BACKGROUND:General Practitioners (GPs) are key providers of paediatric care but do not always feel confident to manage paediatric presentations. This study aimed to assess the acceptability of a multifaceted, online paediatric education programme and its impact on GPs' knowledge, confidence, and perceived practice. METHODS:The study design was informed by Moore's conceptual framework for planning and assessing learning in continuing medical education activities. A mixed methods evaluation was undertaken using quantitative survey data collected pre- and post-webinars and after six months, and analysed descriptively. Qualitative data from semi-structured interviews were analysed thematically. RESULTS:135 GPs participated in the education programme. 71 and 81 responses were received for pre- and post-webinar surveys. Mean knowledge and confidence ratings improved post-webinar (from 2.2/4 (95% CI, 2.0-2.3) to 3.3/4 (95% CI, 3.1-3.4), p < 0.001, and 2.1/4 (95% CI, 2.0-2.3) to 3.3/4 (95% CI, 3.1-3.4), p < 0.001, respectively). Six-to-twelve-month survey participants (n = 28) and interview participants (n = 7) overwhelmingly described the programme as relevant, engaging, and self-reported improvement in knowledge, confidence and clinical practice. Facilitators of success included providing opportunities for questioning, availability of live and recorded webinars, and a community of practice. CONCLUSIONS:An online paediatric education programme for GPs was acceptable, relevant and impactful, with its impact on practice requiring further evaluation. The study provides evidence for effective online education of GPs which can be delivered at scale.

Introduction:The Learning Health System (LHS) concept is gaining traction in high-income countries, yet its implementation in low- and middle-income countries (LMICs) remains limited with few initiatives offering practical strategies tailored to these contexts. The Leading a Learning Health System (LLHS) Program, grounded in LHS principles, aimed to build leadership capacities among health professionals and leaders from five Asia-Pacific LMICs. This study explored participants' learning experiences and applications in their context. Methods:A mixed-method longitudinal study was conducted (13-months), informed by social constructivism and Kirkpatrick's evaluation framework. Surveys and semi-structured interviews were conducted after the intensive course (Survey A and Interview A) and 1 year later (Survey B and Interview B). Quantitative data were analyzed descriptively, and qualitative data were analyzed through inductive content analysis. Results:Thirteen participants (13/20, 65%) completed Survey A. All (100%) rated the program and cross-country network as "high value." Eleven participants (11/20, 55%) completed Survey B. All participants reported applying program learnings regularly on most days (6/11, 55%) or most weeks (5/11, 45%). Nine participants (82%) reported influencing team culture and five (45%) reported influencing organizational change. Qualitative analysis of 20 Interview A and 10 Interview B identified four themes: (1) developing a systems leadership identity, (2) translating leadership intent into practice, (3) contextual challenges to applying learnings, (4) resilience via adaptive leadership capacity and programmatic support. Conclusion:This study demonstrates how a longitudinal leadership program based on the LHS framework supported LMIC health professionals to develop systems leadership identity, foster learning culture, and cultivate adaptive, distributed leadership to build resilience in resource-limited settings. The variability of health information systems in LMICs should not be seen as a barrier to implementing LHS, as improvement can begin with the effective use of locally available data. These findings can inform future capacity-building initiatives to advance LHSs in LMICs.

BACKGROUND:Paediatric Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare, severe mucocutaneous reaction requiring coordinated multidisciplinary care. Existing guidelines provide evidence-based recommendations, but implementation across tertiary paediatric hospitals requires practical consensus on local resources. AIM:To develop and evaluate multidisciplinary consensus-informed practical clinical guidance for assessment and management of paediatric SJS/TEN among clinicians from Australasian tertiary referral hospitals. METHODS:A draft guidance document was developed after review of SJS/TEN guidelines, systematic reviews and other relevant literature. Clinicians from one tertiary paediatric centre (Group A) and other Australian and New Zealand tertiary centres (Group B) completed a 130-item questionnaire. Continuous items were scored on a 1-9 Likert scale. Categorical items addressed referral urgency and whether investigations should be routine, reasonable but not routine, or not ordered. Quantitative responses and free-text comments informed revision. RESULTS:Twenty-two multidisciplinary clinicians from the internal centre and nine clinicians from eight external centres participated. Agreement was high for history, examination, supportive care, multidisciplinary involvement, discharge planning and follow-up. Uncertainty remained regarding fluid requirements compared with burns patients, the scope of initial investigations and systemic immunomodulatory therapy. The guidance was revised to emphasise individualised fluid management, directed differential diagnosis and testing, and case-by-case systemic therapy. CONCLUSIONS:This practical multidisciplinary consensus-informed guidance supports paediatric SJS/TEN care in Australasian tertiary referral hospitals. Its contribution is the quantified consultative process and identification of consistent, variable and uncertain practice. It complements, rather than replaces, existing guidelines.

The International Paediatric Oncology Society Global Mapping Programme aims to collect data on global paediatric oncology services by continent, with Africa and Latin America completed. This study reports on the methodology and lessons learned for Oceania, a unique continent with resource disparity across countries, multiple small island developing states, small populations and complex climate and cultural factors. Recruitment and data collection processes have built invaluable regional connections and highlighted the challenges impacting regional childhood cancer care. This first comprehensive overview of paediatric oncology capacity in Oceania addresses a critical evidence gap and will inform future cancer control plans and advocacy.

AIM:Use of social media platforms such as TikTok within the adolescent population is widespread. Harnessing its accessibility and prevalence provides health professionals an opportunity to disseminate positive, evidence-based health information. However, infiltrating this domain brings challenges such as countering abundant misinformation and understanding the target audience. Creating successful short-form videos for social media is a nuanced skill. University health students produced videos focusing on common adolescent issues for a health-promoting TikTok channel. The aim of this study was to explore secondary school student perceptions of these videos. METHODS:A mixed methods evaluation was undertaken using surveys and focus group interviews. Teachers from participating secondary schools recruited parents and students via the school online communication system. Descriptive statistics from survey responses were used to analyse demographics and scale responses. A uses and gratification lens was used for inductive content analysis of qualitative data. RESULTS:Participant students were predominantly from Year 9 (age 14-15 years), 161/212 (76%). The median score for enjoyment and positive learnings from videos was 5/10 and for likelihood of sharing videos was 3/10. Three themes emerged from the qualitative data: (1) mixed perceptions of video content with a preference for health not disease, (2) engagement driven by entertainment and 3) social media platforms for enjoyment versus education. CONCLUSIONS:Social media platforms are an accessible source of health information for adolescents. Health professionals have an opportunity to provide evidence-based health information and combat misinformation. Creating effective and targeted video content can increase the positive impact on adolescent audiences.

AIM:Despite ward rounds being fundamental to hospital-based clinical training, the reported educational value is low. Especially in busy environments, missed learning opportunities occur due to implicit learning, time barriers, and lack of ward round structure. The STIC framework (Set, Target, Inspect, Close) provides a learner-centred, structured approach to ward round teaching, aimed to enhance education within limited timeframes. We aimed to investigate how the introduction of the STIC framework impacts on learner-centred teaching within a tertiary Paediatric Oncology department. METHODS:A mixed-methods approach was used to evaluate framework implementation, with two participant groups comprising 16 junior and senior doctors over 3 months. Surveys were used to document junior staff experience on rounds pre- and post-implementation, with focus groups and interviews used for all participants to explore satisfaction and attitudes to the tool. RESULTS:Learner satisfaction improved across all domains of the framework, specifically opportunities for leading clinical encounters and learning on consultant-led rounds. Despite consultants reporting lack of uptake, trainees reported improved teaching. Consultant beliefs and enthusiasm had a strong impact on trainee satisfaction. Trainees placed a high value on active participation and autonomy for their learning. Factors distinct to teaching were reported to affect learner satisfaction, such as planning, time management, and departmental culture. CONCLUSIONS:We demonstrate enhanced teaching despite poor perceived uptake, demonstrating the potential of the STIC framework with further implementation. Our study also highlights that in addition to a specific teaching focus, consultant engagement and a safe clinical learning environment are crucial for learning.

Introduction: Feedback up from junior to senior clinical staff is important for junior staff to facilitate their workplace teaching and learning and for senior staff to develop teaching and leadership skills. The aim of our study was to explore experiences and perceptions towards feedback up in junior and senior medical and nursing staff in our tertiary paediatric hospital in Australia. Methods: We invited doctors and nurses in both junior and senior roles at our hospital to participate in a survey regarding their perceptions and experience of giving (junior staff) or receiving (senior staff) feedback up. We offered an optional interview to participants to discuss their experiences in depth. Quantitive data were analysed using descriptive statistics and qualitative data were analysed using inductive content analysis. Results: Sixty-two junior and 70 senior staff completed surveys, and six junior and six senior staff were interviewed. Although 95% of surveyed staff believed that feedback up is important, only 42% were involved in giving or receiving it. Six themes were identified in the qualitative data, including discomfort with feedback up, power dynamics, unclear expectations, no one size fits all, limited time and opportunity and tensions in feedback validity and purpose. Conclusion: Feedback up from junior to senior staff is wanted but is currently inconsistent or nonexistent in our paediatric hospital. We propose that providing an expectation, clear processes and support in engaging in feedback up would improve acceptance, ultimately leading to improved feedback literacy and a better culture of feedback.

Introduction: COVID-19 pandemic disruptions to medical educational programs have been felt worldwide. However, little is understood about the experience of Low to Middle Income Countries’ (LMIC) and the impact of ensuing disruptions on medical education. We aimed to develop a collective understanding of this through the perspectives of individual LMIC educators, exploring how they continued to deliver undergraduate and postgraduate medical education in the context of pandemic barriers, by reflecting on their successes and shortcomings. Methods: A phenomenological study was conducted with ten purposefully recruited educators involved in medical education from mainly the Asia-Pacific region. In-depth interviews via web-conferencing were conducted, and data analysed using Braun & Clarke’s (2006) framework. Results: Four major themes were identified: ‘Navigating Change, ‘Altered and Divided Teaching Roles and Spaces’, ‘Curricula Impact’ and ‘Challenges and Affordances of Remote Learning’. Educators described major disruptions to delivering medical education, particularly clinical education. Remote learning was the mainstay of facilitating continued education, often requiring investment into infrastructure that was non-existent pre-pandemic. Conclusion: LMIC educators’ pandemic response have been robust in pursuit of continued medical education. Necessary adoption of online teaching approaches has provided avenues to close healthcare education gaps by facilitating improved reach and quality of medical education in these regions. Building on this requires strategies that meet LMICs areas of need, focusing on capacity building that sustains and grows new pedagogical practices. We must ensure educational advances are equitable and accessible for all, identifying and supporting countries and contexts at risk of being left behind.

AIM:Maternal Child Health Nurses (MCHN) play an integral role in child health in the community yet lack professional development opportunities. A tertiary hospital sought to fill this gap and developed an online MCHN education programme. This study aimed to assess the impact of the programme on MCHN confidence, knowledge and practice and to understand the factors influencing its impact. METHODS:MCHN enrolled in the programme were invited to participate in a mixed method study based on Moore's Outcomes Framework for continuing medical education. Quantitative data from surveys collected pre and post live webinars and at 6 months post programme implementation assessed participant knowledge and confidence, and the quality of the programme. Qualitative data from individual semi-structured interviews was analysed inductively to understand impact. RESULTS:Reported knowledge and confidence improved after each webinar (for knowledge from 2.60 out of 4 (95% CI 2.54-2.66) to 3.45 out of 4 (95% CI 3.40-3.59) post-webinar (p < 0.001) and for confidence from 2.58 out of 4 (95% CI 2.52-2.64) to 3.42 out of 4 (95% CI 3.38-3.47) post-webinar (p < 0.001)). Four themes emerged which facilitated the programme impact: filling a continuing education void, supporting diverse learning styles and needs, enhancing practice and advocacy through empowerment and fostering connections and respect. CONCLUSION:We demonstrated that a well-designed online education programme led to increased knowledge, confidence and changes in practice. It facilitated connection and respect and reinforced MCHN value and contribution. It highlighted and addressed an educational gap within the MCHN continuing education landscape and has proven to be sustainable and impactful.

AIM:Clown doctors have a unique skill set and role, particularly in paediatric settings. Yet, there is limited research on whether clown doctors themselves could play a role in sharing these skills with health professionals. Acknowledging uncertainty in what our intervention should be, we used a design-based research (DBR) approach with the aim of (i) shaping the educational design and content of communication skills-based workshops for clinicians and (ii) understanding the educational impact on participants. METHODS:Data were collected from initial key stakeholder consultations, then through the delivery of evolving iterations of the workshop in the form of post-workshop group discussions, follow-up short participant surveys and observations of the workshops themselves. Reflexive thematic analysis of group discussions and short survey responses was undertaken to understand the impact. RESULTS:Forty participants participated in five workshops, including staff from medical, nursing, allied health and administrative backgrounds. Five educational principles emerged: self-awareness, curiosity, play, spirit and self-reflection. Four central themes regarding educational impact were generated: creating joy and breaking barriers; the heart, not the science of communication; workplace tensions challenge change; and communication training but not as we know it. CONCLUSIONS:A novel education programme facilitated by clown doctors at a hospital offered unique communication skill learnings, while bringing joy and connection to the workplace through education. The DBR approach enabled this programme to be shaped, implemented, and evaluated, with the results attesting to the value of more novel approaches to communication training. The challenge remains to embed, sustain, and potentially scale the programme to other settings.

(1) Background: There is a need to scale and transform health professional education (HPE) globally to not only improve the quantity but also the quality of health workers. This paper describes the approach undertaken by a Health University in Lao PDR. (2) Approach: The HPE curriculum was designed in an iterative process with key stakeholders from both the institution and government, with external expert advice. (3) Outcomes: The curriculum was successfully developed consisting of nine core modules and one elective module, reflecting both elements seen globally in HPE curricula as well as reflecting local needs. The content and teaching methods were validated and reviewed through piloting with local education leaders. (4) Conclusions: Despite the need to scale HPE globally, there are few examples of how this can be achieved in countries in which large gaps exist in HPE capacity. This paper provides one such example, through recognizing that sustained external partnerships will still be needed for successful future implementation.

Introduction: Mentoring for doctors has benefits for mentors, mentees and their employment organisations. There are emerging examples of formal mentoring programs in hospitals. There remains limited published data evaluating self-selection models for participant satisfaction and long-term outcomes. Our aim was to explore the experience of mentors and mentees who opted in to the dyad mentoring program at the Royal Children’s Hospital (RCH) to understand the longevity of the mentoring relationships and to understand the utilisation of the supporting mentoring tools. Methods: A mixed-methods study was conducted. In 2020, 174 eligible doctors were invited to complete a survey containing multiple-choice and Likert-scale questions to explore Moore’s outcome levels for evaluating continuing medical education. Of the eligible cohort, 66 (38%) responded, and of these, 14 volunteered for in-depth individual interviews. Descriptive statistics from survey responses were used to calculate number and frequency of responses, and inductive thematic analysis was used to identify themes from transcribed interviews as part of a phenomenological approach. Results: One third of mentees and 68.8% (22/32) of mentors reported ongoing relationships beyond the 10-month formal program. A “cycle of mentoring” was evident, with mentees returning to the program as mentors. Four key qualitative themes were identified: “broad benefits” of mentoring, “it’s a relationship and it takes work”, “giving back” and “program foundations”. Outcomes in domains of participation, satisfaction, learning and organisational culture change were identified. Conclusion: The mentoring program at RCH has demonstrated positive impact and long-term sustainability. The program structure could be replicated in different settings.

Objectives To understand parents' attitudes to medical education of junior doctors and students during ward rounds, and to explore how parents' perceptions vary in medical and surgical paediatric wards. Design A mixed-methods descriptive study was done using 100 semistructured interviews across two departments at a single tertiary-level paediatric hospital. Quantitative data were derived from closed-ended interview responses and analysed using descriptive statistics to explore overall parental satisfaction with education on rounds. Qualitative data were obtained from open-ended interview responses using inductive content analysis, with themes agreed between three researchers. Results This study demonstrated high parental satisfaction with education on ward rounds, with over 85% of parents satisfied with education occurring on rounds. There was no difference between medical and surgical cohorts despite more parents witnessing teaching on medical rounds (70%) than on surgical rounds (16%). Qualitative data derived four key themes: altruism as the reason for supporting education, the child still comes first, setting the scene and the location matters. Conclusion This research demonstrates parents support education of medical students and junior doctors during ward rounds, provided ward-based learning is not perceived to compromise care. Intentional communication with parents regarding the teaching process, including timing and location of teaching, helps improve engagement and parental satisfaction. It is well recognised that clinical ward rounds provide valuable opportunities for teaching and training. However, have you ever paused to consider what patients, and their parents, think of education on ward rounds? This study aims to shed some light on this by examining parental perceptions of education on paediatric ward rounds.

AIM:To understand the impact of an asthma education video resource introduced to the short stay unit (SSU) of a tertiary paediatric hospital on: (i) parental understanding of and confidence in managing their child's asthma; (ii) the impact of this resource on nurse-led education practices; and (iii) readmission rates.METHODS:A mixed methods study was conducted in the SSU over an 18-month period using quantitative survey data from parents and nursing staff and qualitative data from nursing staff focus groups.RESULTS:Of 117 parents surveyed, 94% reported an increase in their understanding of asthma. Following the introduction of the resource, there were fewer nurse-led education sessions delivered (1.91 vs. 1.54, P = 0.04) and a trend towards reduction in time spent delivering this education (27.24 vs. 24.98 min, P = 0.47). Nursing staff confidence in the family's understanding of asthma education was similar pre- and post-implementation (4.22 vs. 4.30, P = 0.97). Readmission rates dropped by 25% (readmissions within 1 month) and by 33.3% (readmission within a week) in the post-intervention cohort.CONCLUSIONS:Our asthma education video resource was demonstrated to be an acceptable and effective way of delivering asthma education to families. It created efficiency and consistency for nursing education and practice in our SSU. This resource was viewed by nursing staff as a useful adjunct to their education, enabling consistent messaging and helping structure education delivery. It has been incorporated into hospital systems and national resources which we hope will translate to a reduction in burden of asthma across the community.

ObjectivesWHO Integrated Management of Childhood Illness (IMCI) guidelines changed pneumonia hospitalisation criteria in 2014, which was implemented in Lao People’s Democratic Republic (Lao PDR) in 2015. We determined adherence to: current (2014) IMCI guidelines for children presenting to hospitals with pneumonia, current outpatient management guidelines and identified hospitalisation predictors.DesignProspective observational study (January 2017 to December 2018).SettingOutpatient and emergency departments of four hospitals in Vientiane, Lao PDR.Patients594 children aged 2–59 months diagnosed with pneumonia.Main outcome measuresNumber of children diagnosed, hospitalised, managed, administered preventive measures and followed-up accordant with current guidelines.ResultsNon-severe and severe pneumonia were correctly diagnosed in 97% and 43% of children, respectively. Non-severe pneumonia with lower chest wall indrawing (LCI) was diagnosed as severe in 15%. Hospitalisation rates were: 80% for severe pneumonia, 86% and 3% for non-severe pneumonia with and without LCI, respectively. Outpatient oral antibiotic prescribing was high (99%), but only 30% were prescribed both the recommended antibiotic and duration. Appropriate planned follow-up was 89%. Hospitalisation predictors included age 2–5 months (compared with 24–59 months; OR 3.95, 95% CI 1.90 to 8.24), public transport to hospital (compared with private vehicle; OR 2.60, 95% CI 1.09 to 6.24) and households without piped drinking water (OR 4.67, 95% CI 2.75 to 7.95).ConclusionsHospitalisation practice for childhood pneumonia in Lao PDR remains more closely aligned with the 2005 WHO IMCI guidelines than the currently implemented 2014 iteration. Compliance with current outpatient antibiotic prescribing guidelines was low.

BACKGROUND:In the setting of the COVID-19 pandemic, the modes of hospital service delivery, education, training, and the context surrounding them has undergone enormous change and disruptions. OBJECTIVE:This study aimed to understand the 'lived-experience' of junior doctors in relation to their education, training, and professional development during the pandemic. METHODS:A qualitative study based on thematic and cohort narrative analysis. 20 junior doctors who trained at an Australian tertiary paediatric hospital during the time of COVID-19 restrictions were interviewed. Based on a phenomenological approach, the interviews examined junior doctors' experiences in relation to medical education, adaptive education styles and the value attributed by participants to different forms of education provided to them. RESULTS:Four overarching themes were identified regarding trainee perceptions of the impact of COVID-19 restrictions on learning opportunities, both positive and negative. These were: 'The void' - learning expectations junior doctors felt were missed, education affordances, peers and networks, and professional identity. CONCLUSION:The pace with which educators have adapted to new teaching modes should be harnessed to incite equally novel curriculum evolution, smart investment in clinical moments, reconnect learning communities and create robust virtual learning environments.

AIM:To understand the lived experience of paediatric trainees in relation to their educational opportunities, workforce roles and the interplay between them, during pandemic disruptions.METHODS:Twenty paediatric trainees working at Australian paediatric hospitals during the time of COVID-19 restrictions were interviewed between July and November 2020. Based on a phenomenological approach, the interviews examined junior doctors' experiences in relation to medical education, adaptive education modes, learning opportunities and their workforce roles during the pandemic. Qualitative inductive thematic data analysis was used to develop a cohort narrative.RESULTS:Four overarching themes were identified regarding trainee perceptions of the impact of COVID-19 restrictions on learning opportunities, both positive and negative. These were: impaired rapport building, altered team role, altered care and education affordances versus access. Participants felt ill-equipped to provide optimal clinical care during virtual and stifled in-person consultations, detached from the multidisciplinary team, that changed work roles diminished their professional self-worth, and that online learnings were advantageous if rostering afforded opportunities to engage with them.CONCLUSION:To equip paediatric trainees for the next steps in their careers, we suggest the following areas of focus: the use of new tools of rapport, smart investment in clinical moments, reconnection of multidisciplinary teams and learning, the support of online learning infrastructure with protected education time and roadmaps for learning, and teaching on how to triage information sources and alongside clinical visit types.