Factors determining development of researchers within a research network on cancer diagnosis in primary care (CanTest): an interview study

OBJECTIVES

Developing connections with other researchers in a network, learning informally through these connections and using them to reach goals, is expected to increase research capacity and strengthen performance. So far, this has not been empirically demonstrated. We assessed what and how network collaboration adds to development of researchers.

DESIGN

Exploratory qualitative study using semistructured online interviews, analysed by inductive and deductive methods. For the deductive analysis, an existing value creation framework to study informal learning in networks was used and adjusted to our context.

SETTING

The CanTest Collaborative-an international team of primary care cancer researchers working on early detection and diagnosis of cancer.

PARTICIPANTS

Sixteen primary care cancer researchers.

RESULTS

Connections with other researchers in an international network created diverse value cycles, where most outcomes were in the potential value cycle, acquiring knowledge, skills, social capital, resources and ideas. Not all potential value will be applied but many interviewees described realised as well as transformational value. In our context, the transformational value from the framework appeared to be related to other perspectives on the research process. Advancement of the network depends on opportunities, timing, role models and connections between different perspectives.

CONCLUSIONS

Focus on the factors that are relevant for network advancement will support researchers in early detection and diagnosis of cancer research patients who participate in an international network and bring sustainable change in this domain. When, subsequently, researchers in the CanTest network bring about more realised and transformational learning outcomes, this will contribute to capacity development.

[Physician, disclose thyself! Self-disclosure as an educational tool]

Supervisor self-disclosure is essential for both personal and professional development of the next generation of doctors. We highlight the importance of self-disclosure and urge doctors in a supervising role to embed self-disclosure in their supervisory activities. Effective supervision of residents and interns encompasses many elements. Self-disclosure positively contributes to a safe teaching environment as well as a nurturing supervisor-trainee relationship. Self-disclosure can be used in many supervisory settings to benefit the development of residents and interns. It is of the utmost importance that self-disclosure should be used consciously and at suitable moments. Tools to achieve optimal self-disclosure are provided.

Patients' views on student participation in general practice consultations: a comprehensive review

BACKGROUND

Recruiting general practitioners (GPs) to host students for their clerkship is difficult. GPs often assume patients dislike consulting a student-doctor.

AIM

To systematically review the evidence on patient satisfaction regarding the presence/participation of a student during a consultation in general practice.

METHOD

Medline search (January 1990 to July 2010). One reviewer extracted data from the articles fulfilling the criteria which were set, and a second reviewer checked these for accuracy. Due to heterogeneity a quantitative synthesis could not be performed.

RESULTS

Sixteen studies fulfilled the criteria. The majority of patients gave permission for the presence or participation of a student-doctor. Emotional problems and the need for an intimate examination were the main reasons for refusal. Satisfaction was high. Benefits the patients mentioned were: more time, a more thorough physical examination, better patient education and getting a second opinion. Altruism also played a role.

CONCLUSION

In general, the attitude of patients towards student-doctors is positive. There is a general reluctance to see a student-doctor for emotional or intimate problems. Future research should focus on the effect of the preceptor's presence in the latter case. Another interesting topic would be the effect on consent and appreciation of the student-doctor when there are differences in cultural background between patient and student.

Discussing partner abuse: does doctor's gender really matter?

BACKGROUND

There are conflicting findings on the influence of gender on responding to partner abuse.

OBJECTIVES

We aimed to explore gender differences in family doctors' views, attitudes, experiences and practices regarding intimate partner abuse against women.

METHODS

We used the focus-group method with a stratified, randomized sample of family physicians. Three male and three female groups took part. Two independent researchers analysed the transcripts of the discussions.

RESULTS

There were differences between male and female groups in discussing partner abuse, although similarities were also noted. Major contrasts in opinions were seen in (i) the role of sexuality: part of the male family doctors stated that denial of sexual relationships by a spouse was a contributing and eliciting factor to male aggression, whereas female doctors emphasized unanimously the humiliation of sexual coercion and the danger of opposing. (ii) Children as witnesses: this issue was discussed in female groups only, (iii) female doctors talked about emotional involvement with patients and male doctors about keeping distance, (iv) female doctors viewed leaving an abusive partner as a process whilst male doctors saw no progress, (v) experiences with abused patients: female doctors remembered more actual cases and (vi) practices in managing partner abuse differed between men and women.

CONCLUSION

These remarkable gender-related differences among doctors might affect care for abused women. Doctors should be aware of gender-related views, attitudes and practices that can be harmful to their patients.

Increased awareness of intimate partner abuse after training: a randomised controlled trial

BACKGROUND

Intimate partner abuse is very common among female patients in family practice. In general, doctors overlook the possibility of partner abuse.

AIM

To investigate whether awareness of intimate partner abuse, as well as active questioning, increase after attending focus group and training, or focus group only.

DESIGN OF STUDY

Randomised controlled trial in a stratified sample.

SETTING

Family practices in Rotterdam and surrounding areas.

METHOD

A full-training group (n = 23), a group attending focus group discussions alone (n = 14), and a control group (n = 17) were formed. Data were collected with incident reporting of every female patient (aged >18 years) that was suspected of, or presented, partner abuse during a period of 6 months. The primary outcome measure was the number of reported patients; the secondary outcome measure was the number of patients with whom the GP had non-obvious reasons to suspect/discuss abuse.

RESULTS

Comparison of the full-training group (n = 87 patients) versus the control group (n = 14 patients) resulted in a rate ratio of 4.54 (95% confidence interval [CI] = 2.55 to 8.09, P <0.001); the focus group only group (n = 30 cases) versus control group: rate ratio of 2.2 (95% CI = 1.14 to 4.26, P = 0.019); full-training versus the focus group only group: rate ratio of 2.19 (95% CI = 1.36 to 3.52, P = 0.001). Comparison of the fulltraining group with the untrained groups for awareness of partner abuse in case of non-obvious signs resulted in: odds ratio 5.92 (95% CI = 2.25 to 15.62, P <0.01) all corrected for sex, district, practice setting, working part/full-time, experience, and age of the doctor.

CONCLUSIONS

Training was the most significant determinant to improve awareness and identification of intimate partner abuse. Active questioning increased, especially where there were non-obvious signs. The focus group on its own doubled the awareness of partner abuse.

Symptoms of post-traumatic stress disorder after non-traumatic events: evidence from an open population study

BACKGROUND

Post-traumatic stress disorder (PTSD) is the only psychiatric condition that requires a specific event to have occurred for its diagnosis.

AIMS

To gather evidence from the adult general population on whether life events (e.g. divorce, unemployment) generate as many symptoms of post-traumatic stress as traumatic events (e.g. accidents, abuse).

METHOD

Data on demographic characteristics and history of stressful events were collected through a written questionnaire sent to a random sample of 2997 adults. Respondents also filled out a PTSD symptom checklist, keeping in mind their worst event. Mean PTSD scores were compared, controlling for differences between the two groups. Differences in item scores and in the distribution of the total PTSD scores were analysed.

RESULTS

Of the 1498 respondents, 832 were eligible for inclusion in our analysis. For events from the past 30 years the PTSD scores were higher after life events than after traumatic events; for earlier events the scores were the same for both types of events. These findings could not be explained by differences in demographics, history of stressful events, individual item scores, or the distribution of the total PTSD scores.

CONCLUSIONS

Life events can generate at least as many PTSD symptoms as traumatic events. Our findings call for further studies on the specificity of traumatic events as a cause of PTSD.

Traumatic events in a general practice population: the patient's perspective

OBJECTIVES

The aim of the present study was to describe the patient's perspective on the GP's care after violent events: which role is the GP assigned; and how is the care appreciated. Events studied were serious accidents, burglary, robbery, physical and sexual abuse, disasters and war.

METHOD

A postal questionnaire was sent to a random sample of 2997 patients (> or =20 years) from the practice population of 32 GPs (67 500 patients).

RESULTS

The response was 50%. Forty-two per cent of the respondents had experienced one or more events. Twenty-eight per cent of the victims desired some kind of professional help; more than half of them desired that care from their GP, three-quarters actually seeking it. Most frequently sought care was sympathy, "a number of good talks", and care for physical complaints. Overall, contentment with the GP's contribution was high; patients especially appreciate sympathy and support, as well as initiative on the GP's part in commencing and pursuing care. Of those who felt no need for professional help, 88% found that they could cope with the traumatic event well enough, with or without the help of family and friends. For those who did not seek help, although they did desire it, the main reasons were that they considered their problems insufficiently medical or felt that their GP lacked the time. In the case of physical and sexual abuse, feelings of guilt and issues of patient confidentiality played a role for some patients.

CONCLUSIONS

The number of events experienced by our respondents is lower than in previous studies for burglary, robbery, physical and sexual abuse (adults and children); the occurrence of accidents is similar. The majority of the people who experience traumatic events cope with them well enough without professional help. For those seeking help, the GP plays an important role. Care could be improved as follows: the GP should make it clear to patients that he/she can play a role in caring for them in the aftermath of a traumatic event and stress the confidential nature of the consultation. On the whole, GPs should be more supportive and attentive when being consulted about this topic; also patients would like their doctors to be more active in raising the subject, as well as in initiating follow-up.