Objective: To explore the barriers and enablers to social prescribing for primary healthcare workers in rural and remote Tasmanian general practices.

Design: A mixed-methods approach consisting of an online demographic survey, interviews and focus groups.

Setting: GPs and other health workers were recruited from five rural and remote Tasmanian general practices in 2021.

Participants: Twenty-seven participants with experience in rural general practice ranging between less than a year to 47 years.

Main outcomes measures: Enhanced understanding of knowledge and attitudes about social prescribing, its efficacy, enablers and barriers.

Results: Rural Tasmanian GP practices identified various barriers to social prescribing including lack of service knowledge, inadequate time, service transience, and lack of collated community services’ information. Enablers were described as trusting doctor-patient relationships, increased time availability, and belief in the efficacy of the benefits of social prescribing. A proposed social prescribing pathway and link-worker position received mixed responses, with concerns about creating an unnecessary intermediary, lack of a defined role, loss of health promotion opportunities, and dependence on the capacity of individual workers. The potential benefits included having a contact for current advice on local resources, providing patient advocacy, increased time availability for GPs, and providing a closed-loop feedback system.

Conclusion: While this study identified a need for an Australian social prescribing protocol, it also highlighted a perceived decisive view of the viability of link worker-roles. An accessible and centralised information centre within local areas is required to enable social prescribing in general practices in rural and remote Tasmania.

1. Despite evidence of its efficacy in the UK and calls for a similar program, currently there is no national social prescribing scheme in Australia.
2. The largest barriers to rural and remote Australian general practices engaging with social prescribing are lack of centralised and current information and service transience. General practices support a central information database and a streamlined social prescribing protocol. However, there are diverse views regarding the benefit of link-workers in rural and remote Australia.
3. A flexible localised social prescribing protocol may enable co-designed, non-clinical prescriptions to improve patient health and wellbeing.

The World Health Organisation in the Eastern Mediterranean Region (WHO-EMRO) adopted the concept of family practice for the effective and efficient delivery of primary health care services and for achieving Universal Health Coverage in the countries of the Eastern Mediterranean Region. The main challenges reside in the limited number of available family medicine programmes and the limited number of family physicians. In fact, the total number of certified family physicians in these is much lower than the number of 185,497 family physicians needed to cover the population in these countries based on international standard requirement of at least three family physicians per 10,000 population.
Parallel to this, there are around 250,000 general practitioners without any vocational training working in the primary health care facilities in the countries of the region. Building the capacity of these doctors is arguably the best short-term solution to increasing the number of doctors proficient in family practice. In fact, bridging programmes leading to diplomas or certificates have been adopted by different countries for more than 20 years in the aim of improving the standard of care of general practice.
WHO-EMRO and the Arab Board of Health Specialisations launched a two-year regional professional diploma in family medicine (RPDFM) in collaboration with the World Organisation of Family Doctors (WONCA), and other United Nations Agencies. The professional diploma in family medicine aims at equipping general practitioners with the knowledge, skills and attitudes that are needed to provide comprehensive, continuous, and appropriate health care to individuals and families. The training is delivered in a blended format using a mix of online and face-to-face clinical training with both academic and clinical supervisory support. This presentation will discuss the process followed in the development of the diploma, describing its curriculum, and highlighting the different challenges faced.

1. The value of the regional professional diploma in family medicine as a bridging program
2. An overview of the diploma curriculum and modalities of training
3. Challenges facing the diploma

There is increasing evidence for the positive impact of representation in supporting the career aspirations of rural students to overcome barriers to tertiary study. The Student Series of Destination Medicine© aims to foster the aspirations of rural people to pursue a career in medicine and support their early steps towards that goal. Destination Medicine has produced 30 semi-structured conversations with current medical students. The students were generally of rural origin, but no age, university, or demographic restrictions were used through the voluntary talent recruitment process. An iterative thematic analysis of the student series was undertaken. Interviews were transcribed and analysed to establish the three emergent themes: reciprocity, the rural pipeline in action, and building social capital. The culture of ‘giving-back’ commonly associated with medicine resonated through their narratives. The students spoke about early exposure to the blend of continuous care, excellence in practice, and community engagement modelled in general practice that fostered their own ideas of how they wanted to practice medicine. This pattern of observing the care taken of them and extending that care to others is consistent with the theory of indirect generalised reciprocity: giving without the expectation of receiving, but rather passing on the benefit to another. Their podcast episode became a small but important aspect of student 'paying it forward' by contributing to a social capital repository to connect with and equip prospective rural medical students. This presentation will unpack the ways in which rural Primary Care Doctors have influenced the lives of these young people functioning as early and critical drivers in the rural medical pipeline, unknowingly encouraging those young people to consider the welfare of those coming after them and continue this cycle of care.

Through this presentation attendees will be encouraged to reflect on:
1. their own role in facilitating the career aspirations of young people in their communities
2. the mentors they have had to shape their own career and how they can 'pay it forward'
3. how they could engage with a resource like Destination Medicine to encourage and equip young people, medical students, and doctors in training to pursue rural medical careers

Training to become a Family Medicine Specialist (Spesialis Kedokteran Keluarga Layanan Primer, Sp.KKLP) was formally recognised in Indonesia in 2020. Prior to that, formal training in Family Medicine has been in the form of a Masters course (Universitas Gadjah Mada/UGM), and a one-year fellowship programme (Universitas Padjajaran). Today, the Family Medicine in Primary Care Specialist programme has been established in several universities.

Clinical preceptors play a key clinical education role in the specialty programme. UGM, in partnership with the University of Edinburgh, will be delivering an online advanced course in Family Medicine for clinical preceptors in the specialist programme. To facilitate the development of this course, we explored the needs of doctors with prior Family Medicine training, exploring strategies to improve family medicine in Indonesia.

A qualitative approach using narrative inquiry was applied to guide the study. Two focus group discussions (FGDs) were conducted with alumni of the UGM Masters and Universitas Padjajaran’s fellowship programme, to better understand perceptions on how further training affected practice, additional learning needs, and participants’ readiness to become clinical preceptors. Themes were identified from the transcripts using a thematic approach.

A total of 16 alumni participated. Themes emerging from analysis included: reflective practice, the importance of person centredness, perceived skills and self-awareness of knowledge/skill gaps, and awareness of preceptorship opportunities. Both FGDs identified that reflecting on clinical practice with supervisors was the most effective way of learning, and the most significant change in practice post-training was implementing a person-centred approach. Both groups expressed a need for further clinical skills development in areas such as preventive medicine and palliative care. There was a difference in awareness of preceptorship opportunities between the two groups, with alumni from the masters programme having a greater sense of awareness of the potential to become clinical preceptors compared to fellowship alumni.

1. Courses facilitating participants to reflect on their clinical practice can provide excellent opportunities to advance professional development
2. Further training in clinical skills, and also on how to deliver education and training is needed for clinical preceptors in Family Medicine training in Indonesia
3. Increasing the awareness and confidence of preceptors to optimally facilitate learning of the next generation of Family Medicine Specialists in Indonesia; our UGM-UoE programme aims to address this key training priority.

Background: Japan has the oldest aging population in the world, yet engagement of health care professionals in advance care planning (ACP) is low. This study describes the development of training videos of ACP communication for Japanese primary care professionals based on U.S.-based training videos.
Methods: Preceding Japanese video development, U.S.-based ACP communication skills training workshops were conducted in Japan in 2022. While the workshops were adapted from U.S.-based training for Japanese primary care professionals, they contained English-language training videos with American actors set in a U.S. primary care clinic with Japanese subtitles. Based on qualitative feedback from participants, we developed two 8-minute videos to promote ACP communication by reflecting the reality of Japanese practice settings.
Results: Japanese primary care participants' feedback on the U.S.-based training videos included: 1) initiating ACP is challenging for physicians in the busy outpatient setting; 2) it should be a multidisciplinary collaboration in Japan; 3) Japanese patients may be more reluctant to express their feelings and goals of care; and 4) families may hesitate to discuss ACP with the patient. The adaptation strategies for the Japanese-based videos were: 1) to divide the scenes into 2 parts to present continuous ACP communication in short clinical visits; 2) to include a nurse to facilitate the ACP discussion; 3) to let the patient and family address hesitation in discussing ACP; and 4) to cast well-experienced clinicians as healthcare professionals to provide a real-world example for Japanese primary care professionals. (Parts of the videos will be presented)
Conclusions: ACP training videos for Japanese primary care professionals were developed from U.S.-based training workshops for the real-world setting. As ACP remains a new communication approach, adapting the training content to the Japanese context may maximize its relevance for Japanese primary care professionals.

1. The context of ACP communication initiatives varies by practice location.
2. Communication training materials developed in other countries require cultural adaptation.
3. The adaptation process can help identify locally unique and effective communication approaches in a different social environment.

In October 2022, a research study to investigate “Vertical Integrated Learning in an Australian Urban General Practice” was launched at a teaching General Practice located in Southern Adelaide.
Former Medical Students, Junior Doctors, GP Registrars, Fellowed GP's and GP supervisors who had participated in educational activities in this clinic were invited to complete an electronic questionnaire and then a follow up semi-structured interview. Flinders university Ethics committee approval was attained.
This area was chosen because there is a gap in the literature around vertical integrated learning in urban General Practice. There is evidence that involvement of Medical Students, Registrars, New Fellows and GP Supervisors in Multilevel Learning is beneficial for all participants. To date, a lot of Australian research has centered on longitudinal rural placement. Our aim was to explore this type of learning in an urban context to revive and renew participation in medical education in other practices, as well as inform policy makers of the impact of learning experience on career path choice. A Mixed Methods Exploratory Sequential model was employed with an initial electronic questionnaire followed by a semi-structured interview. Responses from the questionnaire were used to inform the content of the interview.
Initial data suggests 85% found this learning environment to be very influential on their learning style and 70% found it very influential on their teaching style. 85% found this to be extremely influential on their career path and 70% found it impacted on their participation in medical education and teaching. Participants found that each supervisor had their own style and that a varied approach to teaching was ideal. Key benefits included having supportive supervisors and the opportunity for all to contribute in a non-threatening environment. Skills and interest of supervisors also increased. This environment enabled new supervisors to gain confidence.

At the conclusion of my presentation attendees will take away
1. An understanding of the value of integrated teaching and learning in medical education
2. An understanding of the impact this learning and teaching style can have on the career choices of medical students and GP's in training
3. A passion to apply this model in their practice

Triage nurses are expected to analyse differentials, recognise patterns, and notice heuristics responsible for ‘gut feeling’, in order to formulate a perspective that is relevant to a patient’s disposition, within a 5-minute time-frame, to ensure timely access to clinical treatment. The gold standard for nurses, is set in the College of Emergency Nurses Specialist Nurse Guidelines.
Results of a recent survey of triage in Australian EDs concluded that for triage decisions to be accurate and remain consistent, influencing factors must include:
 Ongoing education
 Ongoing professional development at triage
 Regular revision of the Australian Triage Scale
 Quality frameworks to audit triage processes and to self-audit triage.
There is minimal evidence of these factors for triage trained nurses in the EDs at our two local rural hospitals. Auditing occurs infrequently, there are incidences of unprofessional behaviour concerning patient care at triage, particularly the under triaging of elderly patients putting patient safety increasingly at risk. Poor documentation standards and lack of auditing are of concern in EDs which are getting busier each day.
To address this the hospitals are putting in place several strategies to increase awareness and vigilance around triage auditing, including tracking triage audits and introduction of regular ‘Triage Revisited’ workshops.
The Triage Revisited Workshop is an in-person ‘refresher’ workshop targeting triage nurses with a minimum of 24 months experience in the area.
The pilot project evaluation study, undertaken by senior medical students, aimed to evaluate the effectiveness of one of these workshops in raising the accuracy of triage-making decisions.
Broadly the results suggested that triage accuracy may be improved by triage refresher workshops, however more research is required to measure the impact in a real-life ED department setting. It demonstrated that ongoing education specific to triage nursing is valued by triage nursing staff.

1. This pilot evaluation study may set an example for further research as the session identifies difficulties encountered in the way in which data were collected and recorded and makes recommendations as to how these may be addressed.
2. An Emergency Triage Education Kit-based refresher workshop has the potential to improve accuracy and confidence when triaging, and with more research, a nation-wide standard for ongoing training may be able to be developed.
3. This research has important primary health implications for rural health practitioners and their patients.

Background
GP registrars require access to wellbeing support throughout their training. GP supervisors may be well positioned to provide wellbeing support; however, the responsibilities associated with this role lack clarity.
Aim
To explore the perspectives and experiences of GP supervisors and GP registrars as providers and recipients of wellbeing support in GP training.
Method
Consenting GP supervisors and GP registrars anonymously completed an online survey about their sociodemographics, attitudes, perceived norms, barriers, and wellbeing support experiences (5-point Likert-type scales from ‘strongly disagree to ‘strongly agree’).
Results
A total of 94 GP supervisors (age = 54±11 years, 60% women) and 27 GP registrars (age = 35±9 years, 74% women) participated between Sept 2022 - Jan 2023. There was good representation across all Australian States/Territories and metropolitan/non-metropolitan locations. Almost all GP supervisors (95%) were willing to provide wellbeing support; however, only 48% of GP registrars were willing to seek it from them. GP supervisors held more positive attitudes as providers of wellbeing support than GP registrars held as recipients (3.79±0.47 vs 3.59±0.45, respectively; p < .05) but both agreed that GP supervisors were responsible for it (4.19±0.39 vs 4.01±0.45, respectively; p > .05). GP supervisors perceived significantly greater pressure from valued colleagues to provide wellbeing support than GP registrars perceived from their peers to seek it from them (3.71±0.64 vs 3.33±0.74, respectively; p < .05). GP supervisors had significantly greater confidence in their capacity to provide wellbeing support than GP registrars had of them (3.80±0.48 vs 3.31±0.86, respectively; p < .01).
Discussion
GP supervisors were willing to provide wellbeing support to GP registrars, but most GP registrars were reluctant to seek it from them, possibly due to perceived barriers. Research is needed to explore areas of misalignment related to wellbeing support to ensure that high quality support is available in GP training.

At the conclusion of my presentation attendees will take away:
1. GP supervisors are more willing to provide wellbeing support than GP registrars are to seek it from them.
2. There is normative pressure to provide wellbeing support in GP training, but not to seek it.
3. GP supervisors have greater confidence in their capacity to provide wellbeing support than GP registrars have of them.

The COVID pandemic has changed the delivery of medical care around the world. Consultations via phone and videoconference have become part of a ‘new normal’ in General Practice (GP) where they were once reserved for patients in remote areas. Despite the widespread uptake of these modalities by patients, clinicians have been forced to adapt out of necessity without significant guidance. GP consultations conducted over telehealth presents additional challenges outside of the standard face-to-face appointments. Some differences include patient selection, risk management, agenda alignment, therapeutic rapport, and virtual physical examination. The pandemic has accelerated uptake of telehealth and there is a need for medical schools and GP training providers to address the educational deficits.

Prior to the COVID-19 pandemic, medical students had limited exposure to telehealth delivery in their curricula. Education of students mainly focus on face-to-face interactions and few programmes offer specific training on quality telehealth care. Recognising this gap in the traditional curriculum, we introduced a telehealth-focused education session in the Primary Care discipline for a post-graduate medical programme. Teaching focused on delivery of telehealth to enhance patient satisfaction, maximise quality of care, and ensure clinical safety. The sessions were conducted over 60 minutes and were designed to maximise student engagement by utilising live-polling, open discussions, and role-playing. Student perspectives before and after the sessions were obtained from open forum and polling. The feedback provides additional avenues for future curricula re-design.

Student and GP educator perspectives on telehealth pre- and post-intervention will be presented. We will discuss the telehealth-specific challenges outlined above and provide an approach to deliver quality telehealth in the GP setting. We aim to empower attendees with ideas that may facilitate similar curricula inclusions to ensure that medical graduates and GP trainees are equipped with the essential skills to provide care in the new healthcare landscape.

1. Recognise the current gap in the education of medical students on effective care delivery via telehealth.
2. Identify telehealth-specific challenges in medical consultations.
3. Develop a programme that enhances student and GP trainee insights into care delivery via telehealth.