Kim Oates

Personality development following sexual abuse.

Thirty-seven girls and twelve boys who had been sexually abused at an average of 2.6 years previously were traced and reviewed. The nonoffending parents participated in a structured interview and the children were assessed using the Piers-Harris Self-Concept Scale and the Achenbach Child Behavior Checklist. Each child was matched with a child not known to have been sexually abused and these control children underwent a similar psychological assessment. Interviews with the nonoffending parents found that 76% of the children were thought to be less confident than before, 30% had fewer friends, and 20% were more aggressive. Increased sexual awareness was noted in 24%. School teachers reported that 28% still had behavior problems, 17% had repeated a year at school, and a further 17% had deteriorated in their school work. The sexually abused girls had significantly lower self-esteem than the control girls. There was no difference in self-esteem between the control and the sexually abused boys. There was a higher incidence of stranger assault in the boys compared with the girls. The Child Behavior Checklist completed by the parents, the Teacher Report Form, and the Youth Self-Report of the Child Behavior Checklist showed that a highly significant proportion of sexually abused children fell into the clinical range. Sexual abuse appears to have long-term adverse consequences for many of the victims. This may have implications for their ability to relate to others, for the adult friendships they will make, and eventually for the way they will relate to their own children.

Children's memories for stressful and non-stressful events.

Two groups of children aged between 4 and 12 years were studied to look at the effect of stress, time and type of questioning on memory. One group comprised 17 children having a blood sample taken as part of their medical care. The other group of 24 children were studied after reacting with a friendly stranger at their school. Memory was tested either four to ten days after the event or after three to six weeks. Memory was assessed by free recall, by questioning with cues, by structured questions, by leading or misleading questions and by asking the children to identify the blood-collection technician or friendly stranger from a photographic line-up. There was no difference between memory for the stressful or non-stressful events. The older children performed better in free recall although what the younger children did recall was highly accurate. The use of cues facilitated recall in all age groups. Children aged four to six years were less accurate than those aged seven to 12 years when objective questioning was used. Errors were more likely to be errors of omission than of commission in all age groups. Memory was less accurate after the longer time interval. With increasing interest in the reliability of children as witnesses, methods need to be found which will enable the child witness to give the maximum amount of accurate information. Those likely to be working with the child witness need to develop skills in talking with young children.

Children's memory of events: effects of stress, age, time delay and location of interview

To examine the ability of children aged between 4 and 12 years to recall a stressful event (venipuncture) compared with a non-stressful event (demonstration of venipuncture), recall was tested after 6-8 weeks. Half also had recall tested after 2-7 days. Testing took place where the stressful event occurred (n=122) or at a neutral location (n=127). Children who experienced the stressful event were less likely to give inaccurate responses in free recall or to acquiesce to suggestive misleading questions. Apart from incorrect responses in free recall, correct responses increased and incorrect responses decreased with increasing age. Recall after 2-7 days was superior to recall after 6-8 weeks. Those who had an early and a late interview had better recall at the late interview than those who had a late interview only. The location of interview showed no effects on recall.

Breaking the Long Silence: Reports of Child Sexual Abuse in the Anglican Church of Australia

In the last 15 years, there has been extensive study of the problem of child sexual abuse in the Catholic Church. However little is known about the issue of child sexual abuse in other Churches. This article reports on a retrospective study of 191 cases of complaints of child sexual abuse in the Anglican Church of Australia. The accused were clergy, other employed pastoral staff and volunteers helping in church run programs for children and young people between 1990 and 2007. Three quarters of all complainants were male. On average, it took men 25 years to bring forward a complaint, compared with 18 years for women. Males were also less likely than females to report the abuse during childhood. Likely reasons for delay in reporting included threats made at the time and lack of family support for the complainant, particularly boys. Media reporting of child sexual abuse in the Church was a major factor in encouraging victims to come forward. The study demonstrates the need for all churches to develop programs to deal with historic child sexual abuse. There is little reason to think that the major surge of complaints of historic abuse is now over.

Role modelling of clinical tutors: a focus group study among medical students

BackgroundRole modelling by clinicians assists in development of medical students’ professional competencies, values and attitudes. Three core characteristics of a positive role model include 1) clinical attributes, 2) teaching skills, and 3) personal qualities. This study was designed to explore medical students’ perceptions of their bedside clinical tutors as role models during the first year of a medical program.MethodsThe study was conducted with one cohort (n = 301) of students who had completed Year 1 of the Sydney Medical Program in 2013. A total of nine focus groups (n = 59) were conducted with medical students following completion of Year 1. Data were transcribed verbatim. Thematic analysis was used to code and categorise data into themes.ResultsStudents identified both positive and negative characteristics and behaviour displayed by their clinical tutors. Characteristics and behaviour that students would like to emulate as medical practitioners in the future included:1) Clinical attributes: a good knowledge base; articulate history taking skills; the ability to explain and demonstrate skills at the appropriate level for students; and empathy, respect and genuine compassion for patients.2) Teaching skills: development of a rapport with students; provision of time towards the growth of students academically and professionally; provision of a positive learning environment; an understanding of the student curriculum and assessment requirements; immediate and useful feedback; and provision of patient interaction.3) Personal qualities: respectful interprofessional staff interactions; preparedness for tutorials; demonstration of a passion for teaching; and demonstration of a passion for their career choice.ConclusionExcellence in role modelling entails demonstration of excellent clinical care, teaching skills and personal characteristics. Our findings reinforce the important function of clinical bedside tutors as role models, which has implications for faculty development and recruitment.

The new clinical leader

The complexity and cost of health care, along with a greater need for accountability calls for a new style of clinical leadership. The new clinical leader will lead reform by putting the needs of the patient first and foremost, looking at current and planned services from the patients point of view as well as the clinicians. Excellent clinical skills will remain essential but will be supplemented by a focus on team work and mentoring, patient safety, clear communication and reduction in waste and inefficiency, leading to better financial outcomes. The new clinical leaders will understand the importance of consulting widely and engaging colleagues in creating change to improve patient care. They will develop trusting and mutually respectful relationships with health service management and be able to negotiate the delicate balance between clinical judgement, resource constraints and personal loyalties by keeping the best outcome for the patient at the forefront of their thinking.

Physical punishment of children: Can we continue to accept the status quo?

All children require discipline, although physical punishment is just one form of discipline. Parental use of physical punishment is inter‐generational. There is now evidence that physical punishment of children is not only less effective than other forms of discipline but can also lead to aggressive behaviour in childhood and adult life. Twenty‐nine countries, including New Zealand, have laws against physical punishment in the home. Australian attitudes are slowly changing in favour of less use of physical punishment, but there is a long way to go. As advocates for children, paediatricians should not be content to accept the status quo.

How to select the doctors of the future.

Although previous academic performance is acknowledged as the best predictor of achievement in medical school, no one has succeeded in finding a selection method which will choose students who will become doctors with the qualities the community expect. Australian medical schools use various selection methods. It could well be argued that the most important phase in the selection process is informed decision‐making by potential applicants. More effort should be made by medical schools to achieve this.

Patient safety teaching in Australian medical schools: a national survey

Objective To measure perceptions of Australian medical students and staff about whether key Learning Topics included in the National Patient Safety Education Framework (NPSEF) are being taught and what challenges to patient safety teaching are thought to be operating. Methods A cross-sectional survey of medical deans, educators and students was conducted in 2010. Twenty of twenty-one Australian medical schools participated. Using a five-point Likert scale, respondents rated whether patient safety topics were taught in their medical school and challenges to including patient safety in the curriculum. Results There were 2413 eligible responses: deans (or nominees) (n = 14); medical educators (n = 98); and medical students (n = 2301). There was most agreement that teaching occurred about communicating effectively (8% neutral or disagreed) and least agreement that there was teaching about adverse events and near misses (35% neutral or disagreed). Deans, educators and students responded positively about available champions and expertise and negatively to the curriculum being too full to include patient safety. There were consistent differences between the responses of the stakeholder groups (P < 0.0005 in a non-parametric test). Deans were more positive than educators, who were more positive than students. Conclusions Strong variability between perceptions of Learning Areas reveals opportunities for improvement in teaching about patient safety, especially in the area of recognizing and addressing adverse events and risks. Consistent differences across stakeholder groups reveal disparities in the perceptions of the teachers and their students. The results indicate targets for improving patient safety learning and closing the feedback loop between students and staff.

Can we believe what children tell us

It’s a great honour to be able to give the Howard Williams Oration. When I looked at the distinguished list of previous orators, it made me approach the task with some trepidation. But I also approached it with delight because Howard Williams had been a great encouragement to me in my early years and this is an opportunity to acknowledge his contribution to Australian paediatrics I want to start with what I have learned about child abuse, particularly the long-term consequences, how recent research is starting to provide an explanation for some of the things we have observed in the past and then move to the topic of this presentation, ‘Can we believe what children tell us?’