Introduction: Primary care doctors are essential for the healthcare system, with better health outcomes at lower costs and greater equity. Medical education reform as an upstream strategic intervention is needed to improve primary healthcare capacity, especially in resource-limited contexts. Competency-based medical education (CBME) has gained momentum as the premier curricular model to produce competent doctors. However, moving toward a competency-based curriculum comes with challenges. Resource constraints may exacerbate inherent challenges. Contextualization plays a crucial role in curricular change. Adopting the CBME model, originating from the Western world, requires the acceptance of instructional design and social organization. In Cambodia, CBME implementation efforts have been ongoing for a decade now. However, significant barriers persist, and progress is limited. This study aims to explore practical challenges of CBME implementation in a resource-limited, non-Western context.

Methods: Information was collected through document reviews and semi-structured interviews. First, gray literature, public documents, strategic plans, project outputs, and pertinent reports were examined. Second, three international consultants and 10 faculty members from all five medical schools in Cambodia were interviewed. Data were analyzed using inductive thematic analysis.

Results: The study identified 12 themes and numerous sub-themes. Several issues were directly related to the curriculum, including conceptual understanding, the national curriculum standard, clinical training and assessment. Challenges in stakeholder engagement, resources, teachers, and students affected the process of implementing curricular change. Contextual factors also hampered CBME such as policy, culture & organization, accreditation, and leadership.

Conclusion: Study results reveal interrelated factors that may facilitate or hinder CBME implementation. Some challenges are similar across contexts, while others are specific to Cambodia, including pragmatic approaches to CBME adoption, conceptual misconception, the prescriptive curriculum, resource constraints, and contextual barriers. Relevant stakeholders must find collaborative strategies to overcome these challenges, turn them into opportunities, and learn from successful examples.

1. Pre-service medical education reform is an upstream strategic intervention to improve health outcomes by producing competent doctors.
2. CBME is a curricular model to ensure medical graduates responding to the current and future needs of the population.
3. Practical challenges in the implementation of CBME in a resource-limited, non-Western context.

Spaced repeated testing over time results in better long-term knowledge retention than repeated study of the same material. Physicians participating in the low-stakes Continuing Knowledge Self-Assessment (CKSA) receive 25 online questions per quarter. After answering each question, they rate their confidence in their answer before receiving feedback, an educational critique, and list of appropriate references. This study compared the effect of 5 different spaced repetition strategies on physician knowledge retention and transfer of knowledge from one clinical scenario to another.
26,255 family physicians (mostly practicing, some residents) who completed the CKSA in the 4th quarter of 2020 (baseline period) were eligible for study inclusion. Participants were randomized to a control group or one of 5 spaced repetition conditions over the subsequent 5 calendar quarters (1 January 2021 – 31 March 2022). Control group participants received no repeated questions during this time. Participants in the other 5 groups received up to 6 questions repeated either once or twice; the interval between repetitions differed between each group.
Incorrectly answered baseline questions were prioritized for spaced repetition -- those answered extremely confidently received highest priority, with decreasing priority for those questions answered with lesser degrees of confidence. If necessary, correctly answered questions could then be selected for spaced repetition, with higher priority for questions not answered confidently (e.g., “guesses”) than those answered more confidently.
In quarter 6 of the study, all remaining participants received their repeated questions. Participants in spaced repetition groups performed better than those receiving no previous repetition; those who received two prior repetitions performed better than those who received one. There were no substantive differences in performance based on repetition interval in the one repetition groups or in the two repetition groups. Results on transfer (assessed in quarter 8 of the study) are currently being analysed and will be presented.

1. Spaced repetition of multiple-choice questions enhances knowledge retention compared with no spaced repetition. 2. Two spaced repetitions are better than one for enhancing knowledge retention. 3. Intervals of spaced repetition of multiple-choice questions are less important than the number of repetitions.

Aim:
In 2018, Tasmania piloted an optional 3 month rural general practice term for Interns. We sought to establish a qualitative review of the strengths and challenges of this program, to support the reconnection between junior doctors and general practice, and revive general practice pathways for interested junior medical officers.

Content:
Thematic analysis of in-depth interviews was used to generate six main themes. These were the intern role, skill acquisition, the social experience of rural/remote placements, challenges experienced by interns, placements reinforcing ideas of rural general practice and advice to future interns. Rural interns were positive about the program, reporting intensive learning experiences from a range of clinical
environments. There were some challenges initially implementing the
wave consulting model, which highlighted the importance of practice staff being able to integrate interns to the environment. The main difficulty faced by interns was isolation from peers/social support. Interns that were not interested in a general practice pathway still appreciated the opportunity to rotate through general practice, but it was important that they opted into the placement rather than being assigned.

Goals: To present the findings of our 2019 paper to an international audience that may wish to implement similar programs in their region. To discuss the challenges and the strategies to overcome, and the tweaks made to the program since our paper was published. To contribute to the strategy for general practice recovery and revival amongst medical students and junior medical officers.

1. Rural general practice terms for interns offers a unique opportunity for GP exposure and skills acquisition that is unavailable in hospital rotations, and supports rural career pathways
2. Challenges that need addressing to further support the initiative of rural GP terms include education factors, social factors, and program setup factors
3. The wave consulting model was found to be the most useful and efficient way for practices to integrate interns

Background
The modern Doctorate was developed to produce independent scholars capable of becoming professors.
General Practice / Family Medicine (GP/FM) has specific concerns which require research by individuals cognizant of its principles, activities, and problems.
This study was designed to examine if the discipline producing sufficient advanced researchers.
Method
Doctors practicing GP/FM who were awarded a doctorate between 1 Jan 2000 and 31 Dec 2022 were identified using online national and international thesis databases (search terms General practice/ Family medicine, primary care or medical education) , examination of medical school and research institute research websites and data bases, GP/FM research conference abstracts, articles published in national and the 5 leading journals of GP/FM research, searching the social media program Linkedin and a internet search using several search engines. At thesis submission the individual was required to be training or in GP/FM practice, the thesis topic was relevant to the clinical practice or educational development of GP/FM practitioners. Those whose thesis topic was a basic science or MD/PhD thesis were removed as it soon became clear that such individuals rarely produced further research relevant to GP/ FM needs.
Results.
By Feb 2023, 2001 individuals with a relevant thesis were identified. 48% were female. 670 were professors / associate professors. Seven countries, the Netherlands, the United Kingdom, Sweden, Australia, Korea, Denmark and Finland produced 74% of the identified doctorates. The median time at thesis submission was 14 years from medical school graduation and 10 years from completion of GP/FM discipline training. While European countries and Australia have large numbers of International medical graduates in their GP/FM workforce it was rare that they submitted a thesis.
Conclusions.
The WONCA Research Committee should consider developing a GP/FM doctoral theses database. A need exists to develop efficient and equitable ways of producing GP/FM advanced researchers.

1. Low number of discipline doctorates
2. Where are the centres of doctoral excellence for GP/FP?
3. What has worked to increase the number of GP/FP writing doctorates?

Family Medicine is delivering comprehensive, first-contact, person-centred, and community-based medical care. Evidence showed the impact of family medicine (FM) on better outcomes, lower costs, and improved health equity. The World Health Organisation (WHO) adopted the concept of family practice for effective and efficient delivery of primary healthcare services, and for achieving universal health coverage in Eastern Mediterranean Region (EMR). A research study was conducted to map and describe the postgraduate FM training programs in the EMR and to identify challenges facing the FM training and practice. A mixed method approach was used including qualitative and quantitative data collection along with literature review. Results showed that the training in family medicine started in 1979 in the EMR region, with the first programmes being established in Lebanon, Bahrain followed by Egypt. There is a great variability in the family medicine training as well as practice among the different countries. Most countries in the region require a residency in family medicine as the formal postgraduate training such as Kuwait, Egypt, Lebanon, Bahrain, Kingdom of Saudi Arabia, United Arab Emirates, Qatar, and Oman. In other countries like Sudan, Islamic Republic of Iran and Egypt, a master’s degree in family medicine is also recognised as a formal postgraduate training. Fellowships in family medicine are also recognised as formal postgraduate training in other countries. The residency training programmes are of four years duration in most of the countries; however, a three-year residency program is acceptable in few countries. A formal postgraduate training in FM is still absent in a few countries in the region like Yemen and Morocco. Many challenges are facing the development of FM in the region, including characteristics of the health system, the image of family medicine, availability of gate keeping and referral mechanisms, financing issues, contextual factors such as war and others.

1. Identify the different training programs in family medicine in the Eastern Mediterranean Region.
2. Identify the challenges facing these programs.
3. Discuss recommendations that might improve the training and practice in family medicine in the region.

Background and Objectives:
Empathy is an essential component of physician competence. In recent years, the influence of social determinants of health (SDH) on health outcomes and the advocacy role of physicians have gained attention. Therefore, it is becoming increasingly important to nourish both interpersonal and social empathy during medical education. However, little is known about social empathy in graduating medical students. The objective of this study was to clarify the factors related to social empathy in graduating medical students in Japan.

Methods:
The study was a cross-sectional survey using an anonymous, self-administered questionnaire. Participants were 133 sixth-year medical school students at the University of Tsukuba who completed the clinical clerkship in July 2022. The Japanese version of the Social Empathy Index (SEI), which consists of four interpersonal empathy components and two social empathy components, was used. Participant age, sex, volunteer activities, donations, living abroad, studying abroad, and self-rated understanding of SDH was ascertained. Overall and component SEI scores were compared with other factors using the t-test. The study was approved by the University of Tsukuba medical ethics board.

Results: There were 81 participants with a mean age of 24.2±2.2 years; 30 (37.0%) participants were female. Those with a better understanding of SDH had significantly higher overall SEI scores and higher scores on two interpersonal components (affective mentalising and perspective taking) and one social empathy component (contextual understanding of systemic barriers). Participants with experience studying abroad had significantly higher scores on an interpersonal component (affective response) and a social empathy component (contextual understanding of systemic barriers), but this trend was not seen in participants with experience living abroad.

Conclusion: Graduating medical students with better understanding of SDH had higher SEI scores. Those with experience studying abroad had higher scores on some SEI components.

At the conclusion of my presentation attendees will take away
1. better understanding of social determinants of health in graduating medical students may be related to social empathy
2. medical students' experience of studying abroad may be related to social empathy
3. medical students' experience of living abroad may not be related to social empathy

Introduction: Conducting meaningful research as part of a medical student’s training provides essential skills and professional development. Despite its importance, there is limited evidence of medical curriculums which integrate compulsory research projects. The Rural and Remote Medicine (RRM) clinical unit within the University of Queensland’s Doctor of Medicine (MD) program conducts compulsory Rural Health Projects (RHP) as part of their assessed curriculum. The RHPs are community-based and engage students in formal short-term research activities. This study aimed to review RHP topics based on standardised disease categories, as well as their geographical distribution.
Methods: This study conducted a retrospective analysis of RHPs conducted between 2011 and 2021. Descriptive analyses were used to present RHP locations by Modified Monash Model (MMM) geographical classification categories and disease/research categorisation using the International Classification of Diseases and Related Health Problems – 10th Revision (ICD-10) codes and the Human Research Classification System (HRCS) categories.
Results: There were a total of 2806 eligible RHPs conducted between 2011 and 2021, with most conducted in Queensland (n=2728, 97.2%). The RHPs were mostly conducted in small rural towns (MMM-5, n=1044, 37.2%) or other rural towns up to 15,000 population (MMM-4, n=842, 30.0%). Projects most addressed Individual care needs (n=1233, 43.9%) according to HRCS categories, or were related to Factors influencing health status and contact with health services (n=1012, 36.1%) according to ICD-10 code classifications.
Conclusions: The integration of RHPs as part of this program’s MD curriculum demonstrates a valuable approach to engaging medical students in research projects and enhancing their research skills. Students address topics of interest through their RHPs, increase their involvement with the rural communities and other health professionals, develop important resources, and acquire an increased understanding of local health issues in rural and remote communities.

1. Medical students can benefit from conducting research projects to enhance their research skills.
2. Students can enhance their involvement with rural communities and other health professionals, develop important resources, and acquire an increased understanding of local health issues in rural and remote communities by conducting Rural Health scholarly projects.
3. Engaging medical students in rural health research projects is essential to enhance their research skills.

Background
The GP supervisor-registrar relationship is the foundation for successful training in general practice. Mutual willingness to disclose areas of professional or personal uncertainty can deepen the supervisor-registrar relationship and foster learning opportunities.
Aim
To explore reciprocity in disclosures about professional and personal matters between GP supervisors and GP registrars.
Method
GPSA and GPRA members were invited to complete an online survey titled, 'How do self-disclosures influence the GP supervisor-registrar relationship?'. Consenting respondents anonymously completed questions about their sociodemographics, the likelihood of self-disclosures (13-items, 5-point Likert-type scale from ‘Not at all’ to ‘Very’), and their exposure to disclosures (9-items, 5-point Likert-type scale from ‘Not at all’ to ‘Often’).
Results
A total of 58 GP supervisors (mean age = 51.4±10.5, 55% women) and 58 GP registrars (mean age =34.72±6.10, 66% women) completed the survey in June-July 2022. There was good representation across all Australian States/Territories and metro/non-metro locations. GP supervisors self-reported significantly greater likelihood to make self-disclosures than GP registrars (3.78 vs 3.25, p < 0.001). However, GP registrars reported significantly lower exposure to GP supervisor disclosures than vice versa (3.03 vs 3.24, p < 0.05, one-tailed). Higher exposure to disclosures was significantly correlated with increased likelihood of making disclosures for both GP supervisors (r = .28, p < 0.05) and GP registrars (r = .47, p < 0.001). After controlling for sociodemographic factors, exposure to GP supervisors’ disclosures significantly predicted GP registrars’ likelihood of making disclosures (r = .28, p < 0.01). A significant model predicting GP supervisor disclosures did not emerge.
Discussion
Although GP supervisors reported significantly greater likelihood of making disclosures than GP registrars, both cohorts perceived their exposure to disclosures as only occasional. These results highlight the importance of GP supervisor modelling to encourage GP registrars to make reciprocal disclosures about areas of uncertainty.

At the conclusion of my presentation attendees will take away:
1. GP supervisors self-report a greater likelihood to share professional and personal disclosures than do GP registrars
2. Greater exposure to personal and professional disclosures is associated with increased likelihood of making disclosures
3. Exposure to more GP supervisor disclosures predicts greater likelihood that GP registrars will reciprocate

It is recognised that ethnic or linguistic minorities shall not be denied the right to use their own language.
In Australia, one in every ten people does not speak English well; and one in every fourteen GP registrars have consulted in languages other than English (LOTE), however this is not recognised practice during GP training in Australia and not addressed during training.
This qualitative study, as part of a wider project including a quantitative study, aims to better understand the characteristics and impact of consulting in LOTE on registrars during GP training. Registrars were recruited by an email via GP Synergy, a regional training organisation, and those who self-identified as having consulted in LOTE were invited to explore their experiences. Semi-structured interviews were conducted and reflexive thematic analysis applied to the data.
Interviews were undertaken with 15 registrars, of whom five were international medical graduates and ten Australian graduates. Their post graduate experience ranged between four to 23 years, and current training term ranged from term one to fellowship. Registrars report training at rural, remote, and metropolitan areas.
Registrars did not feel that their LOTE consulting was an impediment to their training. They experienced both satisfaction and stress when consulting in LOTE, with most registrars reporting it was cognitively draining. Ambivalence as to whether it was desirable or permissible to undertake LOTE consultations during training was common. Registrars’ experiences were affected by their language confidence, particularly the language of their medical education. It could increase doctor-patient affinity and understanding within the consultation, but for some registrars it was seen as an unwelcome responsibility in patient care, including creating medicolegal concerns. No registrars had discussed these experiences and concerns with educators or GP supervisors.
The implications for registrar training will be discussed, including related to professional identity formation and linguistic rights.

At the conclusion of the presentation attendees will appreciate that:
1. Registrars didn't feel that consulting in a language other than English (LOTE) was an impediment to their training, however reported some concerns which they had not discussed with educators or supervisors.
2. For GP registrars, consulting in LOTE during training may be affected by considerations such as medicolegal implications and patient responsibility.
3. Decision on the provision of LOTE consultation impacts on the linguistic rights of both the registrar, as well as the patient.