Objectives: To develop a valid rurality classification for health purposes in Aotearoa New Zealand (NZ) that is technically robust and incorporates heuristic understandings of rurality.Setting: Our Geographic Classification for Health (GCH) is developed for all of NZ.Participants: We examine the distribution of the entire NZ population across rurality classifications, and use the National Mortality Collection to examine previously masked rural-urban differences in mortality. Outcome measures: Unadjusted all-cause mortality rates and rural:urban incidence rate ratios (IRRs). Results: The GCH modifies key population and drive time thresholds in the generic rurality classifications, thereby identifying 19% of the NZ population as rural. Rural and urban all-cause mortality rates and associated rural:urban IRRs vary considerably depending on rurality classification. The GCH finds a rural mortality rate 21% higher than for urban areas.Conclusions: The GCH identifies a distinct rural population, and highlights rural-urban inequities that are masked by generic classifications.

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A B S T R A C TTargeted postgraduate training increases the likelihood young doctors will take up careers in rural generalist medicine. This article describes the postgraduate pathways that have evolved for these doctors in New Zealand. The Cairns consensus statement 2014 defined rural medical generalism as a scope of practice that encompasses primary care, hospital or secondary care, emergency care, advanced skill sets and a population-based approach to the health needs of rural communities. Even as work goes on to define this role different jurisdictions have developed their own training pathways for these important members of the rural healthcare workforce. In 2002 the University of Otago developed a distance-taught postgraduate diploma aimed at the extended practice of rural general practitioners (GPs) and rural hospital medical officers. This qualification has evolved into a 4-year vocational training program in rural hospital medicine, with the university diploma retained as the academic component. The intentionally flexible and modular nature of the rural hospital training program and university diploma allow for a range of training options. The majority of trainees are taking advantage of this by combining general practice and rural hospital training. Although structured quite differently the components of this combined pathway looks similar to the Australian rural generalist pathways. There is evidence that the program has had a positive impact on the New Zealand rural hospital medical workforce.

INTRODUCTION Point-of-care ultrasound (POCUS) is an increasingly common adjunct to the clinical assessment of patients in rural New Zealand. AIM To describe the scope of POCUS being practiced by rural generalist hospital doctors and gain insights, from their perspective, into its effect. METHODS This was a mixed-methods descriptive study. Main outcome measures were type and frequency of POCUS being undertaken. A questionnaire was given to POCUS-active rural hospital doctors to survey the effect of POCUS on clinical practice and assess issues of quality assurance. RESULTS The most commonly performed scans were: cardiac (18%) and volume scans (inferior vena cava and jugular venous pressure) (14%), followed by gallbladder (13%), kidney (11%), Focused Assessment with Sonography in Trauma (FAST) (7%), bladder (6%), leg veins (6%) and lungs (5%). There was large variation in frequency of scan types between the study hospitals that could not be accounted for by differences in training. The participating doctors considered that POCUS had a positive and significant effect on their practice, largely by adding to diagnostic certainty. Challenges identified included maintenance of POCUS skills, lack of systems for POCUS set-up and the absence of quality assurance for POCUS in rural hospitals. DISCUSSION Rural generalists consider the broad scope of POCUS they practise to be an important but challenging skill set. Clinical governance, including an agreed scope and standards, may increase the benefits and improve the safety of rural POCUS.