MJA
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    Striving for gender equity at the Medical Journal of Australia

    Alisha Dorrigan, Elizabeth Zuccala and Nicholas J Talley
    Med J Aust 2022; 217 (3): . || doi: 10.5694/mja2.51642
    Published online: 1 August 2022

    Diversity and equity are both imperative when it comes to publishing high quality literature that promotes better health outcomes

    In 2019, the Medical Journal of Australia put out a call for articles and asked the question: “Women in medicine and medical leadership in Australia — is there gender equity?”

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      Review of management priorities for invasive infections in people who inject drugs: highlighting the need for patient‐centred multidisciplinary care

      Lucy O Attwood, Megan McKechnie, Olga Vujovic, Peter Higgs, Martyn Lloyd‐Jones, Joseph S Doyle and Andrew J Stewardson
      Med J Aust 2022; 217 (2): . || doi: 10.5694/mja2.51623
      Published online: 18 July 2022

      Summary

      • There has been a global increase in the burden of invasive infections in people who inject drugs (PWID).
      • It is essential that patient‐centred multidisciplinary care is provided in the management of these infections to engage PWID in care and deliver evidence‐based management and preventive strategies.
      • The multidisciplinary team should include infectious diseases, addictions medicine (inclusive of alcohol and other drug services), surgery, psychiatry, pain specialists, pharmacy, nursing staff, social work and peer support workers (where available) to help address the comorbid conditions that may have contributed to the patient’s presentation.
      • PWID have a range of antimicrobial delivery options that can be tailored in a patient‐centred manner and thus are not limited to prolonged hospital admissions to receive intravenous antimicrobials for invasive infections. These options include discharge with outpatient parenteral antimicrobial therapy, long‐acting lipoglycopeptides (dalbavancin and oritavancin) and early oral antimicrobials.
      • Open and respectful discussion with PWID including around harm reduction strategies may decrease the risk of repeat presentations with injecting‐related harms.

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      • 1 Alfred Health, Melbourne, VIC
      • 2 Monash University, Melbourne, VIC
      • 3 Burnet Institute, Melbourne, VIC
      • 4 La Trobe University, Melbourne, VIC


      Correspondence: lucy.attwood@monash.edu

      Open access

      Open access publishing facilitated by Monash University, as part of the Wiley – Monash University agreement via the Council of Australian University Librarians.

      Acknowledgements: 

      The authors acknowledge the work of Thuy Bui and Kelly Cairns for their assistance reviewing the pharmacology in this article. The Burnet Institute acknowledges support from the Victorian Government Operational Infrastructure Fund. Lucy Attwood receives postgraduate support from the Australian National Health and Medical Research Council (NHMRC). Joseph Doyle and Andrew Stewardson receive Fellowship support from the NHMRC.

      Competing interests:

      Peter Higgs has received investigator‐driven research funding from Gilead Sciences and AbbVie for work on hepatitis C unrelated to this manuscript. Martyn Lloyd‐Jones has received honoraria for giving lectures and educational sessions organised by Indivior. Joseph Doyle’s institution has received investigator‐initiated research funding from Gilead Sciences and AbbVie and honoraria from Gilead Sciences and AbbVie.

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      • 47. Hall R, Shaughnessy M, Boll G, et al. Drug use and postoperative mortality following valve surgery for infective endocarditis: A systematic review and meta‐analysis. Clin Infect Dis 2019; 69: 1120‐1129.
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      • 49. Kim JB, Ejiofor JI, Yammine M, et al. Surgical outcomes of infective endocarditis among intravenous drug users. J Thorac Cardiovasc Surg 2016; 152: 832‐841.
      • 50. Rudasill SE, Sanaiha Y, Mardock AL, et al. Clinical outcomes of infective endocarditis in injection drug users. J Am Coll Cardiol 2019; 73: 559‐570.
      • 51. Straw S, Baig MW, Gillott R, et al. Long‐term outcomes are poor in intravenous drug users following infective endocarditis, even after surgery. Clin Infect Dis 2020; 71: 564‐571.
      • 52. Suzuki J, Johnson JA, Montgomery MW, et al. Long‐term outcomes of injection drug‐related infective endocarditis among people who inject drugs. J Addict Med 2020; 14: 282‐286.
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      • 56. Weimer MB, Falker CG, Seval N, et al. The need for multidisciplinary hospital teams for injection drug use‐related infective endocarditis. J Addict Med 2021; doi: https://doi.org/10.1097/ADM.0000000000000916 [Epub ahead of print].
      • 57. Wakeman SE, Metlay JP, Chang Y, et al. Inpatient addiction consultation for hospitalized patients increases post‐discharge abstinence and reduces addiction severity. J Gen Intern Med 2017; 32: 909‐916.
      • 58. Marks LR, Munigala S, Warren DK, et al. Addiction medicine consultations reduce readmission rates for patients with serious infections from opioid use disorder. Clin Infect Dis 2019; 68: 1935‐1937.
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      • 62. Serota DP, Niehaus ED, Schechter MC, et al. Disparity in quality of infectious disease vs addiction care among patients with injection drug use‐associated Staphylococcus aureus bacteremia. Open Forum Infect Dis 2019; 6: ofz289.
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        Doing “deadly” community‐based research during COVID‐19: the Which Way? study

        Michelle Kennedy and Hayley Longbottom
        Med J Aust 2022; 217 (2): . || doi: 10.5694/mja2.51624
        Published online: 18 July 2022

        An Indigenous‐led study aims to empower and support Aboriginal and Torres Strait Islander women to be smoke‐free

        Aboriginal and Torres Strait Islander people have long advocated for a voice on issues that involve them. Aboriginal Community Controlled Health Services are recognised as playing a critical role in mitigating and addressing social and structural determinants of health.1 The Close the Gap campaign report 2022 made recommendations to governments to improve health outcomes, including structural reform, innovation driven by cultural intellect and cultural safety, and empowering communities.2 Real change requires our voice, our rights to sovereignty, self‐determination and agency to transform health systems and beyond, including acknowledging, addressing and mitigating coloniality and systemic racism.

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        • 1 University of Newcastle, Newcastle, NSW
        • 2 Waminda South Coast Women’s Health and Welfare Aboriginal Corporation, Nowra, NSW


        Acknowledgements: 

        Michelle Kennedy is funded by NHMRC Early Career Fellowship #1158670. The Which Way? study was funded by National Heart Foundation Aboriginal and Torres Strait Islander Award #102458. The funding source was not involved in the conduct of this research. We acknowledge the partnering services and staff including: Dhanggan Gudjagang team, Yerin Eleanor Duncan Aboriginal Health Centre, Tamworth Aboriginal Medical Centre, Nunyara Aboriginal Health Unit and Waminda South Coast Women’s Health and Welfare Aboriginal Corporation for their time and commitment to this long term project.

        Competing interests:

        No relevant disclosures.

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          Cutaneous manifestations of COVID‐19: diagnosis and management

          Nicole Seebacher, Julie Kirkham and Saxon D Smith
          Med J Aust 2022; 217 (2): . || doi: 10.5694/mja2.51621
          Published online: 18 July 2022

          A 48‐year‐old female health care worker of European descent, who was otherwise well and on no regular medications, developed cough symptoms the day before testing positive for coronavirus disease 2019 (COVID‐19). Five days after after symptom onset, she developed rhinorrhoea followed by loss of taste and smell (anosmia and ageusia). On day 7, she developed headaches, palpations, subjective fevers and an eruption on the dorsum of her hands; on day 8, the eruption became pruritic and had spread to her elbows, the dorsum of her feet, and chest (Box 1). The pruritus was successfully treated with an oral antihistamine on the advice of a dermatologist after topical moisturiser failed. The rash completely resolved by day 12 without further management, while other influenza‐like symptoms remained. The loss of taste and smell persisted for ten weeks.

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          • 1 University of Oxford, Oxford, UK
          • 2 St James’s Hospital, Dublin, Ireland
          • 3 Australian National University, Canberra, ACT


          Competing interests:

          No relevant disclosures.

          • 1. Guan WJ, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708‐1720.
          • 2. Jia JL, Kamceva M, Rao SA, Linos E. Cutaneous manifestations of COVID‐19: a preliminary review. J Am Acad Dermatol 2020; 83: 687‐690.
          • 3. Jamshidi P, Hajikhani B, Mirsaeidi, M, et al. Skin manifestations in COVID‐19 patients: are they indicators for disease severity? A systematic review. Front Med (Lausanne) 2021; 8: 634208.
          • 4. Galván Casas C, Català A, Carretero Hernández G, et al. Classification of the cutaneous manifestations of COVID‐19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol 2020; 183: 71‐77.
          • 5. Sharma S, Raby E, Kumarasinghe SP. Cutaneous manifestations and dermatological sequelae of Covid‐19 infection compared to those from other viruses. Australas J Dermatol 2021; 62: 141‐150.
          • 6. Visconti A, Bataille V, Rossi N, et al. Diagnostic value of cutaneous manifestation of SARS‐CoV‐2 infection. Br J Dermatol 2021; 184: 880‐887.
          • 7. Freeman EE, McMahon DE, Hruza GJ, et al. Timing of PCR and antibody testing in patients with COVID‐19‐associated dermatologic manifestations. J Am Acad Dermatol 2021; 84: 505‐507.
          • 8. Cevik M, Tate M, Lloyd O, et al. SARS‐CoV‐2, SARS‐CoV, and MERS‐CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review and meta‐analysis. Lancet Microbe 2021; 2: e13‐e22.
          • 9. Sanders JM, Monogue ML, Jodlowski TZ, et al. Pharmacologic treatments for coronavirus disease 2019 (COVID‐19): a review. JAMA 2020; 323: 1824‐1836.
          • 10. Genovese G, Moltrasio C, Berti E, Marzano AV. Skin manifestations associated with COVID‐19: current knowledge and future perspectives. Dermatology 2021; 237: 1‐12.
          • 11. Martinez‐Lopez A, Cuenca‐Barrales C, Montero‐Vilchez T, et al. Review of adverse cutaneous reactions of pharmacologic interventions for COVID‐19: a guide for the dermatologist. J Am Acad Dermatol 2020; 83: 1738‐1748.
          • 12. Türsen Ü, Türsen B, Lotti T. Cutaneous side‐effects of the potential COVID‐19 drugs. Dermatol Ther 2020; 33: e13476.
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            Interrogating the intentions for Aboriginal and Torres Strait Islander health: a narrative review of research outputs since the introduction of Closing the Gap

            Michelle Kennedy, Jessica Bennett, Sian Maidment, Catherine Chamberlain, Kate Booth, Romany McGuffog, Bree Hobden, Lisa J Whop and Jamie Bryant
            Med J Aust 2022; 217 (1): . || doi: 10.5694/mja2.51601
            Published online: 4 July 2022

            Summary

            • Despite the “best of intentions”, Australia has fallen short of federal targets to close the gap in disproportionate health outcomes between Aboriginal and non‐Aboriginal Australians.
            • We examined 2150 original research articles published over the 12‐year period (from 2008 to 2020), of which 58% used descriptive designs and only 2.6% were randomised controlled trials. There were few national studies. Studies were most commonly conducted in remote settings (28.8%) and focused on specific burdens of disease prevalent in remote areas, such as infectious disease, hearing and vision. Analytic observational designs were used more frequently when addressing burdens of disease, such as cancer and kidney and urinary, respiratory and endocrine diseases.
            • The largest number of publications focused on mental and substance use disorders (n = 322, 20.5%); infectious diseases (n = 222, 14.1%); health services planning, delivery and improvement (n = 193, 33.5%); and health and wellbeing (n = 170, 29.5%).
            • This review is timely given new investments in Aboriginal health, which highlights the importance of Aboriginal researchers, community leadership and research priority. We anticipate future outputs for Aboriginal health research to change significantly from this review, and join calls for a broadening of our intellectual investment in Aboriginal health.

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            • 1 University of Newcastle, Newcastle, NSW
            • 2 Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW
            • 3 Centre for Health Equity, University of Melbourne, Melbourne, VIC
            • 4 Judith Lumley Centre, La Trobe University, Melbourne, VIC
            • 5 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT


            Open access

            Open access publishing facilitated by The University of Newcastle, as part of the Wiley ‐ The University of Newcastle agreement via the Council of Australian University Librarians.

            Acknowledgements: 

            Michelle Kennedy is funded by the National Health and Medical Research Council (NHMRC) Early Career Researcher (ECR) Grant (#1158670). Catherine Chamberlain receives an NHMRC Career Development Fellowship (#1161065). Lisa Whop is funded by an NHMRC ECR Grant (#1142035). Bree Hobden is supported by an Australian Rotary Health Colin Dodds Postdoctoral Fellowship (#1801108). Jamie Bryant holds an NHMRC–Australian Research Council Dementia Research Development Fellowship (#APP1105809). This project did not receive funding.

            Competing interests:

            No relevant disclosures.

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              Climate, housing, energy and Indigenous health: a call to action

              Simon Quilty, Norman Frank Jupurrurla, Ross S Bailie and Russell L Gruen
              Med J Aust 2022; 217 (1): . || doi: 10.5694/mja2.51610
              Published online: 4 July 2022

              The convergence of excessive heat, poor housing, energy insecurity and chronic disease has reached critical levels

              Most Australians take safe housing and uninterrupted electricity for granted. Yet in remote Indigenous communities, low quality poorly insulated housing and energy instability are common.1 Most houses require prepaid power cards, resources are meagre, financial literacy is low, and people often have to choose between power and food. New evidence reveals extreme rates of prepaid electricity meters’ disconnection in these communities,2 making people with chronic diseases who depend on cool storage and electrical equipment particularly vulnerable. The convergence of excessive heat, poor housing, energy insecurity and chronic disease has reached critical levels in many parts of northern Australia, and a multisectoral response is needed to avert catastrophe. Medical professionals have a key role to play.

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              • 1 Australian National University, Canberra, ACT
              • 2 Julalikari Council Aboriginal Corporation, Tennant, Creek, NT
              • 3 University Centre for Rural Health, Lismore, NSW


              Correspondence: simon.quilty@anu.edu.au

              Open access

              Open access publishing facilitated by Australian National University, as part of the Wiley ‐ Australian National University agreement via the Council of Australian University Librarians.

              Acknowledgements: 

              We thank Pandora Hope (Bureau of Meteorology) for her work on the climate maps.

              Competing interests:

              No relevant disclosures.

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                Birthing on Country for the best start in life: returning childbirth services to Yolŋu mothers, babies and communities in North East Arnhem, Northern Territory

                Sarah Ireland, Yvette Roe, Suzanne Moore, Elaine Ḻäwurrpa Maypilama, Dorothy Yuŋgirrŋa Bukulatjpi, Evelyn Djota Bukulatjpi and Sue Kildea
                Med J Aust 2022; 217 (1): . || doi: 10.5694/mja2.51586
                Published online: 4 July 2022

                First Nations Yolŋu women are speaking up to reclaim control and return of childbirth services

                Over the millennia, First Nations women across Australia have given birth on their Country, supported by family and cultural caring practices, until recent disruption from European colonisation.1 Today, First Nations women, babies and families experience profound health inequities when comparing health outcomes to their Australian counterparts. A disproportionate number of First Nations women experience adverse outcomes in pregnancy and birth. For the past ten years, there has been little or no improvement in perinatal indicators. Maternal death for First Nations mothers is 3.7 times higher than for other Australian women,2 and perinatal deaths, largely driven by complications of pregnancy, are twice as high, although slightly improved between 2008 and 2018.3

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                • 1 Molly Wardaguga Research Centre, Charles Darwin University, Darwin, NT
                • 2 Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, QLD
                • 3 Yalu Aboriginal Corporation, Galiwin'ku, NT


                Correspondence: sarah.ireland@cdu.edu.au

                Open access

                Open access publishing facilitated by Charles Darwin University, as part of the Wiley ‐ Charles Darwin University agreement via the Council of Australian University Librarians.

                Acknowledgements: 

                Our work was supported by the Birthing on Country Centre for Research Excellence at the Molly Wardaguga Research Centre, Charles Darwin University (APP 1197110), a Lowitja Institute Seeding Grant (20‐SG‐12), and Yalu Aboriginal Corporation. Funding contributed to researcher salaries and costs associated with traveling to and hosting the regional workshop. We acknowledge Raisa Brozalevskaia from Charles Darwin University and Alice McCarthy from Yalu Aboriginal Corporation for their dedication and support of Yolŋu researchers.

                Competing interests:

                No relevant disclosures.

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                  Management of atopic dermatitis: a narrative review

                  Michelle SY Goh, Jenny SW Yun and John C Su
                  Med J Aust 2022; 216 (11): . || doi: 10.5694/mja2.51560
                  Published online: 20 June 2022

                  Summary

                  • Atopic dermatitis (atopic eczema) is the most common inflammatory skin disease and has a significant burden on the quality of life of patients, families and caregivers.
                  • Its pathogenesis is a complex interplay between genetics and environment, involving impaired skin barrier function, immune dysregulation primarily involving the Th2 inflammatory pathway, itch, and skin microbiome.
                  • Restoration of skin barrier integrity with regular emollients and prompt topical anti‐inflammatory therapies are mainstays of treatment. Systemic therapy is considered for moderate to severe disease.
                  • New understanding of inflammatory pathways and developments in targeted systemic immunotherapies have significantly advanced atopic dermatitis management. Dupilumab is a safe and effective treatment that is now available in Australia. Other promising agents for atopic dermatitis include Janus kinase, interleukin (IL)‐13 and IL‐31 inhibitors.

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                  • 1 Peter MacCallum Cancer Centre, Melbourne, VIC
                  • 2 St Vincent’s Hospital Melbourne, Melbourne, VIC
                  • 3 Royal Melbourne Hospital, Melbourne, VIC
                  • 4 Eastern Health, Monash University, Melbourne, VIC
                  • 5 Murdoch Children’s Research Institute, Melbourne, VIC


                  Correspondence: michelle.goh@petermac.org
                  Competing interests:

                  John Su has been a consultant/speaker/investigator for AbbVie, Amgen, Bioderma, Bristol Myers Squibb, Ego Pharmaceuticals, Eli‐Lilly, Janssen, LEO Pharma, L’Oreal, Mayne, Novartis, Pfizer, Pierre‐Fabre, and Sanofi.

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                  • 32. Van Zuuren EJ, Fedorowicz Z, Christensen R, et al. Emollients and moisturisers for eczema. Cochrane Database Syst Rev 2017; (2): CD012119.
                  • 33. Kelleher MM, Cro S, Cornelius V, et al. Skincare interventions in infants for preventing eczema and food allergy. Cochrane Database Syst Rev 2020; (2): CD013534.
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                  • 37. Hebert AA, Rippke F, Weber TM, et al. Efficacy of nonprescription moisturizers for atopic dermatitis: an updated review of clinical evidence. Am J Clin Dermatol 2020; 21: 641‐655.
                  • 38. Lack, G. Update on risk factors for food allergy. J Allergy Clin Immunol 2012; 129: 1187‐1197.
                  • 39. Voskamp AL, Zubrinich CL, Abramovitch JB, et al. Goat’s cheese anaphylaxis after cutaneous sensitization by moisturizer that contained goat’s milk. J Allergy Clin Immunol Pract 2014; 2: 629‐630.
                  • 40. Kobayashi T, Ito T, Kawakami H, et al. Eighteen cases of wheat allergy and wheat‐dependent exercise‐induced urticarial/anaphylaxis sensitized by hydrolyzed wheat protein in soap. Int J Dermatol 2015; 54: e302‐305
                  • 41. Mooney E, Rademaker M, Dailey R, et al. Adverse effects of topical corticosteroids in paediatric eczema: Australasian consensus statement. Australas J Dermatol 2015; 56: 241‐251.
                  • 42. González‐López G, Ceballos‐Rodríguez RM, González‐López JJ. Efficacy and safety of wet wrap therapy for patients with atopic dermatitis: a systematic review and meta‐analysis. Br J Dermatol 2017; 177: 688‐695.
                  • 43. Siegfried EC, Jaworski JC, Kaiser JD, et al. Systematic review of published trials: long‐term safety of topical corticosteroids and topical calcineurin inhibitors in pediatric patients with atopic dermatitis. BMC Pediatrics 2016; 16: 75.
                  • 44. Martins JC, Martins C, Aoki V, et al. Topical tacrolimus for atopic dermatitis. Cochrane Database Syst Rev 2015; (7): CD009864.
                  • 45. Schlessinger J, Shepard JS, Gower R, et al. Safety, effectiveness, and pharmacokinetics of crisaborole in infants aged 3 to < 24 months with mild‐to‐moderate atopic dermatitis: a phase IV open‐label study (CrisADe CARE 1). Am J Clin Dermatol 2020; 21: 272‐284.
                  • 46. Sidbury R, Davis DM, Cohen DE, et al. Guidelines of care for the management of atopic dermatitis. Section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol 2014; 71: 327‐349.
                  • 47. Majewski S, Bhattacharya T, Asztalos M, et al. Sodium hypochlorite body wash in the management of Staphylococcus aureus‐colonized moderate‐to‐severe atopic dermatitis in infants, children, and adolescents. Pediatr Dermatol 2019; 36: 442‐447.
                  • 48. Matterne U, Böhmer MM, Weisshar E, et al. Oral H1 antihistamines as ‘add‐on’ therapy to topical treatment for eczema. Cochrane Database Syst Rev 2019; (1): CD012167.
                  • 49. Fitzsimons R, van der Poel L, Thronhill W, et al. Antihistamine use in children. Arch Dis Child Educ Pract Ed 2015; 100: 122‐131.
                  • 50. Sawangjit R, Dilokthornsakul P, Lloyd‐Lavery A, et al. Systemic treatments for eczema: a network meta‐analysis. Cochrane Database Syst Rev 2020; (9): CD013206.
                  • 51. Halling A, Loft N, Silverberg JI, et al. Real‐world evidence of dupilumab efficacy and risk of adverse events: A systematic review and meta‐analysis. J Am Acad Dermatol 2021; 84: 139‐147.
                  • 52. Eichenfield LF, Bieber T, Beck LA, et al. Infections in Dupilumab clinical trials in atopic dermatitis: A Comprehensive Pooled Analysis. Am J Clin Dermatol 2019; 20: 443‐456.
                  • 53. Drucker AM, Eyerich K, de Bruin‐Weller MS, et al. Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement. Br J Dermatol 2018; 178: 768‐775.
                  • 54. Rademaker M, Agnew K, Andrews M, et al. Managing atopic dermatitis with systemic therapies in adults and adolescents: An Australian/New Zealand narrative. Australas J Dermatol 2020; 61: 9‐22.
                  • 55. Siegels D, Heratizadeh A, Abraham S, et al. Systemic treatments in the management of atopic dermatitis: a systematic review and meta‐analysis. Allergy 2020; 76: 1053‐1076.
                  • 56. Chapman S, Kwa M, Gold LS, Lim HW. Janus kinase inhibitors in dermatology: Part I. A comprehensive review. J Am Acad Dermatol 2022; 86: 406‐413.
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                    Effect of a financial incentive on responses by Australian general practitioners to a postal survey: a randomised controlled trial

                    Alison C Zucca, Mariko Carey, Rob W Sanson‐Fisher, Joel Rhee, Balakrishnan (Kichu) R Nair, Christopher Oldmeadow, Tiffany‐Jane Evans and Simon Chiu
                    Med J Aust 2022; 216 (11): . || doi: 10.5694/mja2.51523
                    Published online: 20 June 2022

                    General practitioners view health and medical research positively, but their participation in postal surveys is typically low.1 Poor response rates reduce the sample size and consequently the generalisability of survey results.

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                    • 1 College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW
                    • 2 Hunter Medical Research Institute (HMRI), Newcastle, NSW
                    • 3 University of Wollongong, Wollongong, NSW
                    • 4 Illawarra Health and Medical Research Institute, Wollongong, NSW


                    Trial registration

                    Open Science Framework, doi: 10.17605/OSF.IO/VZMWJ; 30 September 2021 (retrospective).

                    Open access

                    Open access publishing facilitated by The University of Newcastle, as part of the Wiley ‐ The University of Newcastle agreement via the Council of Australian University Librarians.

                    Acknowledgements: 

                    This study was supported by the National Health and Medical Research Council (NHMRC) with a Dementia Research Team grant (APP1095078) and by infrastructure funding from the Hunter Medical Research Institute. Mariko Carey is supported by an NHMRC Boosting Dementia Research Leadership Fellowship (APP1136168). We acknowledge Grace Norton for research assistance and, Sandra Dowley for data entry (both University of Newcastle and Hunter Medical Research Institute), and Lucy Leigh for statistical analysis (Hunter Medical Research Institute).

                    Competing interests:

                    No relevant disclosures.

                    • 1. Cook JV, Dickinson HO, Eccles MP. Response rates in postal surveys of healthcare professionals between 1996 and 2005: an observational study. BMC Health Serv Res 2009; 9: 160.
                    • 2. Parkinson A, Jorm L, Douglas KA, et al. Recruiting general practitioners for surveys: reflections on the difficulties and some lessons learned. Aust J Prim Health 2015; 21: 254‐258.
                    • 3. Carey M, Zucca A, Rhee, J, et al. Essential components of health assessment for older people in primary care: a cross‐sectional survey of Australian general practitioners. Aust N Z J Public Health 2021; 45: 506‐511.
                    • 4. Pit SW, Vo T, Pyakurel S. The effectiveness of recruitment strategies on general practitioner’s survey response rates: a systematic review. BMC Med Res Methodol 2014; 14: 76.
                    • 5. Edwards PJ, Roberts I, Clarke MJ, et al. Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst Rev 2009; 2009:MR000008.
                    • 6. Campbell MK, Weijer C, Goldstein CE, Edwards SJ. Do doctors have a duty to take part in pragmatic randomised trials? BMJ 2017; 357: j2817.
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                      Beyond rural clinical schools to “by rural, in rural, for rural”: immersive community engaged rural education and training pathways

                      Roger P Strasser
                      Med J Aust 2022; 216 (11): . || doi: 10.5694/mja2.51525
                      Published online: 20 June 2022

                      Cradle‐to‐grave regional programs featuring immersive community engaged education are needed to ensure a sustainable rural medical workforce

                      In this issue of the MJA, Seal and colleagues1 report a multi‐university investigation that found that extended rural clinical school (RCS) placements have a positive impact on rural workforce recruitment and the retention of both rural and metropolitan origin medical graduates. The authors examined the practice locations of medical graduates, as listed in the Australian Health Practitioner Regulation Agency (AHPRA) register, five and eight years after graduation; many doctors were probably still registrars in training locations five years after graduation. The authors considered a limited range of variables in their study, and did not adjust their analyses for registrars who had received bonded or other scholarships, nor for factors such as incentives to relocate and employment opportunities for partners. Nevertheless, there is merit in their conclusion that their “findings reinforce the importance of longitudinal rural and regional training pathways, and the role of RCSs, regional training hubs, and the rural generalist training program in coordinating these initiatives.”1


                      • 1 Northern Ontario School of Medicine University, Sudbury, ON, Canada
                      • 2 Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand


                      Correspondence: roger.strasser@nosm.ca
                      Competing interests:

                      No relevant disclosures.

                      • 1. Seal AN, Playford D, McGrail MR, et al. Influence of rural clinical school experience and rural origin on practising in rural communities five and eight years after graduation. Med J Aust 2022; 216: 572‐577.
                      • 2. Australian Department of Health. National medical workforce strategy 2021–2031. 2021. https://www.health.gov.au/resources/publications/national‐medical‐workforce‐strategy‐2021‐2031 (viewed Apr 2022).
                      • 3. Strasser R. Will Australia have a fit‐for‐purpose medical workforce in 2025? Med J Aust 2018; 208: 198‐199. https://www.mja.com.au/journal/2018/208/5/will‐australia‐have‐fit‐purpose‐medical‐workforce‐2025
                      • 4. Strasser R, Strasser S. Reimagining primary health care workforce in rural and underserved settings [discussion paper: Health, Nutrition, and Population Global Practice of the World Bank]. Aug 2020. https://openknowledge.worldbank.org/handle/10986/34906 (viewed Apr 2022).
                      • 5. Strasser R. Immersive community engaged education: more community engaged learning than work‐integrated learning. In: Pretti J, Stirling A (ed). The practice of co‐op and work‐integrated learning in the Canadian context. Canada: World Association for Co‐op and Work‐Integrated Education (WACE), Co‐operative Education and Work‐Integrated Learning (CEWIL), 2021; pp. 72‐81.
                      • 6. Worley P, Couper I, Strasser R, et al; CLIC Research Collaborative. A typology of longitudinal integrated clerkships. Med Educ 2016; 50: 922‐932.
                      • 7. Strasser R. Students learning medicine in general practice in Canada and Australia. Aust Fam Physician 2016; 45: 22‐25.
                      • 8. Strasser R, Worley P, Cristobal F, et al. Putting communities in the driver’s seat: the realities of community engaged medical education. Acad Med 2015; 90: 1466‐1470.
                      • 9. Strasser R. Recruiting and retaining a rural medical workforce: the value of active community participation. Med J Aust 2017; 207: 154‐158. https://www.mja.com.au/journal/2017/207/4/recruiting‐and‐retaining‐rural‐medical‐workforce‐value‐active‐community
                      • 10. Abelsen B, Strasser R, Heaney D, et al. Plan, recruit, retain: a framework for local healthcare organizations to achieve a stable remote rural workforce. Hum Res Health 2020; 18: 63.
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