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Schwill S, Krug K, Poppleton A, Reith D, Senft JD, Szecsenyi J, Stengel S. How can competencies in minor surgery in general practice be increased? Assessing the effect of a compact intervention in postgraduate training: a mixed-methods study. BMJ Open 2022; 12:e060991. [PMID: 35902194 PMCID: PMC9341175 DOI: 10.1136/bmjopen-2022-060991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/20/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We aimed to assess general practice (GP) trainees' self-perception of surgical competencies and to explore longitudinal effects of a compact intervention. DESIGN We performed a mixed-methods study including a before and after comparison in the intervention group (IG), a comparison of attendees and non-attendees (control group (CG)) and a qualitative evaluation of the intervention. Competencies were self-assessed through surveys. Semi-structured interviews were performed after 9 months. SETTING In 2019, a 2-day voluntary seminar focussing on minor surgery/injuries was offered on 13 occasions by educators from KWBW Verbundweiterbildungplus (Competence Centre for Postgraduate Medical Education Baden-Württemberg). PARTICIPANTS All enrolled GP trainees were offered participation. GP trainees who did not attend a seminar (non-attendees) were recruited for CG after the 13th intervention. INTERVENTION Attendees took part in an interactive, GP-oriented short course incorporating 270 min of focused minor surgery/injuries training (compact intervention) on the second day of the 2-day seminar. RESULTS 326 GP trainees (IG: n=257; CG: n=69) participated in the study. 17 attendees were interviewed. CG had more often experienced a surgical rotation (p=0.03) and reported higher interest in performing minor surgery in future practice (p=0.03). GP trainees self-rated their all-round competency in minor surgery as average (IG: 3.0±1.0, CG: 3.2±0.9, IG:CG p=0.06). After the intervention, attendees felt that surgical skills should be a core component of GP vocational training (p=0.05). After 9 months, attendees remembered a variety of content and valued the interactive, case-oriented, peer-to-peer approach in a mixed learning group. Some attendees reported they had started to overcome competency gaps in minor surgery. CONCLUSIONS A compact intervention in minor surgery provides an 'intense' stimulus which could foster positive attitudes towards minor surgery and promote longitudinal personal development of related competencies in GP trainees, including those with little interest in surgery. Such measures appear crucial to support individual progress of GP trainees to provide comprehensive primary care.
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Affiliation(s)
- Simon Schwill
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Dorothee Reith
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Jonas D Senft
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Sandra Stengel
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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2
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Huy NT, Chico RM, Huan VT, Shaikhkhalil HW, Uyen VNT, Qarawi ATA, Alhady STM, Vuong NL, Truong LV, Luu MN, Dumre SP, Imoto A, Lee PN, Tam DNH, Ng SJ, Hashan MR, Matsui M, Duc NTM, Karimzadeh S, Koonrungsesomboon N, Smith C, Cox S, Moji K, Hirayama K, Linh LK, Abbas KS, Dung TNT, Mohammed Ali AL-Ahdal T, Balogun EO, Duy NT, Mohamed Eltaras M, Huynh T, Hue NTL, Khue BD, Gad A, Tawfik GM, Kubota K, Nguyen HM, Pavlenko D, Trang VTT, Vu LT, Hai Yen T, Yen-Xuan NT, Trang LT, Dong V, Sharma A, Dat VQ, Soliman M, Abdul Aziz J, Shah J, Hung PDL, Jee YS, Phuong DTH, Quynh TTH, Giang HTN, Huynh VTN, Thi NA, Dhouibi N, Phan T, Duru V, Nam NH, Ghozy S. Awareness and preparedness of healthcare workers against the first wave of the COVID-19 pandemic: A cross-sectional survey across 57 countries. PLoS One 2021; 16:e0258348. [PMID: 34936646 PMCID: PMC8694437 DOI: 10.1371/journal.pone.0258348] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 09/24/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Since the COVID-19 pandemic began, there have been concerns related to the preparedness of healthcare workers (HCWs). This study aimed to describe the level of awareness and preparedness of hospital HCWs at the time of the first wave. METHODS This multinational, multicenter, cross-sectional survey was conducted among hospital HCWs from February to May 2020. We used a hierarchical logistic regression multivariate analysis to adjust the influence of variables based on awareness and preparedness. We then used association rule mining to identify relationships between HCW confidence in handling suspected COVID-19 patients and prior COVID-19 case-management training. RESULTS We surveyed 24,653 HCWs from 371 hospitals across 57 countries and received 17,302 responses from 70.2% HCWs overall. The median COVID-19 preparedness score was 11.0 (interquartile range [IQR] = 6.0-14.0) and the median awareness score was 29.6 (IQR = 26.6-32.6). HCWs at COVID-19 designated facilities with previous outbreak experience, or HCWs who were trained for dealing with the SARS-CoV-2 outbreak, had significantly higher levels of preparedness and awareness (p<0.001). Association rule mining suggests that nurses and doctors who had a 'great-extent-of-confidence' in handling suspected COVID-19 patients had participated in COVID-19 training courses. Male participants (mean difference = 0.34; 95% CI = 0.22, 0.46; p<0.001) and nurses (mean difference = 0.67; 95% CI = 0.53, 0.81; p<0.001) had higher preparedness scores compared to women participants and doctors. INTERPRETATION There was an unsurprising high level of awareness and preparedness among HCWs who participated in COVID-19 training courses. However, disparity existed along the lines of gender and type of HCW. It is unknown whether the difference in COVID-19 preparedness that we detected early in the pandemic may have translated into disproportionate SARS-CoV-2 burden of disease by gender or HCW type.
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Affiliation(s)
- Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- * E-mail: (NTH); (RMC)
| | - R. Matthew Chico
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail: (NTH); (RMC)
| | - Vuong Thanh Huan
- Faculty of Medicine, Pham Ngoc Thach University, Ho Chi Minh City, Vietnam
| | | | - Vuong Ngoc Thao Uyen
- School of Biotechnology, International University—Vietnam National University, Ho Chi Minh City, Vietnam
| | | | | | - Nguyen Lam Vuong
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Le Van Truong
- Traditional Medicine Hospital of Ministry of Public Security, Vietnam
| | - Mai Ngoc Luu
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
| | - Shyam Prakash Dumre
- Department of Immunogenetics, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Atsuko Imoto
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Peter N. Lee
- P.N. Lee Statistics and Computing Ltd., Sutton, United Kingdom
| | | | - Sze Jia Ng
- Hospital Enche’ Besar Hajjah Khalsom, Johor, Malaysia
| | - Mohammad Rashidul Hashan
- Government of the People’s Republic of Bangladesh—Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Mitsuaki Matsui
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Nguyen Tran Minh Duc
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Sedighe Karimzadeh
- School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Nut Koonrungsesomboon
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sharon Cox
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kazuhiko Moji
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Kenji Hirayama
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Le Khac Linh
- VinUniversity, College of Health Sciences, Hanoi, Vietnam
| | | | - Tran Nu Thuy Dung
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tareq Mohammed Ali AL-Ahdal
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Ar-Ramtha, Jordan
| | - Emmanuel Oluwadare Balogun
- Department of Biochemistry and African Center of Excellence on Neglected Tropical Diseases and Forensic Biotechnology, Ahmadu Bello University, Zaria, Nigeria
| | - Nguyen The Duy
- Department of Gyn. Endocrinology and Reproductive Medicine, University Hospital Giessen and Marburg, Marburg, Germany
- Philipps University Marburg, Marburg, Germany
| | | | - Trang Huynh
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | - Bui Diem Khue
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | | | | | - Hoang-Minh Nguyen
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | | | - Le Thuong Vu
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tran Hai Yen
- School of Biotechnology, International University—Vietnam National University, Ho Chi Minh City, Vietnam
| | | | | | - Vinh Dong
- American University of the Caribbean, Cupe Coy, Saint Maarten, United States of America
| | - Akash Sharma
- University College of Medical Sciences & Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India
| | - Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam
| | | | - Jeza Abdul Aziz
- Medical Laboratory Science, College of Health Science, University of Human Development, Kurdistan Region, Sulaimani, Iraq
- Baxshin Research Training Organization, Baxshin Hospital, Kurdistan Region, Sulaimani, Iraq
| | - Jaffer Shah
- Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Pham Dinh Long Hung
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Yap Siang Jee
- School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Dang Thuy Ha Phuong
- Center for Biomedical Research, Pham Ngoc Thach University of Medicine, Vietnam
| | | | - Hoang Thi Nam Giang
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
- Faculty of Medicine and Pharmacy, University of Da Nang, Da Nang, Vietnam
| | | | | | - Nacir Dhouibi
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Truc Phan
- Vinmec International Hospital, Hanoi, Vietnam
| | - Vincent Duru
- Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Nguyen Hai Nam
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sherief Ghozy
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Kerr L, Kealy B, Lim D, Walters L. Rural emergency departments: A systematic review to develop a resource typology relevant to developed countries. Aust J Rural Health 2021; 29:7-20. [PMID: 33567157 DOI: 10.1111/ajr.12702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Despite low patient numbers, rural emergency departments have a similar diversity of case presentations as urban tertiary hospitals, with the need to manage high-acuity cases with limited resources. There are no consistent descriptions of the resources available to rural emergency departments internationally, limiting the capacity to compare clinical protocols and standards of care across similarly resourced units. This review aimed to describe the range of human, physical and specialist resources described in rural emergency departments in developed countries and propose a typology for use internationally. DESIGN AND SETTING A systematic literature search was performed for journal articles between 2000 and 2019 describing the staffing, access to radiology and laboratory investigations, and hospital inpatient specialists. RESULTS Considerable diversity in defining rurality and in resource access was found within and between Australia, New Zealand, Canada and USA. DISCUSSION A typology was developed to account for (a) emergency department staff on-floor, (b) emergency department staff on-call, (c) physical resources and (d) access to a specialist surgical service. This provides a valuable tool for relevant stakeholders to effectively communicate rural emergency department resources within a country and internationally. CONCLUSION The proposed five-tiered typology draws together international literature regarding rural emergency department services. Although further research is required to test this tool, the formation of this common language allows a base for effective communication between governments, training providers and policy-makers who are seeking to improve health systems and health outcomes.
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Affiliation(s)
- Lachlan Kerr
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Benjamin Kealy
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - David Lim
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.,School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | - Lucie Walters
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.,Adelaide Rural Clinical School, The University of Adelaide, Mount Gambier, SA, Australia
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4
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Sorensen B, Hunskaar S. Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations. Ultrasound J 2019; 11:31. [PMID: 31749019 PMCID: PMC6868077 DOI: 10.1186/s13089-019-0145-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Both the interest and actual extent of use of point-of-care ultrasound, PoCUS, among general practitioners or family physicians are increasing and training is also increasingly implemented in residency programs. However, the amount of research within the field is still rather limited compared to what is seen within other specialties in which it has become more established, such as in the specialty of emergency medicine. An assumption is made that what is relevant for emergency medicine physicians and their populations is also relevant to the general practitioner, as both groups are generalists working in unselected populations. This systematic review aims to examine the extent of use and to identify clinical studies on the use of PoCUS by either general practitioners or emergency physicians on indications that are relevant for the former, both in their daily practice and in out-of-hours services. METHODS Systematic searches were done in PubMed/MEDLINE using terms related to general practice, emergency medicine, and ultrasound. RESULTS On the extent of use, we identified 19 articles, as well as 26 meta-analyses and 168 primary studies on the clinical use of PoCUS. We found variable, but generally low, use among general practitioners, while it seems to be thoroughly established in emergency medicine in North America, and increasingly also in the rest of the world. In terms of clinical studies, most were on diagnostic accuracy, and most organ systems were studied; the heart, lungs/thorax, vessels, abdominal and pelvic organs, obstetric ultrasound, the eye, soft tissue, and the musculoskeletal system. The studies found in general either high sensitivity or high specificity for the particular test studied, and in some cases high total accuracy and superiority to other established diagnostic imaging modalities. PoCUS also showed faster time to diagnosis and change in management in some studies. CONCLUSION Our review shows that generalists can, given a certain level of pre-test probability, safely use PoCUS in a wide range of clinical settings to aid diagnosis and better the care of their patients.
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Affiliation(s)
- Bjarte Sorensen
- Hjelmeland General Practice Surgery, Prestagarden 13, 4130, Hjelmeland, Norway.
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Bergen, Norway
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5
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Dowling S, Last J, Finnegan H, O'Connor K, Cullen W. What are the current 'top five' perceived educational needs of Irish general practitioners? Ir J Med Sci 2019; 189:381-388. [PMID: 31190220 DOI: 10.1007/s11845-019-02047-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/04/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Doctors' continuing medical educational and professional development (CME and CPD) needs are known to be strongly influenced by national and local contextual characteristics. A crucial step in the development of effective education and training programmes is the assessment of learner needs. METHODS A national needs assessment was conducted among general practitioners (GPs) in the Republic of Ireland who attended continuing medical education small group learning meetings (CME-SGL) in late 2017. Doctors completed a self-administered anonymous three-page questionnaire which gathered demographic data and asked them to choose their 'top five' perceived educational needs from separate lists of topics for CME and CPD. RESULTS There were 1669 responses (98% of monthly attendance). The topics most commonly identified as a priority for further CME were prescribing (updates/therapeutics), elderly medicine, management of common chronic conditions, dermatology, and patient safety/medical error. The most commonly selected CPD topics were applying evidence-based guidelines to practice, appraising performance/conducting practice audits, coping with change, and managing risk and legal medicine. There was no difference between urban and rural practice settings regarding the most commonly chosen topics in each category; however, more rural GPs selected pre-hospital/emergency care as one of their 'top five'. CONCLUSION Our findings identified priority areas where CME and CPD for GPs in Ireland should focus. The topics selected may reflect the changing nature of general practice, which increasingly requires delivery of care to an ageing population with more multi-morbidity and chronic disease management, while trying to apply evidence-based medicine and consider patient safety issues. CME/CPD programmes need to adapt accordingly.
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Affiliation(s)
- Stephanie Dowling
- University College Dublin School of Medicine, Health Sciences Centre, UCD, Dublin, Ireland.
- Cappoquin Health Centre, West Waterford, Ireland.
| | - Jason Last
- University College Dublin School of Medicine, Health Sciences Centre, UCD, Dublin, Ireland
| | - Henry Finnegan
- Irish College of General Practice National CME Director, Irish College of General Practice, Dublin, Ireland
| | | | - Walter Cullen
- University College Dublin School of Medicine, Health Sciences Centre, UCD, Dublin, Ireland
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6
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Pandit T, Sabesan S, Ray RA. Medical emergencies in rural North Queensland: Doctors perceptions of the training needs. Aust J Rural Health 2018; 26:422-428. [DOI: 10.1111/ajr.12433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Tarsh Pandit
- College of Medicine and Dentistry James Cook University TownsvilleQueenslandAustralia
| | - Sabe Sabesan
- College of Medicine and Dentistry James Cook University TownsvilleQueenslandAustralia
- Tropical Centre for Telehealth Practice and Research Townsville Hospital and Health Services Townsville Queensland Australia
| | - Robin A. Ray
- College of Medicine and Dentistry James Cook University TownsvilleQueenslandAustralia
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Pandit T, Ray R, Sabesan S. Review article: Managing medical emergencies in rural Australia: A systematic review of the training needs. Emerg Med Australas 2018; 31:20-28. [PMID: 29473300 DOI: 10.1111/1742-6723.12939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 11/27/2022]
Abstract
The aim of the study was to determine the training needs of doctors managing emergencies in rural and remote Australia. A systematic review of Australian articles was performed using MEDLINE (OVID) and INFORMIT online databases from 1990 to 2016. The search terms included 'Rural Health', 'Emergency Medicine', 'Emergency Medical Services', 'Education, Medical, Continuing' and 'Family Practice'. Only peer-reviewed articles, available in full-text that focussed on the training needs of rural doctors were reviewed. Data was extracted using pre-defined fields such as date of data collection, number of participants, characteristics of participants, location and study findings. A total of eight studies published from 1998 to 2006 were found to be suitable for inclusion in the analysis. Six studies cited the results of self-reported questionnaires and surveys, one used a telephone questionnaire on a hypothetical patient and one utilised a theoretical examination. The studies found a significant proportion of participants wanted more emergency training. Junior rural doctors were found to have deficiencies in knowledge about stroke. Emergency skills doctors wanted more training including: emergency ultrasound, paediatric/neonatal procedures and cricothyroidotomy. However, many of the studies were performed by training providers that may benefit from deficient results. Given that the data was over 10 years old and that advances have been made in knowledge, training opportunities and technology, the implications for current training needs of rural doctors in Australia could not be accurately assessed. Thus there is a need for further research to identify current training needs.
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Affiliation(s)
- Tarsh Pandit
- Division of Tropical Health and Medicine, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Robin Ray
- Division of Tropical Health and Medicine, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Sabe Sabesan
- Tropical Centre for Telehealth Practice and Research, Townsville Hospital, Townsville, Queensland, Australia
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Byrd P, Ward O, Hamdorf J. The Effect of a Surgical Skills Course on Confidence Levels of Rural General Practitioners: An Observational Study. Surg J (N Y) 2017; 2:e109-e112. [PMID: 28825002 PMCID: PMC5553478 DOI: 10.1055/s-0036-1593737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/22/2016] [Indexed: 11/29/2022] Open
Abstract
Objective
To investigate the effect of a short surgical skills course on general practitioners' confidence levels to perform procedural skills.
Design
Prospective observational study.
Setting
The Clinical Evaluation and Training Centre, a practical skills-based educational facility, at The University of Western Australia.
Participants
Medical practitioners who participated in these courses. Nurses, physiotherapists, and medical students were excluded. The response rate was 61% with 61 participants providing 788 responses for pre- and postcourse confidence levels regarding various surgical skills.
Intervention
One- to two-day surgical skills courses consisting of presentations, demonstrations, and practical stations, facilitated by specialists.
Main Outcome Measures
A two-page precourse and postcourse questionnaire was administered to medical practitioners on the day. Participants rated their confidence levels to perform skills addressed during the course on a 4-point Likert scale.
Results
Of the 788 responses regarding confidence levels, 621 were rated as improved postcourse, 163 were rated as no change, and 4 were rated as lower postcourse. Seven of the courses showed a 25% median increase in confidence levels, and one course demonstrated a 50% median increase. All courses showed statistically significant results (
p
< 0.001).
Conclusion
A short surgical skills course resulted in a statistically significant improvement in the confidence levels of rural general practitioners to perform these skills.
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Affiliation(s)
- Pippa Byrd
- Clinical Training and Evaluation Centre, School of Surgery, The University of Western Australia, Crawley, Western Australia, Australia
| | - Olga Ward
- Clinical Training and Evaluation Centre, School of Surgery, The University of Western Australia, Crawley, Western Australia, Australia
| | - Jeffrey Hamdorf
- Clinical Training and Evaluation Centre, School of Surgery, The University of Western Australia, Crawley, Western Australia, Australia
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Brijnath B, Bunzli S, Xia T, Singh N, Schattner P, Collie A, Sterling M, Mazza D. General practitioners knowledge and management of whiplash associated disorders and post-traumatic stress disorder: implications for patient care. BMC FAMILY PRACTICE 2016; 17:82. [PMID: 27440111 PMCID: PMC4955143 DOI: 10.1186/s12875-016-0491-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/13/2016] [Indexed: 11/18/2022]
Abstract
Background In Australia, general practitioners (GPs) see around two-thirds of people injured in road traffic crashes. Road traffic crash injuries are commonly associated with diverse physical and psychological symptoms that may be difficult to diagnose and manage. Clinical guidelines have been developed to assist in delivering quality, consistent care, however the extent to which GPs knowledge and practice in diagnosing and managing road traffic crash injuries concords with the guidelines is unknown. This study aimed to explore Australian GPs knowledge, attitudes and practices regarding the diagnosis and management of road traffic crash injuries, specifically whiplash associated disorders (WAD) and post-traumatic stress disorder (PTSD). Method A cross-sectional survey of 423 GPs across Australia conducted between July and December 2014. We developed a questionnaire to assess their knowledge of WAD and PTSD, confidence in diagnosing and managing WAD and PTSD, frequency of referral to health providers, barriers to referral, and attitudes towards further education and training. Factor analysis, Spearman’s correlation, and multiple ordered logistic regressions were performed. Results Overall, GPs have good level knowledge of WAD and PTSD; only 9.6 % (95 % CI: 7.1 %, 12.8 %) and 23.9 % (95 % CI: 20.8 %, 28.2 %) of them were deemed to have lower level knowledge of WAD and PTSD respectively. Key knowledge gaps included imaging indicators for WAD and indicators for psychological referral for PTSD. GPs who were male, with more years of experience, working in the urban area and with higher knowledge level of WAD were more confident in diagnosing and managing WAD. Only GPs PTSD knowledge level predicted confidence in diagnosing and managing PTSD. GPs most commonly referred to physiotherapists and least commonly to vocational rehabilitation providers. Barriers to referral included out-of-pocket costs incurred by patients and long waiting times. Most GPs felt positive towards further education on road traffic crash injury management. Conclusion This study has enhanced understanding of the knowledge skills and attitudes of GPs towards road traffic crash injury care in Australia, and has identified areas for further education and training. If delivered, this training has the potential to reduce unnecessary imaging for WAD and optimise the early referral of patients at risk of delayed recovery following a road traffic crash.
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Affiliation(s)
- Bianca Brijnath
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia. .,School of Occupational Therapy and Social Work, Curtin University, Perth, WA, 6152, Australia.
| | - Samantha Bunzli
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
| | - Ting Xia
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Nabita Singh
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Peter Schattner
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Alex Collie
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia.,Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, Australia
| | - Michele Sterling
- Recover Injury Research Centre, NHMRC CRE in Road Traffic Injury Recovery, Menzies Health Institute, Griffith University, Gold Coast, Australia
| | - Danielle Mazza
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
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10
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Leeuwenburg T, Hall J. Tyranny of distance and rural prehospital care: Is there potential for a national rural responder network? Emerg Med Australas 2015; 27:481-4. [PMID: 26105215 DOI: 10.1111/1742-6723.12432] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2015] [Indexed: 11/30/2022]
Abstract
Critical illness intersects with the workload of rural doctors in Australia, mostly via their on-call responsibilities to rural hospitals. A significant proportion of these are prehospital incidents - vehicle crashes, farming injuries, bushfire etc. Effective care for such patients requires an integration of prehospital ambulance services, retrieval services and tertiary level trauma services all the way through to rehabilitation. Ambulance services in rural areas are often volunteer based, and with increasing remoteness via the 'tyranny of distance' comes the likelihood of increased delay in arrival of specialist retrieval services. Potential exists to utilise rural clinicians to respond to prehospital incidents in certain defined circumstances, as suggested by a recent survey of rural doctors.
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Affiliation(s)
- Tim Leeuwenburg
- Kangaroo Island Medical Clinic, Kingscote, South Australia, Australia.,MedSTAR Emergency Medical Retrieval Service, SA Ambulance Service, Adelaide, South Australia, Australia
| | - John Hall
- Downs Rural Medical, Oakey, Queensland, Australia
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Curran V, Fleet L, Greene M. An exploratory study of factors influencing resuscitation skills retention and performance among health providers. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2012; 32:126-33. [PMID: 22733640 DOI: 10.1002/chp.21135] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Resuscitation and life support skills training comprises a significant proportion of continuing education programming for health professionals. The purpose of this study was to explore the perceptions and attitudes of certified resuscitation providers toward the retention of resuscitation skills, regular skills updating, and methods for enhancing retention. METHODS A mixed-methods, explanatory study design was undertaken utilizing focus groups and an online survey-questionnaire of rural and urban health care providers. RESULTS Rural providers reported less experience with real codes and lower abilities across a variety of resuscitation areas. Mock codes, practice with an instructor and a team, self-practice with a mannequin, and e-learning were popular methods for skills updating. Aspects of team performance that were felt to influence resuscitation performance included: discrepancies in skill levels, lack of communication, and team leaders not up to date on their skills. Confidence in resuscitation abilities was greatest after one had recently practiced or participated in an update or an effective debriefing session. Lowest confidence was reported when team members did not work well together, there was no clear leader of the resuscitation code, or if team members did not communicate. DISCUSSION The study findings highlight the importance of access to update methods for improving providers' confidence and abilities, and the need for emphasis on teamwork training in resuscitation. An eclectic approach combining methods may be the best strategy for addressing the needs of health professionals across various clinical departments and geographic locales.
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Affiliation(s)
- Vernon Curran
- Faculty of Medicine, Memorial University of Newfoundland, Canada.
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Curran V, Rourke L, Snow P. A framework for enhancing continuing medical education for rural physicians: A summary of the literature. MEDICAL TEACHER 2010; 32:e501-e508. [PMID: 21039092 DOI: 10.3109/0142159x.2010.519065] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Recruitment and retention of rural physicians is vital for rural health care. A key deterrent to rural practice has been identified as professional isolation and access to continuing medical education/continuing professional development (CME/CPD). AIMS The purpose of this article is to review and synthesize key themes from the literature related to CME/CPD and rural physicians to facilitate CME/CPD planning. METHODS A search of the peer-reviewed English language literature and a review of relevant grey literature (e.g., reports, conference proceedings) was conducted. RESULTS There is robust evidence demonstrating that the CME/CPD needs of rural physicians are unique. Promising practices in regional CME/CPD outreach and advanced procedural skills training and other up-skilling areas have been reported. Distance learning initiatives have been particularly helpful in increasing access to CME/CPD. The quality of evidence supporting the overall effect of these different strategies on recruitment and retention is variable. CONCLUSION Supporting the professional careers of rural physicians requires the provision of integrated educational programs that focus on specific information and skills. Future research should examine the linkage between enhanced CME/CPD access and its effect on factors related to retention of physicians in rural communities. A proposed framework is described to aid in developing CME/CPD for rural practitioners.
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Affiliation(s)
- Vernon Curran
- Academic Research and Development, Professional Development and Conferencing Services, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada.
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Abstract
Trauma systems have been shown to provide the best trauma care for injured patients. A trauma system developed for Indigenous people should take into account many factors including geographical remoteness and cultural diversity. Indigenous people suffer from a significant intentional and non-intentional burden of injury, often greater than non-Indigenous populations, and a public health approach in dealing with trauma can be adopted. This includes transport issues, prevention and control of intentional violence, cultural sensitization of health providers, community emergency responses, community rehabilitation and improving resilience. The ultimate aim is to decrease the trauma burden through a trauma system with which indigenous people can fully identify.
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Affiliation(s)
- Frank Plani
- Trauma Surgery, Royal Darwin Hospital, Darwin, NT, Australia.
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