Alexia Papageorgiou

Triadic communication in the primary care paediatric consultation: a review of the literature.

BACKGROUND Children aged 6-12 years are usually seen in primary care with an adult carer. It is a government and professional priority for doctors to try and involve these children in their medical consultations. AIM To ascertain the evidence available on the amount and type of involvement that children in the 6-12 year age group have in their primary care consultations when the consultation was held with a child, a GP, and an adult. DESIGN OF THE STUDY Literature review. METHOD Data sources included MEDLINE, CINAHL, EMBASE, and ERIC, The Cochrane library, PsychINFO, Web of Science and Wilsons Social Science abstracts, hand searching for references, and contact with authors. RESULTS Twenty-one studies were selected for inclusion in the study. Children were found to have little quantitative involvement in their own consultations. They may take part during information gathering but are unlikely to participate in the treatment planning and discussion parts of the consultation. CONCLUSION Children in the 6-12 year age group have little meaningful involvement in their consultations.

Video analysis of communication in paediatric consultations in primary care

BACKGROUND There is a paucity of research evidence concerning communication in paediatric consultations between GPs, adults, and child patients. AIM This study was carried out to identify features of the interaction between a doctor, a child patient aged 6-12 years, and their carer in the consultation associated with the childs participation. DESIGN OF STUDY A qualitative analysis of video recordings of 31 primary care paediatric consultations was undertaken, using strategies from the methodology of conversation analysis. SETTING Primary care, Suffolk, UK. METHOD NHS GPs from three primary care trusts (PCTs), were invited to participate in this study. Sixteen volunteers from this sample took part. RESULTS Analysis of the interaction in the consultations revealed that the children had little involvement. Children participated when invited to do so, and took more time than adults to answer a doctors question. An adult carer was less likely to answer on behalf of a child, when they were in a position to see that the doctors gaze was directed at the child, and the doctor addressed the child by name. Adult carers, who had not voiced their own concerns first, were seen to interrupt doctor-child talk. In consultations where the participants sat in a triangular arrangement, all parties being an equal distance apart, triadic talk was noted. CONCLUSION Child involvement in the primary care consultation is associated with adult carers being able to voice their own concerns early in the consultation, and children being invited to speak with the appropriate recipient design.

The preparedness of newly qualified doctors – Views of Foundation doctors and supervisors

Abstract Background: There is evidence that newly qualified doctors do not feel prepared to start work. Aim: This study examined the views of first year Foundation doctors (F1) and supervisors regarding how prepared they felt newly qualified doctors were for the early weeks of work. Methods: Fifty-two F1s took part in a focus group or individual interview during their first year of Foundation training. Twenty-two supervisors took part in an individual interview. Results: The F1s struggled with new responsibilities, decision-making, time management, prioritizing tasks and the large administrative component to their role. They felt unprepared for making diagnoses, prescribing and acting in an emergency. Supervisors felt F1s were generally well prepared to start work, with skills improving through experience. However, F1s needed more practical experience with real patients and more opportunities to take responsibility, make decisions and perform some clinical skills. Supervisors did not feel that F1s accessed senior support appropriately. F1s indicated they preferred to go to peers for assistance in the first instance, and felt unsupported by seniors, particularly at weekends and on night shifts. Conclusions: Specific areas of unpreparedness were identified by both F1s and supervisors; leading to recommendations to enhance effective transition from medical student to F1.

Mediational Effects of Self-Efficacy Dimensions in the Relationship between Knowledge of Dengue and Dengue Preventive Behaviour with Respect to Control of Dengue Outbreaks:A Structural Equation Model of a Cross-Sectional Survey

Background Dengue fever is endemic in Malaysia, with frequent major outbreaks in urban areas. The major control strategy relies on health promotional campaigns aimed at encouraging people to reduce mosquito breeding sites close to peoples homes. However, such campaigns have not always been 100% effective. The concept of self-efficacy is an area of increasing research interest in understanding how health promotion can be most effective. This paper reports on a study of the impact of self-efficacy on dengue knowledge and dengue preventive behaviour. Methods and Findings We recruited 280 adults from 27 post-outbreak villages in the state of Terengganu, east coast of Malaysia. Measures of health promotion and educational intervention activities and types of communication during outbreak, level of dengue knowledge, level and strength of self-efficacy and dengue preventive behaviour were obtained via face-to-face interviews and questionnaires. A structural equation model was tested and fitted the data well (χ2 = 71.659, df = 40, p = 0.002, RMSEA = 0.053, CFI = 0.973, TLI = 0.963). Mass media, local contact and direct information-giving sessions significantly predicted level of knowledge of dengue. Level and strength of self-efficacy fully mediated the relationship between knowledge of dengue and dengue preventive behaviours. Strength of self-efficacy acted as partial mediator in the relationship between knowledge of dengue and dengue preventive behaviours. Conclusions To control and prevent dengue outbreaks by behavioural measures, health promotion and educational interventions during outbreaks should now focus on those approaches that are most likely to increase the level and strength of self-efficacy.

Acquire, apply, and activate knowledge: A pyramid model for teaching and integrating cultural competence in medical curricula

The importance of cultural competence in health care has been more acknowledged since modern societies are becoming increasingly multi-cultural. Research evidence shows that cultural competence is associated with improved skills and patient satisfaction, and it also seems to have a positive impact on adherence to therapy. Based on this evidence, the acknowledged importance of cultural competence and its poor integration into medical curricula, we present a pyramid model for building cultural competence into medical curricula whereby medical students can enhance their skills through acquiring, applying and activating knowledge.

A Psychology Problem-Based Curriculum

In this chapter, we will take a walk through the three years of the psychology problem-based curriculum we propose. We envision a three-year pure psychology course for a limited amount of students. It will require BPS (British Psychological Society) and APA (American Psychological Association) accreditation and stringent student entrance criteria. It will also provide value for money and an excellent preparation for professional graduate courses in clinical, educational and occupational psychology minimising attrition rates of students who undertake graduate psychology training in the above professional areas. We hope our readers will share our vision that this course could provide excellent preparation for a number of graduates who will look for employment in sectors who care for the elderly. We will achieve this by enabling students to reach deep understanding of different human interactions (normal vs abnormal) through problem-based learning (PBL) cases backed up by exposure to clinics, schools, work and other relevant environments. As the students progress from year one to years two and three, the complexity of the course will increase in terms of knowledge acquisition, difficulty of PBL cases and student placements in working environments (e.g. working with people with learning disabilities, chronically mentally ill and elderly people with dementia).

Problem-Based Learning

In this chapter, we introduce problem-based learning (PBL). We begin by briefly discussing some of the theory behind the process and why it is used throughout the world in many university courses. How it works in practice is described at length, using an example of a short case to illustrate the process. The two main forms of PBL are described — short case and progressive release — and the use of virtual patient PBL is touched upon. Finally, common issues, or frequently asked questions, about PBL are discussed.

Student Assessment in a Problem-Based Curriculum

In this chapter, the basic principles behind a successful, fair and reliable assessment will be discussed. The following will be addressed: context (including whether summative or formative, high stakes or low stakes); reliability and the importance of having assessment criteria and marking schemes; the importance of sampling and blueprinting; validity (including content, face, consequential and criterion validity); generalisability; standard setting; assessor training; and the importance of having a programme of assessment. Types of assessments which can be used are described, and these are illustrated with examples in the field of psychology. Finally, an outline of assessments which could be used in the course described in this book is presented.

Sample Problem-Based Learning Cases in Psychology

In the previous chapters, we were introduced to the content of a PBL psychology course with figures and tables outlining its structure and clearly defining the themes and the modules of the entire course. This chapter outlines two PBL psychology cases, and each of these cases are presented in the short and long case (progressive release) format. The first case is from Year 1, Beginning of Life Cycle module, week one, and covers normal aspects of child development. The second case is from Year 2, Meet the World Module, week 14, and focuses on abnormal aspects of development. For the short cases, the tutor notes and a mind map are presented while for the long cases tutor notes and learning objectives (LOBs) that need to be generated during the PBL session are inserted.

The Development of Undergraduate Psychology Degrees and the Need for Change

As is the case with any scientific discipline, the exploration of psychology from a historical perspective seems to be that of development and advancement of knowledge and research methodology. However, as Shiraev (2014) so eloquently described it, this history does not necessarily follow the path of a straight line. As a result, areas of psychological investigation throughout time were considered and explained from different perspectives (Fancher & Rutherford, 2012). For example, initially psychology was regarded as part of the wider philosophical enquiry into what constitutes behaviour; at other times, it was seen as the means by which to understand the possible interrelation between body and mind. Most contemporary references to psychology consider it to be the discipline that encompasses theories, knowledge and skills that can contribute to the better understanding of human behaviour (Gross, 2010). Moreover, it is considered as the specialty that, where applicable, may help with the modification or elimination of undesirable behaviours, thereby aiding in the establishment of desirable, functional and socially acceptable behaviours. These are the general beliefs and perceptions of psychology without delving into the expectations of more specialised fields of the discipline such as clinical, educational, occupational or forensic psychology, where the demands are usually more refined and specific.