Jenepher Martin

DETERMINING NORMAL VALUES FOR INTRA-ABDOMINAL PRESSURE

Background:  Intra‐abdominal pressure (IAP) measurements can be used for the early detection and management of the abdominal compartment syndrome. IAP values are widely thought to be atmospheric or subatmospheric. However, there are no reports that describe normal IAP values using urinary bladder pressure measurements in patients not suspected of having a raised IAP level. This study sought to determine these normal values to aid our interpretation of IAP measurements in post‐surgical patients or patients with suspected increased IAP.

Bridging the gap: from simulation to clinical practice.

There has been a shift from the initial learning of skills on patients in the clinical setting to initial learning in a simulated environment, using part‐task models, with the risk of a task focus to the learning. We contend that quality learning in both the simulated and the clinical environment is crucial to enhance the transferability of skills to the clinical setting.

Effectiveness of patient feedback as an educational intervention to improve medical student consultation (PTA Feedback Study): study protocol for a randomized controlled trial

BackgroundOral feedback from clinical educators is the traditional teaching method for improving clinical consultation skills in medical students. New approaches are needed to enhance this teaching model. Multisource feedback is a commonly used assessment method for learning among practising clinicians, but this assessment has not been explored rigorously in medical student education. This study seeks to evaluate if additional feedback on patient satisfaction improves medical student performance.MethodsThe Patient Teaching Associate (PTA) Feedback Study is a single site randomized controlled, double-blinded trial with two parallel groups.An after-hours general practitioner clinic in Victoria, Australia, is adapted as a teaching clinic during the day. Medical students from two universities in their first clinical year participate in six simulated clinical consultations with ambulatory patient volunteers living with chronic illness. Eligible students will be randomized in equal proportions to receive patient satisfaction score feedback with the usual multisource feedback and the usual multisource feedback alone as control. Block randomization will be performed. We will assess patient satisfaction and consultation performance outcomes at baseline and after one semester and will compare any change in mean scores at the last session from that at baseline. We will model data using regression analysis to determine any differences between intervention and control groups. Full ethical approval has been obtained for the study. This trial will comply with CONSORT guidelines and we will disseminate data at conferences and in peer-reviewed journals.DiscussionThis is the first proposed trial to determine whether consumer feedback enhances the use of multisource feedback in medical student education, and to assess the value of multisource feedback in teaching and learning about the management of ambulatory patients living with chronic conditions.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613001055796.

Development of the surgical science examination of the Royal Australasian College of Surgeons surgical education and training programme: putting the chicken before the egg

Basic science knowledge is a foundational element of surgical practice. Increasing surgical specialization may merit a reconsideration of the ‘whole‐body’ approach to basic science curriculum in favour of specialty specific depth. The conundrum of depth or breadth of basic science curriculum is currently being addressed by the Royal Australasian College of Surgeons, which introduced a new surgical education and training programme for nine surgical specialties in 2008. This paper describes an innovative solution to the design of a basic science curriculum in the nine different surgical specialty streams of this programme. The task was to develop a curriculum and rigorous assessment in basic sciences to meet the needs of the training programme, for implementation within the first year. A number of political/cultural and technical issues were identified as critical to success. To achieve a robust assessment within the required time frame attention was paid to engagement, governance, curriculum definition, assessment development, and implementation. The pragmatic solution to curriculum and assessment was to use the existing assessment items and blueprint to determine a new curriculum definition and assessment. The resulting curriculum comprises a generic component, undertaken by all trainees, and specialty specific components. In a time critical environment, a pragmatic solution to curriculum, applied with predetermined, structured and meticulous methodology, allowed explicit definition of breadth for the generic basic science curriculum for surgical training in Australia and New Zealand. Implicit definition of specialty specific‐basic science curricula was through the creation of a blueprinted assessment.

Training general practitioners in flexible sigmoidoscopy to screen for colorectal cancer

Background:  A screening programme to detect polyps or early carcinoma would significantly reduce the mortality and morbidity of colorectal cancer (CRC). The aims of the present study were to evaluate: (i) the feasibility of training general practitioners in flexible sigmoidoscopy (FS) for CRC screening; (ii) the acceptability of screening by faecal occult blood testing (FOBT) and FS in asymptomatic standard risk Australians aged over 50 years; and (iii) the yield of such screening.

Searching for a written patient feedback instrument for patient–medical student consultations

Objective The Patient Teaching Associate (PTA) program at Eastern Health Clinical School uses volunteer patients with chronic illnesses in consultation-based medical student education. The PTA program aims to develop students’ patient-centeredness and associated skills. Our study aims, 1) to identify key desirable characteristics of written patient feedback to doctors and/or students that focuses on patient-centeredness in consultations, and 2) to critically evaluate existing instruments to identify any suitable instrument for use for medical student teaching. Methods We reviewed our experience with the PTA program and explored the literature on patient-centeredness and patient feedback to identify desirable characteristics of written feedback for our program. A systematic search was conducted to identify existing patient feedback instruments. These were then evaluated in light of criteria based on desirable characteristics. Results Eight instruments met the inclusion criteria. While all were designed for patient use, none were ideal for the PTA program. The Doctors’ Interpersonal Skills Questionnaire (DISQ), while not used with medical students, is the closest fit to criteria. Conclusion The lack of instruments specifically designed for written patient feedback to medical students highlights a gap in the current literature. Practice implications The DISQ provides a good basis for developing a new feedback instrument focused on patient-centeredness in medical students.

Improving ambulatory patient-centred practice with a patient teaching associate programme.

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