Despite being an efficacious method of pain relief in labour, 1 regional analgesia is used in approximately a third of Australian labours (36%), 2 compared to Canada and the USA (approximately 60%) 3,4 and the UK (approximately 15%). 5 Australian data suggest that a pre-labour intention to use pharmacological options 6 and prior positive experience 7 were associated with an increased epidural preference. Data from outside of Australia suggest that perception of pain, 8,9 personal and peer experience 10,11 and desire for a natural birth 12 may contribute to women's labour analgesia preferences. However, these factors are subject to cultural influences. Therefore, to provide effective counselling and support for women locally to make informed decisions, it would be beneficial

The aim of the study was to determine the training needs of doctors managing emergencies in rural and remote Australia. A systematic review of Australian articles was performed using MEDLINE (OVID) and INFORMIT online databases from 1990 to 2016. The search terms included 'Rural Health', 'Emergency Medicine', 'Emergency Medical Services', 'Education, Medical, Continuing' and 'Family Practice'. Only peer-reviewed articles, available in full-text that focussed on the training needs of rural doctors were reviewed. Data was extracted using pre-defined fields such as date of data collection, number of participants, characteristics of participants, location and study findings. A total of eight studies published from 1998 to 2006 were found to be suitable for inclusion in the analysis. Six studies cited the results of self-reported questionnaires and surveys, one used a telephone questionnaire on a hypothetical patient and one utilised a theoretical examination. The studies found a significant proportion of participants wanted more emergency training. Junior rural doctors were found to have deficiencies in knowledge about stroke. Emergency skills doctors wanted more training including: emergency ultrasound, paediatric/neonatal procedures and cricothyroidotomy. However, many of the studies were performed by training providers that may benefit from deficient results. Given that the data was over 10 years old and that advances have been made in knowledge, training opportunities and technology, the implications for current training needs of rural doctors in Australia could not be accurately assessed. Thus there is a need for further research to identify current training needs.

Objective: This study aimed to explore doctors' perceptions of the training needs of rural doctors in the context of managing emergencies in rural North Queensland. Design: Using a qualitative approach, 20 semistructured interviews were conducted via telephone, video conference and in-person. Using an interview guide, areas such as preparedness of junior doctors for rural practice, areas for further training and confidence with managing emergencies were discussed. Interviews were analysed using the principles of grounded theory. Participant recruitment continued until data saturation was achieved. Setting: Multiple health facilities across three hospital and health services in North Queensland. Participants: (i) Doctors with current or recent work in rural North Queensland; (ii) doctors involved with rural medical training; and (iii) emergency medicine specialists working in a tertiary referral centre. Main outcome measure: Perspectives of doctors on the training needs of rural doctors in North Queensland. Results: Rural doctors were found to be as prepared as they could be to take up rural practice; however, they still had training needs. Region-specific emergencies, access to regular in-house simulations and nonmedical challenges, including understanding local team dynamics and taking on a team leader role, were seen as key training needs. Senior doctors indicated that further formal and informal on-the-job training were required for provisional fellows with limited experience in the emergency department. Conclusion: Certain training needs of rural doctors still remain unmet. Further access to in-house simulations and tele-training could be useful strategies to meet these training needs to further support rural doctors.