Malcolm Moore

What factors in rural and remote extended clinical placements may contribute to preparedness for practice from the perspective of students and clinicians

Background: Community-based rural education opportunities have expanded in Australia, attracting more medical students to placements in rural and remote settings. Aim: To identify the factors in an integrated, community-engaged rural placement that may contribute to preparedness for practice (P4P) from the perspective of students and clinicians. Method: Forty-two semi-structured interviews with medical students, supervisors and clinicians analysed thematically. Results: Opportunities for clinical learning, personal and professional development and cultural awareness were reported by students and clinicians as key factors that contribute to P4P. Potential barriers in rural and remote settings included geographical and academic isolation, perceived educational risk and differing degrees of program engagement. Conclusions: A longitudinal clinical placement in a rural setting may enable development of enhanced competencies leading to P4P. A rural setting can provide a unique experience through hands-on learning, enhanced personal and professional development opportunities and observation of the cultural and contextual impact on health.

Innovative training for rural medical students

Background:  Traditional approaches to curriculum delivery are primarily devoted to producing graduates who are proficient in their professional domain, leaving little time for interaction between disciplines. Rural doctors need to work closely with other health workers in the context of life in smaller communities.

Patients’ attitudes towards privacy in a Nepalese public hospital: a cross-sectional survey

BackgroundMany people in western countries assume that privacy and confidentiality are features of most medical consultations. However, in many developing countries consultations take place in a public setting where privacy is extremely limited. This is often said to be culturally acceptable but there is little research to determine if this is true. This research sought to determine the attitudes of patients in eastern Nepal towards privacy in consultations. A structured survey was administered to a sample of patients attending an outpatients department in eastern Nepal. It asked patients about their attitudes towards physical privacy and confidentiality of information.FindingsThe majority of patients (58%) stated that they were not comfortable having other patients in the same room. A similar percentage (53%) did not want other patients to know their medical information but more patients were happy for nurses and other health staff to know (81%). Females and younger patients were more concerned to have privacy.ConclusionThe results challenge the conventional beliefs about patients’ privacy concerns in Nepal. They suggest that consideration should be given to re-organising existing outpatient facilities and planning future facilities to enable more privacy. The study has implications for other countries where similar conditions prevail. There is a need for more comprehensive research exploring this issue.

ENRICHing the rural clinical experience for undergraduate health science students: a short report on inter-professional education in Broken Hill.

This paper depicts the development, implementation and ‘value-adding’ component of the Enhanced Rural Inter-Professional Cultural Health (ENRICH) Program. ENRICH is a unique program that complements the clinical competency focus of university curricula for health science students. The Broken Hill University Department of Rural Health (BHUDRH) hosts health science students from multiple Australian universities and offers a unique rural/remote placement experience. ENRICH was developed by BHUDRH in response to an identified need to broaden the perspectives of health science students and to encourage the incorporation of a holistic view of their patients within their practice.

The PAUL Suit(©) : an experience of ageing.

An ageing population worldwide makes it increasingly important that health students understand issues that elderly people face and can provide empathic care to them.

Initial resuscitation for Australasian Triage Scale 2 patients in a Nepalese emergency department

Objectives: Triage is recognized as important in providing timely care to emergency patients. However, systematic triage is only practised in two EDs in Nepal. The first objective of this study was to assess the performance of one of these departments in seeing triaged patients in a timely fashion. Second, an epidemiological survey of patients presenting to the ED was performed to describe the conditions seen and initial resuscitation undertaken.

Am I getting an accurate picture: a tool to assess clinical handover in remote settings?

BackgroundGood clinical handover is critical to safe medical care. Little research has investigated handover in rural settings. In a remote setting where nurses and medical students give telephone handover to an aeromedical retrieval service, we developed a tool by which the receiving clinician might assess the handover; and investigated factors impacting on the reliability and validity of that assessment.MethodsResearchers consulted with clinicians to develop an assessment tool, based on the ISBAR handover framework, combining validity evidence and the existing literature. The tool was applied ‘live’ by receiving clinicians and from recorded handovers by academic assessors. The tool’s performance was analysed using generalisability theory. Receiving clinicians and assessors provided feedback.ResultsReliability for assessing a call was good (G = 0.73 with 4 assessments). The scale had a single factor structure with good internal consistency (Cronbach’s alpha = 0.8). The group mean for the global score for nurses and students was 2.30 (SD 0.85) out of a maximum 3.0, with no difference between these sub-groups.ConclusionsWe have developed and evaluated a tool to assess high-stakes handover in a remote setting. It showed good reliability and was easy for working clinicians to use. Further investigation and use is warranted beyond this setting.

Handover training in the workplace: having a CHAT

Clinical handover is a core skill that needs to be learned by students and junior clinical staff to improve patient safety. Despite this, training is frequently lacking and of poor quality. A user‐friendly assessment tool can assist clinicians to provide training and feedback.

Holistic medicine provision in the outback.

155 T remote Australia since its inception in 1927. The service, founded by Reverend John Flynn, started as a single base at Cloncurry in Queensland and now operates out of 21 bases, providing both primary care clinics and emergency retrieval services. RFDS has been servicing clinics from its Broken Hill base since the 1940s; by 1970, there were three full-time doctors conducting the clinics and running the on-call service via the radio network. In 2016, Broken Hill doctors treated patients in 17 different clinic locations each month. On most weekdays, there are general practitioners at three clinic sites, along with dentists, nurses and mental health practitioners.

Attitudes of nepalese medical students toward telling patients a diagnosis of cancer.

Objectives: Patient-centered communication teaching generally encourages doctors to inform patients of cancer diagnoses. In many countries, including Nepal, it is usually the patients family that is informed. Much of the evidence about patient preferences is from western studies. The objectives of this study are: To discover the attitudes of medical students and patients in Nepal toward disclosing a cancer diagnosis; and to identify the reasons for these attitudes. Materials and Methods: A cross-sectional survey was administered to medical students and patients in a teaching hospital in Nepal. The participants were asked about their attitudes toward and reasons for informing patients of a cancer diagnosis. The data were analyzed to compare students’ and patients’ attitudes and to look for differences between the first and fourth year students. Results: Fifty-four percent of the students would inform a patient even if the cancer was incurable, 6% would inform only if curable, and 40% would inform the family instead. Sixty-nine percent of the students and 51% of the patients wanted a close relative informed, even if the relative was incurable (P = 0.0016). There was no significant difference between students (83%) and patients (78%) wanting to be informed of their own diagnosis. The most important reasons for students not informing the patients were fears of loss of hope and of causing depression. Conclusion: The results confirmed the diverse attitudes about informing a cancer diagnosis to patients, in Nepal. Students wanted more information for themselves than they felt patients should be given. This information could enlighten the practice of doctors in Nepal and other similar cultures, as well as guide the communication training of future doctors.