Series: Volume 2, Issue 2 2011

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Editorials

Crossing boundaries – the expansion of the AMSJ

Some staff of the AMSJ. Clockwise from left: Patrick Teo, Timothy Yang, Matthew Schiller, Chris Mulligan, Praveen Indraratna, Aaron Tan, Alexander Murphy, Grace Leo, Veronica Lim and Helena Jang.
Some staff of the AMSJ. Clockwise from left: Patrick Teo, Timothy Yang, Matthew Schiller, Chris Mulligan, Praveen Indraratna, Aaron Tan, Alexander Murphy, Grace Leo, Veronica Lim and Helena Jang.

From treating acute blood loss in children to palliative care barriers for the elderly, this issue truly showcases the enormous potential and diverse interests of Australian medical students. Our authors have not been afraid to address controversial issues such as emergency department waiting times, healthcare financing and comparisons between barrier exams across Australian medical universities. We are also privileged to be sharing the insights of four remarkable professorial guest authors. Former Australian of the Year recipients Fiona Stanley and Ian Frazer shed light on future directions of research; the IVF and stem cell research pioneer Alan Trounson reflects on progress in his field and Alden Harken, Professor of Surgery at the University of California San Francisco reminds us how fortunate we are to be in medicine.

 

A core focus of the AMSJ is to become a national journal, that is, one which represents fairly and equally the academic and research achievements of students Australia-wide, without ties to a particular university. The journal has expanded widely in recent months, our current editorial team now spans four states, and we are moving towards full nationalisation of our staff for future issues. Meeting our readers is also a key priority in shaping a national journal, and we were very pleased to hear many positive comments and suggestions from those who attended the AMSA National Convention and Global Health Conference in July.

One of our exciting new initiatives is the AMSJ Blog, updated regularly at our website: www.amsj.org/blog. Authored by staff members, it provides personal perspectives on medical student life, with articles ranging from practical educational posts to lessons learnt outside the hospital, and tackling the bigger questions we all ask ourselves from time to time (‘So you don’t want to be a doctor anymore?’). We hope you take a look at this terrific new forum for student participation.

As always, support for the AMSJ across Australia’s medical schools has been extraordinary, with the free print copies being in huge demand. Remember that you can download the entire journal for free from our website. Articles from the AMSJ will soon be available on the EBSCOhost database and have gained interest from other major academic research databases and indexing systems. We have also had the pleasant ‘problem’ of reaching our friend limit on Facebook and are switching to a new AMSJ Facebook page: www.facebook.com/amsj.org so please make sure you visit and click ‘Like’ to stay up-to-date!

The journal is a massive undertaking, and we are grateful to have a wonderful and dedicated volunteer staff of medical students and peer-reviewers who work very hard to make this journal a success. Of course we also thank you, our readers, for welcoming and supporting us as the AMSJ continues to display the research abilities of Australia’s medical students.

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Editorials

The great wall of medical school: A comparison of barrier examinations across Australian medical schools

Figure 1: Miller’s Pyramid of Clinical Competence with Associated Assessment Methods. Adapted from [2], with permission.

Figure 1: Miller’s Pyramid of Clinical Competence with Associated Assessment Methods. Adapted from 2, with permission.
From the moment that a medical student receives their university offer until the moment they take the Hippocratic Oath in front of proud family and friends, they will tread a path only taken by a select number before them. However, with medical schools now in every state and territory of Australia, the journey will not be identical for all students. For some, this will be a marathon, with continuous assessment peppering the entire journey, while others will encounter multiple large hurdles, interspaced with periods of calm. Despite this very different experience of medical school, all will ultimately compete for an increasingly competitive pool of internship positions, which represent the key to unlocking their future medical careers…

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Editorials

In and out in four hours: The effects of the four-hour emergency department target on patients, hospitals and junior doctors

Introduction

In the eyes of the general public, a hospital’s Emergency Department (ED) is synonymous with overcrowding and tedious waiting. Keen to change this, last year, at the meeting of the Council of Australian Governments, the states ratified a National Partnership Agreement on health reform. One controversial outcome of this agreement was the four-hour National Access Target (NAT), which requires that all patients that present to EDs will need to be admitted, discharged or referred within four hours, if clinically appropriate. [1-3]

The new targets are currently being phased in, beginning with life-threatening triage 1 cases, but the true impact of the plan is unlikely to be felt until 2015, when non-urgent triage 5 cases will also be required to meet the target. Under the terms of the agreement, if 95% of patients within a particular Australian state are seen within the four hour target, that state will be awarded extra funding out of a national pool of $250 million over the next four years. [2]

The introduction of the NAT has been met with several questions. Does putting a time limit on patients in the ED jeopardise their safety due to rushed management decisions? Is it realistic that this target can be met when there are so many factors impeding efficient patient assessment? How will you be affected when you work against the clock in the coming years?

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Letters

National standards in medical education: Being accountable and striking a balance

The recent suggestions of a national curriculum and a national examination have created important discussions about Australian medical education and its future. [1-2]

The debate surrounding their merits and disadvantages is likely to remain ongoing without reaching a consensus amongst all involved stakeholders. [3] With the significant increase in the number of medical graduates and heterogeneity of current and future medical curriculum and programmes, [4-5] there is an urgent need for regulatory authorities of medical practitioners (such as the Medical Board of Australia and the Australian Medical Council (AMC)) to ensure all Australian medical graduates have reached agreed standards of delivering adequate and safe patient care. [6]

One of the most practical and effective measures that can be immediately taken by the AMC is to conduct an annual external review and audit of each medical school’s final examinations. This will serve the important function of ensuring that valid and reliable assessments are being put into place. The final examinations should be properly “blueprinted” to check that the medical graduates have truly met important learning outcomes and have achieved the competencies set out in their curriculum or programmes. [7] It will also provide opportunities for the AMC to maintain the national agreed standard for Australia. [8] The current key issues here are social accountability and patient safety, both of which are extremely important topics amongst the Australian medical education community and all state health services. [9]

The annual external review and audit of final examinations can also strike a balance, allowing medical schools to maintain autonomy over curriculum development,the AMC is to conduct an annual external review and audit of each medical school’s final examinations. This will serve the important function of ensuring that valid and reliable assessments are being put into place. The final examinations should be properly “blueprinted” to check that the medical graduates have truly met important learning outcomes and have achieved the provided they can demonstrate that their graduates meet the national agreed standard.

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Letters

Mental illness and medical students

The recent article by Nguyen in AMSJ Vol 2, Issue 1 [1] raises several interesting points for discussion regarding the mental health of medical students.

In recent years, the mental well-being of medical students has received increasing publicity and coverage. This was previously a somewhat taboo topic within the medical community, but it has transitioned to become an issue that is now widely discussed and debated amongst students, faculty and the wider medical community. The outcome has been fruitful with a multitude of new initiatives highlighting the importance of mental health in health professionals. Nevertheless, there continues to be a worrying disparity in the prevalence of mental illness between medical students and the wider Australian population.

Nguyen outlined key factors that could contribute to this problem, including the fact that the medical course inflicts on students immense stressors including an overwhelming workload, rigorous examinations and lofty aspirations. [2,3] There is no doubt that this places an increasing burden on medical students. However, it must also be acknowledged that medical students generally have limited constructive coping strategies to deal with such stressors in the first place. Consequently, this may lead to a downward spiral involving concomitant behavioural problems; for example, excessive alcohol intake and the use of recreational drugs. [4]

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Letters

The justice of melancholia

In a previous issue of this journal, Nguyen [1] succinctly identified a high incidence of mental health conditions in Australian medical students.

The increased rates of depression and suicidal ideations experienced by this population depict a bleak future for the medical profession in this country. Of great concern is the fact that the barriers preventing medical students from accessing support are not only unique, but despairingly fraught with immeasurable difficulty and stigmatisation; stigma that is entrenched and perpetuated through the core of the medical culture. [2] Despite our existence in an apparently enlightened and diverse cultural framework, the disconcerting stigma branded upon mental health exists and it is truly deplorable…

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Original Research Articles

Onsite and offsite use of computer aided learning in undergraduate radiology education

Aim: Computer-aided learning (CAL) is considered comparable to traditional media for undergraduate radiology teaching. Previous studies have often compared the efficacy of traditional media to onsite CAL use, yet real world usage of CAL is likely to occur in offsite settings. This study aims to compare usage and learning outcomes of a chest radiology CAL in onsite and offsite settings. Methods: Participants were fourth year medical students (n=52) at the National University of Singapore (NUS) undertaking one week radiology rotations. Students were randomly allocated to complete a web-based chest radiology CAL onsite, or offsite at a time and place of choice. Pre- and post-tests were taken to measure knowledge gain, and a questionnaire was used to explore student usage and preferences.

Results: The onsite CAL group demonstrated significant knowledge gain (+15.8%, p<0.05) whilst the offsite group did not (+5.8%, p>0.05). However, the difference between the groups was not statistically significant (p=0.069). Total time spent and completion of the program was similar between the two groups. Yet, questionnaire results showed that the offsite group multitasked more and appeared to have poorer concentration. A majority of students from both groups preferred the convenience of offsite CAL use over onsite CAL use.

Conclusion: A significant difference between the test groups was not observed, although there was a trend toward onsite CAL use being more effective. In planning CAL teaching, particularly for offsite use, educators need to provide sufficient support and integration for an optimal outcome.

Introduction

Chest radiology is important for acute and emergency management, and is therefore an essential learning component of undergraduate radiology teaching. [1] However, studies show that chest radiology competency amongst graduating medical students is poor. [2,3] Poor competency is attributed to lack of formal teaching of radiology in the curriculum. [2,3] Worldwide, radiology teaching is compromised by limited formal teaching in a hectic curriculum, and competing demands on radiologists. [4,5]

Computer aided learning (CAL) has been advocated as a potential tool to alleviate some of the limitations in radiology teaching. [6] CAL is time and cost effective for educators, [7] and especially useful in an image rich specialty such as radiology. To evaluate the effectiveness of CAL for transferring knowledge gain, previous studies have undertaken media comparisons between CAL and traditional learning, such as lectures or tutorials. Individual studies in radiology and non-radiology medical education [8,9] demonstrate that overall, knowledge gain with CAL is comparable to …

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Original Research Articles

Maternal attitudes towards breast and bottle feeding in a regional community

Background: Based on research demonstrating the many benefits of breastfeeding, it is recommended babies be exclusively breastfed from birth to at least six months of age. However, despite these known benefits, many women choose to bottle feed or cease breastfeeding before six months. Aim: To survey women in order to determine factors associated with their attitudes and choice to bottle feed or breastfeed their children, with the aim of identifying areas to target education to improve breastfeeding rates or duration. Methods: Anonymous surveys were distributed to a convenience sample of 106 adult female patients selected from a suburban general practice. MS-Excel and Epi Info 3.5.3 software package were used for data management. Chi square was used for analysis. Results: The response rate was 94.3% (n=100). There were trends suggesting an association between income and the respondents’ choices (p=0.26); and income and the respondents’ mothers’ choices (p=0.51). Respondents were significantly more likely to choose the feeding method their own mother used (p=0.01). Discussion: Income and respondents’ mothers’ choice regarding breastfeeding were identified as factors possibly associated with respondents’ attitudes and choice. Hence awareness of individual family dynamics may assist in targeting prenatal education to help increase rates of breastfeeding. A large proportion of respondents chose to bottle feed and also believed that the bottle was as good as breastfeeding. The needs of this group also need to be met. Conclusion: To increase breastfeeding rates, individualised prenatal education as well as supporting women through their breastfeeding problems is a likely requirement.

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Original Research Articles

Exploring barriers to the provision of palliative care in Australia

Palliative care provides assistance for people living with a terminal medical condition, for which the primary goal of treatment is improving quality of life. There are numerous barriers to the provision of palliative care. There is little research into barriers to the provision of palliative care and little with an Australian context. This research explores barriers to palliative care in Australia through questionnaires and interviews with stakeholders. One hundred and one questionnaires were given to South East Palliative Care (SEPC) community nursing and allied health staff, general practitioners and aged care facility staff. Five interviews were conducted with representatives from SEPC, Palliative Care Australia and two aged care facilities. Most agreed that palliative care was essential in the community, hospital and aged care setting. Four major themes were identified from interviews: 1.) Education & stigma barriers; 2.) Communication barriers; 3.) Aged care barriers; and 4.) General practice barriers. Inadequate prescriptions of pain medication were a significant issue. These themes were supported by questionnaire data, with 25.6% identifying education and 28.2% identifying resources as major barriers. Knowledge of palliative care was poor in both aged care staff and GPs, only 8.3% and 38.5% respectively answering all palliative care questions correctly, compared to 64.2% amongst SEPC staff. The study addresses a deficit in previous research, identifying barriers to palliation in aged care. The data collected has potential for further research or interventional approaches to improve the provision of palliative care for Australians.

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Original Research Articles

Emergency Department management and referral of self-harm patients

Aim: To outline the socio-demographic characteristics, the means of arrival, management and referral pathways for mental health presentations to the Emergency Department (ED) where the main reason for presentation is self-harm. Methods: A retrospective study conducted in a metropolitan hospital in Sydney. Sampled data were collected from mental health presentations to the ED for the month of May in 2005, 2006 and 2007. The data collected included patient demographics as well as management, referral and follow-up outcomes. Results: There were 606 patients in the sampled data (99.3% of all mental health presentations). The gender distribution of the patient cohort was 63:37 (male n=380 and female n=226) and the average age was 36 ± 16.7 years. Two hundred and three (33.5%) patients had self-harmed and 403 (66.5%) had other mental health problems. Self-harm patients’ mode of arrival included ambulance (38.4%), self-presentations (36.5%), police (14%), and other. Self-harmers were mainly admitted to Psychiatric Emergency Care Centre (PECC) (28%) or discharged home (51.7%). More than one third (35.5%) of self-harm patients did not receive adequate follow-up. Conclusion: Important variations between self-harm patients and other mental health patients were identified in their management and referral outcomes from the ED. Clinicians need to ensure that optimal patient care is provided through appropriate follow-up of every self-harm patient post-discharge from hospital.