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Abstract Background There is little systematic operational guidance about how best to develop complex interventions to reduce the gap between practice and evidence. This article is one in a Series of articles documenting the development and use of the Theoretical Domains Framework (TDF) to advance the science of implementation research. Methods The intervention was developed considering three main components: theory, evidence, and practical issues. We used a four-step approach, consisting of guiding questions, to direct the choice of the most appropriate components of an implementation intervention: Who needs to do what, differently? Using a theoretical framework, which barriers and enablers need to be addressed? Which intervention components (behaviour change techniques and mode(s) of delivery) could overcome the modifiable barriers and enhance the enablers? And how can behaviour change be measured and understood? Results A complex implementation intervention was designed that aimed to improve acute low back pain management in primary care. We used the TDF to identify the barriers and enablers to the uptake of evidence into practice and to guide the choice of intervention components. These components were then combined into a cohesive intervention. The intervention was delivered via two facilitated interactive small group workshops. We also produced a DVD to distribute to all participants in the intervention group. We chose outcome measures in order to assess the mediating mechanisms of behaviour change. Conclusions We have illustrated a four-step systematic method for developing an intervention designed to change clinical practice based on a theoretical framework. The method of development provides a systematic framework that could be used by others developing complex implementation interventions. While this framework should be iteratively adjusted and refined to suit other contexts and settings, we believe that the four-step process should be maintained as the primary framework to guide researchers through a comprehensive intervention development process.

Abstract Background Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidence-based clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters), which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the control arm will receive access to the guideline using the existing dissemination strategy. Practitioners in the intervention arm will be invited to participate in facilitated face-to-face workshops that have been underpinned by behavioural theory. Investigators (not involved in the delivery of the intervention), patients, outcome assessors and the study statistician will be blinded to group allocation. Trial registration Australian New Zealand Clinical Trials Registry ACTRN012606000098538 (date registered 14/03/2006).

Introduction: Retention of general practice registrars in their training practices is important for addressing the GP workforce deficit and maldistribution of GPs. Given that rural and remote general practices are disproportionately affected by low retention, identifying the factors that promote retention may be as important as developing recruitment strategies in these areas. Quantifying the impact of relevant factors on registrar retention will enable a better understanding of how to incentivise retention and attenuate the loss of the rural workforce to other areas. We sought to establish the prevalence and associations of retention of general practice registrars in their training practices. Methods: This analysis was a component of the New alumni Experience of Training and independent Unsupervised Practice (NEXT-UP) study: a cross-sectional questionnaire-based study of early-career GPs in conjunction with evaluation of data contemporaneously recorded as part of vocational training. Participants were former registrars of three regional training organisations delivering general practice training in New South Wales, Tasmania, the Australian Capital Territory and Eastern Victoria, who had attained Fellowship of the Royal Australian College of General Practitioners or the Australian College of Rural and Remote Medicine between January 2016 and July 2018. The outcome measured was whether the registrar had previously worked at their current practice during vocational training. Multivariable logistic regression was used to estimate the association between relevant explanatory variables and the outcome. Results: A total of 354 alumni responded (response rate 28%), of whom 322 provided data regarding previous training practice retention, with 190 (59%) having previously worked at their current practice as registrars. Among respondents who reported currently working in a regional--rural practice location (n=100), 69% reported having previously worked at their current practice during training. GPs were more likely to be retained by a practice they had trained at if it was of lower socioeconomic status (adjusted odds ratio (aOR) 0.82 (95% confidence interval (CI) 0.73-0.91), p<0.001 for each decile of socioeconomic status) and if the practice provided two or more of home visits, nursing home visits or afterhours services (aOR 4.29 (95%CI 2.10-8.75), p<0.001). They were less likely to be retained by the practice if training was completed in a regional-rural area (aOR 0.35 (95%CI 0.17-0.72), p=0.004). Conclusion: Regional--rural training location is associated with reduced odds of subsequent retention of general practice registrars. This is occurring despite significant government investment in expansion of general practice training in regional and rural areas. The practice factor most strongly associated with GP retention was the provision of out-of-practice and after-hours care. There may be altruistic, rather than monetary, reasons that explain this finding. Such training opportunities, if provided to all trainees, especially in regional and rural areas, would be a learning opportunity, a way of promoting holistic community-based care and an incentive for subsequent retention within the practice and community as an established GP. [ABSTRACT FROM AUTHOR]

Background Antibiotics provide minimal benefit for sore throat, otitis media, and sinusitis. Antibiotic stewardship, with reduced prescribing, is required to address antibiotic resistance. As most antibiotic prescribing occurs in general practice and prescribing habits develop early, general practitioner (GP) trainees (registrars) are important for effective antibiotic stewardship. Objectives To establish temporal trends in Australian registrars' antibiotic prescribing for acute sore throat, acute otitis media, and acute sinusitis. Design A longitudinal analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study from 2010 to 2019. Participants ReCEnT is an ongoing cohort study of registrars' in-consultation experiences and clinical behaviours. Pre-2016, 5 of 17 Australian training regions participated. From 2016, 3 of 9 regions (42% of Australian registrars) participate. Main measures The outcome was prescription of an antibiotic for a new acute problem/diagnosis of sore throat, otitis media, or sinusitis. The study factor was year (2010–2019). Key results Antibiotics were prescribed in 66% of sore throat diagnoses, 81% of otitis media, and in 72% of sinusitis. Prescribing frequencies decreased between 2010 and 2019 by 16% for sore throat (from 76% to 60%) by 11% for otitis media (from 88% to 77%) and by 18% for sinusitis (from 84% to 66%). In multivariable analyses, "Year" was associated with reduced prescribing for sore throat (OR 0.89; 95%CI 0.86–0.92; p < 0.001), otitis media (OR 0.90; 95%CI 0.86–0.94; p < 0.001), and sinusitis (OR 0.90; 95%CI 0.86, 0.94; p < 0.001). Conclusions Registrars' prescribing rates for sore throat, otitis media, and sinusitis significantly decreased during the period 2010–2019. However, educational (and other) interventions to further reduce prescribing are warranted. [ABSTRACT FROM AUTHOR]

Purpose 'Low-value' clinical care and medical services are 'questionable' activities, being more likely to cause harm than good or with disproportionately low benefit relative to cost. This study examined the predictive ability of the QUestionable In Training Clinical Activities Index (QUIT-CAI) for general practice (GP) registrars' (trainees') performance in Australian GP Fellowship examinations (licensure/certification examinations for independent GP). Methods The study was nested in ReCEnT, an ongoing cohort study in which Australian GP registrars document their in-consultation clinical practice. Outcome factors in analyses were individual registrars' scores on the three Fellowship examinations ('AKT', 'KFP', and 'OSCE' examinations) and pass/fail rates 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-CAI activity was a plausible option). Results A total of 1265, 1145, and 553 registrars sat Applied Knowledge Test, Key Features Problem, and Objective Structured Clinical Exam examinations, respectively. On multivariable analysis, higher QUIT-CAI score percentages (more questionable activities) were significantly associated with poorer Applied Knowledge Test scores (P  = .001), poorer Key Features Problem scores (P  = .003), and poorer Objective Structured Clinical Exam scores (P  = .005). QUIT-CAI score percentages predicted Royal Australian College of General Practitioner exam failure [odds ratio 1.06 (95% CI 1.00, 1.12) per 1% increase in QUIT-CAI, P  = .043]. Conclusion Performing questionable clinical activities predicted poorer performance in the summative Fellowship examinations, thereby validating these examinations as measures of actual clinical performance (by our measure of clinical performance, which is relevant for a licensure/certification examination). Key message What is already known on this topic—   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 a marker of the quality of health care delivery and clinical competence. Summative medical licensure/certification examination performance should reflect clinically important attributes of the candidate and provide confidence of future patient safety. What this study adds—   This study demonstrates that the Royal Australian College of General Practitioners' (RACGPs') summative examination performance reflects clinical performance as assessed by a measure of 'questionable' actions in clinical practice. Performance on all three individual examination components—Applied Knowledge Test (a multiple-choice examination), Key Features Problem (a short answer plus multiple responses selection examination), and Objective Structured Clinical Exam (a clinical skills station examination), plus pass/fail status—was predicted by 'questionable' clinical practice. How this study might affect research, practice or policy—   The findings provide evidence for the validity of the RACGP Fellowship examination and similar licensure/certification examinations. [ABSTRACT FROM AUTHOR]

Objective: To establish prevalence and associations of provision of nursing home visits (NHV) and home visits (HV) by early‐career specialist GPs. Of particular interest were associations of rurality with performing NHVs and HVs. Methods: A cross‐sectional study. Design: A questionnaire‐based study. Setting: Australian general practice. Participants: Early‐career specialist GPs, practising in Australia, who attained Fellowship between January 2016 and July 2018, inclusive, having completed GP training in NSW, the ACT, Eastern Victoria or Tasmania. Main Outcome Measures: Current provision of NHV and HV. Results: NHV were provided by 34% of participants (59% in rural areas) and HV by 41% of participants (60% in rural areas). Remote, rural or regional practice location, as compared to major‐city practice, was strongly associated with performing NHV as an early‐career specialist GP; multivariable OR 5.87 (95% CI: 2.73, 12.6), p < 0.001, and with the provision of HV; multivariable OR 3.64 (95% CI: 1.63, 8.11), p = 0.002. Rurality of GP training (prior to attaining Fellowship) was significantly univariably associated with providing NHV and with providing HV as an early‐career specialist GP. On multivariable analyses, these were no longer statistically significant. Conclusion: Early‐career specialist GPs located in regional/remote areas are more likely than their urban colleagues to provide NHV and HV. [ABSTRACT FROM AUTHOR]

Background Remunerated telehealth consultations were introduced in Australia in 2020 in response to the COVID-19 pandemic. Videoconferencing has advantages over telephone-consulting, including improved diagnostic and decision-making accuracy. However, videoconferencing uptake in Australia has been low. This study aimed to establish prevalence and associations of video versus telephone consultations in Australian general practice (GP) registrars' practice. Methods A cross-sectional analysis of data from 2020 to 2021 (three 6-monthly data-collection rounds) from the Registrars Clinical Encounters in Training (ReCEnT) study. GP registrars record details of 60 consecutive consultations every 6-month term, for a total of 3 terms. Univariable and multivariable logistic regression were performed within the Generalized Estimating Equations framework with the outcome video versus telephone. Results 102,286 consultations were recorded by 1,168 registrars, with 21.4% of consultations performed via telehealth. Of these, telephone accounted for 96.6% (95% CI: 96.3–96.8%) and videoconferencing for 3.4% (95% CI: 3.2–3.7%). Statistically significant associations of using videoconferencing, compared to telephone, included longer consultation duration (OR 1.02, 95% CI: 1.01–1.03 per minute; and mean 14.9 versus 12.8 min), patients aged 0–14 years old (OR 1.29, 95% CI: 1.03–1.62, compared to age 15–34), patients new to the registrar (OR 1.19, 95% CI: 1.04–1.35), part-time registrars (OR 1.84, 95% CI: 1.08–3.15), and areas of less socioeconomic disadvantage (OR 1.27, 95% CI: 1.00–1.62 per decile). Conclusions Registrars' telehealth consultations were mostly performed via telephone. Telephone use being associated with socioeconomic disadvantage has health equity implications. Future research should explore barriers to videoconferencing use and strategies to increase its uptake. [ABSTRACT FROM AUTHOR]

Aim. The aim of the study was to establish whether two previously described barriers to effective in-consultation assistance-seeking by general practice (GP) vocational specialist trainees (ie concern about patient impressions of their competence, and discomfort presenting to supervisors in front of patients) influenced the frequency of trainee in-consultation assistanceseeking from their supervisor. Methods. This was a cross-sectional study nested in the Registrar Clinical Encounters in Clinical Training ongoing cohort study of Australian GP trainees. Trainee participants completed contemporaneous records of 60 consecutive patient consultations, including whether supervisory assistance was sought. Trainees also completed a cross-sectional survey including items eliciting their beliefs about patient impressions and their own discomfort in seeking in-consultation supervisory assistance. These were factors of interest in multivariable logistic regression analyses; the outcome factor in both regression models was the seeking of inconsultation supervisory assistance. Results. In 2018, 778 trainees (778/876, response rate 89%) completed the cross-sectional survey. No association was found between the odds of inconsultation help-seeking and perceived decrease in patient impressions of trainee competence (OR = 1.09; 95% CI: 0.91, 1.31; P = 0.36) or higher comfort presenting outside patients' hearing (OR = 0.9; 95% CI: 0.77, 1.05; P = 0.19). Discussion. Contrary to expected utility models of helpseeking, trainees may not consider personal discomfort or impression management to be important enough, compared to patient safety and other considerations, to influence decisions regarding in-consultation help-seeking. Clinical supervisors should, nevertheless, consider the potential personal costs to trainees and maintain trainee self-esteem and confidence by providing in-consultation assistance in front of patients as comfortably and effectively as possible. [ABSTRACT FROM AUTHOR]

Background Prompted by the COVID-19 pandemic, remuneration was introduced for Australian general practice telehealth consultations. General practitioner (GP) trainees' telehealth use is of clinical, educational, and policy importance. The aim of this study was to assess the prevalence and associations of telehealth versus face-to-face consultations amongst Australian GP registrars (vocational GP trainees). Methods Cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study, from 2020 to 2021 (three 6-month terms), including registrars in 3 of Australia's 9 Regional Training Organisations. In ReCEnT, GP registrars record details of 60 consecutive consultations, 6 monthly. The primary analysis used univariate and multivariable logistic regression, with outcome of whether the consultation was conducted via telehealth (phone and videoconference) or face-to-face. Results 1,168 registrars recorded details of 102,286 consultations, of which 21.4% (95% confidence interval [CI]: 21.1%–21.6%) were conducted via telehealth. Statistically significant associations of a telehealth consultation included shorter consultation duration (odds ratio [OR] 0.93, 95% CI: 0.93–0.94; and mean 12.9 versus 18.7 min); fewer problems addressed per consultation (OR 0.92, 95% CI: 0.87–0.97); being less likely to seek assistance from a supervisor (OR 0.86, 95% CI: 0.76–0.96) while being more likely to generate learning goals (OR 1.18, 95% CI: 1.02–1.37); and being more likely to arrange a follow-up consultation (OR 1.18, 95% CI: 1.02–1.35). Conclusions That telehealth consultations were shorter, with higher rates of follow-up, has GP workforce/workload implications. That telehealth consultations were less likely to involve in-consultation supervisor support, but more likely to generate learning goals, has educational implications. [ABSTRACT FROM AUTHOR]

Introduction: Access to after‐hours care (AHC) is an important aspect of general practice service provision. Objective: To establish the prevalence and associations of early‐career GPs' provision of AHC. Design: An analysis of data from the New alumni Experiences of Training and independent Unsupervised Practice (NEXT‐UP) cross‐sectional questionnaire‐based study. Participants were early‐career GPs (6‐month to 2‐year post‐Fellowship) following the completion of GP vocational training in NSW, the ACT, Victoria or Tasmania. The outcome factor was 'current provision of after‐hours care'. Associations of the outcome were established using multivariable logistic regression. Findings: Three hundred and fifty‐four early‐career GPs participated (response rate 28%). Of these, 322 had responses available for analysis of currently performing AHC. Of these observations, 128 (40%) reported current provision of AHC (55% of rural participants and 32% of urban participants). On multivariable analysis, participants who provided any AHC during training were more likely to be providing AHC (odds ratio (OR) 5.51, [95% confidence interval (CI) 2.80–10.80], p < 0.001). Current rural location and in‐training rural experience were strongly associated with currently providing AHC in univariable but not multivariable analysis. Discussion: Early‐career GPs who provided AHC during training, compared with those who did not, were more than five times more likely to provide after‐hours care in their first 2 years after gaining Fellowship, suggesting participation in AHC during training may have a role in preparing registrars to provide AHC as independent practitioners. Conclusion: These findings may inform future GP vocational training policy and practice concerning registrars' provision of AHC during training. [ABSTRACT FROM AUTHOR]

While GPs are working fewer clinical hours and many GP trainees (registrars) do not foresee themselves working full-time in clinical practice, little is known of the epidemiology of registrars training part-time. We aimed to establish the prevalence of general practice part-time training (PTT), and part-time registrars' characteristics and practice patterns. A cross-sectional analysis was conducted of data from the Registrar Clinical Encounters in Training project, an ongoing cohort study of Australian GP registrars' clinical experiences over 60 consecutive consultations in each of three training terms. Univariable and multivariable logistic regression analyses were conducted with the outcome 'training part-time'. 1790 registrars contributed data for 4,135 registrar-terms and 241,945 clinical encounters. Nine hundred and twenty-two registrar-terms (22%, 95%CI:21%–24%) and 52,339 clinical encounters (22%, 95%CI:21%–22%) involved PTT. Factors associated with PTT were registrar characteristics – female gender, older age, in a later training stage, performing other regular medical work; practice characteristics – working in a higher socioeconomic status area; and patient characteristics – seeing more patients new to the registrar and seeing more patients from a non-English-speaking background. No consultation or consultation action factors were significantly associated with PTT. Registrars, practices, and patient associations have GP training implications. The lack of registrar consultation or consultation action associations suggests there may be limited impact of PTT on patient care. [ABSTRACT FROM AUTHOR]

Objective To determine the prevalence and associations of general practice registrars' performing absolute cardio-vascular risk (ACVR) assessment (ACVRa). Design A cross-sectional study employing data (2017-2018) from the Registrar Clinical Encounters in Training project, an ongoing inception cohort study of Australian GP registrars. The outcome measure was whether an ACVRa was performed. Analyses employed univariable and multivariable regression. Analysis was conducted for all patient problems/diagnoses, then for an 'at-risk' population (specific problems/diagnoses for which ACVRa is indicated). Setting Three GP regional training organisations (RTOs) across three Australian states. Participants GP registrars training within participating RTOs. Results 1003 registrars (response rate 96.8%) recorded details of 69 105 problems either with Aboriginal and/or Torres Strait patients aged 35 years and older or with non-Indigenous patients aged 45 years and older. Of these problems/diagnoses, 1721 (2.5% (95% CI 2.4% to 2.6%)) involved an ACVRa. An ACVRa was 'plausibly indicated' in 10 384 problems/diagnoses. Of these, 1228 (11.8% (95% CI 11.2% to 12.4%)) involved ACVRa. For 'all problems/diagnoses', on multivariable analysis female gender was associated with reduced odds of ACVRa (OR 0.61 (95% CI 0.54 to 0.68)). There was some evidence for Aboriginal and/or Torres Strait Islander people being more likely to receive ACVRa (OR 1.40 (95% CI 0.94 to 2.08), p=0.10). There were associations with variables related to continuity of care, with reduced odds of ACVRa: if the patient was new to the registrar (OR 0.65 (95% CI 0.57 to 0.75)), new to the practice (OR 0.24 (95% CI 0.15 to 0.38)) or the problem was new (OR 0.68 (95% CI 0.59 to 0.78)); and increased odds if personal follow-up was organised (OR 1.43 (95% CI 1.24 to 1.66)). For 'ACVRa indicated' problems/diagnoses, findings were similar to those for 'all problems/diagnoses'. Association with Aboriginal and/or Torres Strait Islander status, however, was significant at p<0.05 (OR 1.60 (95% CI 1.04 to 2.46)) and association with female gender was attenuated (OR 0.88 (95% CI 0.77 to 1.01)). Conclusion Continuity of care is associated with registrars assessing ACVR, reinforcing the importance of care continuity in general practice. Registrars' assessment of an individual patient's ACVR is targeted to patients with individual risk factors, but this may entail ACVRa underutilisation in female patients and younger age groups. [ABSTRACT FROM AUTHOR]

Aim: Functional bowel (constipation and faecal incontinence) and bladder (urinary incontinence and enuresis) problems in children are often treated by paediatricians yet should mostly be managed by general practitioners (GPs). To understand whether the necessary skills and knowledge are being built in general practice, this study aimed to establish the prevalence and associated skills of Australian general practice registrars managing children with functional bowel and bladder problems. Together as paediatricians and GPs, we use these data to determine how best to ensure high quality, equitable care for children. Methods: We drew on 16 rounds of data collection from the Registrar Clinical Encounters in Training (ReCEnT) multi‐site cohort study (2010–2017) of general practice registrars' in‐consultation experience. It included a measure of paediatric consultations in which a functional bowel or bladder problem was managed, as well as demographic information. Results: Out of 62 721 problems/diagnoses for paediatric patients (0–17 years), 844 (1.4%) were coded as functional bowel (n = 709; 1.13% (95% confidence interval, CI: 1.05–1.22)) and/or bladder (n = 135; 0.22% (95% CI: 0.18–0.25)) presentations. Registrars were more likely to prescribe medication for bowel problems (odds ratio (OR) = 2.22 (95% CI: 1.86–2.64)) than for all other problems, but less likely to prescribe medication (OR = 0.31 (95% CI: 0.18–0.52)) for night‐time wetting and more likely to make a specialist referral (OR = 1.99 (95% CI: 1.22–3.25)) compared to all other problems. Conclusions: Only a small proportion of children with functional bowel and bladder problems were seen by registrars despite high prevalence in the community and amenability to management in the general practice setting (i.e. generally low morbidity and low complexity) versus need for specialists. Registrars appeared to be managing functional bowel and bladder problems according to evidence‐based guidelines, but with relatively high levels of referral. Given the inequitable access to specialist care, paediatricians should support local general practice management of these problems. This might include (i) engaging with training programs to ensure appropriate education and (ii) liaising with individual registrars/practices to provide management advice for individual or example cases. [ABSTRACT FROM AUTHOR]

Objective This study aims to establish prevalence and associations of (1) influenza and influenza-like illness (IILI) presentations to Australian general practice (GP) registrars (trainees) and (2) the use of neuraminidase inhibitors (NAIs) by GP registrars for new presentations of IILI, for the 10 years leading up to the COVID-19 pandemic in Australia (2010-2019). Design This was a cross-sectional analysis of the Registrar Clinical Encounters in Training ongoing inception cohort study of the in-consultation experience and clinical behaviours of GP registrars. Data are collected by individual registrars three times (from 60 consecutive consultations each time) at 6 monthly intervals. Data include diagnoses/problems managed and medicines prescribed, along with multiple other variables. Univariate and multivariable logistic regression was used to establish associations of registrars seeing patients with IILI and of prescribing NAIs for IILI. Setting Teaching practices within the Australian general practitioner specialist vocational training programme. Practices were located in Ave of the six Australian states (plus one territory). Participants GP registrars in each of their three compulsory 6-month GP training terms. Results From 2010 to 2019, 0.2% of diagnoses/ problems seen by registrars were IILI. 15.4% of new IILI presentations were prescribed an NAI. IILI diagnoses were less likely in younger (0-14) and older (65+) age groups, and more likely in an area of higher socioeconomic advantage. There was considerable variation in NAI prescribing between regions. There was no significant association of prescribing NAIs with age or Aboriginal and/ or Torres Strait Islander patients. Conclusions IILI presentations were more likely among working-age adults and not among those groups at higher risk. Similarly, high-risk patient groups who would benefit most were not more likely to receive NAIs. The epidemiology and management of IILI has been distorted by the COVID-19 pandemic, but the burden of influenza in vulnerable populations must not be overlooked. Appropriately targeted antiviral therapy with NAIs influences outcomes for vulnerable patients. General practitioners manage the majority of IILI in Australia, and understanding GP IILI presentation and NAI prescribing patterns is a key first step to enabling sound and rational prescribing decisions for better patient outcomes. [ABSTRACT FROM AUTHOR]

To evaluate Australian early-career general practitioners' perceptions of the utility of their prior vocational training in preparing them for independent specialist practice. We hypothesised that in-practice teaching would be perceived as more useful than formal education delivered by Regional Training Organisations (RTOs). A cross-sectional questionnaire-based study of early-career general practitioners (RTO 'alumni'). The outcomes were Likert scale ratings of alumni's perceived impact of RTO education versus in-practice training on their preparedness for independent practice. Ratings were compared using Wilcoxon signed-rank tests. Multivariable linear regression was used to establish alumni characteristics associated with perceptions of utility of in-practice versus RTO-delivered education. Three hundred and fifty-four alumni responded (response rate 28%). In-practice training was rated statistically significantly higher than RTO education for minor procedural skills, teaching skills, professional responsibilities, tolerating clinical uncertainty, and preparing for managing child and adolescent health, aged care, chronic disease, multi-morbidity and mental health. RTO education rated higher than in-practice training for practising evidence-based medicine and Aboriginal and Torres Strait Islander health. For a number of further areas, there was no statistically significant difference in alumni ratings of utility. In-practice or RTO-led teaching was perceived as more useful for some components of independent practice, whilst for others there was no significant difference. The findings support recognition of the individual educational components of a blended education/training structure. [ABSTRACT FROM AUTHOR]