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There is widespread agreement about the importance of direct observation of trainee practice by clinical supervisors. Less is known about observation by observers external to the supervisory team. We explored the educational affordances of external observation of GP trainee consultations for educational and assessment purposes, from the perspectives of both observers and trainees.GP medical educators, who were scheduled to observe sessions of GP trainee consultations, were recruited as participant observers. They completed field notes, reflective memos and a focus group discussion, and conducted post-observation interviews with trainees, focused on trainee experiences of accessing educational input from supervisors and observers during the sessions. Thematic analysis was guided by constructivist realism and socio-cultural theory.A total of 23 observation sessions (131 observed patient consultations), 33 trainee interviews and 23 observer reflections were completed. External observers embraced teaching, coaching and pastoral opportunities, rather than being 'flies on the wall', despite also having research and assessment roles. They gained useful insights into the challenges of obtaining and providing in-consultation supervisory assistance and provided some in-consultation guidance themselves. Both trainees and observers experienced the sessions as valuable and collegial. Trainees appreciated post-consultation feedback conversations: topics included consultation challenges, managing uncertainty and variation in clinical practice. Patient expectations and pre-existing relationships influenced the distinctive interpersonal dynamic of the externally observed consultation.The educational affordances and interpersonal dynamics of external observation differ from supervisor observation. We recommend wider use in clinical training of observers who cross between educator and clinician communities.

Outside the clinical space, face-to-face education essentially stopped when the COVID-19 pandemic started, largely substituted by online education. This provided an opportunity to explore general practice registrar and educator views about the benefits, challenges and enablers of both types of educational delivery.This qualitative study included 45 registrars and medical educators from across Queensland, Australia. Transcripts of five focus groups and 22 semi-structured interviews were analysed thematically using the Framework Method.Major themes focused on social connection, learning engagement, content delivery, and time and space in relation to education. Other themes included technology, unplanned learning, learning safety and pastoral care. Face-to-face education was viewed more positively than online education, but many suggested ways to enhance online education.The importance of social connection dominated and underpinned many other themes identified as central to achieving safe and effective vocational general practitioner education.

Fostering trainee psychological safety is increasingly being recognised as necessary for effective feedback conversations. Emerging literature has explored psychological safety in peer learning, formal feedback and simulation debrief. Yet, the conditions required for psychologically safe feedback conversations in clinical contexts, and the subsequent effects on feedback, have not been explored.We conducted a qualitative study using interviews and longitudinal audio-diaries with 12 rural general practice trainees. The data were analysed using framework thematic analysis to identify factors across the data and as individual participant case studies with illustrative vignettes of dynamic interleaving of factors in judgements about feedback conversations.Findings identify the influence of intrapersonal (e.g. confidence and comfort to seek help), interpersonal (e.g. trust and relationship) and sociocultural factors (e.g. living and working in a rural community) that contribute to psychological safety in the context of everyday feedback conversations. Multiple factors interplayed in feedback conversations where registrars could feel safe and unsafe within one location and even at the one time.Participants felt psychologically safe to engage their educators in sanctioned systems of conversation related to the immediate care of the patient and yet unsafe to engage in less patient related performance conversations despite the presence of multiple positive interpersonal factors. The concept of a safe 'container' (contained space) is perhaps idealised when it comes to feedback conversations about performance in the informal and emergent spaces of postgraduate training. More research is needed into understanding how clinical environments can sanction feedback conversations in clinical environments.

Timely supervisor input to the care of their trainees' patients plays a key role in ensuring the safety of patients under the care of general practice trainees. Supervisor responses to trainee calls for assistance are also important for trainee learning and professional identity formation. The in-consultation supervisory encounter in general practice training is, however, a complex social space with multiple trainee, supervisor and patient agendas. Trainee requests for assistance during their consultations are known to present general practitioner supervisors with a number of challenges. From the trainee's perspective, a safe learning environment is essential during these supervisory interactions. A number of factors may act as barriers to, or reduce the usefulness of, in-consultation assistance in particular, resulting in trainees being less likely to seek such assistance on future occasions. It is therefore important to improve both trainee and supervisor skills in safe, effective and efficient in-consultation supervision. Making time for trainee and supervisor conversations about their help-seeking and help provision may uncover opportunities for improving skills, aligning agendas and enhancing outcomes. Finding time for debriefing, reflection and effective feedback conversations may be challenging, however, and opportunities for trainees to provide feedback to their supervisors are known to be particularly limited. We introduce a Debriefing, Reflection and Feedback Guide which is designed to prompt reflection, and structure effective and efficient debriefing and reciprocal feedback conversations. We outline the evidence which informed the development of the Guides, and present some preliminary findings from a pilot in Australian general practice training.

Timely clinical supervision of trainee consultations plays a key role in ensuring the safety of patients under the care of general practice trainees, and in trainee learning and professional development. Trainee requests for assistance during their consultations present supervisors with a number of challenges, however, and a number of factors act as barriers to, or reduce the utility of, this in-consultation assistance from the trainee's perspective. Face-to-face supervision in the presence of the patient presents particular challenges and opportunities. It is important to address barriers to trainee help-seeking and improve both trainee and supervisor skills in promoting safe, effective and efficient in-consultation supervision. We introduce a model (β-LACTAM) to assist supervisors in planning and delivering their face-to-face in-consultation supervision. The recent evidence which informed the development of this model is outlined, and some preliminary findings from a pilot of β-LACTAM in Australian general practice training are presented.

Timely supervisor input into patient care plays a key role in ensuring the safety of patients under the care of general practice trainees. Current models of clinical supervision for trainees in both hospital and general practice training have, however, been criticised for placing too much onus on the trainee to request assistance, despite the many known barriers for trainees to do so. An important barrier to general practice trainee help-seeking is trainee uncertainty about when and how their clinical supervisor expects them to seek this assistance. We introduce a tool, 'Flags for Seeking Help', which was modified from an existing checklist, to assist supervisors to tailor their input to the care of their trainee's patients. The tool aims to make supervisor expectations of trainees explicit, including when trainees should request assistance during consultations (rather than defer this until more convenient opportunities) and when this assistance should be face-to-face (rather than by phone or messaging systems). Our aim is to reduce the barriers for trainees to request in-consultation and face-to-face supervision, in particular, when it is indicated. We outline the evidence which informed the development of the tool, and present some preliminary findings from a pilot in Australian general practice training.

To apply the Transtheoretical Model of Behaviour Change (TTM) to cervical cancer screening to determine and report on the level of support required by different language and cultural groups in Queensland to enhance participation. The model consists of six stages: Pre-contemplation (no intention to be screened, no past action), Contemplation (intention to be screened, no past action), Action (intention to be screened, initial screening), Maintenance (intention to be screened, regular screening), Relapse (no intention to be screened, initial screening) and Relapse Risk (no intention to be screened, regular screening).Focus groups and structured interviews were used to classify women in terms of the model and collect information regarding knowledge, health service contact barriers and enhancing factors and sources of information in relation to cervical cancer screening. The sample was recruited by bi-cultural workers for each community using snowball techniques.The interview sample consisted of Australian South Sea Islanders, Chinese, German, Greek and Moslem women. There was no evidence of significant differences in TTM stage according to ethnicity. Women who intended to be screened in the future were more likely to have positive decisional balance scores and higher knowledge scores than women who did not. Women who had had Pap tests were significantly more likely to have received information from their general practitioner (GP) than women who had not had Pap tests. Women in Action and Maintenance were also more likely to have had their last Pap test by a female GP compared to women in relapse categories. Women in Pre-contemplation were more likely than women who had Pap tests to agree that they would travel a long way to see a practitioner who spoke their own language.Classification based on the model was supported both by the decisional balance scale and measures of knowledge. Women in earlier stages of the model were more likely to express preferences for the provision of services in their own language and by a female. Cervical cancer screening among women in Action and Maintenance appeared to be better supported by GPs. Cervical cancer screening promotion for women of diverse cultures and ethnicities has tended to focus on Pre-contemplation and Contemplation stages, however, as most women in this sample were in Action or Maintenance, as are most Australian-born women, structuring cervical cancer screening promotion in terms of the TTM may significantly improve the effectiveness of interventions for women of diverse cultures and ethnicities.

INTRODUCTION It is widely accepted that women experience drug dependency in different ways from men, including a greater sense of social stigma, higher levels of shame and self-blame, and higher rates of psychological co-morbidity. There is also evidence that women's experience of substance dependency may be negatively affected by living in a rural area. Recognising the complex needs of rural drug dependent women, a community-based case management model (known as WRAP--women's referral and access program) was developed, which adopted a holistic approach and aimed to address the physical, social and psychological dimensions of women's lives. This article reports a study to determine if this model was effective in meeting the women's broader support needs; and specifically whether it improved women's quality of life, health and social circumstances. METHODS Women were assessed at baseline, 3 and 6 months, using a semi-structured interview, the WHO Quality of Life brief version (WHOQoL-BREF), Rosenberg Self-Esteem Scale, and the Brief Treatment Outcome Measure (BTOM). RESULTS Sixty-three women were recruited to case management. After 6 months, 62% of women recruited remained in case management, with older women and those with better self-reported health status at recruitment more likely to do so. Consistent with women's subjective experience, there were significant improvements in self-esteem; the psychological domain of the WHOQoL-BREF; severity of dependence, psychological wellbeing and social functioning (BTOM); with reductions in drug dependency and drug use. The model, linking women with services and some direct service provision, was generally well accepted by women. CONCLUSION The WRAP case management model, with its holistic approach and focus on improving women's quality of life rather than on reducing drug use per se and/or trying to move women into drug treatment, was successful. The model is well suited to implementation within the constraints of a rural setting. There is strong evidence for improvement in many areas of women's lives over a 6 month period of case management, and a trend towards continued improvement beyond 3 months of case management in some areas. For women, the success of case management was a result of the consistency and continuity provided by having one person who provided much needed support and assistance.

Objective: To evaluate a family practice intervention to encourage patients to request a skin examination during their consultation. Methods: Family physicians in Queensland, Australia, were randomized to intervention or control groups. In the intervention group, materials were provided by the office receptionist and supported by the family physician. Results: The rate of full-body skin examination was 99.3/ 1000 consultations in intervention-group practices compared to 22.4/ 1000 in control-group practices (p