Introduction:
Non-evidence-based and ‘low value’ clinical care and medical services are ‘questionable’ activities, being more likely to cause harm than good or whose benefit is disproportionately low compared with its cost. We sought to establish if a measure of questionable clinical practice (the QUestionable In Training Clinical Activities Index (QUIT-CAI)) is predictive of GP registrars’ (trainees’) performance in RACGP Fellowship examinations (licensure examinations for independent general practice).

Methods:
The study was nested in the ReCEnT study - an ongoing cohort study in which GP registrars record details of their clinical practice. Outcome factors in analyses were individual NSW- and ACT-based registrars’ scores on the three Fellowship examinations (AKT, KFP, and OSCE) and overall pass/fail, during 2012-21. Analyses used univariable and multivariable regression (linear or logistic, as appropriate). The study factor in each analysis was ‘QUIT-CAI score percentage’ – the percentage of times a registrar performed a QUIT-CAI clinical activity when ‘at risk’ (i.e. when managing a problem where performing a QUIT-CA activity was a plausible option).

Results:
1,265, 1,145, and 553 registrars sat AKT, KFP, and OSCE examinations, respectively. On multivariable analysis, higher QUIT-CAI score percentages (more questionable activities) were significantly associated with poorer AKT scores (p=0.001), poorer KFP scores (p=0.003), and poorer OSCE scores (p=0.005). QUIT-CA score percentages predicted RACGP exam failure (OR 1.06 [95% CI 1.00, 1.12], p=0.043).

Discussion:
Performing questionable clinical activities in training was predictive of summative RACGP Fellowship examination performance. A 1% increase in the absolute percentage of ‘at risk’ problems for which a registrar performed a questionable clinical action was associated with 6% increase odds of failing at least one examination - a modest but clinically significant difference.

Thus, RACGP examination performance reflects actual clinical performance (by the measure of clinical performance we have examined, which is relevant for a licensing examination).

1. Frequent performance of ‘Questionable’ clinical activities – activities more likely to cause harm than good or whose benefit is disproportionately low compared with its cost – can be seen one marker of quality of health care delivery and of clinical competence.
2. Summative medical licensure examination performance should reflect clinically important attributes of the candidate and provide confidence of future patient safety.
3. This study demonstrates that RACGP summative examination performance reflects clinical performance as assessed by a measure of ‘questionable’ practice.

Purpose: Evidence shows healthcare improvements and overall patient experience are supported by advanced interpersonal skills by healthcare professionals. Multisource feedback (MSF) is a validated and robust workplace-based assessment tool that offers 360-degree evaluation of a doctor’s interpersonal relations and communication skills, professional behaviours, and some aspects of patient care. Obtaining structured feedback about how a doctor is performing (with the ability to compare their performance in relation to benchmark datasets of similar doctors, fields, specialism), doctors have an opportunity to improve their performance.
Method: MSF demonstrates strong alignment with the Medical Board of Australia’s (MBA) Professional Performance Framework two key domains; measuring outcomes (patient feedback) and reviewing performance (colleague feedback).
Results: Case studies will be shared to illustrate the MSF process including the debriefing and reflective exercise involved. Benchmark data on 1302 surveys completed by general practitioners and 581 surveys by registrars (2017-2022) will be shared highlighting key trends and areas for improvement. MSF tools and resources will be used to illustrate how doctors can maximise the benefits of undertaking the learning and development process as a part of the Fellowship Support Program or Australian General Practice Training program.
Conclusion: MSF, including self-reflection, patient feedback and colleague feedback, is gaining recognition in the medical profession as a tool to support doctors to reflect on how they work and identify ways for self-improvement. Using evidence-based facilitated feedback is helpful for doctors in facilitating their reflection on and use of the feedback.
The use of an evidence-based MSF that aligns with the MBA’s new framework and the Colleges related CPD Home facilitates lifelong learning and professional development ensuring continuous quality improvement and a culture of collegiality, shared experience and peer support is embedded and sustained.

1. Demonstrate how the the Multi-Source Feedback (MSF) tool aligns with the Medical Board of Australia’s (MBA) Professional Performance Framework
2. Discuss how the MSF can support doctors to reflect on their practice and identify ways for self-improvement despite where they are in their career.
3. Discuss how evidence-based facilitated feedback can support doctors in facilitating their reflection and the use of the MSF feedback.

Let the Humphrey-Bogart film noir style narration walk you through a 'standard consultation' allowing exploration of the doctor's mind as the consultation takes its twists and turns. What will be the final outcome?

Aim: To innovate thinking about the consultation and allow reflection on the doctor's own humanity, struggles and joys as they consult, sharing thoughts we often have but sometimes cannot express to others.

Content:
The play consists of a standard GP consultation occurring in the doctors' office. It is late in the day and the doctor is tired and winding down for the day. Before, during and after the consultation the audeince will hear added narration, 'film noir' style from the doctor's mind, exploring the doctor's unspoken thoughts and feelings as the consultation transpires.

Goals:
a) to have reflected on our own mindset as doctors during consultations
b) to have reviewed simple communication techniques in a new way
c) to explore different ways of presenting medical education
d) to have, hopefully, a laugh or two

Duration 15 minutes

Participant/presenter numbers - 3 - two enacting the consultation as patient and doctor and a narrator

Target audience - all GPs and family doctors, especially those with an interest in medical education and/or exploring communication between patients and doctors

Requirements - maybe 3xmicrophones if a larger room/audience; Otherwise 3 chairs and a table and probably a laptop (does not need to be plugged in; for prop purposes only)

1. It is normal to have thiughts during a consulattion, some of which may be challenging or difficult.
2. Effective communication can be achieved despite these interrupting thoughts.
3. Teaching can be innovative and fun.

The problem of the dwindling rural and regional medical workforce has been recognised for many decades, including General Practitioners and the other specialists that support them. The weight of national and international research supports medical training of rural background individuals, within rural settings, to produce the maximum number of individuals to take up rural and regional medical careers. Accordingly, rural and regional based training has been introduced into medical schools across the country. Despite this move, the rural and regional medical workforce numbers continue to decline.
A deficit remains in this rural and regional training plan. During the years that the majority of medical trainees are establishing long term relationships, starting families and “putting down roots”, they have been required to move to metropolitan areas in order to pursue vocational training for their chosen career. Medical training needs to continue in regional and rural settings, across these transformative years, if a reversal of the decline in rural and regional workforce is to occur.
In 2017, the federal government announced funding for organisations across Australia, to facilitate growth of the rural and regional medical workforce. Over the last five years, one such organisation has engaged with regional specialists, health services, training providers, trainees and government to facilitate the creation of vocational training pathways within a rural region of Australia. During this period, training pathways have been, or are being, developed in the disciplines of General Medicine, General Surgery, Psychiatry, Emergency Medicine and Obstetrics and Gynaecology.
Further, this organisation is also working to enable students and junior doctors to investigate potential career pathways and complete professional development at an early stage in their careers.
These programs have begun to produce specialists who are now working in rural and regional Australian communities.

1. End to end medical training is required to address the rural and regional medical workforce needs
2. Rural and regional vocational training is achievable
3. Rural and regional vocational training is successful in producing rural and regional workforce

Early career medical professionals experience stress and burnout at higher levels than the wider community. Burnout is impacted by competing demands with life and career, which is evident in early career planning, where family planning can coincide with specialty training. General Practice may be seen as a family friendly career option, however little evidence examines the experience of GP trainees with stress and burnout and the impact that parenting has on their experience.

Aim:
This study aims to explore the experience of stress and burnout in GP registrars and the exacerbating and protective factors, with a focus on the experiences of two groups of registrars, those that have children, and those that do not.

Methods:
A qualitative study was conducted with 14 participants, questions exploring experiences of stress and burnout. Participants were grouped into those with children and those without children. The transcripts were thematically analysed.

Results:
Themes were identified as those that contributed to stress and burnout (such as time and financial concerns and isolation) and those factors that reduced stress and burnout (such as support from others and being respected and valued within the workplace). Parenting was identified as both a factor that could contribute to and reduce stress and burnout.

Conclusions:
Stress and Burnout is an important focus for future research and policy to ensure the sustainability of General Practice. System based and individual focused policies, including individualising the parenting impact on training, is required to ensure that registrars are supported through their training years and beyond.

1. Stress and Burnout is a key reason new fellows and registrars are leaving general practice
2. Individualised measured, including around parenting is important in sustainability
3. Parenting impacts registrars in different ways and can contribute to or alleviate stress and burnout

Photovoice is a visual arts-based methodology developed by Wang and Burris (1997); based on the idea that images and words can effectively express needs, problems, and desires. It has been used in teaching students’ reflection in health sciences, with students reporting more emotional and moral undercurrents in their learning experiences. Photovoice reflections are more thoughtful compared to traditional reflective essays. Reflective learning has been used in the professional field since the 1930s. It has helped students develop their ability to formulate their learning objectives and raise their awareness of their learning styles.

This study aims to explore the learning experiences among medical students in primary care medicine clinical rotation during the COVID-19 pandemic and to seek the impact of the pandemic on their learning process. This study was conducted with the final year medical students during their primary care medicine clinical rotation at Universiti Malaya. At the start of this study, the students were briefed about photovoice, the ethics of taking photographs, and the guidelines for submitting their photos. They were required to submit their photos at the end of the rotation, with a sharing session scheduled a few days after that. These sessions were conducted as focus group discussions (FGDs).

Five themes emerged from this study: Uncertainty, Coping, Loneliness and despair, Challenges, and Hope. Most students felt that the pandemic had significantly disrupted their learning experience, having to adapt to the sudden change in learning format and method. However, they were eager to complete their medical programme as planned. Students reported that they enjoyed using photovoice as a reflection tool compared to writing a reflective essay. In conclusion, photovoice should be considered as a teaching method to enhance medical students learning and to encourage the practice of self-reflection.

1. Be able to relate their experience in teaching medical students how to incorporate reflective learning into their medical curriculum.
2. Be able to explore the unique teaching method to enhance medical students learning.
3. Be creative in the process of teaching and learning the MBBS/MD curriculum.

The speed at which General Practice is changing and expanding in its responsibilities is currently increasing. Expansion of clinicians’ roles creates cognitive overload and uncertainty – particular for trainees and early-career GPs. In the past, the WONCA Europe network for medical education, EURACT, published competency-based aims and requirements for postgraduate training in general practice. This study aims to provide a voice to GP trainees in the curriculum redesign process. As a second step, we plan to provide concrete guidance on how to redesign postgraduate curricula, with concrete learning activities and suggestions from the EYFDM evets (European Young Family Doctors Movement, aka: VDGM) at WONCA London 2022 and WONCA Brussels 2023.

Methods:
The results from this study are part of an explorative sequential mixed-methods study within the EYFDM movement. Initial townhall discussions for qualitative data gathering was combined with a two times two step modified Delphi approach. Sociodemographic data, level of agreement and Skew deviation calculations were used to relate and rank competencies and learning activities.

Results:
‘Top competencies rated were GP examination techniques, individualising care and communication skills. Interestingly, doctor’s and patient’s wellbeing ranked top three in the affective category. Results from WONCA Brussels concerning learning activity suggestions (affective competencies) will follow.

Conclusion:
This study provides a voice to the future generation of GPs. With this study future postgraduate curricula will have the opportunity to be more inclusive when setting up learning outcomes and learning outcomes. The relevance of our findings on an international level will need to be revaluated and possible expanded.

1. Role of young doctors in curriculum-design
2. The most important future competencies for Gps-in-training
3. How can affective cometencies be taught in Gp-training

INTRODUCTION
Blended learning refers to the use of internet technologies along with face-to-face teaching to deliver a broad array of solutions that enhance the knowledge and performance of students. It can be used by medical educators to improve the efficiency and effectiveness of educational interventions in the face of social, scientific, and pedagogical challenges.
Rationale of the study:
The main purpose of conducting this study was to bridge the gap between theory and practice among family residents toward dermatology. Dermatologic conditions are seen extensively in family medicine; hence, they need to have a strong foundation in the diagnosis and management of common dermatoses.
METHODOLOGY
This was a Quasi experimental study (pre and posttest) and participants were all the family medicine residents at Aga Khan University Hospital. The duration of the was six months .
The dermatology course was divided into five modules, comprised of both online asynchronous on virtual learning system and through zoom. This study aimed to investigate the approach of blending learning and to measure the learning outcomes by using cognitive and affective domains.
Results: A significant increase in posttest scores of the residents was found as compared with pre-test results. The mean of pretest result was (10.43±5.67)and the posttest result mean was (20.52±4.17). The statistically significant difference was found between pre and post test results of student with mean difference (-10.09) and P value (0.000).
It was statistically proven that blended learning is an effective way of teaching and learning for family medicine residents. Perception of the residents showed excellent satisfaction from this course.

Conclusion:
Based on the findings of this study, we concluded that blended learning helped family medicine residents to improve their teaching and learning and they learned more effectively. This method can be used by other specialties to improve residents teaching and learning.

1. Blended learning can help family medicine residents to improve their teaching and learning.
2. Blended learning may improve the overall results of students and they gain significant knowledge.
3. It is recommended to use this method of teaching in other clinical disciplines as well.