Background: Despite a paucity of evidence to guide teaching about medical professionalism and eth... more Background: Despite a paucity of evidence to guide teaching about medical professionalism and ethical issues, there is a widespread consensus that medical students should learn about these issues on clinical placements. Exploring the confidence of general practitioners (GPs) in teaching various topics will identify areas for further discussion, support and/or training. Methods: A survey was developed and distributed to 65 teaching practices. Thirty-seven GPs responded by rating their confidence in teaching about 32 different ethical issues. Results: Overall, GPs were confident in teaching about these issues. Confidence was lowest for doctors' social and political responsibilities; ethical lapses in colleagues; impairment in colleagues; cross-cultural issues; and moral motivation, judgement, courage and sensitivity. Discussion: Further training for GP teachers may be particularly useful in the important areas of impairment and lapses in colleagues, and cross-cultural issues. Uncertainty about the scope of doctors' social and political responsibilities may limit GP confidence in teaching in these areas.
IntroductionFeedback may play out in the general practice workplace less usefully than anticipate... more IntroductionFeedback may play out in the general practice workplace less usefully than anticipated by educators. We investigated work‐based feedback conversations about directly observed student tasks embedded in the supervisor's clinical consultations with patients.MethodsFeedback conversations between GP teachers and medical students and subsequent student reflections were audio‐recorded. Student and GP teacher focus groups were also conducted and transcribed professionally. An iterative, qualitative descriptive analysis integrating all transcripts was undertaken. Findings are discussed under the descriptive categories of feedback structure, content and perceived value.ResultsTwenty feedback conversations (total duration of 85 min) between five GP teachers, nine students and 20 student reflections (total duration of 58 min) were analysed. GP teachers actively engaged students in reflection and used balancing scripts and soft correction strategies. Students appeared to have some difficulty steering feedback conversations, which focused more on general skills than case‐specific content knowledge. The recorded conversations were fragments of ongoing, in‐practice teaching and learning, explicit and implicit. Student reflections suggested that they were able to grasp learning points effectively and identify room for growth. Praise and positive self‐feedback appeared to reassure students, particularly when they were disappointed by their performances.DiscussionFormal ‘set‐piece’ feedback conversations may be a useful opportunity to explicitly surface and/or reinforce previous ‘in‐practice’ reflection and feedback using a systematic structure. They may also reassure and encourage students and foster positive educational alliances. Students value in‐practice and on‐practice feedback but may prefer more control of the latter conversations.
Medical professionals are in an ideal position to mediate between the benefits and harms of inter... more Medical professionals are in an ideal position to mediate between the benefits and harms of internet-sourced medical information, but there is reluctance by patients to discuss with their doctors information found online. This is the first study undertaken in a rural Australian context, where service limitations mean patients’ use of the internet may be especially important. Patients attending general practice clinics (n = 33) were interviewed to discover how they used the internet for health information and how they discussed this with their doctors. Analysis used a constant comparison method, informed by grounded theory and a dramaturgical framework. Most participants used a range of tactics when discussing internet-sourced medical information, including concealment, disguise or upfront apologetic disclosures to avoid undermining the expertise of the doctor. These findings do not confirm predictions made in the past that patients’ acquisition of internet health information would alter the power dynamic of the medical consultation. Potentially, proactive, doctor-initiated inquiry about internet medical information may help to normalise patients’ internet use, allowing open discussion, so doctors can maximise benefits and reduce harms of internet health information. Further study is required to see if this will be an effective strategy and impact health outcomes.
Aim: To explore ethical challenges for general practitioners teaching medical students in urban g... more Aim: To explore ethical challenges for general practitioners teaching medical students in urban general practice. Methods Semistructured face-to-face interviews with 60 urban general practice teachers with diverse teaching loads and practice demographics. Interview data were analysed following member checking of interview records. Results: Participants identified concerns in relation to a number of areas including: student assessment and professionalism; teaching support from colleagues; patient consent and confidentiality; and the effects of teaching on consultation dynamics, patient satisfaction and patient care. Participants with smaller teaching loads and with full fee-paying patients were more likely to express concerns about involving students actively in consultations. Discussion: General practice teachers should consider modelling seeking informed patient consent in difficult circumstances, while being mindful that patients may be reluctant to refuse or withdraw consent. Arguably students themselves should seek consent. General practitioners should consider maintaining the confidentiality of previously divulged patient information. Concerns about active student involvement in teaching consultations should be discussed with teaching colleagues from similar practice demographics, with reference to pertinent literature about patient attitudes to teaching.
ABSTRACT Introduction and Aim: The harmful consequences of amphetamine (including methamphetamine... more ABSTRACT Introduction and Aim: The harmful consequences of amphetamine (including methamphetamine) misuse in Australia and internationally have been well documented. There has been surprisingly little exploration, however, of the role of opiate substitution therapy (OST), an evidence-based harm minimization strategy for opiate dependence, in eligible high-risk amphetamine users. Design and Methods: This survey study explored histories of substance use and dependence, and eligibility for OST, in a group of Queensland adult male ex-prisoners recently released into a residential supported parole program. Results: 57% of participants were identified as high-risk amphetamine (HRA) users. Of these HRA users, 74% were eligible for opiate substitution treatment under current Australian guidelines, and 59% believed that suboxone (buprenorphine and naloxone) maintenance would reduce their risks of going back to prison due to amphetamine use. Discussion and Conclusions: In recently released prisoners with a history of high-risk amphetamine use and opiate dependence, OST may be a strategy to reduce the harms of both opiate and amphetamine use. Further studies are needed to understand poly-drug use in this population, and optimize the safety, effectiveness, and attractiveness of suboxone maintenance for these potential clients.
Background: A diverse range of ethical and professionalism issues has been identified in Australi... more Background: A diverse range of ethical and professionalism issues has been identified in Australian general practice. Objective: To establish which of these issues general practitioner (GP) teachers and students consider the most important, to enable GP teachers to facilitate student learning in this domain. Methods: A survey instrument was developed and distributed to GP teachers and medical students. Participants rated the importance of students learning about each of 32 different ethical issues. Students rated their confidence in managing these areas. Results: GP teachers and students agreed on many of the most important issues (including patient confidentiality, medical mistakes, working with colleagues and drug-seeking patients); there are also some interesting differences. Student confidence in patient confidentiality was very high, but particularly low in career and training decisions and medical mistakes. Discussion: Students want to learn more about career and training decisions and medical mistakes. They may underestimate the complexity of confidentiality and professional relationships in general practice.
Background: Despite a paucity of evidence to guide teaching about medical professionalism and eth... more Background: Despite a paucity of evidence to guide teaching about medical professionalism and ethical issues, there is a widespread consensus that medical students should learn about these issues on clinical placements. Exploring the confidence of general practitioners (GPs) in teaching various topics will identify areas for further discussion, support and/or training. Methods: A survey was developed and distributed to 65 teaching practices. Thirty-seven GPs responded by rating their confidence in teaching about 32 different ethical issues. Results: Overall, GPs were confident in teaching about these issues. Confidence was lowest for doctors' social and political responsibilities; ethical lapses in colleagues; impairment in colleagues; cross-cultural issues; and moral motivation, judgement, courage and sensitivity. Discussion: Further training for GP teachers may be particularly useful in the important areas of impairment and lapses in colleagues, and cross-cultural issues. Uncertainty about the scope of doctors' social and political responsibilities may limit GP confidence in teaching in these areas.
IntroductionFeedback may play out in the general practice workplace less usefully than anticipate... more IntroductionFeedback may play out in the general practice workplace less usefully than anticipated by educators. We investigated work‐based feedback conversations about directly observed student tasks embedded in the supervisor's clinical consultations with patients.MethodsFeedback conversations between GP teachers and medical students and subsequent student reflections were audio‐recorded. Student and GP teacher focus groups were also conducted and transcribed professionally. An iterative, qualitative descriptive analysis integrating all transcripts was undertaken. Findings are discussed under the descriptive categories of feedback structure, content and perceived value.ResultsTwenty feedback conversations (total duration of 85 min) between five GP teachers, nine students and 20 student reflections (total duration of 58 min) were analysed. GP teachers actively engaged students in reflection and used balancing scripts and soft correction strategies. Students appeared to have some difficulty steering feedback conversations, which focused more on general skills than case‐specific content knowledge. The recorded conversations were fragments of ongoing, in‐practice teaching and learning, explicit and implicit. Student reflections suggested that they were able to grasp learning points effectively and identify room for growth. Praise and positive self‐feedback appeared to reassure students, particularly when they were disappointed by their performances.DiscussionFormal ‘set‐piece’ feedback conversations may be a useful opportunity to explicitly surface and/or reinforce previous ‘in‐practice’ reflection and feedback using a systematic structure. They may also reassure and encourage students and foster positive educational alliances. Students value in‐practice and on‐practice feedback but may prefer more control of the latter conversations.
Medical professionals are in an ideal position to mediate between the benefits and harms of inter... more Medical professionals are in an ideal position to mediate between the benefits and harms of internet-sourced medical information, but there is reluctance by patients to discuss with their doctors information found online. This is the first study undertaken in a rural Australian context, where service limitations mean patients’ use of the internet may be especially important. Patients attending general practice clinics (n = 33) were interviewed to discover how they used the internet for health information and how they discussed this with their doctors. Analysis used a constant comparison method, informed by grounded theory and a dramaturgical framework. Most participants used a range of tactics when discussing internet-sourced medical information, including concealment, disguise or upfront apologetic disclosures to avoid undermining the expertise of the doctor. These findings do not confirm predictions made in the past that patients’ acquisition of internet health information would alter the power dynamic of the medical consultation. Potentially, proactive, doctor-initiated inquiry about internet medical information may help to normalise patients’ internet use, allowing open discussion, so doctors can maximise benefits and reduce harms of internet health information. Further study is required to see if this will be an effective strategy and impact health outcomes.
Aim: To explore ethical challenges for general practitioners teaching medical students in urban g... more Aim: To explore ethical challenges for general practitioners teaching medical students in urban general practice. Methods Semistructured face-to-face interviews with 60 urban general practice teachers with diverse teaching loads and practice demographics. Interview data were analysed following member checking of interview records. Results: Participants identified concerns in relation to a number of areas including: student assessment and professionalism; teaching support from colleagues; patient consent and confidentiality; and the effects of teaching on consultation dynamics, patient satisfaction and patient care. Participants with smaller teaching loads and with full fee-paying patients were more likely to express concerns about involving students actively in consultations. Discussion: General practice teachers should consider modelling seeking informed patient consent in difficult circumstances, while being mindful that patients may be reluctant to refuse or withdraw consent. Arguably students themselves should seek consent. General practitioners should consider maintaining the confidentiality of previously divulged patient information. Concerns about active student involvement in teaching consultations should be discussed with teaching colleagues from similar practice demographics, with reference to pertinent literature about patient attitudes to teaching.
ABSTRACT Introduction and Aim: The harmful consequences of amphetamine (including methamphetamine... more ABSTRACT Introduction and Aim: The harmful consequences of amphetamine (including methamphetamine) misuse in Australia and internationally have been well documented. There has been surprisingly little exploration, however, of the role of opiate substitution therapy (OST), an evidence-based harm minimization strategy for opiate dependence, in eligible high-risk amphetamine users. Design and Methods: This survey study explored histories of substance use and dependence, and eligibility for OST, in a group of Queensland adult male ex-prisoners recently released into a residential supported parole program. Results: 57% of participants were identified as high-risk amphetamine (HRA) users. Of these HRA users, 74% were eligible for opiate substitution treatment under current Australian guidelines, and 59% believed that suboxone (buprenorphine and naloxone) maintenance would reduce their risks of going back to prison due to amphetamine use. Discussion and Conclusions: In recently released prisoners with a history of high-risk amphetamine use and opiate dependence, OST may be a strategy to reduce the harms of both opiate and amphetamine use. Further studies are needed to understand poly-drug use in this population, and optimize the safety, effectiveness, and attractiveness of suboxone maintenance for these potential clients.
Background: A diverse range of ethical and professionalism issues has been identified in Australi... more Background: A diverse range of ethical and professionalism issues has been identified in Australian general practice. Objective: To establish which of these issues general practitioner (GP) teachers and students consider the most important, to enable GP teachers to facilitate student learning in this domain. Methods: A survey instrument was developed and distributed to GP teachers and medical students. Participants rated the importance of students learning about each of 32 different ethical issues. Students rated their confidence in managing these areas. Results: GP teachers and students agreed on many of the most important issues (including patient confidentiality, medical mistakes, working with colleagues and drug-seeking patients); there are also some interesting differences. Student confidence in patient confidentiality was very high, but particularly low in career and training decisions and medical mistakes. Discussion: Students want to learn more about career and training decisions and medical mistakes. They may underestimate the complexity of confidentiality and professional relationships in general practice.
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