Introduction: Pathways aimed at increasing the medical workforce in regional and rural areas in Aotearoa New Zealand have been implemented in universities, such as the Regional and Rural Admission Scheme (RRAS) at Waipapa Taumata Rau | The University of Auckland, to address urban-rural variations in health outcomes. A recent review of the university's scheme suggested the program was not providing equitable opportunities for students from a rural background as originally intended. Therefore, an updated RRAS was required to be developed to address these inequities, creating a more genuine scheme that may more strongly contribute to developing the regional and rural workforce in New Zealand. Methods: We developed a methodological framework to identify and evaluate candidate rural definitions for the purposes of developing a new RRAS for the university. Following an extensive literature review, we utilised two sets of criteria to select candidate rural definitions, which were then evaluated using visual evaluation (mapping) and exploratory analysis. Candidate definitions were modified to use a three-group (rural-regional-urban) version to be suitable for use as an updated RRAS. We used a de-identified student dataset of applicants enrolled for the MBChB medical program at the University of Auckland from 2017 to 2023 (inclusive) and population counts from the New Zealand 2018 Census to investigate differences in potential admission numbers under each candidate definition. The New Zealand Index of Multiple Deprivation 2018 was used to assess the distribution of potential admission numbers by area-level socioeconomic status. We also examined the suitability of the candidate definitions by ethnicity, specifically for students of Māori ethnicity. Results: We selected two candidate definitions for exploratory analysis: Geographic Classification for Health (GCH) developed by the University of Otago, and the urban accessibility classification 2020 (UA 2020) by Stats NZ. We found that the three-group modified version of the UA 2020 definition consistently classified a higher proportion of students as regional and rural compared to the current RRAS and the alternative candidate definition, the three-group GCH. The modified UA 2020 was found to classify a higher number of Māori students and those living in less-deprived neighbourhoods as rural when compared to the other definitions. Therefore, our final recommendation is to update the existing RRAS using a three-group modified version of the UA 2020 by Stats NZ. Our proposed version will refocus attention to address the under-representation of rural students admitted to professional health programs at the University of Auckland, while not disadvantaging regional students. Conclusion: The updated RRAS will assist in supplementing the future professional rural medical workforce, and subsequently help to reduce health outcome variations between rural and urban areas in New Zealand. The modified UA 2020 is likely to be updated regularly by Stats NZ, and therefore the RRAS can be kept up to date in the future.

AIM:To explore solutions and innovations implemented by medical schools in high-income countries to teach the general practice and primary care components within their medical programmes. METHODS:This qualitative study involved semi-structured interviews with academic leaders of general practice curricula at their medical school about the nature of their medical programme, how general practice is taught each year, specific longitudinal integrated clerkships, benefits to teaching, challenges to delivering the programme and solutions. Data were coded, categorised and themes developed in an inductive process. RESULTS:Interviews involved 44 medical schools: 16 Australian; 15 English; 6 Irish; 4 Canadian; 3 Nordic. Range of curricula from traditional to integrated, problem-based to spiral with undergraduate or postgraduate entry or both. Five themes were developed: curriculum organisation; non-clinical patient engagement; authentic GP experiences; exposure to GP teacher role-models; simulation and information technology. DISCUSSION:How the general practice curriculum is organised within a medical programme is not uniform. Placements may occur at the beginning, end or throughout; may range from half-days to full-time year-long placements. GP-led curricula exposing students to GPs as teachers and role-models may counter negative stereotypes and increase interest in general practice careers. Growing use of simulation, remote consulting and the use of IT innovations provides alternatives to traditional parallel general practice consulting model for teaching and learning. The findings from this study will inform the development of our redesigned curriculum at the University of Auckland.

Objectives:To describe and compare how undergraduate general practice (GP) is taught across medical school programmes in selected high-income countries, to inform curriculum redesign at the University of Auckland, New Zealand. Methods:International observational cross sectional comparative study. Study participants were academic leads responsible for undergraduate general practice curricula in medical schools in Australia, England, Ireland, Canada, Norway, Iceland. Forty-four medical schools. Pragmatic purposive sampling to maximise diversity in geography, institutional age, programme structure, rural-urban context, student intake size. Single semi-structured interviews conducted April to November 2024, face-to-face or by videoconference. Interviews audio recorded with consent, transcribed verbatim, and supported by field notes. Data analysed using EPIC GP, modified SPICES derived framework examining electives, problem-based learning, curriculum integration, community based exposure, GP focused university teaching, and interprofessional education. Programmes coded and scored using a structured consensus process. Descriptive statistics and hierarchical cluster analysis used to identify patterns. Results:Marked variation observed in the organisation and visibility of general practice. Three curriculum typologies identified: hospital focused programmes with limited GP exposure; GP focused programmes with integrated, GP-led teaching; and community- or primary-health-care-focused programmes emphasising interprofessional education. Conclusions:This study provides an international comparative description of undergraduate GP teaching models. The findings demonstrate multiple approaches to embedding general practice beyond traditional block placements. Medical schools facing placement constraints may consider earlier GP engagement, increased GP led campus teaching, and selective use of simulation or digital learning. Further studies should examine educational and workforce outcomes.

Introduction Rural M & amacr;ori experience inequities in heart health outcomes compared to rural non-M & amacr;ori and urban M & amacr;ori. Access to health care is a significant contributor to these inequities. There is a wealth of literature that explores M & amacr;ori access to health care; however, the voice of rural M & amacr;ori within the literature is limited. Under Te Tiriti o Waitangi (The Treaty of Waitangi), M & amacr;ori have legislative rights to access, engage, and participate in the health care system equitably.Aim This study aimed to investigate the barriers and facilitators of accessing heart health care for rural M & amacr;ori.Methods The study was informed by Kaupapa M & amacr;ori Theory, which centres on M & amacr;ori worldviews and epistemologies. Rural M & amacr;ori (n = 11) with lived experience of (or who had supported their wh & amacr;nau (family) member with) acute coronary syndrome, heart failure or cardiovascular risk assessment were interviewed, and reflective thematic analysis of the data was undertaken.Results Three overarching themes were generated: rural M & amacr;ori desires and expectations of heart health care; how the system engages with rural M & amacr;ori; and knowing what is important to rural M & amacr;ori when it comes to heart health.Discussion Participants experienced many barriers to accessing quality heart health care, some of which were unique to rural settings. Participants sought heart health care that was close to home, culturally responsive, included a representative M & amacr;ori workforce, involved their wh & amacr;nau, and valued partnership. System-level action is needed to adequately address inequities in health care access and outcomes in rural M & amacr;ori and to meet obligations under Te Tiriti o Waitangi.

The metaphor of a pipeline is used for rural medical workforces: the sections involve structured contact between high school students, rural physicians and universities; university admission schemes to increase rural student representation in medicine; rural exposure during medical training; and to retain a rural medical workforce upon graduation. Social capital is the benefit people gain from social networks, from both their relationships, and the resources those relationships provide, and is associated with positive physical and mental health and wellbeing. Rural communities generally have a greater sense of community and social involvement and cohesion than their urban counterparts. Relationships tend to be closer and stronger in rural communities with shared sense of identity, norms and understanding and hence greater social capital. There is evidence that social capital impacts on educational outcomes. Social capital factors tend to be enacted in-place, where the student is undertaking their learning. This paper draws on examples from the literature of different social capital interventions that can support the rural pipeline. We suggest that the flow of a rural medical workforce can be boosted by social capital and the analogy of a rural river may be more apt, with the banks of the river representing different locations of rural social networks and distanced medical schools. The student journey is represented by movement down the river, moving side to side on the banks, being in-place in different settings at different parts of the medical programme with different social capital factors at play.

INTRODUCTION:In New Zealand, lower immunisation coverage is seen among those of Māori and Pacific ethnicity, as well as in communities with higher levels of socioeconomic deprivation. However, the impact of rurality on routine childhood immunisations has been incompletely investigated. AIM:This study aims to measure the effect of rurality on second-dose measles-mumps-rubella vaccination (MMR2) within the Taranaki region. METHODS:This was a retrospective observational study using routinely collected health data. Participants were born in 2019, 2020, or 2021 and lived in the Taranaki region at age 24 months. Rurality was determined using the Geographic Classification for Health (GCH). The percentage of MMR2 coverage was calculated for each rurality grouping, and logistic regression was used to adjust for confounders. RESULTS:A total of 4596 participants were enrolled across three GCH levels. MMR2 coverage rates were 56.2% in the most rural group (R2 + 3), compared to 63.0% in R1 (Rural 1) and 62.3% in U2 (Urban 2). Adjusting for ethnicity and socioeconomic deprivation produced odds ratios (ORs) of 1.33 for R1 participants and 1.18 for U2 participants, compared to R2 + 3. It was also shown that Māori had lower immunisation coverage than non-Māori at every GCH classification. DISCUSSION:Children living in more rural areas had lower rates of MMR2 coverage at age 24 months. This may reflect inequitable impacts of the COVID-19 pandemic or uneven rollout of the 2020 changes to the National Immunisation Schedule.

The need for effective primary healthcare to address social and structural determinants of health and to mitigate health inequalities has been well established. Here, we report on the international forum of the 2023 NAPCRG (formerly known as North American Primary Care Research Group) Annual Meeting. The aim of the forum was to develop principles for action for the primary healthcare research community on addressing social and structural determinants of health. From this forum, 10 key recommendations for the primary care research community were identified.

Introduction Fundus examination by direct ophthalmoscopy is widely used in general practice; however, it offers limited field of view, requires close approximation to the patient, has a steep learning curve and is a difficult skill to master and maintain. Non-mydriatic fundus photography (NMFP) offers an alternative with a wider field of view, ability for image analysis and transmission, and is able to be conducted by allied healthcare staff.Aim This study aimed to compare the use of direct ophthalmoscopy with smart-phone NMFP in a large rural general practice. It also aimed to analyse the number of adequate views and positive findings achieved with each instrument and the impact of NMFP on ophthalmology referral decisions.Methods Patients aged ≥16 years presenting to Dargaville Medical Centre (Dargaville, New Zealand) with visual disturbance, headache, hypertensive urgency (systolic blood pressure (BP) >200 mmHg or diastolic BP >120 mmHg), transient ischemic attack (TIA) or stroke were enrolled prospectively into an observational study of visualisation, diagnosis and management impact for a 1-year period (n = 152, 304 eyes). Direct ophthalmoscopy findings and management plans were documented by the attending general practitioner (GP), and then again following assessment of the NMFP.Results NMFP significantly improved visualisation of the fundal structures with an increase in adequate views achieved of both the optic disc and the retina. Inter-rater agreement between the referring GP and ophthalmologist was good.Discussion The use of NMFP in general practice might result in greater accuracy in diagnosing retina and optic disc disease. Routine transmission of NMFP images to specialist eye clinics as part of the referral might improve management and result in health system efficiencies.

Community-based primary care, such as general practice (GP) or urgent care, serves as the primary point of access to healthcare for most Australians and New Zealanders. Coronavirus disease 2019 (COVID-19) has created significant and ongoing disruptions to primary care. Traditional research methods have contributed to gaps in understanding the experiences of primary care workers during the pandemic. This paper describes a novel research design and method that intended to capture the evolving impact of the COVID-19 pandemic on primary care workers in Australia and New Zealand. Recurrent, rapid cycle surveys were fielded from May 2020 through December 2021 in Australia, and May 2020 through February 2021 in New Zealand. Rapid survey development, fielding, triangulated analysis and dissemination of results allowed close to real-time communication of relevant issues among general practice workers, researchers and policy-makers. A conceptual model is presented to support longitudinal analysis of primary care worker experiences during the COVID-19 pandemic in Australia and New Zealand, and key learnings from applying this novel method are discussed. This paper will assist future research teams in development and execution of policy-relevant research in times of change and may inform further areas of interest for COVID-19 research in primary care.

Introduction: Health disparities between rural and urban areas in Aotearoa New Zealand are exacerbated by rural workforce issues. Traditionally, undergraduate medical programs are urban-based, and reconfiguring the curriculum to meet the needs of rural communities is challenging. The aim of this project is explore how urban-located universities might develop and implement a rural strategy. Evaluation of a rural strategy may lead to the strategy's ongoing improvements designed to increase the rural workforce. Methods: This is a qualitative study involving semi-structured interviews with purposively selected key stakeholders. Enquiry included the systematic identification of processes required to develop a rural strategy, including possible facilitators and challenges to be addressed. Qualitative analysis of de-identified data was conducted using a thematic approach. Results: Fourteen stakeholders were interviewed: four rural GPs, two rural hospital doctors, four administrators involved in placing students, and four senior medical academics with involvement in the regional and rural programs. Five overarching themes were identified: (1) developing rural pathways into medical school, (2) improving and expanding rural exposures, (3) developing rural GP pathways, (4) implementing interprofessional education and (5) having a social mission. Conclusion: These findings align with the literature relating to developing rural strategies for universities. However, this study also suggested that rural health interprofessional programs may have a role. A key finding was that the social mission of a university may not be visible to rural stakeholders. Reorientating an urban-located university to having a rural strategy requires moving past having policy around social accountability to operationalising it.

Introduction: Māori (the Indigenous Peoples of Aotearoa New Zealand) are disproportionately represented in cardiovascular disease (CVD) prevalence, morbidity and mortality rates, and are less likely to receive evidence-based CVD health care. Rural Māori experience additional barriers to treatment access, poorer health outcomes and a greater burden of CVD risk factors compared to Non-Māori and Māori living in urban areas. Importantly, these inequities are similarly experienced by Indigenous Peoples in other nations impacted by colonisation. Given the scarcity of available literature, a systematic scoping review was conducted on literature exploring barriers and facilitators in accessing CVD health care for rural Māori and other Indigenous Peoples in nations impacted by colonisation. Methods: The review was underpinned by Kaupapa Māori Research methodology and was conducted utilising Arksey and O'Malley's (2005) methodological framework. A database search of MEDLINE (OVID), PubMed, Embase, SCOPUS, CINAHL Plus, Australia/New Zealand Reference Centre and NZResearch.org was used to explore empirical research literature. A grey literature search was also conducted. Literature based in any healthcare setting providing care to adults for CVD was included. Rural or remote Indigenous Peoples from New Zealand, Australia, Canada, and the US were included. Literature was included if it addressed cardiovascular conditions and reported barriers and facilitators to healthcare access in any care setting. Results: A total of 363 articles were identified from the database search. An additional 19 reports were identified in the grey literature search. Following screening, 16 articles were included from the database search and 5 articles from the grey literature search. The literature was summarised using the Te Tiriti o Waitangi (Treaty of Waitangi) Framework principles: tino rangatiratanga (self-determination), partnership, active protection, equity and options. Themes elucidated from the literature were described as key drivers of CVD healthcare access for rural Indigenous Peoples. Key driver themes included input from rural Indigenous Peoples on healthcare service design and delivery, adequate resourcing and support of indigenous and rural healthcare services, addressing systemic racism and historical trauma, providing culturally appropriate health care, rural Indigenous Peoples' access to family and wellbeing support, rural Indigenous Peoples' differential access to the wider social determinants of health, effective interservice linkages and communication, and equity-driven and congruent data systems. Conclusion: The findings are consistent with other literature exploring access to health care for rural Indigenous Peoples. This review offers a novel approach to summarising literature by situating the themes within the context of equity and rights for Indigenous Peoples. This review also highlighted the need for further research in this area to be conducted in the context of Aotearoa New Zealand.

World PsychiatryVolume 22, Issue 2 p. 340-340 Letters to the EditorFree Access Antidepressants in primary care: limited value at the first visit Bruce Arroll, Bruce Arroll Department of General Practice and Primary Health Care, University of Auckland, Auckland, New ZealandSearch for more papers by this authorRachel Roskvist, Rachel Roskvist Department of General Practice and Primary Health Care, University of Auckland, Auckland, New ZealandSearch for more papers by this authorFiona Moir, Fiona Moir Department of General Practice and Primary Health Care, University of Auckland, Auckland, New ZealandSearch for more papers by this authorMatire Harwood, Matire Harwood Department of General Practice and Primary Health Care, University of Auckland, Auckland, New ZealandSearch for more papers by this authorKyle Eggleton, Kyle Eggleton Department of General Practice and Primary Health Care, University of Auckland, Auckland, New ZealandSearch for more papers by this authorChristopher Dowrick, Christopher Dowrick Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UKSearch for more papers by this authorPim Cuijpers, Pim Cuijpers Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The NetherlandsSearch for more papers by this author Bruce Arroll, Bruce Arroll Department of General Practice and Primary Health Care, University of Auckland, Auckland, New ZealandSearch for more papers by this authorRachel Roskvist, Rachel Roskvist Department of General Practice and Primary Health Care, University of Auckland, Auckland, New ZealandSearch for more papers by this authorFiona Moir, Fiona Moir Department of General Practice and Primary Health Care, University of Auckland, Auckland, New ZealandSearch for more papers by this authorMatire Harwood, Matire Harwood Department of General Practice and Primary Health Care, University of Auckland, Auckland, New ZealandSearch for more papers by this authorKyle Eggleton, Kyle Eggleton Department of General Practice and Primary Health Care, University of Auckland, Auckland, New ZealandSearch for more papers by this authorChristopher Dowrick, Christopher Dowrick Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UKSearch for more papers by this authorPim Cuijpers, Pim Cuijpers Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The NetherlandsSearch for more papers by this author First published: 09 May 2023 https://doi.org/10.1002/wps.21057 The authors are grateful to the Guideline Development Group, the Evidence Review Teams, and the External Review Group. This work was funded by the Wellcome Trust. The authors are responsible for the views expressed in this letter and, except for the specifically noted recommendations, they do not necessarily represent the decisions, policies or views of the WHO. The copyright of this letter belongs to the WHO. This is an open access paper distributed under the terms of the Creative Commons Attribution IGO License. AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL When patients with a depressive condition first visit a general practitioner, they often get the prescription of an antidepressant1. We think that it is better to prescribe medication at a later stage, if at all. Here we explain why. It is well known that most patients in primary care have mild to moderate depression, while severe depression is an exception. For example, we found that, among primary care patients in waiting rooms, 13% had a score on the Patient Health Questionnaire-9 (PHQ-9) between 9 and 11, which is above the threshold for major depression, but only 5% had a severe depression (PHQ-9 score higher than 14)2. There is also considerable evidence that the effects of antidepressants in mild and moderate depression are small, and may not be clinically relevant. In one individual patient data meta-analysis, the risk difference (percent response to medication minus percent response to placebo) was only 6% in mild depression, which corresponds to a number needed to treat (NNT) of 163. In very severe depression, the risk difference was 25% (NNT=4); in severe depression, it was 9% (NNT=11). These results were recently confirmed in a large individual patient data meta-analysis of 232 trials with more than 73,000 patients4. Furthermore, a recent pragmatic placebo-controlled trial confirmed that antidepressants are not very effective in patients with mild depression seen in primary care: with an average PHQ-9 score of 12, the NNT was only 12.55. It is also well known that many patients in primary care who use antidepressants are not willing to stop their medication, even when it is clearly not working, because they are afraid that they will get worse. Much of the confusion about the effects of medications in depressed patients seen in primary care is due to an earlier Cochrane review6, reporting that the NNT was 8.5 for tricyclic antidepressants and 6.5 for selective serotonin reuptake inhibitors, which would be considered a reasonable clinical effect by most clinicians. However, the problem with that review was that the included trials focused on patients with severe to very severe depression, thus being not representative of the majority of patients with depression seen in primary care. The above-mentioned meta-analyses and pragmatic trial provide a much better evidence of the effects of antidepressants in this population. Even for patients with more severe depression seen in primary care, antidepressants may not be the best treatment at the first visit. Many of the few patients who initially present in primary care with a severe depression get better over time with or without medication7. Indeed, the above-mentioned Cochrane review found a median response rate of 42% with pill placebo. So, what to do at the first visit in primary care with a patient who presents with a depressive condition? Most treatment guidelines, such as those of the National Institute for Health and Care Excellence (NICE), recommend watchful waiting or a psychological intervention before medication for mild to moderate depression, unless it is the person's preference to receive an antidepressant. Behavioural activation may be the best intervention8, but also other brief therapies specifically developed for this context, such as problem-solving therapies, may be good treatment options. It is less clear what should be done for severe depression at the first visit in primary care. The best strategy may be to reframe some of the negative cognitions of the patient and advice physical activity. In those who do not improve over the subsequent weeks, a psychotherapy or antidepressant medication should be considered. A recent meta-analysis showed that, at one-year follow-up, psychotherapies had better results than antidepressants9. This meta-analysis also found that a combination of psychotherapy and medication was better than either therapy alone. We conclude that most patients in primary care have mild to moderate depression, and that severe depression is an exception. Antidepressants should not be prescribed at the first visit if the patient has mild to moderate depression, because they have a limited efficacy and may have significant side effects. Antidepressant medication should be considered in severe depression, but not at the first visit and as an alternative to or in combination with a psychological intervention. References 1 Moir F, Roskvist R, Arroll B et al. J Fam Pract Prim Care 2022; 11: 2597- 602. 2 Arroll B, Goodyear-Smith F, Kerse N et al. J Prim Health Care 2009; 1: 26- 9. 3 Fournier JC, DeRubeis RJ, Hollon SD et al. JAMA 2010; 303: 47- 53. 4 Stone MB, Yaseen ZS, Miller BJ et al. BMJ 2022; 378:e067606. 5 Lewis G, Duffy L, Ades A et al. Lancet Psychiatry 2019; 6: 903- 14. 6 Arroll B, Chin W, Matris W et al. J Prim Health Care 2016; 8: 325- 34. 7 Chin WY, Chan KT, Lam CL et al. Fam Pract 2015; 32: 288- 96. 8 Ekers D, Webster L, Van Straten A et al. PLoS One 2014; 9:e100100. 9 Furukawa TA, Shinohara K, Sahker E et al. World Psychiatry 2021; 20: 387- 96. Volume22, Issue2June 2023Pages 340-340 ReferencesRelatedInformation

Introduction Key New Zealand ethical documents that describe appropriate ethical behaviour for doctors do not consider rurality and how this might impact on the practice of medicine. Aim The aim of this study was to understand the literature on key ethical issues experienced by general practitioners in a rural context that might inform the development of a New Zealand agenda of rural medical ethics Methods A rapid review was undertaken of three databases using a variety of key words relating to rurality, ethics, professionalism and medicine. Inclusion criteria were research articles focussing on the experience of doctors working in a rural healthcare setting, commentaries and narratives. The findings from the paper were synthesised and broad ethical categories created. Results Twelve studies were identified that met the inclusion and exclusion criteria. Synthesis of the data revealed five ethical issues that predominately arose from living and working within communities. These ethical issues related to juggling personal and professional lives, managing friendships with patients, managing loss of privacy and anonymity, assuring confidentiality and practicing outside of comfort zones. Discussion The majority of ethical issues arose from managing overlapping relationships. However, these overlapping relationships and roles are considered normal in rural settings. A tension is created between adhering to urban normative ethical guidelines and the reality of living in a rural environment. Professional ethical guidelines, such as those developed by the New Zealand Medical Council, do not account for this rural lived reality. Rural practitioners in New Zealand should be engaged with to progress a specific rural ethics agenda.

The education literature suggests that there are rural-urban differences in educational achievement. Lower educational achievement in rural schools may impact entry into highly competitive medical programmes and disadvantage rural students. Within this study, the National Certificate of Educational Achievement (NCEA) and University Entrance (UE) attainment rates are compared across Aotearoa New Zealand secondary schools for 2012-2021. High schools were classified as urban or rural according to the two rural admission schemes used in the medical programmes at the University of Otago and the University of Auckland. Descriptive statistics were calculated and regression models created to adjust for a range of variables. The data demonstrates that rural high schools have lower NCEA and UE attainment. Lower Maori student NCEA and UE attainment, greater socioeconomic disadvantage and differing characteristics account for the majority of differences between rural and urban schools. The lower UE attainment rate for rural schools will likely mean that rural students will have greater difficulty in entering medical programmes and that this inequity is worse for rural Maori students. Medical programme admission pathways need to undergo a fundamental shift-from workforce pathways to workforce and equity pathways in order to address rural workforce issues.

BACKGROUNDTelehealth involves real-time communication (telephone or video-call) between patients and health providers. The COVID-19 pandemic propelled general practitioners to conduct most consultations remotely, seeing patients face-to-face only when required. Placement opportunities and experience for medical students were reduced. Initially online learning programmes replaced clinical attachments. Subsequently, clinical teachers supervised students to engage in remote consultations, either in clinics or from their homes. This study aimed to explore the experience of New Zealand general practitioners undertaking clinical teaching with medical students when telehealth consulting.METHODSSemi-structured interviews with general practitioners who had taught medical students whilst consulting remotely. General inductive thematic analysis of transcribed interviews.RESULTSSix female and four male participants aged 40 to over 65 years. Participants often focused on general practicalities of telehealth consultations and effects on the patient-doctor relationship, and needed direction to consider remote consultations with students, which added to the interactions. Four themes were identified: changes needed in teaching delivery format; direct comparison with face-to-face; challenges and advantages to remote teaching, each with subthemes.DISCUSSIONClinicians needed to determine practical logistics and develop skills for both remote consulting and teaching. New format and structures of consultations needed planning. Differences from face-to-face teaching included scene-setting for the consultation and supervision factors. Telehealth teaching conferred new opportunities for learning but also challenges (e.g. consent, cues, uncertainty). Remote consultations are likely to remain a significant mode for doctor-patient interactions. Preliminary guidelines for teaching and learning using telehealth need to be developed and embedded into medical programmes and then evaluated.