Julie Ash

Outcomes of longitudinal integrated clinical placements for students, clinicians and society

Medical Education 2012: 46: 1028–1041

Long-term Outcome after Corneal Transplantation: Visual Result and Patient Perception of Success

Snellen acuity, reading line, and keratometry were measured in a cohort of 60 patients at 2 or more years after penetrating keratoplasty was performed. Patients were asked to complete a questionnaire to elicit information on their perceptions of visual function and the success of the procedure. Using preferred correction, a Snellen acuity of 6/18 or better was achieved by 65%, and a reading line of N8 or better was achieved by 57% of index grafts. Thirty-eight percent had more than 5 diopters (D) of astigmatism in the graft. Approximately 75% of patients reported satisfaction with their graft (satisfaction being associated with better acuity in the grafted eye than the other eye), graft clarity, and a perceived improvement in lifestyle. Dissatisfaction appeared to be associated with graft failure and problems with contact lens wear. The findings have implications for patient selection for corneal transplantation and for the measurement of outcome.

Leukocytes in the Graft Bed Associated with Corneal Graft Failure: Analysis by Immunohistology and Actuarial Graft Survival

Immunohistochemical staining analysis using monoclonal antibodies was performed on 107 recipient corneas removed at graft. There were significantly more infiltrating cells bearing one or more of the leukocyte-common antigen, class II major histocompatibility complex antigens, various myeloid-lineage markers, and a peripheral T cell marker, in the graft beds of those recipients who subsequently lost a corneal graft than there were in the graft beds of those for whom the outcome was successful. The hypothesis that large numbers of leukocytes in the recipient graft bed would be correlated with subsequent graft failure was examined by actuarial graft survival analysis. Recipients whose corneas contained fewer than 50 leukocyte-common antigen-positive cells/mm2 of corneal stroma showed a 3-year actuarial graft survival of 83%, compared with 39% in those whose corneas contained more than 50 such cells/mm2. The corneal leukocyte count was a particularly useful prognostic indicator of outcome in those patients judged clinically to be at risk of graft failure.

Assessing tomorrow's learners: In competency-based education only a radically different holistic method of assessment will work. Six things we could forget

In this paper we are challenging six traditional notions about assessment that are unhelpful when designing ‘assessment for learning’-programmes for competency-based education. We are arguing for the following: Reductionism is not the only way to assure rigour in high-stakes assessment; holistic judgements can be equally rigorous. Combining results of assessment parts only because they are of the same format (like different stations in an OSCE) is often not defensible; instead there must be a logically justifiable combination. Numbers describe the quality of the assessment. Therefore, manipulating the numbers is usually not the best way to improve its quality. Not every assessment moment needs to be a decision moment, disconnecting both makes combining summative and formative functions of assessment easier. Standardisation is not the only route to equity. Especially with diverse student groups tailoring is more equitable than standardisation. The most important element to standardise is the quality of the process and not the process itself. Finally, most assessment is too much focussed on detecting deficiencies and not on valuing individual student differences. In competency-based education – especially with a focus on learner orientation – this ‘deficiency-model’ is not as well aligned as a ‘differences-model’.

The context of clinical teaching and learning in Australia

Gaining clinical experience for an extended period of time in teaching hospitals is one of the enduring strengths of medical education. Teaching hospitals have recently faced significant challenges, with increasing specialisation of services and workload pressures reducing clinical learning opportunities. New clinical teaching environments have been established in Australia, particularly in rural and regional areas; these are proving to be ideal contexts for student learning. The new clinical teaching environments have shown the importance of developing symbiotic relationships between universities and health services. Symbiotic clinical learning is built around longitudinal, patient‐based learning emphasising priority health concerns. The symbiotic framework provides a basis for reconstructing clinical teaching in teaching hospitals so that they continue to play a vital role in Australian medical education, with additional clinical experience provided by primary care and community, rural and regional hospitals.

Understanding clinical teaching in times of change

At Flinders University, the introduction of problem-based learning (PBL) tutorials into the clinical program within a new PBL-based medical curriculum had been difficult for the Department of Surgery, stirring up considerable discontent. To understand this phenomenon of change better, a group of 18 surgeons who had responded to interview invitations were asked what clinical teaching meant to them and how they saw their role as clinical The success of any change in clinical education depends on what that change means to clinical teachers Clinical teachers

Stakeholder views of rural community-based medical education: a narrative review of the international literature.

Rural community‐based medical education (RCBME), in which medical student learning activities take place within a rural community, requires students, clinical teachers, patients, community members and representatives of health and government sectors to actively contribute to the educational process. Therefore, academics seeking to develop RCBME need to understand the rural context, and the views and needs of local stakeholders.