Aim: International Medical Graduates (IMG) are an important part of the international physician workforce and exploring the predictors of success and failure for IMG could help international and national physician labour workforce planning. Anesthesia
Methods: Medline, PubMed Cochrane Central Register of Controlled Trials, BIOSIS Citation Index, CINAHL, Embase, ERIC, DARE, Global Health, LILACS via Global Index Medicus, Health Technology Assessment Database, Web of Science, Science citation index, Clinical Trials.gov, PsycINFO, Scielo and grey literature were searched for studies that explored the predictors of success and failure in IMGs. Baseline probability, effect size (in relative risk (RR), odds ratio (OR) or hazard ratio (HR) and absolute probability change for success and failure were reported.
Results: Twenty-four studies (373,784 participants) reported the association of 93 predictors of success and failure for IMGs. Female sex, English language proficiency, being graduated ≤5 years and higher score in USMLE step 2, Clinical Problem-Solving Test and Situational Judgment Test were associated with success in qualifying exams.
IMGs who got higher score on USMLE 2 clinical knowledge and in-training examination in post graduate year (PGY) 1, 2 and 3 were more likely to pass in American board of family medicine certificate.
IMG residents who previously completed internship were more likely to pass Royal College of Physicians and Surgeons of Canada exam on first try.
IMGs and candidates who attempt PLAB part 1, ≥4 times vs first attempters, and candidates who attempt PLAB part 2, ≥3 times vs first attempters were more likely to be censured.
Patients of non-USIMG vs. US medical graduates had significantly lower mortality than U.S. graduates and patients of non-USIMGs had lower mortalities than patients of USIMGs.
Conclusions: This study informed factors associated with success and failures for IMGs. Rigorously conducted studies are required on topic.

1. Succes and failure can be organized into five groups
2. Younger age, female sex and fluency in English were associated with success in qualifying and certificate exams for IMGs
3. Rigorously conducted studies are required on this topic

Background
The Objective Structured Clinical Examination (OSCE) is a versatile multipurpose evaluative tool that can be utilized to assess residents in training. It includes assessment of different learning activities and allows a global assessment of the student’s performance. It has the advantage that it allows a large number of competencies to be assessed in learners within a short duration. Traditionally, a paper-based methodology was the standard when executing OSCEs. The B – Line debriefing system was introduced at the Aga Khan University Hospital, Nairobi (AKUHN) to mitigate potential challenges of a paper based system such as illegible handwriting, lost assessment sheets, data entry errors, and time consumption.
Aim
The aim of this presentation is to describe an innovative method of conducting OSCE exams to post graduate medical students through technology and explore the challenges and opportunities.
Content
The Family Medicine Department at AKUHN began using computerized software to conduct their OSCE exams in 2021. The Centre of Innovation in Medical Education within the facility availed the B-line technology that is used to run the OSCEs. The OSCE comprise twelve to eighteen separate stations at any given time. Three to six stations can operate simultaneously based on the examinees available. The OSCE is designed with specific learning outcomes using an online template. Subsequently, the door note is uploaded for the candidate to read outside the examination room. Once the cameras are verified to be in position, the scenario begins as well as the recording. Faculty are allowed to score the candidates from wherever they are, taking annotations. The recordings are then used during debrief at the end.
CONCLUSION
Technology in post graduate medical education is a welcome approach and has the potential to improve efficiency in conducting OSCE examinations.

1. Understand the use of technology to conduct and manage OSCEs.
2. Describe the factors to consider when designing a technology based OSCE.
3. Critically appraise challenges and opportunities of technology based OSCEs

Australia, like other parts of the world, is experiencing a General Practitioner (GP) workforce collapse. An estimated 25% of GPs plan to retire within the next 5 years and there is a projected shortfall of 11,517 GPs by 2032. Primary care forms the essential cornerstone of a health system and patients with a regular GP have significantly reduced utilisation of out of hours services, hospital admissions and reduction in mortality by up to 25%. Consequently, if the primary care workforce issue is not addressed, there will be subsequent increases in the use of downstream health services such as Emergency Departments, outpatient clinics and hospital admissions.

There are various potential timepoints during a medical career to make substantial impacts on an individual’s choice regarding speciality. In chronological order, this can be during premedical studies, during medical school and at pre-vocational training. In 2022, only 13.8% of medical students considered General Practice as a preferred career path. This continues the sustained pattern of decline from 16.5% in 2017 and 16.1% in 2021. With 31,620 (30%) of the 105,293 medical practitioners in Australia practicing as GPs in 2020, increased interest from students in medical school is vital for the sustainability of the specialty.

We present a literature review on the demographics and factors that attract students to General Practice. Influences on career choice can occur due to a variety of reasons including but not limited to positive role-modelling from mentors, good quality teaching and increased exposure to the speciality. We discuss the positive aspects of General Practice such as continuity of care, patient-doctor interactions and diversity of practice. We then link how the evidence has resulted in the development of the Macquarie University General Practice Intensive Stream launching in 2024 and the projected benefits this model may have for students and the workforce.

1. Recognise the downstream consequences of a General Practitioner shortage.
2. Identify the factors resulting in medical students choosing a career in General Practice.
3. Discuss potential solutions to increase medical student engagement in General Practice.

Background

The World Health Organisation advocates training of health workers to have the required skills to address community needs. Workplace-based learning (WBL) provides authentic learning opportunities to develop fit-for-practice healthcare workers. The types of WBL opportunities have been well described in high-income countries, but less is known about how this takes place in countries in sub-Saharan Africa.

Aim

This study explored family physicians’ and registrars’ perceptions of WBL opportunities in a decentralised postgraduate family medicine training programme in a South African university.

Study setting

The study was conducted at five decentralised district health training sites across two provinces affiliated with the University of the Witwatersrand in South Africa.

Methods

This qualitative study involved semi-structured interviews with 11 family physicians and 11 trainees, purposive sampled to represent gender and all the training sites. The verbatim transcripts were thematically analysed using Braun and Clark’s six-step approach. MAXQDA 2020 was used to manage the analysis.

Results

WBL opportunities were grouped into four themes: Learning from interactions with people, Learning from district activities, Self-directed learning, and Contextual influences on learning opportunities. Trainees learned from patients, peers, family physicians, and other professionals. Self-directed learning occurred from feedback, self-reflection, and the use of portfolios. Participation in district activities like student and staff teaching, continuous medical education, and mortality and morbidity meetings augmented learning. Contextual influences were from health facilities, resource availability, district management and university support, workload, and lack of standardisation.

Conclusion

Trainees are exposed to several types of WBL opportunities in a district health system. Effective engagement with available WBL opportunities and addressing contextual challenges could enhance learning. Maximising opportunities promotes trainees’ acquisition of required skills to efficiently address community needs in a middle-income country like South Africa.

1. Multiple workplace-based learning opportunities exist in family medicine decentralised clinical training in district health systems of Sub-Saharan Africa.
2. Workplace-based opportunities occur from interactions with people, involvement in district activities, self-directed learning, and are influenced by contextual factors.
3. Maximum utilisation of available WBL opportunities optimise trainees' learning, making them fit for practice for the communities they serve.

Aim
Primary care recovery and sustainability in a post-COVID healthcare system requires reconnection with community healthcare professionals, bringing an opportunity to reshape medical education through the involvement of multidisciplinary professionals as teachers alongside physicians. The fee-for-service model of Japanese healthcare siloes professional practice, leaving few opportunities for medical students to learn about interprofessional interactions, particularly between medical and social care fields. We designed an interactive session co-facilitated by a general practitioner and a medical social worker (MSW), incorporating a lecture, case studies of patients with complex social needs and role-play. We conducted a mixed-methods analysis to understand how the session impacted on student understanding of the role of a MSW and how liaison between clinical work and social care fits into comprehensive community care and contributes to primary care sustainability.
Content
We administered a questionnaire before and after the session, asking students to self-rate their understanding of the role of MSWs, comprehensive community care, the importance of patient background and sustainability in primary care on a 5-point Likert scale which was analysed by a student’s t-test (p<0.05). Free-text comments were collected and underwent content analysis.
Participants were 120 4th-year-Japanese medical students undertaking their rotation in family medicine. The questionnaire was answered by 111 students with 69 students contributing free-text comments. All questionnaire items showed significant improvement in student understanding after the class, with strongest improvement in understanding the role of MSWs and comprehensive community care. Content analysis extracted four themes, expertise and collaboration, learning strategies, clinical skills and healthcare systems, with nine categories and 49 subcategories identified.
Goal
Our research identifies a key role for multidisciplinary co-facilitation, alongside the delivery of case-based content reflective of interprofessional community interactions, in supporting student understanding of professional roles in the community, and a reconnection to comprehensive community care teaching to support future practice.

1. We designed an interactive session co-facilitated by a general practitioner and a medical social worker (MSW), incorporating a lecture, case studies of patients with complex social needs and role-play.

2.We used a mixed-methods analysis to understand how the session impacted on student understanding of the role of a MSW and how liaison between clinical work and social care fits into comprehensive community care and contributes to primary care sustainability.

3.There is a key role for multidisciplinary co-facilitation, alongside the delivery of case-based content reflective of interprofessional community interactions, in supporting student understanding of professional roles in the community. This may support reconnection with the community and strengthen the provision of comprehensive community care.

Australia is promoted as being rugged and sparsely populated [1]. Remoteness is central. Reality differs. Australia is highly urbanised [2]. But almost 15% of Australians living outside cities have poorer access to healthcare [3] even though there is greater demand [4]. The distribution of specialists is highly skewed to major urban centres. Complex specialist services are appropriately co-located in cities but urban-trained graduates are reluctant to live in rurally. Effective, equitable health services require both primary and secondary health care within a reasonable distance.

26 Regional Training Hubs (RTHs) were established in 2017 as an Australian Government initiative to increase the number of medical graduates committed to living in rural and remote areas [5]. Evidence suggests that medical students who spend time in rural placements are more likely to continue to practice outside major urban centres after graduation [6]. It is likely a similar effect could be present for non-primary care specialists and that increasing the number and length of rural placements will increase the availability of key specialties in rural areas as well.

Although evidence to support this extrapolation is limited it is clear that there is a need for investment in regional training faculty, in order to facilitate training in both primary and secondary healthcare in regional Australia. At present, the majority of both primary and secondary medical specialist positions are filled by international medical graduates (IMGs) [7]. These doctors are providing supervision and training in our context.

This presentation will explore the challenges of provision of supervision in medical training, the importance of inclusion of International Medical Graduates in training to enhance their roles as clinical service providers and supervisors. RTHs must prioritise the inclusion of specialist IMGs training in programmes for training in education, supervision and assessment in regional Australia.

1. The medical needs of patients in rural and remote Australia are proportionally greater but their needs are less adequately met than those in urban centres.
2. It is likely that increasing training opportunities based in regional Australia will address this imbalance.
3. International Medical Graduates provide a substantial part of the medical services in rural and remote Australia and an often forgotten but key part of the specialist training faculty.

Title:
An evaluation of a mentoring program for Tongan doctors participating in a family medicine program

Background:
Primary healthcare in Pacific Island countries (PICs) has been chronically underfunded and under-resourced. A commitment to universal healthcare delivery must be achieved through strengthening primary healthcare in these Island nations. This includes health systems strengthening and local healthcare staff capacity-building. Prior to 2019, there were few options for primary care training for Pacific Islander doctors.

In 2019 Fiji National University (FNU) commenced a new Postgraduate Diploma in Family Medicine program. Rocketship is an international non-for-profit health organization dedicated to improving health in PICs through enhancing primary health care delivery. In collaboration with the Tonga ministry of health, Rocketship began a mentoring and support program to assist trainees of FNU’s family medicine program who are completing their studies within Tonga. The aim of this research project is to determine trainees experience and early impacts of the mentoring and education support provided to Tongan FMP participants by Rocketship.

Methods:
This qualitative research project will employ a phenomenological approach through semi-structured interviews and questionnaires to illuminate the doctors’ perspectives on their experience of participating in Rocketship mentoring program as part of the FMP. All FMP graduates from Tonga will be invited to participate. It is anticipated that results from this project will be used to expand the family medicine program to other PICs. Ethical approval has been granted by the Tonga National Health Ethics and Research Committee (Ref.20221121) and University of Melbourne Office of Research Ethics and Integrity (Ref.2022-24970-35161-3).

Results:
Data collection and analysis will occur throughout early 2023 and results will be presented at the World Organisation of Family Doctors 2023 conference.

Discussion:
The importance of this research project is two-fold. Firstly, results will provide direct feedback to the Rocketship mentoring program developers and educators in improving and refining the program. Secondly, results will guide program expansion to train doctors in other PICs, ultimately improving health workforce competencies through professional development and strengthening primary healthcare.

1. The importance of local healthcare staff capacity-building in Pacific Island countries in strengthening primary healthcare
2. An understanding of trainees experience and early impacts of the program of this primary care medical speciality training program in Tonga
3. The value of this Family Medicine program if implemented to train doctors in other Pacific Island countries

Introduction
The University of Botswana (UB) like other universities, adopted the use of students’ feedback forms to improve teaching, promote better learning experiences, and appraise teachers. This form is used across disciplines at UB and is known as the student evaluation of course and teaching (SECAT). SECAT sections are students self-rating, teaching evaluation with teachers’ attributes of performance, course evaluation, and overall general appraisal of the lecturer and the course. This study aimed to assess the usefulness of completed final year’s SECAT forms in assessing teaching and learning during the Family Medicine Rotation (FMR) and explored students’ views on SECAT use in the evaluation of the FMR.
Methods.
A cross-sectional descriptive study using a mixed method approach analysed the 2016 final-year medical students completed SECAT forms and findings from a focus group discussion (FGD) with these students the same year.
Results
In 56 (71.7%) of the 78 SECAT forms expected, 23 (41.1%) assessed the overall teaching and learning(T&L) during FMR as very good. More than a quarter (26.8%, n=15) assessed the T&L as excellent, while the assessment was rated as good in a third (33.1 %, n=18) of forms. No SECAT had a poor assessment. The FMR organisation was assessed as unsatisfactory in about a third of forms (30%). Students’ overall satisfaction with FMR was associated with their satisfaction with the lecturer’s attributes like the teacher’s ability to explain concepts(P<0.001) and provide useful feedback (p =0.01).
Emerging FGD themes were: Different relevance of SECAT sections for FMR and the need for alteration of SECAT sections to align with FMR.
Conclusion
SECAT may be providing useful information for teachers’ performance across disciplines. However, customisation of the tool with relevant clinical domain activities is needed. This will improve the FMR’s constructive alignment of assessment and the validity of the overall FMR’s assessment.

¬ The use of a student feedback questionnaire may give the teacher a clue for improvement of the learning experiences of students
¬ Using a standard-designed feedback form for all domains in a university may not be appropriate.
¬The validity of an assessment done with a such standard tool will depend on agreed adjustments of the tool to specifics expected outcomes and teaching activities of each domain.