Karen M. Scott

Objectives: To explore the perspectives of medical students in diverse clinical settings to enhance understanding of the sustained, system-wide effects of flooding on health systems. Design: A qualitative descriptive study using interviews and focus groups (17 April − 12 May 2023). Data were first analysed using inductive content analysis, and an analytical framework was then developed through an iterative process. The analysis and interpretation were refined with input from co-authors, including clinicians based in the region during and after the flooding events. Setting: Rural area of the Northern Rivers region, New South Wales, Australia, 14 months after major river flooding in 2022. Participants: Medical students undertaking rural clinical placements who were in the region after the flooding event. Results: Of the 39 students in the cohort, 32 (82%) participated. Four key domains of ongoing impact were identified: community, health services, clinicians, and broader social and physical environments. Ten categories emerged, highlighting the breadth of ongoing impacts. These included community psychological trauma, disruptions to health services, staffing challenges, and delays in patient discharge. Significant psychological impacts on healthcare workers were observed, with burnout affecting the delivery of medical education. Displacement was found to limit both access to healthcare and broader health outcomes. Additionally, the floods disproportionately affected socially vulnerable groups, and delays in government housing support contributed to ongoing stress within affected communities. Conclusion: Our findings demonstrated that catastrophic flooding disrupted health service delivery and community wellbeing, with impacts including psychological trauma, workforce strain, displacement, and disproportionate effects on socially vulnerable groups, as well as consequences for medical education. They highlight the importance of supporting medical students to reflect on and learn from these experiences. The analytical framework developed, grounded in student perspectives and consistent with clinician experiences, contributes to the foundation for future research, intervention design, and preparedness planning.

Background: In 2020, the Sydney Medical School introduced the ‘Personalised Pathways’ (PP) program in Year 2 of the medical curriculum. The PP aimed to provide students with access to specific specialty areas and an opportunity to individualise their educational experience at an early stage. The role this program plays in student career preference is not well understood. We sought to explore students' engagement and experience of the placement and gain an understanding of how it may influence their views of specialities, the role of the consultant and career intentions. Approach: In 2023, 220 PP placements were offered to Year 2 students ( n = 254) across six teaching hospitals as an optional activity. In total, 122/254 (48%) students applied for a PP; of these, 103/122 (84%) gained a placement. Students attended an individualised PP for 4 h each week across 12 weeks. Evaluation: Qualitative data were collected by survey, reflecting on students' perception of the placement, the role of the consultant and potential influence on career choice. Data were coded and categorised into themes. In total, 24/103 (23%) students responded to the survey, reporting an increased awareness of specialty career pathways, lifelong learning requirements and work–life balance. The PP also provided insight into the breadth of the consultants' leadership role and teaching responsibilities. Implications: Implementation of the personalised pathway provided valuable opportunities that students appreciated being afforded early on. Notably, it gave some students a reason to rethink their career choice, while others found the experience reinforced their initial plans regarding career pathway intentions.

Background: Technology‐enhanced learning (TEL) can promote knowledge consolidation and retention, feedback and active learning. There are scant data on how broad TEL usage affects assessment in clinical rotations. Through learning analytics, we investigated TEL usage patterns in a paediatric medicine term, examining associations with student characteristics and assessment results. Methods: TEL usage measures were extracted from virtual learning environment access logs for an in situ sample of 266 students who completed all assessments. The dataset included 38 measures that summarised 116,518 website accesses and 10,033 hours, reduced by principal components analysis to 12 independent TEL summary measures, input to K‐means cluster analysis to identify usage patterns. Chi‐square and analysis of variance were used to analyse differences in TEL usage clusters according to student characteristics and assessment results. Results: A three‐cluster K‐means solution was the best fit for identifying TEL usage patterns with associated assessment results: ‘Conscientious’ (25.9% students; high TEL usage, high duration, high assessment results); ‘Savvy’ (54.55% students; selective TEL usage, moderate duration, good assessment results); ‘Borderline’(19.6% students; low TEL usage, low duration, low assessment results). Although demographic differences were nonsignificant ( p > 0.05), the ‘Conscientious’ cluster included more females and international students and the ‘Borderline’ cluster included more males and domestic students. Conclusions: We identified three TEL usage patterns that corresponded with assessment results in paediatrics. TEL usage review could enable early identification of at‐risk students. While research in other disciplines would strengthen the results, embedding learning analytics into education programmes through dashboards, synchronous feedback and resource evaluation is recommended.

Objectives: Although the health impacts of floods are well described, there is limited research on how flooding affects health systems, services and the health workforce—despite their central role in mitigating and responding to these impacts. This scoping review examines the nature and extent of existing research evidence on the impact of flooding events on Australia’s health system. Design: A scoping review following the Johanna Briggs Institute methodology. Data sources: MEDLINE, Embase, CINAHL, Scopus, Web of Science, ProQuest Central and PsycINFO were searched through to 22 October 2024. Reference lists of included publications were screened for additional publications. Eligibility: We included studies that reported any health system or health service disruption associated with flooding in Australia. Disruptions encompassed impacts on hospitals, primary care, health information systems, infrastructure, public health and health promotion activities, and the health workforce. We included peer-reviewed publications, including original research, commentaries, perspectives, editorials, letters to the editor, modelling studies and reviews. Grey literature was excluded. Data extraction and synthesis: Screening of full texts and data extraction were completed by two independent reviewers. A health system disruption analytical framework was iteratively developed and was used to categorise the findings. Results: Our search identified 6687 publications, of which 28 were included in the final review. 13 publications were original research publications and 15 were commentaries or reviews, with the majority published in the past ten years. Of the publications included, most focused on disruptions to hospital services and transport systems, including a reduction in health workforce availability, primarily due to the latter. Less than one-third reported impacts on health services for socially vulnerable populations. Floods affect multiple levels of the health system, intersecting with impacts across three key domains: infrastructure and health information systems, access to healthcare and the health workforce. Conclusions: Original research on how floods impact Australia’s health system, its services and workforce has been limited, particularly in relation to general practice, allied health and the differential impacts on socially vulnerable populations. Further research is needed to inform targeted disaster preparedness and response strategies and to understand the complex and intersecting impacts. The analytical framework developed in this review provides a way to conceptualise how floods disrupt different components of the health system and offers a foundation for future research and policy development to strengthen system resilience in the face of increasing flood risk.

With more people turning to the unregulated environment of the internet for health information, digital health literacy is increasingly important to assess trustworthiness of online health information. Adolescents’ digital health literacy has long been overlooked because of the false assumption that they possess advanced skills due to being raised in a digital age. It is important that adolescents are given opportunities to develop their digital health literacy, however there is a lack of relevant educational resources, especially self-directed online resources. With adolescents, we co-designed a digital health literacy educational resource. In this study we aimed to evaluate its effectiveness at enhancing adolescents’ digital health literacy. The study utilised a pre/post mixed-method design with 12–17-year-olds. One-on-one video conference meetings were held with participants. Participants completed a digital health literacy self-assessment survey and practical search task before and after using the brief educational resource misAdventures (10–15 min), then completed an evaluation survey. Survey data were analysed using descriptive statistics; the search task was analysed using an observational checklist; inductive content analysis of qualitative data identified key themes in search and appraisal behaviours. For most of the 30 participants, there was a general increase in self-assessed digital health literacy post-intervention. Improvements in appraising the trustworthiness of online health information were seen across multiple search and appraisal skills, including choosing government or official health websites and cross-checking information. Most participants combed through search engine results listings to identify trustworthy sources rather than relying on Google suggestions or the top search result. Some skills, such as investigating bias, were not demonstrated pre- or post-intervention. Evaluation survey results indicated the app was easy to use (100% agreement), with 90% of participants reporting they could see they were learning while using the app and it would change how they use online health information. Use of the co-designed educational resource misAdventures improved adolescents’ digital health literacy and self-efficacy. Adolescents acknowledged they learnt through using the app and believed it would change the way they used online health information. A brief, self-directed digital educational resource can improve adolescents’ ability and disposition to identify trustworthy health information online and on social media.

Background: Surging Australian medical student numbers over the past two decades have strained hospital teaching capacity, impacting student exposure to paediatric surgery. Aim: Improving access to education in paediatric surgery for medical students by creating an online learning module and evaluating its efficacy. Methods: To determine learning needs, we conducted two medical student focus groups in September 2018 and anonymous evaluation surveys, using 5‐point Likert scales. Using feedback, local curricula guidelines and curricula from other medical schools, medical educators and paediatric surgeons created an online self‐directed learning module, implemented in October 2018. Post‐implementation, we used mixed methods to assess effectiveness, including additional focus groups the following month and evaluation surveys. Pre‐ and post‐intervention assessment results were compared. We analysed quantitative data using descriptive statistics and qualitative data using inductive content analysis. Results: Over the study period there were 919 students. Eighteen participated in pre‐implementation focus groups. Sixteen participated in post‐implementation focus groups. There were 109 student feedback survey responses. Pre‐implementation, there was dissatisfaction with paediatric surgical teaching, including inadequate framework, inconsistencies in teaching quality, and inequity in teaching quantity. Post‐implementation, students exhibited high levels of satisfaction with teaching quality and quantity. Conclusion: The online learning module improved access to, and satisfaction with, paediatric surgery learning, enabling equitable distribution of educational material. There may be a broader role for online learning for undergraduate surgical education, particularly where there are accessibility issues, but further research and analysis are required.

Digital media is ubiquitous in adolescents’ lives and provides many opportunities to engage with health information. However, there is an increased risk of engaging with inaccurate or biased health information on the internet, resulting in poor health-related behaviours. As such, adolescents would benefit from improving their digital health literacy (DHL). There are limited education tools in DHL that are interactive and relatable for adolescents. A co-design approach can incorporate adolescents’ perspectives in designing an education tool to ensure its relevance. This study aimed to determine the effectiveness of the co-design approach in creating an educational resource designed to improve adolescents’ DHL. Three workshops were conducted with adolescents (12–17 years) to explore their DHL habits and education needs, evaluate an existing DHL educational app, co-design new storylines to better meet their needs and beta test the expanded resource. Data was collected through creation of storyboards, annotated posters and worksheets. Data analysis of these artefacts was undertaken through content analysis to identify themes and sub-themes. Forty-four participants attended two co-design workshops. Participants preferred using video-based social media and considered using artificial intelligence (AI) tools for extracting online health information. They designed storylines involving health topics such as dietary supplements, fitness and mental health. Storylines focused on identifying trustworthy online health information sources and dealing with concerns regarding scams, social media influencers and misinformation conveyed by parents. Eight participants who attended the beta-testing workshop positively evaluated the app as engaging and relatable. This study clarified the DHL educational needs of adolescents. In particular, it demonstrated the need to include other media literacies, the use of AI tools and interactions with family in the resource to maximise relevance to adolescents. The co-design methodology was useful for understanding adolescents’ DHL lived experiences and developing an engaging educational resource to help them navigate and appraise online health information.