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Ahluwalia S, Spicer J. Professional identity and GP trainers as educational leaders. Educ Prim Care 2024:1-5. [PMID: 38651611 DOI: 10.1080/14739879.2024.2329891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/09/2024] [Indexed: 04/25/2024]
Abstract
GP training in the UK has a long history of success, however that is measured. That success is in part due to the formality and credentialling that underlies preparation to take on that role of a GP teacher, which is somewhat under current threat due to workforce pressures. We identify three important factors associated with the GP trainer function [leadership, professional identity and clinical care improvement] that are not often analysed but are at some risk if preparation for the GP trainer role is reduced or devalued. Of particular note are the differing ways that GPs conceptualise their professional roles as teachers and clinicians, despite the transferable skills between them, the demonstrably improved patient care that occurs in practices that teach, and the necessary connections between educational theory and practice. We suggest that these areas define a research agenda ripe for exploration.
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Affiliation(s)
- Sanjiv Ahluwalia
- Primary Care and Medical Education, Head of School of Medicine, Anglia Ruskin University, Chelmsford, UK
| | - John Spicer
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
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Pardhan S, Raman R, Biswas A, Jaisankar D, Ahluwalia S, Sapkota R. Knowledge, attitude, and practice of diabetes in patients with and without sight-threatening diabetic retinopathy from two secondary eye care centres in India. BMC Public Health 2024; 24:55. [PMID: 38167028 PMCID: PMC10763332 DOI: 10.1186/s12889-023-17371-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND/AIMS Good knowledge, Attitude, and Practice (KAP) of diabetes influence its control and complications. We examined the KAP of diabetes in patients with sight-threatening diabetic retinopathy (STDR) and non-sight-threatening diabetic retinopathy (NSTDR) attending two different referral hospitals in India. METHODS 400 consecutive patients (mean age = 58.5 years ± 10.3) with diabetic retinopathy attending retina referral clinics in Chennai (private) and Darjeeling (public) were recruited. A validated questionnaire on diabetic KAP was administered in English or the local language. Data were analysed using an established scalar-scoring method in which a score of 1 was assigned to the correct answer/healthy lifestyle and 0 to an incorrect answer/unhealthy lifestyle/practice. Clinical data included fasting blood sugar, blood pressure, retinopathy, and visual acuity. Retinopathy was graded as STDR/NSTDR from retinal images using Early Treatment of Diabetic Retinopathy Study criteria. RESULTS Usable data from 383 participants (95.8%) were analysed. Of these, 83 (21.7%) had STDR, and 300 (78.3%) had NSTDR. The NSTDR group reported a significantly lower total KAP score (mean rank = 183.4) compared to the STDR group (mean rank = 233.1), z = -3.0, p < 0.001. A significantly greater percentage in the NSTDR group reported to being unaware that diabetes could affect eyes, did not know about possible treatment for DR, and checked their blood sugar less frequently than once a month. CONCLUSION Patients who had not developed STDR had poorer KAP about diabetes and diabetes-related eye diseases. This is an important issue to address as the risk of their progressing to STDR is high unless appropriate steps to improve their knowledge/awareness and lifestyle practice are introduced early.
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Affiliation(s)
- Shahina Pardhan
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Young Street, Cambridge, CB1 2 LZ, UK.
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Anupama Biswas
- Department of Ophthalmology, Kurseong Sub-Divisional Hospital, Darjeeling, India
| | - Durgasri Jaisankar
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sanjiv Ahluwalia
- School of Medicine, Anglia Ruskin University, Chelmsford, CM11SQ, UK
| | - Raju Sapkota
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Young Street, Cambridge, CB1 2 LZ, UK.
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Ahluwalia S, Hughes E. Protecting patients and learners: educational leadership on the fringes. BMJ Lead 2023:leader-2023-000907. [PMID: 37945333 DOI: 10.1136/leader-2023-000907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
The development of high-quality clinicians takes place through immersion in clinical practice facilitated by educational supervisors with appropriate capabilities and organisational support to undertake the role. Learners give feedback on the quality of their learning experience on placement, which provides insights about the quality of clinical care received by patients.In this article, we explore the role of educational leaders in engaging with learner feedback about patient care, the challenges and tensions this generates, and the path through resolution. We use a lived example to showcase the issues raised and offer reflections on the challenges faced.
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Affiliation(s)
- Sanjiv Ahluwalia
- School of Medicine, Anglia Ruskin University - Chelmsford Campus, Chelmsford, UK
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Pardhan S, Driscoll R, Ingleton H, Slade J, Bowen M, Lovell-Patel R, Farrell S, Bourne R, Mahoney S, Ahluwalia S, Trott M. Confusion around Certification of Vision Impairment (CVI) and registration processes-are patients falling through the cracks? Eye (Lond) 2023; 37:3412-3416. [PMID: 37076690 PMCID: PMC10630472 DOI: 10.1038/s41433-023-02520-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND In the UK, the Certificate of Vision Impairment (CVI) certifies a person as sight impaired (partially sighted) or severely sight impaired (blind). This is completed by ophthalmologists and passed with the patient's consent to their GP, their local authority, and The Royal College of Ophthalmologists Certifications office. Once a person is certified, they can be registered by their local authority which is voluntary but enables the person to access rehabilitation or habitation services, financial concessions, welfare benefits and other services provided by local authorities. METHODS We conducted semi-structured individual interviews with 17 patients with a diagnosed eye condition, 4 Eye Clinic Liaison Officers (ECLO) and 4 referring optometrists around their experiences around CVI and registration processes. Analysis of themes was conducted with results synthesised in a narrative analysis. RESULTS Patients reported lack of clarity around the processes of certification and registration, benefits of certification and what happens beyond certification, the type of support that they are entitled to, delays in accessing support. Optometrists appear not to engage with the process much, especially if the patient is being treated by the hospital eye service. CONCLUSION Vision loss can be a devastating experience for the patient. There is a lack of information and confusion around the process. The lack of a joined-up process between certification and registration needs to be addressed if we are to provide the support that patients deserve in order to improve their quality of life and wellbeing.
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Affiliation(s)
- Shahina Pardhan
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK.
| | - Robin Driscoll
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK
| | | | - John Slade
- Royal National Institute of Blind People, London, UK
| | | | | | - Sarah Farrell
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Rupert Bourne
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK
| | - Simon Mahoney
- Department of Information Studies, University College London, London, UK
| | | | - Mike Trott
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Shah R, Ahluwalia S, Spicer J. Relational care and epistemic injustice. Prim Health Care Res Dev 2023; 24:e62. [PMID: 37870126 PMCID: PMC10594641 DOI: 10.1017/s1463423623000555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/18/2023] [Accepted: 08/07/2023] [Indexed: 10/24/2023] Open
Abstract
The philosophical underpinnings of primary care have been examined from several perspectives in recent years. In two previous articles, we have argued that a relational view of autonomy is better matched to the primary care setting than others, and that view is mainly formed from the descriptors of its practice. Here we develop that analysis further, linking it to other relevant theory: the experience of human suffering and epistemic injustice. We argue that relational care is fundamental to ameliorating epistemic injustice and that relationships are integral to ethical practice, rather than being distinct. We propose that personalised care as described in the NHS Long Term Plan is not possible without addressing epistemic injustice and therefore without reconsidering our existing normative ethical frameworks.
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Affiliation(s)
| | | | - John Spicer
- Institute of Medical and Biomedical Education, St George’s University of London, London, UK
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Shah R, Clarke R, Ahluwalia S, Launer J, Spicer J. Measuring meaning. Br J Gen Pract 2023; 73:226-227. [PMID: 37105735 PMCID: PMC10147414 DOI: 10.3399/bjgp23x732813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Affiliation(s)
- Rupal Shah
- Rupal is a GP and medical educator in London.
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Morein-Zamir S, Ahluwalia S. Hoarding disorder: evidence and best practice in primary care. Br J Gen Pract 2023; 73:182-183. [PMID: 36997219 PMCID: PMC10049603 DOI: 10.3399/bjgp23x732513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Affiliation(s)
- Sharon Morein-Zamir
- School of Psychology and Sports Science, Anglia Ruskin University, Cambridge
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Shah R, Clarke R, Ahluwalia S, Launer J. Finding meaning in medical education - how the hermeneutic window can help primary care educators. Educ Prim Care 2022; 33:308-311. [PMID: 35899592 DOI: 10.1080/14739879.2022.2081936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
We have published a model in which biomedical and humanistic elements of the consultation are seen as complementary and where hermeneutics, the discovery and creation of meaning, plays an integral role in enriching conversations both between clinicians and patients and also between teachers and learners. We have also proposed that hermeneutics can be particularly powerful in exploring and making explicit elements of the hidden curriculum. In this article, we consider how hermeneutics can be applied in primary care training and supervision, in order to enhance the experience for both teacher and learner.
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Affiliation(s)
- Rupal Shah
- GP Partner Bridge Lane Group Practice, Professional Development Team Health Education England, London, England
| | | | - Sanjiv Ahluwalia
- Head of School of Medicine, Anglia Ruskin University, Chelmsford, UK
| | - John Launer
- Programme Director for Innovation, Health Education England, London, UK
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Shah R, Clarke R, Ahluwalia S, Launer J. Finding meaning in the hidden curriculum - the use of the hermeneutic window in medical education. Educ Prim Care 2022; 33:132-136. [PMID: 35272579 DOI: 10.1080/14739879.2022.2047112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We have published a model of the GP consultation where biomedical and humanistic elements of the consultation are seen as complementary and where hermeneutics, the discovery and creation of meaning, plays an integral role in enriching the conversation between clinicians and patients. The relationship between teachers and learners shows strong parallels with the relationship between practitioners and patients. We therefore explore how a similar analysis can enhance the relationship between teachers and learners and propose that hermeneutics can be particularly powerful in exploring and making explicit elements of the hidden curriculum.
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Affiliation(s)
- Rupal Shah
- GP Partner Bridge Lane Group Practice, Associate Dean Professional Development Team Health Education England, London, England
| | | | - Sanjiv Ahluwalia
- Head of School of Medicine, Anglia Ruskin University, Chelmsford, England
| | - John Launer
- Programme Director for Innovation, Health Education England, London, England
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Affiliation(s)
- Rupal Shah
- Professional Development, Health Education England London; GP, Bridge Lane Group Practice, London
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Spicer J, Ahluwalia S, Shah R. Moral flux in primary care : the effect of complexity. J Med Ethics 2021; 47:86-89. [PMID: 32409623 DOI: 10.1136/medethics-2020-106149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 06/11/2023]
Abstract
In this article, we examine the inter-relationship between moral theory and the unpredictable and complex world of primary health care, where the values of patient and doctor, or groups of patients and doctors, may often clash. We introduce complexity science and its relevance to primary care; going on to explore how it can assist in understanding ethical decision making, as well as considering implications for clinical practice. Throughout the article, we showcase aspects and key concepts using examples and a case study developed from our day-to-day experience working as clinical practitioners in primary care.
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Affiliation(s)
- John Spicer
- Institute for Medical and Biomedical Education, St George's, University of London, London, UK
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Affiliation(s)
- Rupal Shah
- Health Education England, London, UK; Bridge Lane Group Practice, London SW11 3AD, UK.
| | - Sanjiv Ahluwalia
- Health Education England, London, UK; Wentworth Medical Practice, London, UK
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Ahluwalia S, Spicer J, Patel A, Cunningham B, Gill D. Understanding the relationship between GP training and improved patient care - a qualitative study of GP educators. Educ Prim Care 2020; 31:145-152. [PMID: 32106783 DOI: 10.1080/14739879.2020.1729252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Previous research has highlighted the benefits of receiving care in a postgraduate GP training practice including improved patient satisfaction, more appropriate secondary care usage, cancer diagnosis, and antibiotic prescribing. Whilst the influence of being registered in a postgraduate GP training practice on patient outcomes is modest relative to other factors such as deprivation, disease burden, demography, and ethnicity, the reasons for this benefit is not clear. AIM This study explores how GP trainers perceive engagement with clinical education influences patient care. METHODS Socio-cultural theories were used as a framework for guiding the research. Semi-structured interviews were conducted with 11 GP educators. Interviews were recorded and transcribed verbatim. Data analysis involved thematic analysis. RESULTS GP educators identified four overarching themes that, for them, seemed to explain how clinical education mediates its influence on patient care. These included: influencing through (i) educational leadership; (ii) learners; (iii) the educational process; and (iv) educational standards. DISCUSSION Findings suggest that GP trainees have a significant effect on the learning environment, professional development of GP trainers, and patient care. The nature of the relationship between GP trainers and trainees appears far more bilateral than acknowledged in the apprenticeship model.
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Affiliation(s)
| | | | | | - Bryan Cunningham
- Department of Education, Practice and Society, Institute of Education, University College London , London, UK
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Wong S, Ahluwalia S. M206 BENRALIZUMAB FOR THE TREATMENT OF REFRACTORY ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Affiliation(s)
- Andy Tate
- Head of GP School, Health Education England, North West London, UK
| | - Sanjiv Ahluwalia
- Postgraduate Dean, Health Education England, North Central and East London, UK
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Ahluwalia S, Sadak M, Ashworth M. Antimicrobial prescribing in post-graduate training practices: a cross-sectional study of prescribing data in general practices in England. Education for Primary Care 2018; 29:139-143. [DOI: 10.1080/14739879.2018.1430515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Mohamed Sadak
- Health Education England North and Central London, London, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
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Sanfey J, Ahluwalia S. Lifting the dead hand on general practice. Br J Gen Pract 2018; 68:10-11. [PMID: 29284618 PMCID: PMC5737285 DOI: 10.3399/bjgp17x693989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- John Sanfey
- Supplier to GP Resilience Programme - Renervate. Freelance GP, South Central London Pallant Chambers
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Weston C, Ahluwalia S, Bassett P, Lock J, Durbaba S, Ashworth M. GP Training practices in England: a description of their unique features based on national data. Education for Primary Care 2017; 28:313-318. [DOI: 10.1080/14739879.2017.1345649] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Charlotte Weston
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | | | | | - Justin Lock
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Stevo Durbaba
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King’s College London, London, UK
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Ahluwalia S, Tavabie A, Spicer J, Chana N. Community-based education providers network: an opportunity to unleash the potential for innovation in primary care education. Education for Primary Care 2015; 24:394-7. [PMID: 24196593 DOI: 10.1080/14739879.2013.11494207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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McLaren P, Patel A, Trafford P, Ahluwalia S. GP trainers’ experience of managing a trainee in difficulty: a qualitative study. Education for Primary Care 2015; 24:363-71. [DOI: 10.1080/14739879.2013.11494201] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ahluwalia S, de Silva D, Chana N. Evaluation of a programme in population health management for GP trainees. Public Health 2014; 128:925-33. [PMID: 25369356 DOI: 10.1016/j.puhe.2014.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 08/02/2014] [Accepted: 08/06/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVES There is an increasing focus on improving outcomes for populations. General practice has a key role to play in achieving better patient outcomes. A programme in population health management was developed for GP trainees in their fourth year. The objective was to evaluate this educational intervention for impact upon learners, and lessons learned in the delivery of this innovative programme. METHODS The evaluation approach combined qualitative and quantitative approaches involving GP trainees, GP trainers, and faculty. RESULTS Involvement in the programme had a positive impact upon trainees' knowledge of population health management, developed transferable skills, and encouraged a shift in mindset to considering the needs of a practice population. The impact upon patients and practices is also described. Lessons learned for enhancing the programme are explained. CONCLUSIONS Encouraging GP trainees to become involved with population health has significant benefits for their professional development. The Royal College of General Practitioners (RCGP) curriculum should consider incorporating population health competencies.
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Affiliation(s)
- S Ahluwalia
- Health Education North Central and East London, Stewart House, 32 Russell Square, London WC1B5DN, United Kingdom.
| | - D de Silva
- The Evidence Centre, London, United Kingdom.
| | - N Chana
- Health Education South London, Stewart House, 32 Russell Square, London WC1B5DN, United Kingdom.
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de Kare-Silver N, Spicer J, Khan A, Ahluwalia S. Competency and practice: selection of specialty GP trainees for the 21st century. Educ Prim Care 2014; 25:129-31. [PMID: 25198469 DOI: 10.1080/14739879.2014.11494262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Poirrier AL, Ahluwalia S, Kwame I, Chau H, Bentley M, Andrews P. External nasal valve collapse: validation of novel outcome measurement tool. Rhinology 2014; 52:127-32. [PMID: 24932623 DOI: 10.4193/rhino13.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aim to validate a clinical scoring system of external nasal valve collapse. External nasal valve collapse is a rare and challenging condition. We attempted to simplify the examination of the external valve, the surgical planning and the outcome measure. To validate our external valve score, we first assessed its reliability (inter-rater agreement and test-retest repeatability). We secondly considered the clinical relevance by using our scoring system in patients undergoing septorhinoplasty for external valve collapse. METHODOLOGY For validation, 16 Rhinologists scored patients separately on two occasions. For the clinical relevance, 26 patients with external valve collapse were scored pre- and post-operatively (responsiveness). The external valve score was correlated to peak nasal inspiratory flow. RESULTS The devised scoring system was reliable (substantial agreement between 16 surgeons with reproducibility over time). All patients in our prospective series showed significant improvement in their external valve score. The quality of life measured by the SNOT-22 tool showed significant improvement after surgery. CONCLUSION External nasal valve collapse can be diagnosed and graded using this simple scoring system in the outpatient clinic. This paper reinforces the pivotal role of septorhinoplasty surgery in nasal airway reconstruction and the ongoing need to quantify success.
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Poirrier A, Ahluwalia S, Kwame I, Chau H, Bentley M, Andrews P. External nasal valve collapse: validation of novel outcome measurement tool. Rhinology 2014. [DOI: 10.4193/rhin13.051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ashworth M, Schofield P, Durbaba S, Ahluwalia S. Patient experience and the role of postgraduate GP training: a cross-sectional analysis of national Patient Survey data in England. Br J Gen Pract 2014; 64:e168-77. [PMID: 24567656 PMCID: PMC3933833 DOI: 10.3399/bjgp14x677545] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 11/30/2013] [Accepted: 12/02/2013] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Quality indicators for primary care focus predominantly on the public health model and organisational measures. Patient experience is an important dimension of quality. Accreditation for GP training practices requires demonstration of a series of attributes including patient-centred care. AIM The national GP Patient Survey (GPPS) was used to determine the characteristics of general practices scoring highly in responses relating to the professional skills and characteristics of doctors. Specifically, to determine whether active participation in postgraduate GP training was associated with more positive experiences of care. DESIGN AND SETTING Retrospective cross-sectional study in general practices in England. METHOD Data were obtained from the national QOF dataset for England, 2011/12 (8164 general practices); the GPPS in 2012 (2.7 million questionnaires in England; response rate 36%); general practice and demographic characteristics. Sensitivity analyses included local data validated by practice inspections. OUTCOME MEASURES multilevel regression models adjusted for clustering. RESULTS GP training practice status (29% of practices) was a significant predictor of positive GPPS responses to all questions in the 'doctor care' (n = 6) and 'overall satisfaction' (n = 2) domains but not to any of the 'nurse care' or 'out-of-hours' domain questions. The findings were supported by the sensitivity analyses. Other positive determinants were: smaller practice and individual GP list sizes, more older patients, lower social deprivation and fewer ethnic minority patients. CONCLUSION Based on GPPS responses, doctors in GP training practices appeared to offer more patient-centred care with patients reporting more positively on attributes of doctors such as 'listening' or 'care and concern'.
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Affiliation(s)
- Mark Ashworth
- Department of Primary Care and Public Health Sciences, King's College London School of Medicine
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Ahluwalia S, de Silva D, Kumar S, Viney R, Chana N. Teaching GP trainees to use health coaching in consultations with patients: evaluation of a pilot study. Educ Prim Care 2014; 24:418-26. [PMID: 24196598 DOI: 10.1080/14739879.2013.11494212] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this paper is to describe the results of an evaluation of teaching health coaching to GP trainees for use in consultations with patients. DESIGN Fourteen GP trainees were invited to attend a coaching skills training course. Each trainee was asked to apply coaching skills to up to four patients with long-term conditions. The evaluation used observation, surveys, review of trainee portfolios, and interviews with GP trainees, patients, and other stakeholders. FINDINGS This evaluation found that it is feasible and useful to train GPs in health coaching. It had positive benefits for GP trainees, their patients, and the wider system. Lessons were also learned about the timing of the training, the style and content, the challenges of practising coaching skills within clinical practice, and selecting the most appropriate patients for coaching. LIMITATIONS This is a small pilot with a keen group of GP trainees. Further research is needed to determine if such an approach provides meaningful changes to patient outcomes and whether such approaches are cost-effective.
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Affiliation(s)
- Sanjiv Ahluwalia
- London School of General Practice, Health Education South London, UK
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Fox C, Alessi C, Ahluwalia S, Hachinski V. The use of wide-scale mental agility testing to identify people at risk of dementia: crucial or harmful? J R Coll Physicians Edinb 2014; 44:30-5. [DOI: 10.4997/jrcpe.2014.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Chana N, Ahluwalia S. Evaluating the care of patients with long term conditions. London J Prim Care (Abingdon) 2014; 6:131-5. [PMID: 25949734 DOI: 10.1080/17571472.2014.11494364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Approaches to evaluating the care of patients with long-term conditions first need to be framed around defining outcomes that 'matter to people', rather than those that are focused on disease and easily measurable. Secondly, approaches to evaluating such care should be organised with the ability to 'deliver what matters to people' - such models of care must allow for the opportunity to maximise the impact of primary care. Finally, any approach to evaluation must also 'enable the delivery of what matters to people', including approaches to promote self-care, well-being and interprofessional workforce development organised around educational networks.
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Affiliation(s)
- Nav Chana
- National Association of Primary Care, London, UK
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Morgan-Jones D, Wilkie V, Mohanna K, Nicol E, Cowpe J, Swanwick T, Ahluwalia S, Chana N, Alden E. Innovations and developments. Education for Primary Care 2013; 24:73-6. [DOI: 10.1080/14739879.2013.11493458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Swanwick T, Ahluwalia S, Chana N. Clinical leadership for commissioning. Educ Prim Care 2013; 24:80-82. [PMID: 23451360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Goodson A, Poirrier AL, Ahluwalia S, Bentley M, Andrews P. Sino-Nasal Outcome Test (SNOT-22) in septorhinoplasty: a useful outcome measure? Br J Oral Maxillofac Surg 2012. [DOI: 10.1016/j.bjoms.2012.04.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Stimpson P, Ahluwalia S, Vaz F, O'Flynn P. A flexible option for organ preservation in head and neck surgery. Clin Otolaryngol 2011; 36:96-7. [PMID: 21414173 DOI: 10.1111/j.1749-4486.2010.02245.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
A case of meningeal melanocytoma in the posterior fossa of a 16-year-old male is reported. Computed tomographic and magnetic resonance imaging features are presented. Pathological investigation including light and electron microscopy, and immunohistochemical staining are discussed. Current literature is reviewed and differentiating criteria from meningioma and other pigmented tumours of the nervous system are discussed.
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Affiliation(s)
- S Ahluwalia
- Victor Horsley Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK.
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Ahluwalia S, Hannan SA, Mehrzad H, Crofton M, Tolley NS. A randomised controlled trial of routine suction drainage after elective thyroid and parathyroid surgery with ultrasound evaluation of fluid collection. Clin Otolaryngol 2007; 32:28-31. [PMID: 17298307 DOI: 10.1111/j.1365-2273.2007.01382.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the need for suction drainage after elective thyroid and parathyroid surgery. DESIGN Randomised controlled trial. SETTING University teaching hospital. PARTICIPANTS Patients requiring elective thyroid or parathyroid surgery were recruited and informed consent was obtained (n = 100). Before wound closure, patients were randomised into either group A (to remain without suction drainage) or group B (to receive suction drainage). Excluded patients were those requiring associated neck dissection and those with bleeding diatheses, all of whom would necessarily require drainage in our unit. MAIN OUTCOME MEASURES Primary - ultrasound evaluation of any collection in the thyroid bed, performed 1-day postoperatively. Secondary - postoperative complications; length of in-patient stay. RESULTS One hundred patients completed the study, and groups A and B comprised 50 patients each. Patients in each group exhibited a mean age of 49 years, and a male to female ratio of 1 : 9. Both groups were also well-matched regarding type of operation, size of tumour and histopathological diagnosis. Modal and median postoperative neck collection volume on ultrasound examination was 0 and 0 cm(3) respectively (range 0-16 cm(3)) in group A and was 0 and 0 cm(3) (range 0-70 cm(3)) in group B. This difference was not statistically significant, but three patients with a haematoma were all in the suction drainage group. Difference in complication rates between groups was also not statistically significant. Modal and median length of in-patient stay was 2 and 2 days respectively (range 2-3 days) in group A and 3 and 3 days (range 2-4 days) in group B, and this difference was statistically significant (P = 0.0006). CONCLUSION Routine suction drainage after uncomplicated elective thyroid and parathyroid surgery appears unnecessary, and prolongs in-patient stay.
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Affiliation(s)
- S Ahluwalia
- Department of Otorhinolaryngology - Head and Neck Surgery, St Mary's Hospital, London, UK.
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Swanwick T, Ahluwalia S, Rennison T, Talbot T. The Quality and Outcomes Framework (QOF) and the Assessment of Training Practices as Learning Organisations. Education for Primary Care 2007. [DOI: 10.1080/14739879.2007.11493546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
The introduction of the European Working Time Directive has meant a reduction in the number of hours that junior doctors may spend at work. The impact that this legislation will have on training and the continuity of patient care may be significant. In an attempt to reduce the number of doctors required to look after patients after hours, the Hospital at Night programme has been introduced. The basis of the project is to have a team of generically skilled surgeons on call to handle emergencies and routine ward work from all surgical specialties. The reasoning behind this move is that most SHOs have sufficient training to deal with most surgical problems; any more advanced problems are to be referred to the SpR or consultant surgeon for that specialty.
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Ahluwalia S, Offredy M. A qualitative study of the impact of the implementation of advanced access in primary healthcare on the working lives of general practice staff. BMC Fam Pract 2005; 6:39. [PMID: 16188036 PMCID: PMC1249563 DOI: 10.1186/1471-2296-6-39] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2005] [Accepted: 09/27/2005] [Indexed: 11/10/2022]
Abstract
Background The North American model of 'advanced access' has been emulated by the National Primary Care Collaborative in the UK as a way of improving patients' access in primary care. The aim of this study was to explore the impact of the implementation of advanced access on the working lives of general practice staff. Methods A qualitative study design, using semi-structured interviews, was conducted with 18 general practice staff: 6 GPs, 6 practice managers and 6 receptionists. Two neighbouring boroughs in southeast England were used as the study sites. NUD*IST computer software assisted in data management to identify concepts, categories and themes of the data. A framework approach was used to analyse the data. Results Whilst practice managers and receptionists saw advanced access as having a positive effect on their working lives, the responses of general practitioners (GPs) were more ambivalent. Receptionists reported improvements in their working lives with a change in their role from gatekeepers for appointments to providing access to appointments, fewer confrontations with patients, and greater job satisfaction. Practice managers perceived reductions in work stress from fewer patient complaints, better use of time, and greater flexibility for contingency planning. GPs recognised benefits in terms of improved consultations, but had concerns about the impact on workload and continuity of care. Conclusion AA has improved working conditions for receptionists, converting their perceived role from gatekeeper to access facilitator, and for practice managers as patients were more satisfied. GP responses were more ambivalent, as they experienced both positive and negative effects.
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Affiliation(s)
| | - Maxine Offredy
- Faculty of Health and Human Sciences, University of Hertfordshire, College Lane, Hatfield, AL10 9AB, UK
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Abstract
Interprofessional education (IPE) is the foundation for collaborative practice. It is resource intensive because it requires a shift away from didactic teaching towards a model of facilitated small group learning. This article discusses the ways in which IPE is supported by educational theory and summarizes the increasing evidence for its effectiveness in transforming health-care organizations, leading to increased staff motivation and direct improvements in patient care.
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Abstract
The authors report a novel treatment of a case of type I laryngeal cleft diagnosed in an adult. They describe a technique of endoscopic obliteration of the posterior commissure defect. Initially, a test implant of starch and adrenaline was used, followed by permanent staged injections of Bioplastique to the posterior commissure. This rare congenital anomaly usually presents in childhood but late presentation should be considered when adults present with lifelong dysphonia especially when associated with gastro-oesophageal reflux disease.
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Affiliation(s)
- S Ahluwalia
- Department of Otolaryngology, The Lister Hospital, Stevenage, Herts., UK.
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Abstract
This is the first report of a contractile actin isoform, a-smooth muscle actin (SMA), in the cells of the human meniscus that lacked meniscal tears based on gross anatomical appearance. Approximately 25% of the cells in the tissue contained SMA by immunohistochemistry. Most of the SMA-positive cells were chondrocytic in morphology.
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Affiliation(s)
- S Ahluwalia
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Abstract
This article describes the findings of an exploratory study which aimed to discover how clinically effective nursing care is fostered among clinical nurse specialists (CNSs) and nurse practitioners (NPs) in an NHS trust in East London. The study was funded by the Central and East London Education Consortium in January 1999. Qualitative approaches included non-participant observation of practice, interviews during observaton and focus group meetings, Findings from the research identify areas that both foster and hinder the ability of the CNSs and NPs to engage in and provide clinically effective nursing care.
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Affiliation(s)
- C L Cox
- St Bartholomew School of Nursing and Midwifery, City University, London
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Abstract
1. In the presence of dihydroxyfumarate, horseradish peroxidase catalyses the conversion of p-coumaric acid into caffeic acid at pH 6. This hydroxylation is completely inhibited by superoxide dismutase. 2. Dihydroxyfumarate cannot be replaced by ascorbate H2O2, NADH, cysteine or sulphite. Peroxidase can be replaced by high (10 mM) concentrations of FeSO4, but this reaction is almost unaffected by superoxide dismutase. 3. Hydroxylation by the peroxidase/dihydroxyfumarate system is completely inhibited by low concentrations of Mn2+ or Cu2+. It is proposed that this is due to the ability of these metal ions to react with the superoxide radical O2--. 4. Hydroxylation is partially inhibited by mannitol, Tris or ethanol and completely inhibited by formate. This seems to be due to the ability of these reagents to react with the hydroxyl radical -OH. 5. It is concluded that O2-- is generated during the oxidation of dihydroxyfumarate by peroxidase and reacts with H2O2 to produce hydroxyl radicals, which then convert p-coumaric acid into caffeic acid.
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Ahluwalia S, Alberts JO, Hanson LE. Effect of cortisone on Leptospira pomona infection in guinea pig. Indian Vet J 1965; 42:837-48. [PMID: 5848746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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