Liz Farmer
Professor Elizabeth Ann (Liz) Farmer BSc (Hons), MBBS, PhD, FRACGP, MAICD is a Clinical Professor at the University of Wollongong, Graduate School of Medicine, Adjunct Professor in the Discipline of General Practice within the School of Population Health and Clinical Practice at the University of Adelaide and Professorial Fellow in the School of Medicine at Flinders University Adelaide.
Liz is currently working as an independent consultant at Liz Farmer & Associates (www.lizfarmerassociates.com).
Past appointments
Executive Director, Workforce Innovation and Reform Health Workforce Australia
Dean of Medicine University of Wollongong Graduate School of Medicine
Roberta Williams Chair in Medicine (General Practice) University of Wollongong
Foundation Scientific Director (Rural Health and Primary Care Theme) Illawarra Health and Medical Research Institute (IHMRI). University of Wollongong
External Examiner, University of Hong Kong School of Medicine
Director of Education National Primary Care Collaboratives Program
Professorial Fellow University of Wollongong Graduate School of Medicine
Awards
Vice Chancellor’s Award for Excellence and Innovation in Education Flinders University
Academic and Consultancy Interests and Expertise
Health Sciences
• Medical and health sciences education, curriculum development, policy, standards, quality assurance and governance
• Faculty development in medical and health sciences education and early career researcher development
• Innovation and strategic planning in medical and health sciences education
• Major curriculum reform or renewal, new medical schools
• Assessment of competence and performance of health practitioners
Workforce innovation and systems change
• Workforce innovation and reform, policy and practice, scopes of practice development, alternative models, inter-professional education
• Systems change and innovation in health care
• Quality improvement in health service delivery in primary care
Program evaluation
• Program evaluation in health sciences education and grant funded health or health service programs
Health care issues
• Rural regional and remote, and Indigenous health issues
• Health issues writing for consumers
• Consumer engagement in health and health education delivery
Other Skills
• Health sciences literature review
• Workshop facilitation
Liz has consulted nationally and internationally over the past 2 decades in medicine and in health sciences and dentistry. She also has wide experience in the evaluation of health and educational programs.
Phone: + 61 412 597 593
Address: Graduate School of Medicine
University of Wollongong
Northfields Avenue
NSW 2522
Liz is currently working as an independent consultant at Liz Farmer & Associates (www.lizfarmerassociates.com).
Past appointments
Executive Director, Workforce Innovation and Reform Health Workforce Australia
Dean of Medicine University of Wollongong Graduate School of Medicine
Roberta Williams Chair in Medicine (General Practice) University of Wollongong
Foundation Scientific Director (Rural Health and Primary Care Theme) Illawarra Health and Medical Research Institute (IHMRI). University of Wollongong
External Examiner, University of Hong Kong School of Medicine
Director of Education National Primary Care Collaboratives Program
Professorial Fellow University of Wollongong Graduate School of Medicine
Awards
Vice Chancellor’s Award for Excellence and Innovation in Education Flinders University
Academic and Consultancy Interests and Expertise
Health Sciences
• Medical and health sciences education, curriculum development, policy, standards, quality assurance and governance
• Faculty development in medical and health sciences education and early career researcher development
• Innovation and strategic planning in medical and health sciences education
• Major curriculum reform or renewal, new medical schools
• Assessment of competence and performance of health practitioners
Workforce innovation and systems change
• Workforce innovation and reform, policy and practice, scopes of practice development, alternative models, inter-professional education
• Systems change and innovation in health care
• Quality improvement in health service delivery in primary care
Program evaluation
• Program evaluation in health sciences education and grant funded health or health service programs
Health care issues
• Rural regional and remote, and Indigenous health issues
• Health issues writing for consumers
• Consumer engagement in health and health education delivery
Other Skills
• Health sciences literature review
• Workshop facilitation
Liz has consulted nationally and internationally over the past 2 decades in medicine and in health sciences and dentistry. She also has wide experience in the evaluation of health and educational programs.
Phone: + 61 412 597 593
Address: Graduate School of Medicine
University of Wollongong
Northfields Avenue
NSW 2522
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Papers by Liz Farmer
Aim: This article describes and illustrates a conceptual framework for an approach termed capability-based portfolio assessment.
Results and conclusions: Thinking about capability, i.e. the ability to perform in the real world, is needed for a contemporary curriculum and assessment design. A capability-focus will help students to integrate the foundations of medical practice with learning how to become a capable, reflective and life-long learner.
A well-structured capability portfolio, regularly presented and reviewed, will be a useful tool to guide the journey, and should have the potential to help drive deep learning and allow the assessment of capabilities that are hard to assess using conventional approaches.
Assessment based on portfolio approaches should not equate to increasing the overall assessment burden as it will reduce the need for more traditional assessment methods.
Methods: Gross practice financial data were compared before and during the year-long placement. Interview data pre- and post-placement were analysed by two researchers who concurred on emergent themes and categories.
Results: This study suggested a financial ‘turning point’ of 1–2 months when the student became beneficial to the practice. Most preceptors (66%) perceived the longitudinal placement as financially neutral or favourable. Nineteen per cent of supervisors reported a negative financial impact, some attributing this to reduced patient throughput, inadequacy of the government teaching subsidy and/or time spent on assessment preparation. Other supervisors were unconcerned about costs, perceiving that minor financial loss was outweighed by personal satisfaction.
Conclusions: Senior students learning in long-term clerkships are legitimate members of regional/rural communities of practice. These students can be cost-neutral or have a small positive financial impact on the practice within a few months. Further financial impact research should include consideration of different models of supervisor teaching subsidies. The ultimate financial benefit of a model may lie in the recruitment and retention of much-needed regional and rural practitioners.
Background: In keeping with its mission to produce doctors for rural and regional Australia, the University of Wollongong, Graduate School of Medicine has established an innovative model of clinical education. This includes a 12-month integrated community-based clerkship in a regional or rural setting, offering senior students longitudinal participation in a ‘community of practice’ with access to continuity of patient care experiences, continuity of supervision and curriculum, and individualised personal and professional development. This required developing new teaching sites, based on attracting preceptors and providing them with educational and physical infrastructure. A major challenge was severe health workforce shortages.
Methods: Before the new clerkship started, we interviewed 28 general practitioners to determine why they engaged as clerkship preceptors. Independent researchers conducted semi-structured interviews. Responses were transcribed for inductive qualitative content analysis.
Results: The new model motivated preceptors to engage because it enhanced their opportunities to contribute to authentic learning when compared with the perceived limitations of short-term attachments. Preceptors appreciated the significant recognition of the value of general practice teaching and the honour of major involvement in the university. They predicted that the initiative would have positive effects on general practitioner morale and improve the quality of their practice. Other themes included the doctors’ commitment to their profession, ‘handing on’ to the next generation and helping their community to attract doctors in the future.
Conclusions: Supervisors perceive that new models of clinical education offer alternative solutions to health care education, delivery and workforce. The longitudinal relationship between preceptor, student and community was seen as offering reciprocal benefits. General practitioners are committed to refining practice and ensuring generation of new members in their profession. They are motivated to engage in novel regional and rural longitudinal clinical clerkships as they perceive that they offer students an authentic learning experience and are a potential strategy to help address workforce shortages and maldistribution.
Objective: Community-based medical education is growing to meet the increased demand for quality clinical education in expanded settings, and its sustainability relies on patient participation. This study investigated patients’ views on being used as an educational resource for teaching medical students.
Design: Questionnaire-based survey.
Setting and participants: Patients attending six rural and 11 regional general practices in New South Wales over 18 teaching sessions in November 2008, who consented to student involvement in their consultation.
Main outcome measures: Patient perceptions, expectations and acceptance of medical student involvement in consultations, assessed by surveys before and after their consultations.
Results: 118 of 122 patients consented to medical student involvement; of these, 117 (99%) completed a survey before the consultation, and 100 (85%) after the consultation. Patients were overwhelmingly positive about their doctor and practice being involved in student teaching and felt they themselves played an important role. Pre-consultation, patients expressed reluctance to allow students to conduct some or all aspects of the consultation independently. However, after the consultation, they reported they would have accepted higher levels of involvement than actually occurred.
Conclusions: Patients in regional and rural settings were willing partners in developing skills of junior medical students, who had greater involvement in patient consultations than previously reported for urban students. Our study extends the findings from urban general practice that patients are underutilised partners in community-based medical training. The support of patients from regional and rural settings could facilitate the expansion of primary care-based medical education in these areas of workforce need.
GOOD LUCK
Aim This paper in the series on professional assessment provides a practical guide to writing key features problems (KFPs). Key features problems test clinical decision-making skills in written or computer-based formats. They are based on the concept of critical steps or 'key features' in decision making and represent an advance on the older, less reliable patient management problem (PMP) formats.
Method The practical steps in writing these problems are discussed and illustrated by examples. Steps include assembling problem-writing groups, selecting a suitable clinical scenario or problem and defining its key features, writing the questions, selecting question response formats, preparing scoring keys, reviewing item quality and item banking.
Conclusion The KFP format provides educators with a flexible approach to testing clinical decision-making skills with demonstrated validity and reliability when constructed according to the guidelines provided.
Methods This paper reflects the combined experiences of a group of experienced education researchers and the results of literature searches on performance assessment methods.
Conclusion Measurement of competence is different to measurement of performance. Components of performance could be re-conceptualised within a different domain structure. Assessment methods may be of a different utility to that in competence assessment and, indeed, of different utility according to the purpose of the assessment. An exploration of the utility of potential performance assessment methods suggests significant gaps that indicate priority areas for research and development.
Aim: This article describes and illustrates a conceptual framework for an approach termed capability-based portfolio assessment.
Results and conclusions: Thinking about capability, i.e. the ability to perform in the real world, is needed for a contemporary curriculum and assessment design. A capability-focus will help students to integrate the foundations of medical practice with learning how to become a capable, reflective and life-long learner.
A well-structured capability portfolio, regularly presented and reviewed, will be a useful tool to guide the journey, and should have the potential to help drive deep learning and allow the assessment of capabilities that are hard to assess using conventional approaches.
Assessment based on portfolio approaches should not equate to increasing the overall assessment burden as it will reduce the need for more traditional assessment methods.
Methods: Gross practice financial data were compared before and during the year-long placement. Interview data pre- and post-placement were analysed by two researchers who concurred on emergent themes and categories.
Results: This study suggested a financial ‘turning point’ of 1–2 months when the student became beneficial to the practice. Most preceptors (66%) perceived the longitudinal placement as financially neutral or favourable. Nineteen per cent of supervisors reported a negative financial impact, some attributing this to reduced patient throughput, inadequacy of the government teaching subsidy and/or time spent on assessment preparation. Other supervisors were unconcerned about costs, perceiving that minor financial loss was outweighed by personal satisfaction.
Conclusions: Senior students learning in long-term clerkships are legitimate members of regional/rural communities of practice. These students can be cost-neutral or have a small positive financial impact on the practice within a few months. Further financial impact research should include consideration of different models of supervisor teaching subsidies. The ultimate financial benefit of a model may lie in the recruitment and retention of much-needed regional and rural practitioners.
Background: In keeping with its mission to produce doctors for rural and regional Australia, the University of Wollongong, Graduate School of Medicine has established an innovative model of clinical education. This includes a 12-month integrated community-based clerkship in a regional or rural setting, offering senior students longitudinal participation in a ‘community of practice’ with access to continuity of patient care experiences, continuity of supervision and curriculum, and individualised personal and professional development. This required developing new teaching sites, based on attracting preceptors and providing them with educational and physical infrastructure. A major challenge was severe health workforce shortages.
Methods: Before the new clerkship started, we interviewed 28 general practitioners to determine why they engaged as clerkship preceptors. Independent researchers conducted semi-structured interviews. Responses were transcribed for inductive qualitative content analysis.
Results: The new model motivated preceptors to engage because it enhanced their opportunities to contribute to authentic learning when compared with the perceived limitations of short-term attachments. Preceptors appreciated the significant recognition of the value of general practice teaching and the honour of major involvement in the university. They predicted that the initiative would have positive effects on general practitioner morale and improve the quality of their practice. Other themes included the doctors’ commitment to their profession, ‘handing on’ to the next generation and helping their community to attract doctors in the future.
Conclusions: Supervisors perceive that new models of clinical education offer alternative solutions to health care education, delivery and workforce. The longitudinal relationship between preceptor, student and community was seen as offering reciprocal benefits. General practitioners are committed to refining practice and ensuring generation of new members in their profession. They are motivated to engage in novel regional and rural longitudinal clinical clerkships as they perceive that they offer students an authentic learning experience and are a potential strategy to help address workforce shortages and maldistribution.
Objective: Community-based medical education is growing to meet the increased demand for quality clinical education in expanded settings, and its sustainability relies on patient participation. This study investigated patients’ views on being used as an educational resource for teaching medical students.
Design: Questionnaire-based survey.
Setting and participants: Patients attending six rural and 11 regional general practices in New South Wales over 18 teaching sessions in November 2008, who consented to student involvement in their consultation.
Main outcome measures: Patient perceptions, expectations and acceptance of medical student involvement in consultations, assessed by surveys before and after their consultations.
Results: 118 of 122 patients consented to medical student involvement; of these, 117 (99%) completed a survey before the consultation, and 100 (85%) after the consultation. Patients were overwhelmingly positive about their doctor and practice being involved in student teaching and felt they themselves played an important role. Pre-consultation, patients expressed reluctance to allow students to conduct some or all aspects of the consultation independently. However, after the consultation, they reported they would have accepted higher levels of involvement than actually occurred.
Conclusions: Patients in regional and rural settings were willing partners in developing skills of junior medical students, who had greater involvement in patient consultations than previously reported for urban students. Our study extends the findings from urban general practice that patients are underutilised partners in community-based medical training. The support of patients from regional and rural settings could facilitate the expansion of primary care-based medical education in these areas of workforce need.
GOOD LUCK
Aim This paper in the series on professional assessment provides a practical guide to writing key features problems (KFPs). Key features problems test clinical decision-making skills in written or computer-based formats. They are based on the concept of critical steps or 'key features' in decision making and represent an advance on the older, less reliable patient management problem (PMP) formats.
Method The practical steps in writing these problems are discussed and illustrated by examples. Steps include assembling problem-writing groups, selecting a suitable clinical scenario or problem and defining its key features, writing the questions, selecting question response formats, preparing scoring keys, reviewing item quality and item banking.
Conclusion The KFP format provides educators with a flexible approach to testing clinical decision-making skills with demonstrated validity and reliability when constructed according to the guidelines provided.
Methods This paper reflects the combined experiences of a group of experienced education researchers and the results of literature searches on performance assessment methods.
Conclusion Measurement of competence is different to measurement of performance. Components of performance could be re-conceptualised within a different domain structure. Assessment methods may be of a different utility to that in competence assessment and, indeed, of different utility according to the purpose of the assessment. An exploration of the utility of potential performance assessment methods suggests significant gaps that indicate priority areas for research and development.