Patricia Rego

Rewards, costs and challenges: the general practitioner's experience of teaching medical students

Medical Education 2011: 45 : 722–730

Bullying in the Australian medical workforce: cross-sectional data from an Australian e-Cohort study

OBJECTIVE This study aimed to describe the prevalence of perceived workplace bullying in the Australian medical workforce, and investigate the relationship between workplace bullying and job satisfaction, health status, and current and planned medical workforce participation. METHODS An electronic cross-sectional survey of doctors currently in the paid workforce, conducted between April 2008 and October 2009, was nested within a longitudinal cohort study investigating factors affecting the recruitment and retention of the Australian medical workforce. To address the specific aims of this study, a subset of questions in the survey investigated the prevalence of self-reported bullying; physical and mental health; workforce participation patterns; job satisfaction; and job stressors. RESULTS Seven hundred and forty-seven participants responded to the bullying question and were included in this analysis. Twenty-five percent of participants reported being bullied in the last 12 months. There were no differences in the reported rates of bullying across age groups, sex and country of medical qualification. Bullied doctors were least satisfied with their jobs (P<0.001), had taken more sick leave in the last 12 months (P<0.001), and were more likely to be planning to decrease the number of hours worked in medicine in the next 12 months (P=0.01) or ceasing direct patient care in the next 5 years (independent of their age or the number of hours currently worked in patient care) (P=0.006). CONCLUSIONS Our findings suggest that Australian doctors, independent of age or sex, have experienced workplace bullying, and although no conclusions can be made about causal pathways, there were strong associations between this exposure and poorer health and wellbeing, and on remaining in the medical workforce.

Using a structured clinical coaching program to improve clinical skills training and assessment, as well as teachers' and students' satisfaction.

Introduction: The ability to deliver the traditional apprenticeship method of teaching clinical skills is becoming increasingly more difficult as a result of greater demands in health care delivery, increasing student numbers and changing medical curricula. Serious consequences globally include: students not covering all elements of clinical skills curricula; insufficient opportunity to practise clinical skills; and increasing reports of graduates’ incompetence in some clinical skills. Methods: A systematic Structured Clinical Coaching Program (SCCP) for a large cohort of Year 1 students was developed, providing explicit learning objectives for both students and paid generalist clinical tutors. It incorporated ongoing multi-source formative assessment and was evaluated using a case-study methodology, a control-group design, and comparison of formative assessment scores with summative Objective Structured Clinical Examination (OSCE) scores. Results: Students demonstrated a higher level of competence and confidence, and the formative assessment scores correlated with the Research students’ summative OSCE scores. SCCP tutors reported greater satisfaction and confidence through knowing what they were meant to teach. At-risk students were identified early and remediated. Discussion: The SCCP ensures consistent quality in the teaching and assessment of all relevant clinical skills of all students, despite large numbers. It improves student and teacher confidence and satisfaction, ensures clinical skills competence, and could replace costly OSCEs.

Clinical Location and Student Learning: Outcomes From the LCAP Program in Queensland, Australia

Background: Three students in the 3rd year of a graduate entry medical program self-selected to participate in a 1-year clinical placement, each with a rural general practitioner in central western Queensland, Australia. Description: Students completed 32 weeks in a rural generalist community immersion medical program and were compared with matched students who completed their year in urban tertiary hospitals. Evaluations included teaching and learning opportunities, assessment of clinical competencies, and semistructured interviews. Views of preceptors, spouses, and community were also evaluated. Evaluation: All outcome measures were positive and many were greater for the rural immersion students than for the matched urban group. Students were able to achieve the requirements of their medical program in a nontraditional placement. Views of preceptors indicated satisfaction with long-term medical student placements including enjoyment, negligible time or financial impact, and beneficial professional and collegial support. Conclusions: Long-term immersion placements benefited student learning and had a favorable impact on the preceptors.

IVIMEDS: a short report on an evaluation of the cardiovascular system learning module

Background: On-line learning technology can be used to present curricular material in a variety of formats to stimulate and support student learning in both content and potentially skills-based areas in medicine. In 2005, second-year medical students at the University of Queensland evaluated the IVIMEDS’ cardiovascular module, and were given access to all learning objects in the module. Aim: The study aimed to determine the value to students of the IVIMEDS’ Cardio-vascular System (CVS) module compared with existing CVS learning resources. Method: Research and control groups (n = 50 respectively) completed a 16-item questionnaire relating either to the IVIMEDS’ CVS module or to the existing CVS resources. Responses were analysed for common themes, and the performance of the control and research groups on the mid-year summative assessment results was compared. Results: Thirty-five students in the research group completed the IVIMEDS evaluation. Thirty-one-percent had difficulty learning to navigate the software, and 17% felt that they would have derived greater benefit with prior training. Students in the research group scored significantly higher on one question in the summative assessment than did students in the control group (F(66) = 2.1, p < 0.5). Qualitative data suggest that for students to fully accept the IVIMEDS’ material, it will be essential to ensure that students are fully aware of its place in the medical program so they are confident that by using it, they will be able to achieve the set learning objectives. Conclusions: The students appreciated the potential of the IVIMEDS’ cardiovascular module, but a full evaluation of the package would require that the module be presented at an appropriate time using an easily navigable system, after training in use of the software package.

Foot ulcer simulation training (FUST): are podiatrists FUST with long-term clinical confidence?

Background Foot ulcers are a leading cause of diabetes-related hospitalisations. Clinical training has been shown to be beneficial in foot ulcer management. Recently, improved selfconfidence in podiatrists was reported immediately after foot ulcer simulation training (FUST) pilot programs. This study aimed to investigate the longer-term impacts of the FUST program on podiatrists’ self-confidence over 12 months in a larger sample.

Rewards, costs and challenges: The experience of teaching medical students in general practice

Medical Education 2011: 45 : 722–730

Rewards, costs and challenges: the general practitioner’s experience of teaching medical students: Teaching medical students: the GP experience

Medical Education 2011: 45 : 722–730

Is simulation training effective in increasing podiatrists’ knowledge and confidence in foot ulcer management? A pilot study

Background Diabetic foot ulcers are commonly acknowledged as the most frequent reason for admission into hospital for diabetes-related complications. Clinical training is known to have a beneficial impact on diabetic foot ulcer outcomes. Simulation clinical training has rarely been used in the management of diabetic feet or chronic wounds. The few simulation courses in this area have focused solely on training for a single technical skill. This pilot study aimed to investigate the effect of a mixed modality simulation training program on podiatry participants’ clinical knowledge, confidence and satisfaction in the management of foot ulcers.