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
Lenelle Papertalk
Lenny is a Yamatji woman who grew up in Mullewa and has lived in Geraldton for over 25 years. She has completed a Bachelor of Applied Science and Diploma of Indigenous Community Management and Development, a Diploma of Management and her Master of Social Work. She has worked in many community-facing roles: education liaison, Police Department of WA, Centrelink, Mission Australia, Bundiyarra Aboriginal Corporation and as a research assistant with the WA Centre for Rural Health in Geraldton since 2015. She has contributed to research through consultations, data collection and analysis, and has co-authored several reports and peer-reviewed publications. She has established and is currently the facilitator of the Mullewa/Geraldton Yarning Circle for Aboriginal people with brain injury.
The establishment of yarning circles for Aboriginal Australians after acquired brain injury
Aims: Aboriginal Australians experience brain injury through stroke or brain trauma more than twice as often as non-Aboriginal Australians. Building on previous research on culturally secure services, this paper reports on the development and progress of the first support groups in the form of yarning circles specifically for Aboriginal people with brain injury and their families, in metropolitan and regional areas, to encourage social and emotional wellbeing, and improve health outcomes for this population. This includes barriers and facilitators to establishment of the groups.
Method: Yarning circles led by Aboriginal facilitators are being established within one regional and one metropolitan Aboriginal Community Controlled Health Service. They offer culturally secure psychosocial support, education, practical problem-solving, yarning and socialisation. A participatory action research methodology is monitoring the development and outcomes over six months. Qualitative and quantitative methods will assess feasibility, acceptability and effectiveness of the group intervention. Ten Aboriginal people ≥18 years, post either stroke or traumatic brain injury and their family members/carers will be recruited at each site.
Results: Completed to date – Aboriginal research engagement and ethics approval; appointment of an Aboriginal project manager and two trained Aboriginal group facilitators. In progress – initial recruitment and commencement of yarning circles; ongoing marketing of the groups via social media; circulation of flyers to Aboriginal corporations, hospitals and brain injury services; interviews on Aboriginal community radio promoting the local groups.
Conclusions: This co-designed study embeds knowledge transfer and sustainability in the development of the support groups. The study will document both challenges and facilitators involved in the establishment of such groups and will inform the feasibility of future culturally secure implementation of brain injury yarning circles in metropolitan and regional/remote areas across the state and nationally.
Pene Pariagh
Pene is a New-Zealand-trained registered comprehensive nurse, who specialised in mental health early in her career, completing a postgraduate certificate in forensic psychiatry and postgraduate diploma in advanced mental health nursing. Pene has spent a significant part of her nursing career living and working throughout several of the different health regions of rural and remote Western Australia, across inpatient, community and crisis services.
Pene is currently a mental health clinical nurse consultant and the Nursing Team Lead for the Mental Health Emergency Telehealth Service, a clinical stream of the WA Country Health Service Command Centre. The Mental Health Emergency Telehealth Service operates 24/7 and provides access to specialist mental health clinicians for country residents presenting with acute mental health and AOD problems to rural and remote hospitals, nursing posts and Aboriginal Medical Services.
Improving access to emergency mental health services across regional and remote WA through telehealth
Introduction/background: The Mental Health Emergency Telehealth Service (MH-ETS) was introduced in 2019 and is utilised across all WA Country Health Service (WACHS) regions. Currently, the service covers over 85 sites and is expected to expand further. Historically, in rural/remote locations where specialist mental health services are sometimes unavailable, patients presenting to emergency departments and other health facilities with mental health and alcohol and other drugs issues are seen by health clinicians from a generalist background. Should these patients require additional support, there is often a need to transfer the client to specialist mental health services, often outside of the local area. In 2018, the Western Australian Sustainable Health Review Interim Report recommended an expansion of the existing emergency telehealth service, which resulted in a speciality pilot in mental health to meet increasing mental health service demand and the needs of the rural/remote population. The MH-ETS was established to deliver 24/7 service using cutting-edge video technology. Provided by specialist mental health clinicians, the service provides mental health assessment, care plan development and management for patients with mental health and drug and alcohol issues in rural/remote emergency departments and other health facilities. Alongside the establishment of the service, there has been significant investment in additional skills development and weekly practice training to support non-mental-health clinicians working in rural/remote emergency departments and other health facilities.
Methods: The presentation will provide an overview of the service pathway and key outcomes during the first two years of operation.
Findings: Since the commencement of the service in July 2019, over 3,300 patients have been seen by the MH-ETS service, representing 8.5 per cent of shared-care episodes. The one-year service evaluation indicates that, out of a total of 1,250 patients assessed, unnecessary transfer was avoided in over 80 per cent of cases. In addition, in the period June 2020 to June 2021 alone, a total of 120 educational sessions were delivered, attended by 499 rural/remote clinicians.
Conclusion: The MH-ETS has greatly contributed to removing geographical barriers in accessing specialist emergency mental health care. Historically, clients requiring mental health support had to wait for visiting mental health specialists or be referred to services outside of their locality, leading to unnecessary displacement/dislocation. Travel outside the home region to access mental health care is a source of significant stress, especially to Aboriginal people and the establishment of the MH-ETS has enabled WACHS to significantly reduce this and contributed to the skills development of non-mental-health clinicians working across country Western Australia.
Nicola Parkin
Dr Nicola Parkin likes questions, enigmas and human depths. She is a higher education practitioner who locates her work in the difficult spaces between teaching, learning, professional practice, philosophy, design and creative practices. Sometimes she just stumbles into the borderless worlds between things because she is following her nose and sometimes she is drawn to purposefully transgress constructed bounds, just so she can find out what is fertile when we do that. Nicola’s educative commitments have been forged over many decades of work in community cultural development and adult community education programs. However, it is the wild, untamed inner forces of learning and becoming in each individual that most delight and intrigue her; forces that are themselves forged in the fertile tensional spaces between individual and community. Methodologically, Nicola leans into the existential, the hermeneutical, the phenomenological. Her research is about finding meaningful ways to see, say and save the deeper undercurrents of our educative work, and how we might purposefully and profitably bring these qualitative riches into our everyday practices.
Learning lived experience: strategies to support medicine students to learn from the patient as a person
This presentation reports on a key finding of a year-long evaluation of the longitudinal rural stream of the Flinders University Doctor of Medicine program. The evaluation collected input from 63 program members (students, administrators, clinical supervisors and educators) using a participatory visual mapping method to explore how the clinical learning experience might be enhanced. The evaluation found that there was something critical missing from the students’ learning picture: the voice and context of the lived experience of the patient themselves, as a person living in a rural community. This presentation examines some of the ways that this important perspective might be foregrounded in the rural clinical learning curriculum, including: incorporating patient feedback in the clinic; non-clinical community attachments; continuity of care strategies; consumer representation; and, ultimately, reframing the student–patient relationship towards a truly person-centred learning model where the patient is a person and a partner in the teaching community.
Ashleigh Parnell
Ashleigh Parnell is a research officer at the Australian Indigenous HealthInfoNet. The main projects that she works on are the Alcohol and Other Drugs Knowledge Centre and the Tackling Indigenous Smoking website.
Ashleigh has a Bachelor of Science (Health Promotion) from Curtin University and has been with the HealthInfoNet since 2019.
Finding information about FASD among Aboriginal and Torres Strait Islander people
Background and aims: For an often time-poor health workforce, it is important that timely, relevant information is easily and freely accessible, particularly in rural and remote areas. This presentation will provide an overview of a project that aims to provide health practitioners who are working to reduce the harms from alcohol and other drug (AOD) use among Aboriginal and Torres Strait Islander people with relevant and culturally appropriate information. There will be a focus on fetal alcohol spectrum disorder (FASD), including an overview of findings from a recent review of FASD among Aboriginal and Torres Strait Islander people. The review provides a synthesis of key, up-to-date information about FASD in this population group. The presentation will also provide information on how to access resources and information about FASD to inform practice, research and policies.
Methods: This presentation will discuss how the project is informed by the knowledge exchange process in order to support the practice of AOD workers, researchers, policymakers and health practitioners. The aim of this process is to make research and other information available in a form that has immediate and practical utility. A collaborative process resulted in the development of a review of FASD and associated knowledge exchange products.
Results: Key findings from the review of FASD among Aboriginal and Torres Strait Islander people will be discussed, including:
- impacts of FASD on individuals and communities
- historical, social and cultural context of FASD
- the role of women and men in FASD prevention and management
- current FASD programs and services for Aboriginal and Torres Strait Islander communities
- future directions for FASD prevention, diagnosis and management.
An overview will also be provided of the resources that have been produced to accompany this review to help make the information more easily accessible to a time-poor workforce.
An outline will also be provided of how to access information online via the project, such as publications, policies, programs, health practice and health promotion resources and organisations particularly about those relating to FASD among Aboriginal and Torres Strait Islander people.
Conclusions: This presentation will demonstrate how health practitioners who are working in rural and remote areas to reduce the harms from AOD use among Aboriginal and Torres Strait Islander people can easily find relevant information. It will focus on a new review and knowledge exchange products about FASD that were produced in a collaborative process.
Kerri-Lynn Peachey
Kerri-Lynn is the Farm Safety Research Manager at AgHealth Australia, at the University of Sydney, School of Rural Health. For many years at AgHealth she has worked with the agricultural and horticultural sectors on translation into policy and practice, although in 2016 she moved to the area of farm safety research. Currently she is involved with monitoring all fatal and non-fatal incidents which occur on a farm in Australia. It is this monitoring service which enables her to maintain a national database of all fatal incidents and direct research opportunities. Combined with directing research, her aspiration is to continue providing advice on farm safety and wellbeing to the broader farming community. In addition, she operates a mixed cropping and livestock enterprise with her husband and, therefore, recognises and acknowledges the necessity to educate farming families and communities on the importance of protecting every person in the farm environment.
Farm injury deaths in Australia 2001–20
Background: Agriculture is recognised as a high-risk industry. Safe Work Australia indicates agriculture has surpassed road transport in relation to the number and rate (per 100,000 workers) of work-related fatalities. Furthermore, the agriculture rate (12.7) is nine times higher than the all industries rate (1.4). This study aimed to describe the nature, trends and pattern of unintentional farm fatalities in Australia for the 2001 to 2020 period and determine the scope for further interventions to reduce fatalities.
Methods: Data from the National Coronial Information System for farm-related incidents (2001–20) were analysed. Denominator data on the number of persons working in the agricultural sector, hours worked and the number of farms nationally and by state, were derived from the Australian Bureau of Statistics. A Poisson regression model was used to assess the temporal pattern nationally over the study period.
Results: In the period, there were 1,584 unintentional farm fatalities. The annual mean number of deaths was 79 (SD 12.2), consisting of 54 (SD 8.7) work cases and 25 (SD 9.7) non-work cases. Males accounted for 1,398 (88%) of decedents. Persons over 65 years exceeded one-third of all work-related cases (n=374) and had significantly higher incidence rate ratios (4.63; CI 3.75-5.70). Throughout the period, the mean death rate was 5.9 per 10,000 farms; 17.6 (Range 12.6-21.4; SE 0.56) per 100,000 workers; and 0.12 (Range 0.08-0.15; SE 0.003) per million hours worked.
There was no significant variation over the period in work-related rates per 100,000 workers or per million hours worked. There was a curvilinear response with a slight reduction through to 2006–07, followed by an increase. Farm vehicles (n=618) and mobile farm machinery (n=409), were responsible for almost two-thirds of cases. More specifically, leading agents were: tractors (15.8%); quads (All Terrain Vehicles – ATVs) (12.3%); water bodies (6.3%; n=100 – including dams 3.8%; n=60); farm utilities (6.6%); motorbikes (5.2%); horses (4.7%) and tree felling (3.4%). In sum, these factors accounted for almost 58% of all fatal cases.
Conclusion: While the study suggests a reduction in all deaths (work and non-work) through to 2005, no significant improvement has been achieved through to 2020. The lack of progress in reducing unintentional fatal injury, indicates that greater attention be directed to minimising risks associated with the leading agents through use of evidence-based approaches. Data in this study can be used to strengthen investment and revitalise adoption of evidence-based approaches that address relevant issues.
Elizabeth Anne Pengelly
Elizabeth was raised on a property in rural Queensland and through university was supported with the Australian College of Nursing rural scholarship which provided opportunities and a foundation for her passion to work and care for people in rural areas.
Elizabeth is an experienced and passionate emergency nurse who has spent the past 16 years working in rural areas including Fraser Coast, North Burnett, Northern Territory, Southwest, Darling Downs and currently in the West Moreton district.
Elizabeth regularly steps up from her clinical nurse role and acts in the nurse unit manager position.
In 2019, Elizabeth was given the opportunity to participate in a pilot program for clinical supervision and, through this successful pilot program, Clinical Excellence Queensland developed the Clinical Supervision Framework for Queensland Nurses and Midwives.
Elizabeth currently works with three supervisees providing valuable support for staff to think critically and provide a supported space for self evaluation, and an opportunity for them to find their own solutions and answers to practice issues. Working in this space for two and a half years, Elizabeth has seen great outcomes with staff, has enjoyed watching staff become confident and supported, and is passionate about creating awareness for clinical supervision in rural areas.
Clinical supervision for rural and remote nurses and midwives
While the work of nurses and midwives in contemporary healthcare settings can bring considerable rewards, it can also be challenging and emotionally burdensome. Clinical supervision provides a forum for all nurses and midwives to receive support and maintain psychological wellness (Butterworth, Bell, Jackson & Pajankar, 2008; Cutcliff, Sloan & Bashaw, 2018; Love, Siebotham, Fenwick, Harvey & Fairbrother, 2017; Pollock et al, 2017) while promoting reflective practice.
For the purposes of this document, clinical supervision does not refer to the direct or indirect supervision of a student or colleague’s work practice (including observation and assessment), nor does it refer to managerial supervision or mentorship (Australian College of Midwives et al, 2019; Martin et al, 2017; HETI, 2013).
Clinical supervision for nurses and midwives (Australian College of Midwives et al, 2019) recommends clinical supervision for all nurses and midwives, regardless of their role, area of practice or years of experience.
In September 2020, clinical supervision was rolled out in rural health by a clinical nurse (CN) who had undertaken a four-day training program. The CN was appointed a clinical supervisor, an experienced clinical educator from the local mental health unit (as this was the first course offered to Queensland nurses). The supervisor and the supervisee (CN) built a rapport and the supervisee became a supervisor to two CNs at another rural hospital. A challenge first recognised was the adjoining rural hospital was 44 kilometres from CN and the mental health supervisor was 49 kilometres. With the support of line managers and the concept of ‘washing off the grime in the boss’s time’, travel was supported. When rapport was built (six months) Microsoft Teams was used for concurrent sessions.
The supervisor and the supervisee meet for an hour once a month. On evaluation, after three months the feedback stated supervisees felt they created a space which enabled them to think of solutions to problems that they felt they could not solve, they feel they can now help others reflect and enable their own problem solving skills, provided them with knowledge of their own empathy and they felt they were able to be more supportive and approachable as a team member.
Looking after other nurses requires compassion, patience and empathy. A space was created to focus on self-awareness, self-development and self-care, honouring the person within the role and promoting reflections on the personal and interpersonal elements of their work. Reflection that is well managed can move individuals from worry to movement.
Jean-Baptiste Philibert
Jean-Baptiste (commonly referred to as JB) is a fourth-year medical student at Western Sydney University. He developed a keen interest for other cultures through his early journey; born in France, moved onward to attend school in Africa and lived in several Australian states. After travelling to 40 countries and working in public service, his experiences led him to seek a purpose in life. Accepting a place in medicine lead to Jean-Baptiste starting his journey from the very bottom once more. His passion for rural and remote health was further ignited following several placements in Central Australia. In 2021, he was elected Chair of the National Rural Health Student Network (NRHSN) that represents over 11,000 rural health students in 29 university rural health clubs. Jean-Baptiste has embraced the opportunities to give back to his community by facilitating first-year medicine Peer-Assisted Study Sessions (PASS) and mentoring junior facilitators. He is also an academic representative on several faculty committees, listed on the Dean’s merit list and a recipient of several scholarships, including the prestigious NSW Rural Resident Medical Officer Cadetship, the John Flynn Placement Program and the RACGP Rural Medical Student Award.
Equal opportunities needed for all health students
The Australian healthcare system exposes its students to various settings and locations to best prepare them for the diversity of their future practice. This includes crucial exposure to rural and remote practice. Unfortunately, despite the best efforts of all involved, the COVID-19 pandemic has and continues to disproportionately affect the more remote placements of health students due to a variety of factors such as protecting vulnerable communities and border closures. The Northern Territory had some of the most disrupted placements over that period, yet provides life-changing experiences, as I was lucky enough to experience in Tennant Creek in 2019 and Yuendumu in 2020.
Medical students, such as myself, are well-supported to experience long-term placements in rural and remote areas via funding provided by the Rural Health Multidisciplinary Training (RHMT) program. These opportunities are, however, sparser to students studying non-medical courses, yet these professions are crucial to the future of rural and remote Australia and constantly face shortages. Disciplines such as nursing, pharmacy and audiology only have placements in rural and remote settings of less than four weeks and none of the non-medical degrees have the opportunity for a long-term placement in rural and remote Australia (greater than six months). Furthermore, the literature demonstrates that often these students had to source and fund the placements themselves.
This gap in training is reflected in a 2021 survey from the National Rural Health Student Network (NRHSN) to its members on short-term rural placement opportunities. The NRHSN received over 500 responses, of which over 50 per cent were non-medical students; 87 per cent of the survey respondents were interested in short-term placements in rural and remote settings; 33 per cent of the survey respondents had not had any exposure to rural health through their degree, increasing to 53 per cent for nursing students. Two-thirds of nursing students never had the opportunity to complete a rural and remote placement. Similar figures were seen in allied health students. Of the students who had been on a short-term placement program, 85 per cent intended to work or train rurally and the main factor influencing them was their past placement in such settings.
These figures demonstrate that rural intent is not necessarily followed through in non-medical students due to the lack of opportunities provided to them. This was confirmed by the two main barriers identified by these students which were contacts to facilitate placements (31 per cent) and financial barriers (22 per cent). These are essentially removed for medical students who take part in the extended placements in rural and remote Australia through their rural clinical school. The survey respondents saw an ideal placement being between two and five weeks in length, and regarded accommodation and financial support as a key component of a successful placement.
There is, therefore, significant scope to remove the existing barriers that these students face, for them to experience all that rural and remote Australia has to offer.
Bronwyn Phillips
Bronwyn is committed to building equity and innovation in healthcare access and provision in rural and regional communities.
Bronwyn brings a lifetime of regional and rural living, plus 20+ years of practitioner experience and healthcare management, to interface with health systems design for commissioning of quality consumer-centred care.
Murray Connect: remote patient monitoring for chronic disease management
The number of people living with enduring chronic and complex conditions in rural and regional Australia is increasing, with people often experiencing a lack of care coordination across the health system. Digital health solutions have been developed which can better support people and healthcare professionals that care for them, while COVID-19 has increased provider and patient readiness for uptake of digital health solutions.
Building upon the lessons learned from two years of trials across varying health sectors and settings in rural Victoria, this remote patient monitoring (RPM) flagship program, Murray Connect, has settled into a third delivery phase (2020–22). Across a substantial patient cohort (n=up to 220) and large geographical area (100,000 square kilometres), Murray Connect provides a chronic disease RPM program across 20 monitoring hubs.
The re-positioning of RPM within smaller coordinating clusters has enabled a more agile rural and primary care oriented approach, with a focus on preventing potentially avoidable hospitalisations (PAH) and re-admissions for diabetes complications, chronic heart failure and/or COPD.
The rate of PAH for chronic conditions is significantly higher in northern Victoria compared to Victorian averages (VHISS data 2019–20). As a data set, rates of potentially avoidable (or preventable) hospitalisations are considered a proxy measure of primary care effectiveness. With the increasing reach of technology into our daily lives, RPM provides the ideal opportunity and tool for primary care providers to enhance their chronic disease management and care coordination. The program allows for individual tailoring and parameter setting for patient care plans, wireless and connected monitoring devices for patients’ vitals and a web-based care monitoring platform for use by the healthcare team. These elements work together to enable patients to build their health literacy and understanding of their condition(s), while having the backup, reassurance and guidance from their healthcare team.
The current commissioned program is in place until mid-2022 and is working to build the evidence of RPM effectiveness, particularly regarding patient experience and outcome measures and realistic health economics.
This presentation will share data and feedback from the program and the recommendations that may inform future chronic disease management and PAH commissioning.
Social prescribing in central Victoria: embracing the broader definition of health
Consistent with World Health Organization recommendations, social prescribing aims to address the broader causes of ill health by seeking solutions to psychosocial problems beyond the clinical environment.
Social prescribing integrates clinical aspects of primary care with the broad range of social, economic and environmental factors that affect the health and wellbeing of individuals who have specific health and social care needs.
This may involve a general practitioner, nurse or mental or allied health practitioner referring a patient to a non-clinical link worker, who works with the client to facilitate connection into a range of community-based activities, including arts activities (such as music, dance and visual arts), walking groups, adult education, volunteering, self-help programs, skill development and gardening.
Arts on prescription has seen rapid growth in the United Kingdom, Europe and the United States in recent years, as preventive health strategies focus more on maintaining wellness in order to prevent ill health. Social prescribing provides the opportunity to shift the focus of a patient’s care from illness to wellness in the health system.
While chronic conditions are quickly becoming the leading cause of illness, disability and death in Australia, the significant personal, social and economic impacts of disease become more complex and burdensome with each additional condition. The broad scope of pervasive chronic conditions includes arthritis, asthma, back pain and back problems, cancer, cardiovascular diseases, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, mental and behavioural conditions (including mood disorders, alcohol and drug problems, and dementia) and osteoporosis.
In 2021, a two-year social prescribing program was commissioned in a larger regional location. This innovative approach was centred on a 2019 report from the Royal Australian College of General Practitioners (RACGP) and the Consumers Health Forum of Australia (CHF) highlighting social prescribing as an approach to counter rising chronic health problems in Victoria. This need is further evidenced by the report of the Royal Commission into Victoria’s Mental Health System (2021), recommending establishment of social prescribing trials across Victoria by the end of 2022.
The essential elements of the trial involve a partnership between the funder and the local government area council, with the employment of link worker roles, brokerage for payment of artists/community groups to facilitate access of social prescribing participants, and evaluation focused on quality-of-life outcomes, psychological distress levels and impacts on healthcare usage.
This presentation will discuss mid-way progress, outcomes and recommendations of the central Victorian model.
Sophie Ping
Dr Sophie Ping, BA BSc(Hons) PhD MBBS, is the Director of Medical Services at East Grampians Health Service and at Central Highlands Rural Health. She has significant experience in rural health administration, general practice, and medical education and training. She is passionate about rural training pathways for doctors as a mechanism to improve the health of rural communities.
The impact of a novel HMO position at a rural health service
Introduction: The long-standing model of contracting general practitioners (VMO GPs) to provide medical care to patients at rural health services is heavily reliant on the local GP workforce. There is sparse literature on supportive models for VMO GPs who provide such services.
Aim: The aim of this study was to measure the impact of a salaried medical officer position (HMO, accredited PGY2+) on service provision and performance at a rural health service against the traditional model involving only VMO GPs, and determine overall satisfaction with the position in order to inform future workforce planning.
Method: A salaried HMO worked weekdays to support VMO GPs providing medical services in a medium-sized rural health service in Victoria. VMO GPs, nursing staff and allied health staff completed surveys about their experience with the HMO position (such as satisfaction, time saved) using a semantic scale of 0–10. Semi-structured interviews with hospital personnel further explored these concepts. Financial, administrative and quality information was extracted for analysis.
Results: There were 40 survey responses received and 10 interviews completed. The mean satisfaction with the HMO position was high at 8.4. Addressing patient care concerns was rated significantly easier by nursing and allied health staff when the HMO was working (8.4) compared to when the HMO wasn’t working (4.7, mean difference 3.7, 95% CI 2.6-4.8, p<0.001). The VMO GPs reported less time spent on hospital patient-specific tasks (mean 3.1) and an increase in connectedness with patients (mean 6.3). The interviews broadly reflected the findings of the survey, with a high level of satisfaction with the position. Qualitative analysis identified three broad themes: improved efficiency, increased accessibility and eliminated service gaps. Organisational performance data indicated that there were no major differences in quality measures such as antibiotic appropriateness or patient experience. Computerised tomography (CT) scan numbers increased by approximately 20 per cent (223) compared to the same time in 2019. The anticipated return to the community of the inaugural HMO as a GP obstetrician was a powerful workforce retention outcome.
Conclusion: Staff at a rural health service were highly satisfied with an innovative initiative to employ a HMO to support VMO GPs who provide medical services. These findings support the creation of further HMO positions in health services that have the capability and capacity to sustain such a position, and inform future funding strategies to address rural medical workforce issues.