Kf Rooney

Enhancing international medical graduates’ communication: the contribution of applied linguistics

International medical graduates (IMGs) make up one‐third of the Australian medical workforce. Those from non‐English‐language backgrounds can face cultural and communication barriers, yet linguistic support is variable and medical educators are often required to provide feedback on both medical and communication issues. However, some communication difficulties may be very specific to the experiences of IMGs as second language users.

Developing a patient focussed professional identity: an exploratory investigation of medical students’ encounters with patient partnership in learning

Patient encounters are central to the provision of learning opportunities for medical students and their development as medical professionals. The primary aim of the study reported in this paper was to discover how partnering medical students with patients with chronic illness in undergraduate learning influenced the development of a patient centred professional identity and professionalism. An exploratory interpretive research design was used to address the research aim within a patient partner program (P3). Three qualitative data collection methods were used: (1) focus groups (2) extended response questionnaire and (3) semi-structured interviews. Data were coded and analysed thematically. The professional identity of medical students is constructed along traditional lines in the preclinical years. Patient-partnership offers a disruption to this development by way of an intersection with patients with chronic illness which potentially allows meaningful construction of what a patient-centred identity should be. This point of reflection provides an opportunity to engage at a higher level in medical identity development and professionalism. The findings discussed in this paper further stimulate the patient-centred agenda by understanding the conflict associated with the student–patient nexus in medical education and its potential for building professionalism and a patient-centred professional identity. To continue the drive for a patient-centred professional identity there must be ongoing engagement with patients in medical education, preferably commencing early in a student’s journey so that it becomes the expected norm. This study has highlighted that a true patient-centred emphasis is being encountered too late in their socialisation process.

Committing to patient-centred medical education

Regular encounters of patients and medical students in a managed and structured consultation format, to focus on partnership in health care and chronic illness management, can address the student learning and professional development requirements facing contemporary medical education.

Sustainable involvement of real patients in medical education : thanks to volunteerism and relationship management

Our experience with patient-centred teaching partnerships, which have involved weekly activities over the last 4 years, has clearly shown that real, volunteer community patients participate freely and willingly in the medical education of senior medical students. In total, 200 patient partners participate in our Patient Partner Programme (P3), thereby highlighting the fact that volunteerism – social capital harnessed for education – can and does ensure sustainable patient-centred teaching and learning opportunities for students. Other recent opinions endorse the promotion of a louder patient voice in medical education to ensure the output of more patientcentred doctors. How do we best do that? Nestel et al. used volunteers differently to P3, by writing simulated roles for them; however, we support their acknowledgement of the contribution and value that volunteers provide to medical education in various programmes and add our voice to the suggestion that real community patients are an under-utilised resource whose greater involvement should be fostered and input sought.

Building the community of patient‐centred care practice across all sectors of health care and health professional education

complications and medication errors. Similar to these two studies, Von Laue et al. describes the majority of adverse events as operative or drug errors. Presumably, nowhere in the literature is misinterpretation of ‘abnormal’ results mentioned as integral to adverse events and medical errors. ‘Incorrect or delayed diagnosis’ and ‘incorrect or delayed therapy’ have been approximated to contribute to 8.1% and 7.5% of medical errors, respectively, but the specifics of these definitions are unclear and poorly defined. Of great concern is that these ill-defined categories (‘Incorrect or delayed diagnosis’ and ‘incorrect or delayed therapy’) are highly preventable and/or associated with negligence (56–94%), and often leave patients with permanent disability (35–47%). Given this enormous burden, more research and education should focus on identifying and reducing mistakes concerning the interpretation of patient data and results. At the very least, high-quality health care is that which does not harm patients, especially through medical errors. On any given day, doctors are incessantly barraged with large quantities of patient data and information. Although most of these results are ‘normal’ and deemed insignificant, a few are flagged as ‘abnormal’ to alert potential deterioration. Reacting hastily to these ‘abnormal’ results without considering the clinical context has enormous potential to harm our patients. To preserve our patients’ health, it is essential that more attention and effort be devoted to treating sick patients than ‘sick’ numbers.

An imatinib-only window followed by imatinib and chemotherapy for Philadelphia chromosome-positive acute leukemia: long-term results of the CMLALL1 trial

Abstract We report long-term results in 40 patients with Philadlephia chromosome-positive (Ph+) acute leukemia who received an imatinib monotherapy window to evaluate in vivo effects on BCR–ABL signaling prior to induction chemotherapy. The first 25 patients (cohort 1) received the LALA-94 protocol without further imatinib (newly diagnosed Ph+ acute lymphoblastic leukemia [ALL]) or induction chemotherapy followed by single-agent imatinib. Subsequent patients (cohort 2) continued imatinib concurrently with either LALA-94 (newly diagnosed Ph + ALL) or other intensive chemotherapy regimens. Cohort 2 had a complete response (CR) rate of 93% and 5-year survival of 69%. For newly diagnosed Ph+ ALL, survival was superior in cohort 2 compared with cohort 1. Toxicity was similar to that expected for chemotherapy alone. Among 10 evaluable patients, rapid loss of phospho-CRKL occurred during the imatinib window in seven patients (all achieved CR) and incomplete inhibition in three patients (none with CR). In summary, a pharmacodynamic window design permitted biomarker assessment of BCR–ABL targeting without compromising clinical outcomes.

Successful rituximab therapy in the treatment of refractory cold haemagglutinin disease with long-term disease control.

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