Nick Cooling

Retention of knowledge and perceived relevance of basic sciences in an integrated case-based learning (CBL) curriculum

BackgroundKnowledge and understanding of basic biomedical sciences remain essential to medical practice, particularly when faced with the continual advancement of diagnostic and therapeutic modalities. Evidence suggests, however, that retention tends to atrophy across the span of an average medical course and into the early postgraduate years, as preoccupation with clinical medicine predominates. We postulated that perceived relevance demonstrated through applicability to clinical situations may assist in retention of basic science knowledge.MethodsTo test this hypothesis in our own medical student cohort, we administered a paper-based 50 MCQ assessment to a sample of students from Years 2 through 5. Covariates pertaining to demographics, prior educational experience, and the perceived clinical relevance of each question were also collected.ResultsA total of 232 students (Years 2–5, response rate 50%) undertook the assessment task. This sample had comparable demographic and performance characteristics to the whole medical school cohort. In general, discipline-specific and overall scores were better for students in the latter years of the course compared to those in Year 2; male students and domestic students tended to perform better than their respective counterparts in certain disciplines. In the clinical years, perceived clinical relevance was significantly and positively correlated with item performance.ConclusionsThis study suggests that perceived clinical relevance is a contributing factor to the retention of basic science knowledge and behoves curriculum planners to make clinical relevance a more explicit component of applied science teaching throughout the medical course.

Promoting clinical reasoning in general practice trainees: role of the clinical teacher

Background:  Clinical reasoning requires knowledge, cognition and metacognition, and is contextually bound. Clinical teachers can and should play a key role in explicitly promoting clinical reasoning.

Prescribing of psychotropic medication for nursing home residents with dementia: a general practitioner survey

Objective The aim of this study was to identify factors influencing the prescribing of psychotropic medication by general practitioners (GPs) to nursing home residents with dementia. Subjects and methods GPs with experience in nursing homes were recruited through professional body newsletter advertising, while 1,000 randomly selected GPs from southeastern Australia were invited to participate, along with a targeted group of GPs in Tasmania. An anonymous survey was used to collect GPs’ opinions. Results A lack of nursing staff and resources was cited as the major barrier to GPs recommending non-pharmacological techniques for behavioral and psychological symptoms of dementia (BPSD; cited by 55%; 78/141), and increasing staff levels at the nursing home ranked as the most important factor to reduce the usage of psychotropic agents (cited by 60%; 76/126). Conclusion According to GPs, strategies to reduce the reliance on psychotropic medication by nursing home residents should be directed toward improved staffing and resources at the facilities.

Learning global health: a pilot study of an online collaborative intercultural peer group activity involving medical students in Australia and Indonesia

BackgroundThere is limited research to inform effective pedagogies for teaching global health to undergraduate medical students. Theoretically, using a combination of teaching pedagogies typically used in ‘international classrooms’ may prove to be an effective way of learning global health. This pilot study aimed to explore the experiences of medical students in Australia and Indonesia who participated in a reciprocal intercultural participatory peer e-learning activity (RIPPLE) in global health.MethodsSeventy-one third year medical students (49 from Australia and 22 from Indonesia) from the University of Tasmania (Australia) and the University of Nusa Cendana (Indonesia) participated in the RIPPLE activity. Participants were randomly distributed into 11 intercultural ‘virtual’ groups. The groups collaborated online over two weeks to study a global health topic of their choice, and each group produced a structured research abstract. Pre— and post-RIPPLE questionnaires were used to capture students’ experiences of the activity. Descriptive quantitative data were analysed with Microsoft Excel and qualitative data were thematically analysed.ResultsStudents’ motivation to volunteer for this activity included: curiosity about the innovative approach to learning; wanting to expand knowledge of global health; hoping to build personal and professional relationships; and a desire to be part of an intercultural experience. Afer completing the RIPPLE program, participants reported on global health knowledge acquisition, the development of peer relationships, and insight into another culture. Barriers to achieving the learning outcomes associated with RIPPLE included problems with establishing consistent online communication, and effectively managing time to simultaneously complete RIPPLE and other curricula activities.ConclusionsMedical students from both countries found benefits in working together in small virtual groups to complement existing teaching in global health. However, our pilot study demonstrated that while intercultural collaborative peer learning activities like RIPPLE are feasible, they require robust logistical support and an awareness of the need to manage curriculum alignment in ways that facilitate more effective student engagement.

Early predictors of summative assessment performance in general practice post-graduate training: A retrospective cohort study

Abstract Background: Success in summative general practice (GP) training assessments is one indicator of competence for practice. Early-training factors predictive of outcomes would facilitate targeted interventions aimed at preventing candidate failures. Methods: We undertook a retrospective cohort study of Australian GP trainees in two training organizations over five years. Associations of pre-training and early-training predictors with summative examination scores in an Applied Knowledge Test (AKT), Key Features Paper (KFP), and Objective Structured Clinical Examination (OSCE), plus failure on any one of these, were tested via univariate and multivariable regression. Predictors were program-entry selection-score decile, pre-training-commencement multiple choice assessment (MCQA), direct observation of practice performance, and clinical supervisor reports. Results: On univariate analyses, selection decile and MCQA were associated with all outcomes except AKT. There were no associations of other predictors with any outcomes. On multivariable analysis, selection decile and MCQA performance were predictive of OSCE performance. MCQA performance was also predictive of KFP performance. On multivariable analysis, no predictors were associated with AKT performance or failing any examination. Conclusions: Selection decile and pre-commencement MCQA performance were predictive of performance in some summative assessments. These findings could inform selection policies and targeted early interventions for trainees at most risk for exam failure.

Health and Well-Being of International University Students, and Comparison with Domestic Students, in Tasmania, Australia

International students comprise an increasingly larger proportion of higher education students globally. Empirical evidence about the health and well-being of these students is, however, limited. We sought to examine the health and well-being of international students, primarily from Asian countries, attending the University of Tasmania, Australia, using domestic students as a comparison group. Ethics approval was given to invite (via email) all currently enrolled students to participate in the study by completing a pilot-tested, online survey. The survey was completed by 382 international students (response rate = 8.9%) and 1013 domestic students (9.2%). Independent samples t-tests, analysis of variance (ANOVA) and chi-square tests were used for bivariate comparisons between international and domestic students, and between subgroups of international students. Regression models were used to examine the associations between student status (international vs. domestic) and health outcomes, controlling for demographic and enrolment variables. International students, particularly male students, were found to be at increased risk of several adverse health outcomes while also being less likely to seek help for mental health and related problems. The findings indicate the need for accessible, targeted, culturally-sensitive health promotion and early intervention programs.

The effectiveness of student-run organizations within global health promotion initiatives

Introduction: This commentary describes a student-led project that distributed long-lasting insecticide-treated nets in Masaka, Uganda. The role of student-led initiatives in global health promotion projects is also discussed. Methods: A survey of 213 net recipients was conducted after a 12-month period to evaluate malaria prevention knowledge, and net use and maintenance. Results: Only 4.7% of recipients could not recall any malaria prevention methods. Seventy percent of pregnant women and 86.5% of children under five slept under a net the previous night. Only two households (0.9%) no longer possessed a net, and nets were not used in 2.3% of houses. Household observation revealed 17.4% of nets had at least one problem that would compromise effectiveness. Conclusions: Student-led projects can play an important role in effectively preventing malaria. However coordination with existing programs, targeting hard-to-access groups, and training of students overcomes some common limitations of such student-led initiatives.