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ObjectivesTimely intravenous-to-oral antibiotic switching for children is important for paediatric antimicrobial stewardship (AMS). However, low decision-making confidence and fragmentation of patient care can hamper implementation, with difficulties heightened regionally where AMS programmes for children are lacking. The aim of this study was to develop and evaluate user-led creation and implementation of an intervention package for early intravenous-to-oral switching at regional hospitals in Queensland, Australia.DesignGuided by theory, a four-phase approach was used to: (1) develop multifaceted intervention materials; (2) review materials and their usage through stakeholders; (3) adapt materials based on user-feedback and (4) qualitatively evaluate health workers experiences at 6 months postintervention.SettingSeven regional hospitals in Queensland, Australia.ParticipantsPhase 2 included 15 stakeholders; health workers and patient representatives (patient-guardians and Indigenous liaison officers). Phase 4 included 20 health workers across the seven intervention sites.ResultsContent analysis of health worker and parent/guardian reviews identified the ‘perceived utility of materials’ and ‘possible barriers to use’. ‘Recommendations and strategies for improvement’ provided adjustments for the materials that were able to be tailored to individual practice. Postintervention interviews generated three overarching themes that combined facilitators and barriers to switching: (1) application of materials, (2) education and support, and (3) team dynamics. Overall, despite difficulties with turnover and problems with the medical hierarchy, interventions aided and empowered antibiotic therapy decision-making and enhanced education and self-reflection.ConclusionsDespite structural barriers to AMS for switching from intravenous-to-oral antibiotics in paediatric patients, offering a tailored multifaceted intervention was reported to provide support and confidence to adjust practice across a diverse set of health workers in regional areas. Future AMS activities should be guided by users and provide opportunities for tailoring tools to practice setting and patients’ requirements.

Aboriginal and Torres Strait Islander peoples continue to be pathologised in medical curriculum, leaving graduates feeling unequipped to effectively work cross-culturally. These factors create barriers to culturally safe health care for Aboriginal and Torres Strait Islander peoples. In this pilot pre-post study, the learning experiences of seven medical students and four medical registrars undertaking clinical placements at an urban Aboriginal and Torres Strait Islander primary healthcare service in 2014 were followed. Through analysis and comparison of pre- and post-placement responses to a paper-based case study of a fictitious Aboriginal patient, four learning principles for medical professionalism were identified: student exposure to nuanced, complex and positive representations of Aboriginal peoples; positive practitioner role modelling; interpersonal skills that build trust and minimise patient–practitioner relational power imbalances; and knowledge, understanding and skills for providing patient-centred, holistic care. Though not exhaustive, these principles can increase the capacity of practitioners to foster culturally safe and optimal health care for Aboriginal peoples. Furthermore, competence and effectiveness in Aboriginal health care is an essential component of medical professionalism.

Introduction: Incongruence between the formal, informal and hidden curricula of Aboriginal and Torres Strait Islander health education is a barrier to student learning and preparedness for delivering effective and culturally-safe healthcare to Aboriginal people. We investigated the impact of student and registrar immersion experiences in an urban Aboriginal and Torres Strait Islander primary healthcare service, where greater alignmentbetween the formal, informal and hidden curricula is evident. Methods: In 2014, 11 students and registrars participated in this qualitative study. At the commencement of their placement, they received a project-specific vignette describing a 46-year-old Aboriginal woman with type 2 diabetes, wrote responses to questions about her clinical care and participated in a semi-structured interview, which explored the assumptions underpinning their responses. Post-placement, participants reflected on their earlier responses and what they had learned from their placement about Aboriginal and Torres Strait Islander people and their health and healthcare. Results: The placement negated many of the students’ and registrars’ previously held assumptions about Aboriginal people, for example, that Aboriginal people don’t care about their health and will not engage with health professionals. Participants became aware of the benefits of long-term doctor–patient relationships based on trust and respect. Participants realised that doctors have a role in addressing social determinants of health. Conclusions: Our participants’ shifts in thinking and knowing suggest that greater alignment between the formal, informal and hidden curricula can lead to deepened and more effective learning outcomes for medical students and registrars and, critically, to improved Aboriginal health outcomes. Identification and reproduction of the key elements of Aboriginal health services may enrich medical students’ learning about culturally-safe and appropriate care for Aboriginal people.