E Warnecke

A randomised controlled trial of the effects of mindfulness practice on medical student stress levels.

Medical Education 2011: 45: 381–388

Barriers to lifestyle risk factor assessment and management in hypertension: a qualitative study of Australian general practitioners

Hypertension is a leading cause of mortality and disease burden worldwide, yet its management remains suboptimal. Identification and management of lifestyle risk factors should be a clinical priority in all patients because of the beneficial effects of lifestyle intervention on blood pressure. The objective of this qualitative focus group study was to identify barriers to lifestyle management in hypertension in Australian general practice. Purposeful sampling was used to select large group practices. Six focus groups (n=30) were audio recorded and transcribed. An iterative thematic analysis was conducted. Overall participants felt they had the required knowledge to provide broad lifestyle advice. However, cynicism dominated due to an overwhelming lack of success in practice. Patient reluctance and ambivalence were identified as major barriers but participants were willing to share the responsibility. Other barriers included time, reduced access to allied health and broader determinants of health. General practitioners need to be empowered to allow continuation of valuable lifestyle advice and counselling. The results emphasise the importance of ongoing lifestyle assessment and tailoring of management to the complex interplay of factors that impact on a patient’s ability to adopt and maintain lifestyle change. System issues need to be addressed to provide better streamlined care.

The efficacy of medical student selection tools in Australia and New Zealand

Objectives: To estimate the efficacy of selection tools employed by medical schools for predicting the binary outcomes of completing or not completing medical training and passing or failing a key examination; to investigate the potential usefulness of selection algorithms that do not allow low scores on one tool to be compensated by higher scores on other tools.

Research: Why aren’t more medical students doing it?

Background: Many medical schools in Australia and Internationally struggle to engage medical students along a research pathway. Aims: The aim of this study was to identify medical student’s confidence, attitudes and perceived obstacles to participating in research during medical school. Methods: A cross-sectional survey was carried out of undergraduate medical students in years 1–5 attending the University of Tasmania. Results: Of the 237 students who responded to the survey (response rate of 41.9 per cent) the majority (70.3 per cent) agreed that research was a useful experience and expressed a desire to be involved in research (60.1 per cent). Women were generally less confident than men in their ability to conduct research while research experience was significantly associated with an increase in confidence in conducting research. Frequently endorsed reasons by students for not undertaking an Honours year were a desire to not delay graduation by a year for financial (79 per cent) and employment reasons (71 per cent) and social concerns regarding integrating with a different year group (69 per cent). Additional concerns included a lack of time and motivation. Conclusion: The difficulties inherent for students in undertaking research including low confidence, lack of time, financial constraints and pressure to get out into the workforce should help to inform medical educators in developing solutions to encourage student participation in research.

8 BARRIERS TO LIFESTYLE DISCUSSIONS IN HYPERTENSION: A QUALITATIVE STUDY OF AUSTRALIAN GENERAL PRACTITIONERS

Background: Despite hypertension being a leading cause of mortality and disease burden worldwide its management remains suboptimal. Lifestyle interventions have significantly beneficial effects on hypertension such that lifestyle risk factors should be identified and managed in all patients regardless of blood pressure measured. Design and methods: Six focus groups involving 30 general practitioners (GPs) were conducted. Focus groups were audio recorded and transcribed verbatim. An iterative thematic analysis was conducted. This paper, which aims to identify barriers specifically to lifestyle risk factor management in hypertension in Australian general practice is drawn from our previous work which identified and explored barriers to managing hypertension in general1. Results: Although participants felt they had the broad knowledge and skills required to provide lifestyle advice and counselling, they described an overwhelming lack of success in practice. Participants described the complex interplay of factors that impact on a patients ability to adopt and maintain lifestyle change. Patient ambivalence and reluctance were identified as major barriers, but interestingly GPs described shared responsibility for their patients failure. Other barriers included time constraints, inability to provide regular follow-up, lack of access to allied health practitioners, and broader determinants of health. Conclusion: There is a need to improve the self-efficacy of GPs so they continue to provide valuable lifestyle advice and counselling. The results emphasise the importance of ongoing lifestyle assessment and tailoring of management appropriate to the patients readiness to change. System issues exist and need to be addressed to better streamline provision of care. ReferencesHowes F, Hansen E, Williams D, Nelson MR. A qualitative study of barriers to initiating treatment in hypertension and treating to target levels in primary care. Australian Family Physician 2010; 39(7):511-516.