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Objectives: Blended learning has been presented as a promising learner-centred model that emphasises the learning outcome rather than the process of education, but it can negatively affect learners’ engagement with learning. Subject and Methods: Using a mixed-methods approach, this study aimed to determine the significant predictors of learning satisfaction and to evaluate the experiences of medical students with the different domains of an introduced blended integrated learning approach. Results: The survey was administered to 92 respondents with a mean age of 20.5 years. Male students had significantly higher computer self-efficacy and overall learner satisfaction ratings than their female counterparts. Multiple regression analysis showed that gender (student characteristics), performance expectations (cognitive factors), and learning climate (social environment) were predictors of the perceived satisfaction of learners. Conclusion: Wider integration of blended learning into pre-clinical undergraduate medical education could enhance the shift towards competency-based education and life-long learning among medical students. However, effective implementation would depend largely on student characteristics, as well as environmental and cognitive components of the delivery method.

Exertional heat illness (EHI) is an occupational hazard among military personnel. This systematic review describes the incidence, risk factors, clinical manifestations, and biomarkers of EHI in the military. Six databases from inception to 28 May 2020 were systematically reviewed using the PRISMA guidelines. Forty-one articles met the inclusion criteria and the incidence of EHI ranged from 0.2 to 10.5 per 1000 person years, while the prevalence rates ranged from 0.3% to 9.3%. Intrinsic risk factors influencing EHI were gender, physical fitness, obesity, previous history of heat illness, and motivation, while the extrinsic factors included hot environmental conditions and service unit. Evidence suggests that loss of consciousness, absence of sweating and confusion were the common clinical features of exertional heat stroke (EHS). The mean core temperature ranged from 40 to 41.6 °C, while elevated levels of creatine phosphokinase, liver enzymes, and creatinine were common biochemical markers of EHS. The findings of the review suggest a variation in the incidence of EHI among military populations possibly due to the varying definitions used. Although some risk factors of EHI were identified, more analytical studies are needed to investigate the association between EHI and other important factors such as acclimatisation and occlusive clothing.

Several neglected infectious pathogens, such as the monkeypox virus (MPXV), have re-emerged in the last few decades, becoming a global health burden. Despite the incipient vaccine against MPXV infection, the global incidence of travel-related outbreaks continues to rise. About 472 confirmed cases have been reported in 27 countries as of 31 May 2022, the largest recorded number of cases outside Africa since the disease was discovered in the early 1970s.

Efforts to control the COVID-19 pandemic have expanded to the vaccination of children and adolescents. This systematic review assesses the utility of the BNT162b2 (Pfizer-BioNTech) vaccine in children and adolescents aged 5–18 years, considering its effectiveness against COVID infection, hospital and intensive care admission and duration of effectiveness after vaccination. Six databases were searched following the PRISMA guidelines. Pooled estimates and 95% confidence intervals (CIs) were calculated using meta-analysis. Fifteen studies were included in the systematic review, while 12 studies were included in the meta-analysis. Evidence suggests that the two-dose vaccination regime provided high effectiveness of 92% (95% CI, 86–96) against COVID infection. Vaccination also conferred high protection against hospitalisation (91%) and intensive care admission (85%). The vaccine was highly protective against the Delta variant of the virus, but showed a lower protection against the Omicron variant. Most adverse effects were transient and mild, commonly including pain at the injection site, fatigue and headache. Current findings are suggestive of waning immunity over time; however, further research is needed to investigate the relevance of booster doses in this age group. In summary, the Pfizer-BioNTech BNT162b2 vaccine demonstrated high levels of protection against COVID-19 infection and its complications while maintaining an adequate safety profile in children and adolescents.

Background and Objectives: Drowning is a leading cause of unintentional injury related mortality worldwide, and accounts for roughly 320,000 deaths yearly. Over 90% of these deaths occur in low- and middle-income countries with inadequate prevention measures. The highest rates of drowning are observed in Africa. The aim of this review is to describe the epidemiology of drowning and identify the risk factors and strategies for prevention of drowning in Africa. Materials and Methods: A review of multiple databases (MEDLINE, CINAHL, PsycINFO, Scopus and Emcare) was conducted from inception of the databases to the 1st of April 2019 to identify studies investigating drowning in Africa. The preferred reporting items for systematic review and meta-analysis (PRISMA) was utilised. Results: Forty-two articles from 15 countries were included. Twelve articles explored drowning, while in 30 articles, drowning was reported as part of a wider study. The data sources were coronial, central registry, hospital record, sea rescue and self-generated data. Measures used to describe drowning were proportions and rates. There was a huge variation in the proportion and incidence rate of drowning reported by the studies included in the review. The potential risk factors for drowning included young age, male gender, ethnicity, alcohol, access to bodies of water, age and carrying capacity of the boat, weather and summer season. No study evaluated prevention strategies, however, strategies proposed were education, increased supervision and community awareness. Conclusions: There is a need to address the high rate of drowning in Africa. Good epidemiological studies across all African countries are needed to describe the patterns of drowning and understand risk factors. Further research is needed to investigate the risk factors and to evaluate prevention strategies.

Background Medical education offers the foundational base for future healthcare professionals, with basic sciences playing a pivotal role in providing essential knowledge and skills for clinical practice. However, the long-term retention and application of this knowledge in clinical practice remain a significant challenge. This systematic review synthesised global evidence from diverse studies on the short / long-term retention and clinical application of basic sciences among medical doctors. Methods A comprehensive search was conducted across six databases, including Web of Science, Scopus, Medline, CINAHL, Emcare, and Informit. The review included studies that encompassed a variety of study designs, participant groups, and educational interventions. The Quality Assessment with Diverse Studies (QuADS) tool was utilised to assess the quality of the reviewed studies. Results A total of 10 studies were included in the review. The findings revealed that rehearsals significantly optimise the retention of basic science knowledge among medical practitioners. Retention varied by discipline, with medical practitioners retaining more knowledge in anatomy (mean scores ranging from 45.0 to 82.9%), while microbiology had the lowest retention score (39.1%). Factors influencing retention included age, gender, and curriculum type. Educational interventions such as targeted courses, integration of basic sciences with clinical skills, generative retrieval and continuous quality improvement in the curriculum were found to enhance both knowledge retention and clinical reasoning. The concept of ‘encapsulated knowledge’ demonstrates that integrated basic science knowledge helps in synthesising clinical presentations, reducing the need for detailed recall as clinical experience increases. The reviewed studies primarily involved interns and surgeons, leaving a significant gap in research for specialties like internal medicine and primary care/ general practice. Conclusion Detailed retention of basic science knowledge may diminish over time; however, the conceptual framework remains essential for ongoing learning and clinical reasoning. This review’s findings highlight the need for specialised educational interventions to improve long-term retention. Continuous professional development and targeted educational techniques are vital for maintaining clinical competence and applying basic science knowledge effectively throughout a medical career. Further research is needed to address gaps in specialty-specific knowledge application and the impact of different instructional methods.

Introduction: Advanced Skills Training (AST) is designed to provide GPs with an opportunity to enhance their clinical practice in a narrower speciality. This is valuable particularly for rural and remote communities that cannot justify narrower specialist services in the local community. ASTs require additional focused training, usually for 12 months, in a selected procedural or non-procedural skill such as anaesthetics, obstetrics, surgery, emergency medicine, paediatrics, adult internal medicine, mental health, Indigenous health or palliative care. Ideally, several practitioners with complementary AST experiences work together to provide a wider range of extended scope practice according to community need. However, experience so far suggests that this goal is not necessarily achieved. Thus, this systematic review aimed to assess the value and fitness for purpose of AST and ensure that it is meeting the growing demand for coordinated care in rural communities. This review addressed three questions: What is the effectiveness of AST programs in improving GPs’ knowledge, attitudes and competence regarding rural clinical practice? How do stakeholders – including trainees, patients, management and the community – perceive the impact (value and fitness for purpose) of the AST program in rural clinical practice? To what extent are advanced skills training programs aligned with the needs of the community served? Methods: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and MetaAnalyses guidelines. A comprehensive search strategy was implemented across six electronic databases (Medline Ovid, CINAHL, Emcare, Scopus, Web of Science and Informit) in December 2024. The quality of the studies was appraised using the Quality Assessment for Diverse Studies tool. Across all the reviewed articles, data on the effectiveness of AST, stakeholder perceptions of its value and extent of alignment of AST with community needs in rural clinical practice were extracted and synthesised using a data extraction template. Results: Sixteen peer-reviewed articles met the inclusion criteria. Of these, 11 employed qualitative study designs (n=11, 68.8%) and five were quantitative (n=5, 31.3%). The majority were conducted in Canada (n=5, 31.3%) and Australia (n=5, 31.3%), followed by the US (n=4, 25.0%) and England (n=2, 12.5%). The findings revealed that the definition and scope of AST varied across the literature. Some defined it as advanced training that involves 12 months fulltime equivalent in an accredited training post while others defined it as ‘tracks’, certificates, extended fellowships, residency programs or placements. Across the literature, participants noted improvements in their knowledge, attitudes and competence regarding their clinical practice. The value and fitness for purpose of the AST program was demonstrated by registrars’ continued use of skills after AST training, soft skills development and community engagement opportunities, and rural workforce retention. The challenges reported for those undertaking AST programs were barriers to inclusion on remote visits (eg transportation space, training space), time efficiency and management, workload fluctuation, gaps between training and use of skills, peer acknowledgement, and differences between the hospital settings in which training occurred and the rural contexts in which the skills would be applied. Conclusion: Overall, this review provided evidence on the utility of AST for GPs. Despite the value of AST in GP clinical practice, some bottlenecks may be limiting its effectiveness. Current AST opportunities (both training and final practice location) and career pathways are not always aligned, potentially limiting the success of the AST strategy in bridging the gap between urban and rural health service status. Concerted efforts are required to improve alignment of career advice, community needs, training pathways, AST opportunities and final practice location in order to achieve the intended purpose. Further research is required on the impact of AST programs on community health outcomes.

IntroductionAdvanced skills training (AST) is a requirement for rural generalist training in Australia. This study explored the lived experience of general practitioners who have undertaken AST to better appreciate its value and fitness for purpose.MethodsThirteen participants were recruited via convenience sampling. A descriptive phenomenological study design was employed. Semistructured interviews were conducted and thematically analysed to identify patterns in the data.ResultsParticipants identified the professional value of AST, describing improved clinical competence, clinical courage, development of professional networks, work satisfaction and recognition. AST enabled better provision and continuity of care to rural communities. Potential service mismatches between AST specialty selection and perceived community needs are a current challenge.ConclusionRecommendations include refining the programme selection process, increasing programme flexibility and developing clearer guidelines to navigate training pathways. Future research should explore the value of AST from community perspectives to inform tailored approaches.

Background Basic sciences are crucial for clinical medicine, yet studies focusing on their perceived utility among general practitioners (GPs) are sparse. Considering the broad scope of GPs’ practice, an in-depth understanding of basic sciences is fundamental for making informed clinical decisions. This study evaluated GP registrars’ retention and perceptions of the utility of basic sciences in clinical practice. Methods Using sequential explanatory mixed methods study design, knowledge retention was assessed by a multiple-choice question (MCQ) examination followed by interviews on the perception of the relevance and utility of basic sciences among GP registrars at James Cook University's (JCU) General Practice Training (GPT) program. Descriptive and inferential statistical analyses were conducted on the MCQ exam data, while thematic analysis was employed for the qualitative interview data. Results Sixty-one GP registrars participated in the MCQ exam, while 11 of them were involved in the interviews. The highest mean score was obtained in biochemistry (75.1 ± 2.23) while the lowest mean score was in anatomy (56.07 ± 3.16). Key performance predictors included the formative clinical examination scores (β = 0.83, 95% CI: 0.45 to 1.2, p  < 0.001) and gender (β = -9.7, 95% CI: -17 to -2.3, p  = 0.011). The qualitative data analysis revealed five themes, including the backbone of clinical medicine, varying utility over time and by specialty, clinical synthesis integrates encapsulated knowledge, professional pressures hinder revisitation of knowledge and knowledge renewal enhances updates. Conclusion Basic sciences were considered relevant in clinical practice. Development of continuing professional development (CPDs) sessions and clinically relevant online resources were measures proposed to enhance the retention of knowledge. Future research could focus on innovative educational strategies for GPs.

ObjectivesEvidence in the literature suggests that satisfaction with postgraduate general practice (GP) training is associated with the quality of the educational environment. This study aimed to examine GP registrars’ level of satisfaction with a distributed model of training in a regional educational environment and investigate the relationship between satisfaction and academic performance.Study designA longitudinal 3-year study was conducted among GP registrars at James Cook University using a sequential explanatory mixed methods research design. GP registrars’ satisfaction was obtained using the scan of postgraduate educational environment domains tool. A focus group discussion was conducted to explore GP registrars’ perceptions of satisfaction with the educational environment.SettingJames Cook University General Practice Training (JCU GPT) programme.ParticipantsSix hundred and fifty one (651) GP registrars enrolled between 2016 and 2018 at JCU GPT programme.Results651 registrars completed the satisfaction survey between 2016 and 2018. Overall, 92% of the registrars were satisfied with the educational training environment. Registrars who had become fellows reported higher satisfaction levels compared with those who were still in training (mean=4.39 vs 4.20, p=0.001). However, academic performance had no impact on level of satisfaction with the educational environment. Similarly, practice location did not influence registrars’ satisfaction rates. Four themes (rich rural/remote educational environment, supportive learning environment, readiness to continue with rural practice and practice culture) emerged from the thematic data analysis.ConclusionA clinical learning environment that focuses on and supports individual learning needs is vital for effective postgraduate medical training. This study suggests that JCU GPT programme’s distributed model fostered a satisfying and supportive training environment with rich educational experiences that enhance retention of GP registrars in rural/remote North Queensland, Australia. The findings of this study may be applicable to other settings with similar training models.