Graeme Horton

Drought, drying and climate change: Emerging health issues for ageing Australians in rural areas

Older Australians living in rural areas have long faced significant challenges in maintaining health. Their circumstances are shaped by the occupations, lifestyles, environments and remoteness which characterise the diversity of rural communities. Many rural regions face threats to future sustainability and greater proportions of the aged reside in these areas.

Climate change: could it help develop ‘adaptive expertise’?

Preparing health practitioners to respond to the rising burden of disease from climate change is emerging as a priority in health workforce policy and planning. However, this issue is hardly represented in the medical education research. The rapidly evolving wide range of direct and indirect consequences of climate change will require health professionals to have not only broad content knowledge but also flexibility and responsiveness to diverse regional conditions as part of complex health problem-solving and adaptation. It is known that adaptive experts may not necessarily be quick at solving familiar problems, but they do creatively seek to better solve novel problems. This may be the result of an acquired approach to practice or a pathway that can be fostered by learning environments. It is also known that building adaptive expertise in medical education involves putting students on a learning pathway that requires them to have, first, the motivation to innovatively problem-solve and, second, exposure to diverse content material, meaningfully presented. Including curriculum content on the health effects of climate change could help meet these two conditions for some students at least. A working definition and illustrative competencies for adaptive expertise for climate change, as well as examples of teaching and assessment approaches extrapolated from rural curricula, are provided.

Effectiveness of a peer-mediated educational intervention in improving general practitioner diagnostic assessment and management of dementia: a cluster randomised controlled trial

Objective Test effectiveness of an educational intervention for general practitioners (GPs) on quality of life and depression outcomes for patients. Design Double-blind, cluster randomised controlled trial. Setting General practices in Australia between 2007 and 2010. Participants General practices were randomly allocated to the waitlist (n=37) or intervention (n=66) group, in a ratio of 1:2. A total of 2030 (1478 intervention; 552 waitlist) community-dwelling participants aged 75 years or older were recruited via 168 GPs (113 intervention; 55 waitlist). Interventions A practice-based academic detailing intervention led by a peer educator that included: (1) training in use of the GP assessment of cognition dementia screening instrument; (2) training in diagnosis and management based on Royal Australian College of General Practitioners Dementia Guidelines; (3) addressing GPs’ barriers to dementia diagnosis; and (4) a business case outlining a cost-effective dementia assessment approach. Outcome measures Primary outcome measures were patient quality of life and depression; secondary outcome measures were: (1) sensitivity and specificity of GP identification of dementia; (2) referral to medical specialists and/or support services; (3) patient satisfaction with care; and (4) carer quality of life, depression and satisfaction with care. Results The educational intervention had no significant effect on patient quality of life or depression scores after 12 months. There were however improvements in secondary outcome measures including sensitivity of GP judgement of dementia (p=0.002; OR 6.0, 95% CI 1.92 to 18.73), satisfaction with GP communication for all patients (p=0.024; mean difference 2.1, 95% CI 0.27 to 3.93) and for patients with dementia (p=0.007; mean difference 7.44, 95% CI 2.02 to 12.86) and enablement of carers (p=0.0185; mean difference 24.77, 95% CI 4.15 to 45.40). Conclusion Practice-based academic detailing did not improve patient quality of life or depression scores but did improve detection of dementia in primary care and patient satisfaction with GP communication. Trial registration number ACTRN12607000117415; Pre-results.

Promoting the Learning of Basic Sciences in a Changing Small-Group Learning Landscape. Interviews of tutors and students in a medical program

Tomorrow’s medical graduate needs to be equipped today to be able to make sense of continued advancements in medical science and then apply these to the benefit of patents and communities. It is important that current methods of teaching and learning in medical programs such as problem-based learning are subject to critical evaluation as to whether they are fit for purpose, and many medical programs are questioning whether problem-based learning provides adequate grounding in basic science. In this context, we interviewed twelve tutors and four students of one distributed medical program in order to explore their views on what elements of PBL promoted understanding of basic science. Our participants reported that setting a clear agenda about basic science learning was crucial; that tutor preparation and guides needed to take account of different tutor backgrounds; particular styles of prompting and questioning from the tutor were valuable; and that students could benefit from being primed with key introductory concepts about how basic sciences related to each other prior to commencing PBL. These findings will be useful for medical curriculum developers who are seeking to innovate with their curriculum but wish to retain what may be currently most valuable by stakeholders.

Student selection for medicine: Still a “Thorny” issue

Despite the growth in literature and concerted efforts on many fronts to improve the selection process for medicine, there remain a number of contentious issues. Medical schools worldwide need to consider the often disparate priorities of multiple stakeholders when selecting students. They seek to recruit students who are likely not only to succeed in their program but also need to meet their own and often their governments agenda to meet equity and workforce targets. Academic performance prior to medical school predicts academic success at medical schools and beyond, but if weighed too heavily will restrict access to disadvantaged groups. This article outlines the various components of medical student selection and describes the different contexts in which they are used. We aim for this to be an informative article for reference as medical school selection committees worldwide constantly evaluate whether admissions processes are fulfilling their criteria. Discussion among medical schools must surely improve efficiency and cross-cultural understanding in the global medical education environment to provide suitable doctors needed for the 21st century.