Dr Anne Croker

Introduction: Challenges to addressing workforce maldistribution for equitable rural healthcare access continue, including for dermatology services. The conceptual complexity of the notion of ¿rural¿ adds to the challenges, with the term¿rural¿ reflecting socially constructed meanings. In relation to healthcare workforce strategies, socially constructed meanings of ¿rural¿ indicate preferences for quantifiable framings and tendencies towards deficit-based portrayals. While quantifiable framings provide impetus for implementing and evaluating important rural healthcare workforce strategies, their tendency towards deficit-based portrayals risks overlooking positives of rural healthcare practice and stereotyping rural areas as problematic environments for health care. The importance of balancing deficit-based portrayals of ¿rural¿ with more positive orientations is recognised as important for addressing the maldistribution of the healthcare workforce. Addi g further to the complexity of addressing workforce maldistribution is the range of strategies required. Encompassed in these strategies are socially constructed approaches and conflicting interests. The notion of ¿tensions¿ has potential for making sense of, and addressing, the complexity of these competing interests. Importantly, not all ¿tensions¿ need to be resolved. By identifying, embracing and holding ¿tensions¿ rather than necessarily resolving them, space for ongoing rich discussion can be deliberately created. Methods: This qualitative research used a wide-angle, strengthbased lens to explore the topic of working in a rural area, from the perspectives of dermatologists and dermatology trainees. The wide-angle lens allowed consideration of the multiplicity of approaches. The strength-based lens allowed the research to go beyond deficit-based portrayals and embrace ¿tensions¿ inherent in the complexities of addressing workforce maldistribution. This study, undertaken in the interpretive research paradigm, was informed by philosophical hermeneutics. The research question was, ¿How can working in a rural area be conceptualised from the perspectives of dermatologists and dermatology trainees?¿. Data collected through semi-structured interviews with 17 participants providing dermatology services in rural areas (11 dermatologists and 6 dermatology trainees) were iteratively interpreted. Data were initially coded descriptively, with iterations moving towards more conceptual themes. Results: A conceptual model of dimensions and tensions of working in a rural area, from the perspective of dermatologists and dermatology trainees, is presented to illustrate the interpreted key themes, subthemes and implications. The four key themes are dimensions of working in a rural area: choosing to work in a rural area, transitioning out of a metropolitan area, embedding into the rural community and working within the complexity of ¿rural¿. As illustrated in the model, subthemes are characteristics capturing inherent diversity within each dimension, and the implications are ¿tensions¿. Issues for ongoing discussion arising from these ¿tensions¿ include metropolitan as a gravitational force to be overcome; complexities of individual choice, including implications for absence of choice; importance of community as people at the core of the strategies; and the taken-for-granted language for ¿rural¿ inadvertently reinforcing deficit-based portrayals. A set of reflective questions related to these issues is provided. Conclusion: The reflective questions posed can be discussed, grappled with and considered when developing strategies that address workforce maldistribution and when exploring different experiences within the complex social construction of ¿rural¿.

Aim: The aim was to support rich collaborative practice between two professions who frequently work together across both ordered and organic modes of collaboration. Methods: This study uses a qualitative research approach of collaborative dialogical inquiry to explore the question ¿From the perspective of dietitians and speech pathologists, ¿what works well¿ for developing and maintaining collaborative practice?¿ We deliberately chose a context where collaborative practice is evident, University Department of Rural Health (UONDRH). Participants in the research were academics and clinicians from dietetics and speech pathology. Data were sourced from our research reflections and focus group transcriptions. Analysis was dialogical and iterative. Results: Beyond shared purpose, knowledge of roles and good communication, the notions of curiosity, willingness and momentum were at the core of ¿what works well¿ for collaborative practice between dietitians and speech pathologists. Participant perspectives related to collaborative practice between these professions and beyond to other professions, and involved collaborative practice within and across healthcare organisations and a university setting. Conclusions: Our interpreted themes of curiosity, willingness and momentum for developing and maintaining collaborative practice highlight the importance of paying attention to the less visible and difficult to measure aspects of patient-centred care. Questions for reflection are suggested to inform the ongoing process of developing and maintaining our and others¿ collaborative practice.

Context: The Edinburgh Declaration, developed in 1998 as a pledge to alter the character of medical education to more effectively meet the needs of society, included a recommendation to increase the opportunity for joint learning between health and health-related professions, as part of the training for teamwork. This article acknowledges achievements since the Declaration in relation to this recommendation, using an umbrella term for the phenomenon, ¿educating for collaborative practice¿, and presents a perspective framed as a series of questions to encourage reflection on future directions. Methods: A literature interpretation, informed by philosophical hermeneutics, was conducted using text sets comprising reports and reviews from a section of the international literature since 1988. The interpretation involved: engaging with meanings as presented in the chosen texts; making iterative returns to the texts to explore emerging understanding; and ensuring parts of our understanding from particular texts were fused with complete understanding of the texts as a whole. A lens of appreciative inquiry facilitated acknowledgement of what has been achieved, while being curious about how it could be. Results: Interpretation of the selected literature revealed notable achievements. Areas for further consideration were identified in relation to three themes: establishing shared understanding AND purpose behind use of terminology; being a conduit AND sharing responsibility for change; exploring ways of doing things AND ensuring ongoing inclusivity. Conclusions: Interpreting the current literature on ¿educating for collaborative practice¿ has generated questions for reflection on how it may be otherwise. Readers are encouraged to embrace the tensions inherent in unanswered questions, providing space for communication, initiative and diversity of thought. An ongoing dialogue with the literature is proposed, asking whether educating students for a collective identity in settings where they are learning for and with patients is likely to advance educating for patient-centred collaborative practice.

Background: Development of core research competency is a principle of orthopaedic surgical training in Australia. This paper aims to provide an objective snapshot of publications by Australian orthopaedic trainees and surgeons, to contribute to the discussion on how to identify and build on research capability in the Australian Orthopaedic Association (AOA). Methods: By analysing journals with a journal impact factor >1 from 2009 to 2015, data were gathered to explore scientific journal publications by Australian orthopaedic surgeons and trainees in relation to who are the authors, what they are reporting and where they are publishing. Results: One thousand five hundred and thirty-nine articles were identified with 134 orthopaedic trainees and 519 surgeons as authors. The publication rate for both trainees and surgeons was just over two in five. The majority of studies were of level three or four evidence (Oxford's Centre for Evidence-Based Medicine guidelines). Only 5% of trainee papers were published without surgeons¿ co-authorship. Eighty-six percent of papers published by surgeons did not involve a trainee. The rates of trainees publishing with other trainees were low. Conclusion: Only 5% of trainee papers were published without surgeons' co-authorship, highlighting the importance of surgeon mentorship in developing trainee research capability. The 86% of papers published by surgeons without trainee co-authorship raises the question of missed mentoring opportunities. Low rates of trainee co-authorship highlight potential for trainees to work together to support each other's research efforts. There is scope for more studies involving higher levels of evidence. This paper raises discussion points and areas for further exploration in relation to AOA trainee research capability.

This article explores the development of interprofessional relationships between healthcare educators working together for interprofessional education (IPE). As part of a collaborative dialogical inquiry, data from 19 semi-structured interviews and 9 focus groups were used to explore how IPE educators develop shared purpose to help students learn to work with other health professions. Consistent with this methodology, the research group and study participants comprised educators from eight different professions. Questions asked of the data, using a lens of intersubjectivity, included: ¿What implicit assumptions are brought to interactions?¿ and ¿What happens to these assumptions as educators interact?¿ The emergent themes caution against assuming that all educators initially bring to interprofessional spaces only positive attitudes towards all professions. Educators beginning in a fragmented interprofessional space needed to reflect on earlier negative experiences with particular professions for reframing in a socially aware interprofessional space to enable collaborating in an intentional interprofessional space.