist training to grow Aboriginal and Torres Strait Islander rural workforce
Growing the rural Aboriginal and Torres Strait Islander medical workforce is key to culturally safe care for rural Indigenous patients. Specialist training is a driver for the development of Aboriginal and Torres Strait Islander doctors. In 2020, the number of Aboriginal and Torres Strait Islander specialist doctors remained low when compared with the general specialist doctor workforce numbers. The Australian Indigenous Doctors’ Association (AIDA) is developing a specialist trainee support program, where we provide:
- upskilling of junior doctors to quickly obtain the skill set required of registrars
- support for examination and assessment techniques
- assistance with career planning and networking
- advocacy and assistance in the development of pipelines to specialties
- exploring opportunities for training to occur in non-traditional settings such as ACCHOs, community settings and Aboriginal health ‘outreach’ clinics
- advocacy on the importance of a culturally safe training environment.
AIDA has recently appointed a Specialist Trainee Support Lead, to support Aboriginal and Torres Strait Islander doctors to undertake specialist training, as well as provide advocacy and support needed for colleges and individuals to create successful pathways into specialist training. Supporting culturally safe and rural-specific specialist training for Aboriginal and Torres Strait Islander trainees is vital in growing the Aboriginal and Torres Strait Islander workforce and promoting culturally safe care for rural Aboriginal and Torres Strait Islander patients.
Ilsa Nielsen
Ilsa Nielsen is currently employed as a Principal Workforce Officer in the Allied Health Professions’ Office of Queensland, Department of Health Queensland. This role is based in Cairns and supports workforce policy, planning and development for rural and remote allied health services across Queensland Health. The focus of Ilsa’s work in recent years has been the development of a rural generalist pathway for the allied health professions. This strategy is demonstrating positive workforce and service outcomes in Queensland and is expanding into other Australian states and territories. Ilsa is a physiotherapist and has postgraduate qualifications in public health, education, health economics and policy. Her former appointments include academic and clinical physiotherapy positions in metropolitan and regional Queensland. Ilsa maintains involvement in undergraduate teaching as an Adjunct Senior Lecturer at James Cook University.
Evaluation of the Queensland Health Allied Health Rural Generalist Pathway 2019–22
Aims: The Allied Health Rural Generalist (AHRG) Pathway was developed in Queensland Health between 2014 and 2018. Following successful evaluated trials, the Pathway was embedded in system funding and employment structures. The AHRG Pathway is an integrated service, workforce and training strategy that supports rural and remote health service outcomes. The Pathway includes: (1) early-career, designated training positions for nine allied health professions supported by postgraduate training in rural generalist practice; and (2) a leadership development program for senior allied health professionals (AHPs).
The purpose of this project is to examine the implementation and outcomes of the AHRG Pathway 2019–22 on:
- workforce development and sustainability
- training and development
- service development and delivery.
Methods: This project employed a mixed-method, implementation-effectiveness hybrid design to evaluate the pathway using both retrospective and prospective data. Primary data sources included: (1) online surveys with AHPs involved in the AHRG Pathway (such as trainees, managers/supervisors); (2) online surveys with a matched cohort of rural AHPs without connection to the Pathway; and (3) follow-up semi-structured interviews and virtual site visits with focus groups. Secondary data included de-identified AHRG Pathway program documentation and payroll data used to compare longitudinal tracking of trainees/participants and matched cohorts.
Survey data were analysed using descriptive and non-parametric statistics and content analysis. Individual interviews and focus groups were recorded, transcribed and analysed to identify themes. Both survey and individual interview data informed questions asked of key contacts and focus group participants at the virtual site visits.
Results: Preliminary findings describing factors for engagement in the AHRG Pathway include interest in rural practice/career and professional development, and indicate challenges and enablers of success, including the key role of the professional supervisor and access to protected development time. Attraction and retention factors include workforce and service pressures.
Strategies used to address the methodological challenges of investigating small, dispersed rural and remote teams will be presented, including the use of virtual site visits and leveraging existing finance and payroll data.
Conclusion and relevance: The AHRG Pathway is being implemented in most state and territory health systems and the primary care sector nationally. Outcomes from this evaluation can guide decision-making on improvements and investment in the strategy.
Anna Noonan
Anna commenced her PhD in July 2020 as a rurally based researcher investigating the experiences of rural women and rural healthcare providers in managing unintended pregnancies, with a specific focus on abortion. Anna has a multidisciplinary tertiary background, with a Bachelor of Media and Communications (Journalism), Bachelor of International Studies (Latin America) from UTS and a Master of Public Health from the University of Sydney. After a decade working in human rights and international development, a summer internship at the World Health Organization’s Maternal and Child Health Unit in Geneva in 2010 inspired a career shift into the university sector. Since then, Anna has worked in strategic research and education initiatives in the fields of arts, social sciences, planetary health and, most recently, rural health for the University of Sydney. Anna lives and works on Wiradjuri country in Orange, New South Wales.
'Where do you actually go?': how rural NSW women manage unintended pregnancies
Aims: This rurally led study aims to explore the experiences of rural New South Wales (NSW) women in managing unintended pregnancies where they live. In doing so, this study aims to provide evidence to help inform and improve reproductive healthcare services, including abortion, for Australia’s rural population.
Methods: This qualitative study involves semi-structured qualitative interviews with women from a range of rural locations across central to far-west NSW about their experiences of the current realities of rural reproductive health care. Recruited through community networks and social media, rural women of all ages and backgrounds share their stories of managing an unintended pregnancy, and the impact of rurality on their decision-making and access to their preferred care. Data collected from interviews are audio-recorded, transcribed and will be analysed for themes using the framework method.
Relevance: Decriminalisation of abortion and favourable government policies about comprehensive reproductive health for all women is now evident across all states and territories. Yet rural women are still 1.4 times more likely than urban women to make up the one-third of all unintended pregnancies in Australia. Management of unintended pregnancies in rural settings is facing new challenges: regular travel restrictions caused by the COVID-19 pandemic, closure of abortion clinics, compounded with chronic workforce shortages. New innovations are also emerging. Online training and telehealth options for prescribing medical termination of pregnancy for women who cannot access local services are two such examples. However, clear information about what consumers – rural women themselves – experience, expect and require is pivotal to ensure new innovations meet local needs.
Results: At this stage of the research, approximately half the interviews have been conducted and thematic analysis is yet to be undertaken. All current participants (n=9) managed an unintended pregnancy in rural NSW in the past five years, with over half (n=5) obtaining a termination for that pregnancy. The mean age of participants is 30 years, and 55 per cent of participants live in outer regional or remote Australia. Further results for this study are pending and will be updated at the conference.
Conclusions: Service provision models that seek to meet the needs of rural women should not only be informed by national and international evidence of what works elsewhere. They should equally be informed by original research with consumers on the particularities of rural settings and rural women’s expectations and preferences of optimal reproductive healthcare services, particularly when managing unintended pregnancies.
Shannon Nott
Dr Shannon Nott completed a Churchill Fellowship in 2015 throughout Canada, the United States and Brazil on the utilisation of technology to address health challenges in rural and remote communities, and has since led the implementation of a number of successful telehealth programs. Through the COVID-19 pandemic, Dr Nott was tasked with leading the NSW Virtual Care Community of Practice, directly inputting into NSW Ministry of Health COVID-19 priorities and activities to address the sudden take-up of virtual care programs across the state. During this time, he has also been appointed as the NSW Health Virtual Care Accelerator Clinical Director, tasked with supporting local health districts, specialty hospital networks and the broader NSW Health system to adopt virtual care programs. Dr Nott also sits on the NSW Telehealth Strategic Advisory Committee, is a member of the World Health Organization’s Roster of Digital Health Experts and is a member of the Australian College of Rural and Remote Medicine’s Digital Advisory Committee. Dr Nott is considered a leading expert on telehealth, having spoken at multiple national and international conferences.
Efficacy of a virtual clinical pharmacy service in rural and remote hospitals
Background: Many small rural and remote hospitals do not have access to pharmacy services to support best-practice medication management and the quality use of medications. To improve access at hospitals without onsite pharmacists, a clinical telehealth pharmacy model of care was implemented. The pharmacist uses the electronic medical record, electronic medication management and a wireless teleconferencing cart to provide medication reconciliation, medication review, patient counselling, advice on prescribing, and administration and staff education.
Aim: To evaluate the efficacy of a new virtual pharmacy model of care and determine if it can improve quality use of medicines and patient outcomes.
Methods: In 2020, a virtual clinical pharmacy service was implemented to eight facilities via a stepped-wedge randomised controlled trial. Patient-level data was extracted from health information systems to evaluate the service and a patient-reported experience measures survey used to evaluate patient acceptability. The primary outcome measure was medication reconciliation at transfers of care. Secondary outcomes included patient outcomes such as length of stay, 28-day readmission, falls and detection of medication errors. Quality use of medicines was assessed by measures such as proportion of patients receiving best possible medication history, VTE prophylaxis and medication lists on discharge.
Results: 1062 eligible patients were evaluated for quality use of medicines and outcomes. Best possible medication history, medication reconciliation, VTE rates and detection of medication errors improved. There was no detectable change in length of stay, falls and readmission rates. Patient feedback was positive and comparable to face-to-face care, with 95 per cent of patients (n=189) reporting overall experience of care as good or very good.
Discussion: The virtual clinical pharmacy model is an innovative telehealth program that can efficiently bridge vast distances to increase access to clinical pharmacists’ specialised medication knowledge and unique skills. This patient-centred model can improve the quality use of medicines for patients in under-resourced rural and remote hospitals. This model is acceptable to patients, scalable and likely transferrable to rural areas.