Virtual Pre-Symposium Session Presenters

Dr Alison Beauchamp is a senior lecturer in the School of Rural Health at Monash University (0.5 EFT) and a Medical Research Future Fund NHMRC TRIP Fellow at the University of Melbourne (0.5 EFT). She has a clinical background as a registered nurse and completed a NHMRC PhD scholarship in social epidemiology at Monash University in 2011. Between 2013 and 2015 she was Australian Research Council post-doctoral Fellow at Deakin University, where she managed the large Optimising Health Literacy (Ophelia) study in which she supported clinicians to implement health literacy interventions.

Dr Beauchamp has published 58 peer-reviewed articles and three book chapters. She has been invited or keynote speaker at seven international or national conferences, and lead or co-investigator on grants over AU$3.5 million. She currently co-supervises two PhD scholars and has co-supervised two PhD and three honours students to completion.

A key interest is understanding the factors underlying the maldistribution of nursing and allied health professionals in rural Australia. The Nursing and Allied Health Graduate Outcomes Tracking (NAHGOT) study is a longitudinal cohort study that follow students for ten years after graduation using data linkage and repeat surveys to identify why graduates practice in rural or metropolitan locations. 

Aim: There is limited understanding of influences on graduate practice location of nursing and allied health students in Australia. The Nursing and Allied Health Graduate Outcomes Tracking (NAHGOT) Study, a collaboration between the University of Newcastle (UON) and Monash University (MU) Departments of Rural Health, was designed to address this evidence gap. 

Methods: This longitudinal cohort study links data from:

• university enrolment and placement databases
• surveys of first and final year students, plus Student Experience Survey responses
• graduate surveys at 1 and 3 years, part of the Graduate Outcome Survey along with an internal survey over 10 years
• Australian Health Practitioner Regulation Agency (AHPRA) data.

Data collection is ongoing and survey data is pending. This presentation focuses on the research methods and retrospective data linkage for graduates of 2018. 

Relevance: In accordance with the RHMT Program funding requirements, the NAHGOT study will track student workforce outcomes, targeting entire annual cohorts of students enrolled in nursing and allied health at participating universities, allowing for multiple variables to be compared with graduate practice location. Findings will be relevant to universities, researchers and policy makers. 

Results: Data were linked for 1338 students from the 2018 graduate cohort, 911 from UON and 427 from MU. Nursing and midwifery accounted for 56.2%, with the remainder from eight allied health disciplines. Overall, 82.3% were female, 54% under 21 years of age at enrolment, and 23.8% of rural origin. More than half (54.4%) had at least one rural placement during their studies, with about half of those having had more than one (26.8%). A similar proportion (28.6%) had a total rural placement duration of six weeks or more. Rural placements varied considerably between the two universities and between disciplines. The UON had a greater proportion of rural placements than MU, and Nursing and Midwifery had the least graduates who had multiple rural placements or > 6 week placements.

Principal place of practice (PPP) data from AHPRA was dichotomised into metropolitan versus regional, rural and remote. There was no statistically significant relationship between PPP and age or gender. Graduates of rural origin were at least three times more likely to be practicing in a rural location; as were those who had done at least one rural placement (p < 0.0001). Those who had ≥ two placements or at least six weeks' rural undergraduate experience, were three to six times as likely to be working in a rural area (p < 0.0001).

Conclusion: Deakin University recently joined this research collaboration. This retrospective pilot demonstrates the feasibility of the data linkage components of the methodology, while the findings potentially reflect the positive impact of rural placements on graduate rural practice. Further analysis, addition of survey data, new partners and ongoing follow-up promise to shape the future. This work will support identification of graduates most likely to practice in a rural location. This will aid universities in their selection processes, improve targeting of student subsides, and quarantining of high quality rural placements that often require a substantial investment and planning.

Dung Trung Bui is a PhD candidate at the Centre for Rural Health (CRH), University of Tasmania. He has a background in the Doctor of Medicine program and worked as the Continuing Medical Education manager in a government hospital in Hanoi, Vietnam. He has worked with an extensive network of training units of provincial general and specialist hospitals in Northern Vietnam regarding practical skill training programs with purposes of enhancing the professional capacities of medical staff there.

He is interested in many aspects of public health, but particularly medical education, hospital management and oral care. He has several publications, written in both English and Vietnamese, in domestic journals in the areas of e-learning, oral care, health care leadership, and machine learning technique. He has studied at the CRH since August 2018. His PhD thesis relates to the application of technologies to enhance the remote learning of health care workers in rural and remote areas in Australia.

Background: Many remote areas in Australia suffer from the inadequate quantity, skill set, and skill mix of the health care workforce. Telementoring activities can potentially offer a solution to maintain professional skills of more isolated rural health care workers ‘at a distance’. It is a method using a technological communication device to provide instruction from an expert to a local, less-experienced practitioner at a different geographic location in real time. The incorporation of augmented reality (AR) technology into telementoring systems has been reported. Augmented reality is defined as a form of immersive experience in which the real world is enhanced by computer-generated three-dimensional content, which is overlaid on the real environment. However, there is a gap in identifying the true value and usefulness of AR in mentoring clinical care professionals remotely.

Aims: To compare the learning outcomes of students receiving AR-based telementoring with traditional instruction mentoring for management of a complex clinical care scenario.

Methods: This study will use a randomised control trial design. Second-year nursing students at the University of Tasmania (UTAS) are randomised into either the experimental group using HoloLens under telementoring conditions or the control group who receive usual instruction. The scenario of acute myocardial infarction is selected among 20 patient cases that make up the Australian and New Zealand Nursing Education scenarios. Simulation labs in UTAS are set up to be a standard emergency room to run the scenario. Skill performance checklists will be used to measure the learning outcomes of participants. As secondary outcomes, the perspectives of participants on the AR device’s performance will be assessed by the System Usability Scale. The NASA Task Load Index will also be used to determine the mental workload of participants while they are practicing in the scenario.

Significance: This study contributes to the overall continuing medical education of rural health care workers, particularly in the areas of health service delivery, workforce qualification, and workforce retention. It provides rural health care workers access to the professional practice from a far distance. The study also promotes understanding of advanced technologies in remote assistance between the urban and suburban communities.

By most measures, human health is better now than at any time in human history. However, these gains in human health have been unequally distributed and have come at the high price of degradation of natural systems on a scale never before seen. Published in 2015, The Rockefeller Foundation–Lancet Commission on Planetary Health report Safeguarding human health in the Anthropocene epoch concludes that the continuing degradation of natural systems threatens to reverse the health gains seen over the last century. Anthropogenic global changes—including climate change, ocean acidification, land degradation, water scarcity, biodiversity loss and toxic pollution of air, water and ecosystems—have direct and indirect health impacts. The consequences for future health are far-reaching, ranging from increasing emergence of zoonotic diseases, food insecurity and malnutrition, to conflict and displacement. Those who are least responsible for driving these changes—poor people in developing countries—will be most vulnerable to their consequences. Put simply, planetary health is the health of human civilisation and the state of the natural systems on which it depends. In this presentation, Professor Capon will introduce the findings of the Commission and canvass their implications for the future of rural and remote health.

Professor Tony Capon is the Director of the Monash Sustainable Development Institute (MSDI) and holds a chair in Planetary Health in the School of Public Health and Preventive Medicine at Monash University. A former Director of the global health institute at United Nations University (UNU-IIGH), he is a public health physician and authority in environmental health and health promotion. His research focuses on urbanisation, sustainable development and population health. Tony has 30 years of leadership and management experience in research, education, policy and practice. Previously, Tony held professorial appointments with the University of Sydney and Australian National University. He was the founding convenor of the climate change adaptation research network for human health in Australia. The inaugural director of public health and medical officer of health in western Sydney, Tony also worked on the control of non-communicable diseases with the charitable organisation Oxford Health Alliance. Since 2008, Tony has been advising the International Council for Science on the development of a global interdisciplinary science program on health and wellbeing in the changing urban environment using systems approaches. He has held National Health and Medical Research Council and World Health Organization Fellowships, and has served in numerous honorary leadership roles with professional societies and not-for-profit organisations including the Australasian Faculty of Public Health Medicine in the Royal Australasian College of Physicians, the International Society for Urban Health and the Frank Fenner Foundation (previously called Nature and Society Forum).

Leigh has become highly regarded in Australia for her contribution as a social worker to the field of paediatric bereavement. Leigh held the inaugural position of Bereavement Coordinator, Paediatric Palliative Care Service, at the Queensland Children’s Hospital Brisbane between 2010 and 2018 while also completing her PhD exploring the experience and needs of parents whose child has died from cancer. In collaboration with Redkite, and drawing on her PhD themes, Leigh developed two educational and advocacy resources: By My Side—stories of parents whose child has died from cancer and Walking Alongside: a guide for health professionals caring for a dying child. Leigh has been a long-term advocate for a hospital-wide response for bereavement care for families following the death of a child and, in 2017, Leigh was awarded a Churchill Fellowship to visit international hospital, hospice and community-based bereavement programs with the aim to inform guidelines for bereavement care in tertiary children’s hospitals in Australia. In 2019, Leigh became the inaugural Bereavement Coordinator for Children’s Health Queensland and is currently developing an innovative, responsive and compassionate program of care for families whose child has died, and the formal and informal caregivers who walk alongside them.

Aims: The Quality of Care Collaborative Australia (QuoCCA) has provided education for health professionals in paediatric palliative care (PPC) across Australia since 2015 with an aim to improve the quality of services in regional areas.

Relevance: The lessons learnt from the QuoCCA Project will be applied to the context of building capability of the future rural and remote workforce.

Methods: National education in PPC through QuoCCA has been achieved through a collaboration of six tertiary PPC services, funded by the Australian Government Department of Health. Informed with learning needs analyses, the education was evaluated through:

• Impact surveys completed before and after the session with responses related to knowledge and confidence across 9 domains. These were analysed against 8 independent variables which were education and participant related.
• Outcome surveys completed more than 6 months following their QuoCCA education session regarding the value of different aspects of the education and any changes in practice or care of patients and families they had implemented as a result.

Results: The first QuoCCA Project 2015–17 provided 337 education sessions, consisting of 767 hours and attended by 5773 professionals (medical, nursing, allied health, and others). Education was provided in every state and territory in Australia, with 203 provided in major cities, 117 in regional areas, and 16 in remote areas.

The analysis of paired impact surveys completed by 969 participants showed that all participants had a significant increase in knowledge and confidence for all measures. Factors that predicted an increase in confidence/knowledge were:

• Previous experience caring for a child with a life limiting condition—participants with previous experience had significantly higher scores before and after education. Those with no previous experience were more likely to improve in confidence and knowledge.
• Previous PPC education—those with previous education had significantly higher scores before and after education. Those with no previous education were more likely to improve in confidence and knowledge.
• Length of education session—participants in longer education sessions were more likely to improve in confidence and knowledge.
• Regional and remote participants were more likely to improve than city participants in confidence in the management of nausea and seizures and knowledge of resources that can assist in providing care.

In the outcome survey completed more than 6 months following education, QuoCCA education was rated by 98% of surveyed participants as valuable (36%) or extremely valuable (62%) (n=90) and 74% said it was extremely or very helpful in making a difference to their practice and care of patients (n=57).

Conclusions:

• Dosage of education was an important factor in predicting improvement in knowledge or confidence, including prior attendance and the length of the education session.
• Although those with no previous experience in caring for a child with a life limiting condition showed a greater improvement following education, both novice and experienced providers moved to higher levels of knowledge and confidence.
• The next steps for the project are simulation, interactive training and improving access to training through the national website www.quocca.com.au

Steve Gilbert has been a consultant in anaesthetics and pain medicine for 22 years. He moved to Queensland from Scotland in 2016. His interests include: explaining and demystifying pain for patients and doctors; developing community and primary care pain management; and education at undergraduate level to promote a biopsychosocial approach to health. Since arriving in Townsville, he has been working on establishing a patient support group and a group-based opioid reduction program.

Persistent or chronic pain is a common problem, affecting 1 in 5 of the population and it is one of the most common reasons for GP consultations. Despite the prevalence of pain and its effect on patients’ quality of life, there is little undergraduate or postgraduate education on pain management. The resources that do exist often focus on pain as a symptom of a disease, investigations and pharmacological treatment.

The epidemiology of persistent pain, however, suggests that most persistent pain is not necessarily related to underlying tissue damage or disease and that pharmacological treatment has limited effectiveness as well as carrying risks. The prime example of this is chronic low back pain, which was found to be the leading cause of years lived with disability in the Lancet Global Burden of Disease survey. The Lancet back pain papers of 2018 outline the research evidence for treatment with reliable information, physical rehabilitation and psychosocial interventions. Despite this knowledge, the first intervention in primary care is usually pharmacological and there are rising rates of imaging, interventional techniques and spinal surgery—all of which have limited evidence for effectiveness. The development of the opioid prescribing epidemic is partly a result of this lack of understanding. We aim to help GPs to have a deeper understanding of the nature of persistent pain, the use and limitations of pharmacological treatment, and how to help patients with non-pharmacological treatments. We will also address aberrant drug-related behaviour, dependence and how to help patients to reduce ineffective or harmful treatments.

The workshop will be based on an interactive case-based discussion, with the opportunity to discuss the challenges of managing patients in remote and rural settings as well how cultural and societal factors can be addressed to be able to help patients with the resources of state-of-the-art, multidisciplinary pain management.

The sectors of Health and Medicine, and Environment, appear discrete with separate budgets and ministries, separate core businesses, imperatives and activities. The two sectors have more in common than that—‘healthy environments healthy people’ as a catch cry is underpinned by sound reasoning and plenty of evidence. Links are profoundly exemplified by Indigenous peoples and relationships with Country. Climate change and other global environmental changes, infectious diseases and antibiotic resistance, water, food and waste systems, environmental justice and place-based health are some of many more examples, suggesting that public health and ecosystem management are interdependent and closely interwoven. Many opportunities are available for community-based and integrated public health and environmental conservation actions that are regenerative, providing multiple benefits for regional sustainability—as place-based, locally relevant activities. Indigenous-led examples are particularly promising. We draw on cases where non-governmental organisations have revealed such prospects.

Pierre Horwitz is a Professor at Edith Cowan University in Western Australia and Director of its Centre for Ecosystem Management.

For the last 30 years his research and teaching have included an ecosystems approach to the relationships between biodiversity, culture and human health and well-being, with a particular interest in wetlands and water resource management in Australia.

Pierre has held an appointment for the Ramsar International Convention on Wetlands as Theme Coordinator for Wetlands and Health on its Scientific and Technical Review Panel 2009–15, during which time he also worked with the Convention for Biological Diversity and the World Health Organization. He is a former Director of Bush Heritage Australia, President of the Australian Freshwater Sciences Society (1999–2001), and co-founder of the International Association for Ecology and Health.

Pierre is currently working with colleagues in Fijian rural communities to investigate watershed-based interventions for health systems. In Australia his current projects include the ecological characteristics of Nyoongar songlines, locating loss of values from the effects of climate change in rural and regional communities, and predicting the effects of fire on water quality in water catchments.

Ornissa Naidoo is a registered occupational therapist, health educator and researcher. She is a lecturer of Rural Health at the Western Australian Centre for Rural Health (WACRH), University of Western Australia, based in Karratha. Her current research areas are falls prevention programs suitable for the Aboriginal population and enhancing pre-writing skills in the Pilbara. She has strong clinical and management experience of more than 20 years over a range of areas including hospitals, schools and community settings.

Ornissa currently manages occupational therapy paediatric and adult placements for WACRH across the Pilbara. She is also the research coordinator for the Developmental Occupational Therapy Network of Western Australia. Her other research interests include leading an international research project on the Kawa Model which is a culturally specific model that uses the river as a metaphor of life. In addition, she enjoys educational research, in particular evaluative judgement, which looks at students assessing the quality of their work as well as others.

Background: According to the Australian Early Development Census, approximately 12.5 per cent of children across the Pilbara are developmentally vulnerable in the physical health and wellbeing domain. Aboriginal and Torres Strait Islander children are more than twice as likely as other children to be developmentally vulnerable at transition from kindy to school.

Pre-writing skills are foundational skills children need to develop before they are able to start learning to write and they contribute to school readiness. They require an integration of sensory and motor skills that contribute to a child gaining mastery in a range of activities including holding and using a pencil, the ability to draw, copy and colour. A review of the literature suggests that there is a paucity of Aboriginal-specific pre-writing skills programs. Occupational therapists are frequently requested to assist in the remediation of handwriting difficulties in the classroom.

In 2019, a pilot project of a kindergarten play-based pre-writing skills program was implemented at two schools in the Pilbara. Teachers were trained to implement the program and a training package was left at each school. Preliminary evaluation was conducted after this pilot. The evaluation used focus groups and interviews with teachers and education assistants to explore their perceptions of the contribution of the play-based pre-writing skills program to improved learning outcomes in their children. The results are positive in terms of teacher uptake and satisfaction with the program. They report that children’s skills improved and their ability to help children develop pre-writing skills also improved.

Successful transitioning into school is important to both children and families as it is predictive of long-term academic achievement. The authors now plan to scale up this program across multiple schools in the Pilbara and implement an evaluative research project to generate evidence for its efficacy. It is hoped that this research will influence the development of a regional approach to promoting early literacy for children in rural and remote locations.

Aim: This research aims to evaluate the implementation of a kindergarten play-based pre-writing skills program and its impact on literacy (pre-writing skills) outcomes for children in multiple schools in the Pilbara.

Proposed methods: For the next phase of this research project we are considering an action research study using mixed methods. This will integrate qualitative stakeholder perspectives with data-driven quantitative outcomes.

Issues/dilemmas: Feedback from the pilot study suggests that the program be modified to include elements like a home program. For people who have used action research, how many cycles might be used?

As we hope to deliver the program across the primary schools in the Pilbara, discussion on how to scale up this research is sought. Recommendations for selecting quantitative measures to progress this mixed methods study would be welcomed.

Advice on how to translate the results of the study to inform early learning curriculum development would also be welcomed.

Dr O'Sullivan is a research academic in rural health workforce with longstanding involvement in Australia's MABEL study. Belinda currently works at the University of Queensland, having previously led the Monash Medical tracking study and led the evaluation framework for the National Rural Generalist Pathway.

Background: Globally, rural pathways are essential to recruit, train, support and retain a generalist rural health workforce and thereby improve rural health outcomes. However, the components of rural pathways, and range of actions needed within comprehensive pathways are not well conceptualised. Many countries, regions and communities are seeking guidance as to effective action, and low and middle income countries (LMIC) in particular require targeted support.

Objective: This WHO-sponsored project involved the development of a Rural Pathways Checklist, as a complete guide to the implementation of rural pathways in a range of contexts, sensitive to LMIC settings, various health workers, stakeholders and starting points.

Method: The Checklist was developed by way of a global Steering Committee, who led concept testing through two LMIC-specific focus groups, defining principles, undertaking a scoping review drawing on LMIC-published evidence, doing an analysis of LMIC rural health policies and three stages of virtual consultation with a global Expert Reference Group in 2018.

The Checklist applied the WHO rural retention guidelines to cover all aspects of the rural pathway to recruit, train, support and retain rural health workers, specifically in LMIC settings. It allows for different problems and starting points, tailored to context.

The Checklist was field tested at international conferences/workshops and via online dissemination-feedback loops.

To enhance its application to real-world problems, a Checklist self-assessment tool was developed based on the Checklist evidence in each action (allowing people to self-rate progress and identify actions relevant to context, barriers and enablers).

Results: The Checklist included eight core action areas: establishing community needs, policies and partners, exploring existing workers and their scope, selecting health workers, education and training, considering working conditions for recruitment and retention, accreditation and recognition of qualified workers, professional support and up-skilling and monitoring and evaluation.

For ease of use, each action area has a series of reflective questions and summary of evidence.

The Checklist comes with exemplars of best practice from different WHO global regions to guide others.

By addressing all the components of rural pathways and the actions to implement them, it provides an avenue for advocacy and action to achieve more trained and qualified rural generalists, retained in rural communities, worldwide. This includes the capacity to move between actions, given that rural pathways implementation is an iterative process.

Field testing demonstrated it is applicable to various settings, health workers and stakeholders and a valuable document for planning and benchmarking rural pathways. The self-assessment tool allowed stakeholders to benchmark the health of their rural training pathway specific to a local problem and plan solutions.

Conclusion: This important project of the WHO signals a significant step forward in conceptualising and developing rural pathways, for improving health outcomes and promoting social and economic development of rural communities around the world, particularly LMIC.

Dr James Purnell is an Assistant Professor with Northern Medical Services through the University of Saskatchewan, Canada, providing clinical services to Northern Saskatchewan communities and investigating ways to enhance care using virtual care. At home in Saskatoon he does in-house coverage for internal medicine and obstetrics as well as locums throughout Saskatchewan and the Yukon Territory. He has recently commenced his MPhil through the University of Queensland looking at expanding virtual care to augment and deliver services to rural and remote populations.

James lives in Saskatoon, Canada, with his two children. He enjoys outdoor activities including skiing, biking, and hiking as well as doing home renovations in his spare time.

Virtual care has the potential to augment primary care service access in remote Indigenous communities, improving continuity of care with the same provider and increasing access to services. Canada, like Australia, has a large land mass with many rural and remote populations that have limited access to local health resources due to their geographic and sociocultural and economic barriers. The lack of primary care services for a few months to a remote northern Canadian Indigenous community (Wollaston Lake, population ~ 1500) prompted the introduction of an innovative service delivery model of primary care clinics. Weekly clinics were delivered via virtual care with access to a Bluetooth stethoscope, otoscope, opthalmascope, and dermatoscope and once per month the same physician would fly into the community for a few days to deliver in-person primary care clinics.

Now I am conducting in-depth research about this model, with the hope of informing its wider adoption, including in places like Australia. On this note, I hope to use this rogano to discuss what sort of research about remote primary care telehealth models would most usefully inform the adoption of these models for other Indigenous communities. Does this research simply need to provide evidence of service continuity? Or what other barriers and assumptions must it test to show that virtual primary care can be a viable model for remote Indigenous communities? The audience will provide critical reflections on:

1. policy assumptions that need to be broken down
2. compensation systems for practitioners
3. real cost to communities
4. actual care outcomes
5. infrastructure
6. culture.

The findings of the rogano will assist with structuring the design of my thesis to build a useful platform to advocate for the adoption of more viable virtual care supported primary care models in Australia and other countries.

Caroline is the Associate Professor, Podiatry, and Associate Head of School of Community Health at Charles Sturt University (CSU). Previously she has worked as a course director and developed experience in quality assurance for curriculum, learning and teaching across a range of undergraduate and postgraduate health courses. Caroline’s collaboration with the School of Indigenous Australian Studies and the Gulaay Indigenous Australian Curriculum and Resources Team at CSU, informs her work in scaffolding Indigenous Australian content in courses to facilitate the students' cultural competence journey. As a non-Indigenous academic, Caroline’s cultural competence journey has been enabled and enriched by collaboration with Aboriginal and non-Aboriginal colleagues; participation in an on-country immersion at Menindee Lakes, NSW; completion of the 'Aboriginal Sydney' MOOC, University of Sydney; participation in the LIME VII and LIME VIII conferences (2017 and 2019); and completion of the CSU Indigenous Cultural Competence training program. Her interests include whole of course assessment in relation to the Indigenous curriculum and also the concept of 'care' in health curricula. Caroline’s current research is related to academic staff cultural competence in relation to learning and teaching, and developing cultural competence for allied health students.

The importance of educating culturally capable health and social care practitioners must not be underestimated and should be perceived as a core responsibility for all educators whether in academic institutions or in clinical practice. Avoiding or sidelining this responsibility risks the perpetuation of culturally unsafe practice in health and social care, and continuing cultural exclusion of Aboriginal and Torres Strait Islander peoples. Pitama et al (2018) identified a range of actors and events that work to disrupt or support the implementation of an Indigenous health curriculum. These include external influences driving the curriculum, limited leadership capacity, hidden curricula, and insufficient institutional investment to support a comprehensive curriculum and the appropriate development of faculty staff. Workforce development and training is one of six domains that underpin culturally respectful health service delivery and is the focus of the work presented here.

This paper presents the preliminary outcomes of a cross-sectional survey of 101 health and social care academics representing 15 disciplines at Charles Sturt University (CSU), NSW. The purpose of this online survey was to gain insight into academics’ knowledge of and experiences with Indigenous cultural competency, in order to identify the need for continuing support and professional development. The survey was developed by an interdisciplinary team in consultation with the Gulaay Indigenous Australian Curriculum and Resources team and reviewed by a reference group which included Wiradyuri Elders. Anonymous data was collected relevant to four headings: CSU context; personal cultural competence; professional development; and demographic information.

Participants who completed the survey represent a range of academic experience, from ‘currently on probation’ to ‘more than 20 years’. 61 of the academics (61%) indicated that they were at the stage of ‘cultural sensitivity’ as compared to 21 who considered that they were at a level of ‘cultural competence’ (21%). 83 of the participants (83%) reported being capable or highly capable in evaluating their own cultural values and world view. The barriers which this group of academics had experienced in progressing their own cultural competency journey include: self-limitations; developing intercultural relationships; institutional factors including racism and discrimination; cultural privilege and the ignorance of others; and workplace cultures.

This survey explored a range of topics in regard to Indigenous cultural competency journeys. It is important to illuminate the barriers that health and social care academics experience, as this knowledge provides a foundation to inform professional development planning at CSU. If academics are not well-supported to develop their own cultural capabilities, their efforts to progress cultural competency journeys for their students, communities and workplaces will be compromised. The outcomes of this pilot survey will inform a larger study across CSU which aligns well with a whole of university approach. The development of academics’ cultural capabilities is foundational to enabling the timely implementation of CSU’s Indigenous Australian Content in the Curriculum (IACC) policy and, more broadly, assisting the institution in addressing the National Best Practice Framework for Indigenous Cultural Competency in Australian Universities and the Universities Australia Indigenous Strategy 2017–20.

Dr Slater is a nurse practitioner with the statewide Paediatric Palliative Care Service, incorporating clinical care, support and education across the state for children with palliative care needs, their families and health professionals involved. She is continuing to advance this specialist field on a national and international level.

Aims: The Quality of Care Collaborative Australia (QuoCCA) has provided education for health professionals in paediatric palliative care (PPC) across Australia since 2015, with the aim to improve the quality of services in regional areas. Pop-up education aims to improve care provided to children and young people who have a life-limiting illness with palliative care needs, with a focus on education and support of regional teams.

Relevance: The lessons learnt from the QuoCCA project will be applied to the context of a successful model of delivering support to families and local health professionals to care for the patient and family when they return home.

Methods: National education in PPC through QuoCCA has been achieved through a collaboration of six tertiary PPC services, with educator and support positions funded by the Australian Government Department of Health.

The project includes pop-up and scheduled visits, as well as incidental sessions in the team’s hospital and community settings. Education was provided in Indigenous communities, detention centres, metropolitan and rural and remote areas in all states and territories of Australia.

The education was evaluated through impact surveys completed before and after the session with responses related to knowledge and confidence across nine domains. A case study is presented to illustrate the outcomes from one such experience, with quote provided by health professionals.

Results: A pop-up was a creative way for the specialist paediatric palliative care team to support regional teams. The palliative care team liaises with local teams and care providers to arrange the QuoCCA visit, and there is ongoing discussion with the QuoCCA educator, clinical teams and the palliative team regarding logistics and needs. The visit provided in-time education, peer support, clinical handover/teaching, coordination of resources, identifying a 24-hour support for the family, strengthening communication strategies and an opportunity for professional growth.

The poster presents a case study of a 12-year-old with devastating neurological complication secondary to bone marrow transplant, who was facing only days of life. The care needs were very complex with high symptom burden and required extensive skin care. The family were wanting to be home to country as soon as possible. The local team was a very small rural hospital with limited resources and limited capacity to care for sick children as an inpatient, but they were very keen to support transfer to home and try to meet the family’s wishes.

Feedback from the health professionals involved is included.

Conclusions: QuoCCA has enabled rapid change in workforce capability in PPC in Australia, enhanced quality of service delivery and access to PPC in a geographically dispersed population of children with PPC needs and their families.

Next steps include examining sustainability of this model, with creative funding models, a focus on the pop-up style education and support, continued national collaboration and writing up journal articles.

Penny Slater is program manager for the Oncology Services Group at Queensland Children’s Hospital, including the Queensland Paediatric Palliative Care, Haematology and Oncology Network. In that role, she manages planning, evaluation, projects, quality and safety, and consumer engagement. She has been project adviser for the Quality of Care Collaborative Australia Project (delivering national paediatric palliative care education) since its commencement in 2014, and manages the evaluation of that project. Penny has been with Queensland Health since 1990 in various research, planning and evaluation positions related to diabetes, aged care, suicide prevention and oral health.

Aims: The Quality of Care Collaborative Australia (QuoCCA) has provided education for health professionals in paediatric palliative care (PPC) across Australia since 2015 with an aim to improve the quality of services in regional areas.

Relevance: The lessons learnt from the QuoCCA Project will be applied to the context of building capability of the future rural and remote workforce.

Methods: National education in PPC through QuoCCA has been achieved through a collaboration of six tertiary PPC services, funded by the Australian Government Department of Health. Informed with learning needs analyses, the education was evaluated through:

• Impact surveys completed before and after the session with responses related to knowledge and confidence across 9 domains. These were analysed against 8 independent variables which were education and participant related.
• Outcome surveys completed more than 6 months following their QuoCCA education session regarding the value of different aspects of the education and any changes in practice or care of patients and families they had implemented as a result.

Results: The first QuoCCA Project 2015–17 provided 337 education sessions, consisting of 767 hours and attended by 5773 professionals (medical, nursing, allied health, and others). Education was provided in every state and territory in Australia, with 203 provided in major cities, 117 in regional areas, and 16 in remote areas.

The analysis of paired impact surveys completed by 969 participants showed that all participants had a significant increase in knowledge and confidence for all measures. Factors that predicted an increase in confidence/knowledge were:

• Previous experience caring for a child with a life limiting condition—participants with previous experience had significantly higher scores before and after education. Those with no previous experience were more likely to improve in confidence and knowledge.
• Previous PPC education—those with previous education had significantly higher scores before and after education. Those with no previous education were more likely to improve in confidence and knowledge.
• Length of education session—participants in longer education sessions were more likely to improve in confidence and knowledge.
• Regional and remote participants were more likely to improve than city participants in confidence in the management of nausea and seizures and knowledge of resources that can assist in providing care.

In the outcome survey completed more than 6 months following education, QuoCCA education was rated by 98% of surveyed participants as valuable (36%) or extremely valuable (62%) (n=90) and 74% said it was extremely or very helpful in making a difference to their practice and care of patients (n=57).

Conclusions:

• Dosage of education was an important factor in predicting improvement in knowledge or confidence, including prior attendance and the length of the education session.
• Although those with no previous experience in caring for a child with a life limiting condition showed a greater improvement following education, both novice and experienced providers moved to higher levels of knowledge and confidence.
• The next steps for the project are simulation, interactive training and improving access to training through the national website www.quocca.com.au

Emma Taylor is a research officer with the WA Centre for Rural Health, at the University of Western Australia. Recently Emma’s research has focused on developing and supporting the Indigenous health workforce, specifically the factors affecting the retention of Indigenous health professionals and students. Emma is also involved in a national study to identify how cancer services are working to meet the needs of Indigenous cancer patients. Prior to joining the WA Centre for Rural Health, Emma worked as a librarian for 10 years in university and corporate libraries.

Aims: The aim of this systematic literature review was two-fold: to identify factors affecting the retention of Indigenous students across all tertiary health disciplines, and the strategies used to support Indigenous students to remain with, and successfully complete, their studies.

Methods: Eight electronic databases were systematically searched between July and September 2018. Articles were screened for inclusion using predefined criteria and assessed for quality using the Mixed Methods Assessment Tool and the Joanna Briggs Institute Checklist for Text and Opinion.

Relevance: With increasing remoteness, the proportion of Indigenous people increases, as do the challenges in ensuring a sustainable health workforce appropriate for the local population. Indigenous Australians are under-represented in the health workforce for every health profession, including nursing, medicine and all allied health professions. Indigenous patients have long requested to have Indigenous practitioners involved in their health care, with this increasing the likelihood of culturally safe care. Encouraging people raised in rural and remote areas to take up health careers is one strategy to reduce rural health workforce turnover. To address the shortage of Indigenous health professionals, it is important to not only recruit more Indigenous people into health science courses, but also to support them throughout their studies so that they graduate as qualified health professionals.

Results: Twenty-six articles met the criteria for inclusion. Key factors reported by students as affecting retention were: family and peer support; competing obligations; academic preparation and prior educational experiences; access to the Indigenous Student Support Centre; financial hardship; and racism and discrimination. The most successful strategies implemented by nursing, health and medical science faculties to improve retention were multi-layered and included: culturally appropriate recruitment and selection processes; comprehensive orientation and pre-entry programs; building a supportive and enabling school culture; appointing Indigenous academics; embedding Indigenous content throughout the curriculum; developing mentoring and tutoring programs; flexible delivery of content; partnerships with the Indigenous Student Support Centre; providing social and financial support; and ‘leaving the university door open’ for students who leave before graduation to return.

Conclusions: Universities have an important role to play in addressing rural health workforce challenges, including low numbers of Indigenous people in the health workforce which contribute to health inequities. The literature provides insight into the suite of measures which if implemented concurrently to provide support, can enable talented Indigenous people to overcome adversities and graduate as health professionals. These need to start with recruitment and pre-entry preparation programs, then continue throughout the student’s time at university. Rural and remote areas seeking to support local Indigenous people to enter the health workforce may be able to assist around the financial challenges and personal/family issues that occur and can impede Indigenous students' progress through to graduation.

Rory van der Linden is a University of NSW medical student based at the Port Macquarie Rural Clinical School. His interest in rural medicine and primary care stems from his experiences growing up on Kangaroo Island, South Australia, and travelling around Australia with his family in search of good waves and beautiful scenery. Rory has recently completed the research component of his MD in which he investigated the treatment of childhood obesity in the Australian primary care setting. Rory will complete his final clinical years in Port Macquarie with an aim to ultimately enter a rural general practitioner pathway through either the RACGP or ACRRM. 

Background and objectives: Childhood obesity (COb) is a growing global pandemic with the number of obese children worldwide set to increase by 50% by 2025. Among Australian children (5–17 years), prevalence of overweight and obesity has risen from 21% in 1995 to 27% in 2015, with those living in Outer regional/Remote areas up to 1.5 times more likely to be above a healthy weight than those in Major cities. In addition, those within the lower socio-economic groups, and Australian Indigenous people are more likely to be overweight or obese. This not only affects the individual but has a cascading impact on the broader community and health care system. General practitioners (GPs) are identified as important figures in COb management, and despite them considering it a top health care priority, their provision of treatment does not match guideline recommendations. This research aims to evaluate GPs’ management of COb in general but will also investigate differences between metro and regional/rural doctors.

Methodologies: This mixed methods, cross-sectional survey study incorporated qualitative and quantitative questions in a short online questionnaire distributed among Australian GPs. The survey included questions which assessed knowledge, confidence, and attitudes towards COb management in clinical practice. It evaluated these areas with respect to various demographic factors including location of practice, gender, and experience.

Results: Responses from 239 Australian GPs were recorded and analysed; of those, 127 respondents practiced in regional or rural settings. Overall, GPs demonstrated varied knowledge with just 20% accurately defining COb and overall knowledge of guideline recommendations being moderate to high. Confidence in clinical scenarios relating to COb was high, however, GPs were not confident in community support options available for COb management. Rural and less experienced GPs were significantly more likely (p<0.032) to cite time and the potential for negative parental or child reactions as strong barriers to COb management than other GPs.

Discussion: The current study offers new insights into Australian GPs’ knowledge of COb; it explicitly assesses respondents’ knowledge of the guidelines, demonstrating that GPs should collectively improve their COb related knowledge. It demonstrated the need to improve support for GP registrars and rural GPs, which is particularly important given the high rates of overweight and obesity in regional and rural Australia. The data reaffirmed that GPs require and want support in the form of multidisciplinary community management options; this is clearly documented in existing literature and leads to the study’s final conclusion that these findings must be collated and presented to governing bodies in order to drive change on an organisational level as progression in this area is currently underdeveloped.

Dr Sharon Varela is Senior Clinical Lead/Senior Lecturer with the Centre for Rural and Remote Health, James Cook University. She completed her PhD at the University of Queensland, researching resilience in youth. Sharon is the current Chair of the ARHEN Mental Health Academic Network, a network of academics contributing to the national conversation on mental health through research, policy input, student placements and workforce development. She is located in Longreach and has a passion for rural and remote practice. Sharon has extensive experience in the training and supervision of provisional and student psychologists, and with other allied health professions through collaborative and professional practice models. Her research interest areas are resilience, youth, mental health, wellbeing, clinical supervision and ethical practice.

Background: Developing the rural and remote psychology workforce presents unique challenges: higher workloads, more complex cases, less resources, and limited collegial support compared to their metropolitan colleagues. Further, rural and remote psychologists experience increased professional isolation, role strain, scope of practice concerns, ethical conflicts related to boundaries, and multiple and dual relationships. These challenges of rural and remote practice can lead to impaired clinical decision making, ethical violations and burnout, with the burden of support often being placed on the Board-approved supervisor. Rural and remote practice is further impacted by the idiosyncrasies of training the psychologist workforce. Psychology is unique in the health disciplines, with an absence of clinical placements in the undergraduate degree and postgraduate training being predominantly designed for on-campus teaching with a metropolitan-centric focus. Not only is there a serious shortage of psychologists in rural and remote Australia, there is an urgent need to adequately prepare our supervisor workforce to address the unique demands of rural and remote psychology practice.

Aims: This research will inform practice by identifying evidence-based models, training and tools that are designed for supervisors of the rural and remote trainee psychologist workforce. It aims to develop skills training that focuses on the needs of rural and remote supervisors, and to identify and develop sustainable pathways to ongoing mentoring and support for supervisors of the rural and remote trainee psychologist workforce.

Proposed methods: A mixed methods design will be employed using qualitative interviews, focus groups and surveys. Experienced supervisors and ‘new to supervision’ supervisors will be targeted through separate phases of the research. The interviews and focus groups will be semi-structured, asking supervisors to share their opinions on key areas of rural and remote practice. The surveys will collect more information about supervisors’ experiences in working and supervising in rural and remote regions, rural origin and confidence in supervising rural and remote professionals/students. A thematic qualitative analysis will be employed to understand the key themes and issues raised through the focus groups, interviews and surveys. Ethics approval has been granted by the HREC at JCU (approval number H7961).

Issues/dilemmas: This presentation will discuss the research design in detail, with preliminary data presented from the focus groups. There is a significant gap in the research regarding the supervisory needs of rural and remote psychologists, with the frameworks employed being mandated by the Psychology Board of Australia. This research project will contribute to the conversation on the training needs of supervisors and trainee psychologists and aims to influence policy around training and support provided to supervisors of rural and remote trainee psychologists. Advice is sought from conference delegates on the following: issues or concerns with the design of the research project: whether the project should be extended to include the views of supervisees and/or other allied health professions; whether it is important to include a comparative (ie health professionals supervising metropolitan-based supervisees); and any other general advice or comments on the research project.

Leesa Walker is a rural general practitioner working in general practice in Hamilton, Victoria. She is Discipline Head of Flinders University Rural and Remote Health South Australia where she leads the rural programs and staff that are distributed across South Australia and Victoria. Previously she has been academic coordinator of the Parallel Rural Community Curriculum (PRCC), an internationally recognised longitudinal integrated clerkship where penultimate year medical students learn from rural doctors based in general practice. In this role she has overseen the expansion of the Rural PRCC sub quota selection process expansion and the implementation of programmatic assessment for learning into the rural program. She has led the Progress Test for the Doctor of Medicine as academic coordinator since 2018 and chairs the Progress Test Item Review Committee. Her academic interests include the wellbeing of students and clinicians, community-engaged medical education, progress testing and medical school selection processes.

Australian Government Rural Clinical School (RCS) programs were developed as rural workforce initiatives to provide experiences that positively influence medical graduates to choose rural careers. The RCS program has a mandate for 25% of all domestic medical students to spend a year or more of their clinical training based in a rural location. Flinders University were pioneers in community-engaged rural medical education with the introduction of Parallel Rural Community Curriculum (PRCC) in 1997 (Worley 2001). Over the years, the PRCC developed to be an internationally renowned, patient‐centred, community‐based and educationally sound, rural medical curriculum, based in Australian rural general practice. The consequence and impact of the PRCC on rural careers of their students was improbable to comprehend at the beginning, but now after 20 years it's possible to view the tangible impact of the program. This data-linkage study aims to compare the medical graduates who have undergone training in the city (Adelaide Flinders Medical Centre) with those who participated in PRCC program based in rural towns of South Australia and Victoria between 1999 and 2016 on their registration type, speciality and current location of practice in 2017, using the Australian Health Practitioner Regulation Agency (AHPRA) database. Ethics approval was obtained from Flinders University Social and Behavioural Ethics Committee.

The study tracked 1921 Flinders medical graduates who completed their undergraduate course between 1999 and 2016. 367 (19.1%) participated in the PRCC Rural Clinical School program. More women graduated through the PRCC program (n=228, 62.1%) compared to graduates from the city campus (n=766, 49.3%). PRCC graduates were more likely to report a speciality in general practice (56.2%), compared to city-based graduates (33.6%). We analysed the current location of medical practice by transforming postcodes to Modified Monash Model (MMM) categories. Flinders PRCC rural campus graduates were 2.5 times more likely to practise in a rural location (MMM 3–7) in the year 2017, compared to Flinders graduates from the main campus (odds ratio 2.6 [95% CI 1.9–3.4], p<0.001).

The study clearly illustrates the positive impact of the rural training program in the translation of rural medical workforce, especially in rural general practice. The study contributes to the evidence base on the contribution of rural undergraduate medical training in addressing the medical workforce challenge in rural areas.

Beneficial microorganisms within the human body (microbiome) support health and stave off disease. However, changes to these communities linked to lifestyle and environmental changes may underpin many of the key Industrial or 'Western' diseases observed today, especially those that significantly contribute to the Indigenous health gap in Australia. Investigations of the microbiome revealed that Aboriginal and Torres Strait Islanders maintain unique microorganisms that reflect their deep connection to country and that may underpin different causes and outcomes of non-communicable disease, especially oral diseases. Further research into these microorganisms and their histories in Indigenous peoples are needed if we are to bridge the health gap.

Dr Weyrich obtained a PhD from The Pennsylvania State University in 2012 and began a post-doctoral research appointment at the University of Adelaide, in the Australian Centre for Ancient DNA.

Using her medical expertise, she helped establish calcified dental plaque (calculus) as the only fossil record of human microbiome in existence, and linked ancient and historic changes in human microbial communities to large shifts in health and disease.

In 2015, Dr Weyrich obtained a prestigious Australian Research Council DECRA fellowship, aimed at reconstructing the diversity of human microbiota around the world, including working with Indigenous people to reconstruct the microbiota from their ancestors. She became the first person to reconstruct a microbiome from an extinct species, Neandertals, and has reassembled the oldest microbial genome to date—at 48,000 years old.

In 2018, she was again recognised for her work on human oral microbiomes when she received an ARC Future Fellowship to investigate how industrialisation affected our microbes and health in the past and today.

As an Associate Professor at Penn State, she now directs the Penn State Ancient Biomolecules Research Environment (PSABRE)—one of the largest ancient DNA labs in North America—and leads a research team focused on understanding how and why microbial communities change over time in the human body and the environment.

She has received over $5 million in research funding, 21 awards for research excellence, and given over 50 guest lectures on the topic. Her research has been featured by the BBC, NPR, Science, Nature, New Scientist, NY Times, Smithsonian Magazine, National Geographic, and many others, and has been highlighted on Catalyst and a SBS documentary entitled 'Life on Us'. She has even had a Buzz Feed quiz written about her research. Her commitment to understanding how beneficial, friendly microorganisms contribute to disease, and how they shape the world around us, is changing how we view the human health today.