Irritable bowel syndrome : Reply

In reply to a letter to the Editor, original article Crocker K, Chur-Hansen A, Andrews J. Interpersonal relationships for patients with irritable bowel syndrome: A qualitative study of gps' perceptions Australian Family Physician 42(11):805-810 2013Katie Crocker, Anna Chur-Hansen, Jane Andrew

A thematic study of the role of social support in the body image of burn survivors

There is evidence that social support is important for the development and maintenance of body image satisfaction for people who have sustained burn injuries. This qualitative study explored the specific mechanisms by which social support impacts the body image satisfaction of burn survivors, drawing on nine participants' in depth accounts. Participants were recruited through a burns unit at a public hospital in South Australia. Interviews were conducted with nine female burn survivors aged between 24 and 65 (mean age 44.6). Participants described their perceptions about their appearance post burn and their social support experiences. Four themes were identified: acceptance, social comparison, talking about appearance concerns, and the gaze of others. Results indicate that for these participants, social support was an important factor in coming to terms with changes in appearance, specifically support that helps to minimise feelings of difference. Unhelpful aspects of social support were also identified included feeling that suffering was being dismissed and resenting the perceived expectation from supports to be positive. Social supports are important to consider in relation to body image for those working with people who have survived burn injuries.Kellie Hodder, Anna Chur-Hansen, Andrea Parke

What does learning together mean for pharmacy and medicine students: is it really about from and with?

Published: 28/05/2018Healthcare students from different professional backgrounds are often brought together under the banner of Interprofessional Education (IPE) in an effort to improve collaborative practice. Despite the demonstrated positive impact of IPE on students’ knowledge, skills and attitudes, it is not clear what students think about learning with students from another health profession. The aim of this study was to explore pharmacy and medicine students’ views and experiences of learning together. Participants were Year 3 Pharmacy and Year 4 Medicine students, with qualitative data gathered via a written reflection. Three main themes were identified. Students were accepting of learning with the other professional group. Learning about was evident, particularly in relation to each other’s roles and contributions to patient care. Learning from another professional group was the most problematic as students tended to view and treat knowledge as a commodity to be acquired from another rather than something that could be jointly developed. While medicine and pharmacy students’ valued learning with and about each other, they were less likely to engage in co-constructing and sharing new meanings and thus learn from one another. To provide a basis for meaningful collaborative practice, IPE needs to challenge students’ fundamental assumptions, beliefs and values about learning with, from and about other professions.Josephine Thomas, Koshila Kumar, Anna Chur-Hanse

A qualitative study to explore communication skills in veterinary medical education

OBJECTIVE: To explore and gain an understanding of what "clinical communication skills" mean to veterinarians working in private practice and what implications this might have for veterinary medical education. METHODS: Qualitative research methods were used to purposefully sample a range of veterinary practitioners from a pool of South Australian veterinary practices who were interviewed to determine their understanding of what communication skills mean in the context of veterinary practice. Interviews were conducted with fourteen veterinary practitioners. Participants were sampled from a range of ages, veterinary schools of graduation plus urban and rural locations. Interview transcripts were analysed for themes, definitions and contexts. RESULTS: Participants' accounts included a number of skills which they considered to be "communication". Some of the definitions of these skills parallel communication skills and competencies for human medicine on which communication skills training incorporated into veterinary curricula to date have largely been based. However, the veterinarians in this study also raised interesting contextual differences unique to the veterinary profession, such as communication with the animal, selling service, discussing money in relation to decisions for care, and communicating about euthanasia. CONCLUSIONS: Veterinary practitioners require high level communication skills. Education and training in veterinary medicine may be better tailored to reflect the unique context of the veterinary profession.Wendy J. Hamood, Anna Chur-Hansen, Michelle L. McArthu

The experience of being a guide dog puppy raiser volunteer: a longitudinal qualitative collective case study

There are no published studies that consider the experiences of guide dog puppy raisers. As these people are volunteers, their continued willingness to participate in the training of dogs for assisting the vision impaired and blind is essential for the viability of guide dog schools around the world. Using a qualitative, longitudinal methodology, data were collected from nine guide dog puppy raisers at four time points: before receiving the puppy, one week, then three months after the puppy arrived, and 13 months after the puppy arrived (at which time all puppies had left the raisers). Participants reported more challenges than benefits in raising the puppies. Volunteering to be a guide dog puppy raiser may not be the pleasant experience that is anticipated when community members first offer their services. Understanding what it is like to be a puppy raiser and working towards ways in which to address problems is essential, given that, without volunteers to train and care for puppies, vision impaired and blind people would not have access to guide dogs.Anna Chur-Hansen, Lucy-Kate Werner, Clare E. McGuiness, and Susan Haze

Work and SCI: a pilot randomized controlled study of an online resource for job-seekers with spinal cord dysfunction.

STUDY DESIGN:A prospective, parallel randomized controlled trial (RCT). OBJECTIVES:To test the preliminary effects of an online resource targeted to job-seekers with spinal cord injury or disorder (SCI/D), and to determine the feasibility of proceeding to a full-scale RCT. SETTING:A community cohort in Australia. METHODS:Forty-eight adults (M = 42 years, SD = 10.95, 27 males) were randomized to receive 4-weeks access to the Work and SCI resource (n = 25) or to a wait-list control group (n = 23). The Work and SCI intervention involved six stand-alone learning modules which provided job-searching and career-planning information through text, videos, and interactive activities. Self-report measures were administered at baseline and after 4 weeks: Job Procurement Self-Efficacy Scale (JSES), Life Orientation Test-Revised (LOT-R), and Patient Health Questionnaire-9 (PHQ-9). RESULTS:Online usage data identified high uptake of the Work and SCI resource, although study attrition was problematic. Intention-to-treat analyses failed to reach statistical significance, whereas complete data revealed a significant interaction effect for optimism (LOT-R). CONCLUSION:Further research to develop and enhance Work and SCI is indicated. Remediable strategies to optimize recruitment and statistical power in a future definitive RCT are discussed. SPONSORSHIP:This project was funded by the auDA Foundation (project 16019)

Radiographer gender and breast-screening uptake

BreastCheck, the Irish National Breast Screening Programme, screens women aged 50–64. Radiographer recruitment has been a challenge; doubling of numbers is required for full national expansion; to date females are employed. The aim was to document attitudes to male radiographers and effect on return for subsequent screening. In all 85.8% of a random sample of 2000 women recently screened by BreastCheck completed a postal questionnaire. The commonest reaction women felt they would have if there were a male radiographer was embarrassment; significantly greater among those attending a static unit (45.6%) than mobile (38.4%) and in younger women (46%) than older (38.7%). Nine per cent would not have proceeded if the radiographer was male and 9% would only have proceeded if female chaperone present. In all 17.5% (95% CI 15.7–19.4%) agreed that ‘If there were male radiographers I would not return for another screening appointment'; 18.3% were unsure. One-quarter agreed ‘if I heard there could be male radiographers it would change my opinion of BreastCheck for the worse'. The proportions agreeing with these statements did not vary significantly by screening unit type, age group, area of residence or insurance status. This is the largest published study to date of this important issue; the correct balance between equality and programme performance must be identified

Teaching Medicine to Non-English Speaking Background Learners in a Foreign Country

Teaching abroad exposes medical educators to unfamiliar teaching methods and learning styles that can enhance their overall teaching repertoire. Based on the author’s experience teaching residents for one month at a community hospital in Japan and a review of the non-English speaking background (NESB) educational literature, pedagogical principles and lessons for successful international NESB instruction are outlined. These methods include understanding the dissimilar linguistic, cultural, and academic backgrounds of the learners, emphasizing pace and clarity of speech, presenting a conceptual framework instead of detailed discourse on subjects, and regular visual reinforcement of spoken words. The limitations introduced by the language barrier and the use of interpreters are briefly discussed. As society and institutions of higher learning become more global and multicultural, clinician–educators may benefit from teaching in other countries in order to enhance their teaching skills with NESB learners, both abroad and in their own institutions

Evaluation of a communication skills program for first-year medical students at the University of Toronto

Abstract Background Effective doctor-patient communication has been linked to numerous benefits for both patient and physician. The purpose of this study was to evaluate the effectiveness of the University of Toronto's Therapeutic Communication Program (TCom) at improving first-year medical students' communication skills. Methods Data were collected during the 1996/97, 1997/98, 1998/99 and 1999/00 academic years. The study used a repeated measures design with a waiting list control group: students were randomly assigned to groups starting the educational intervention in either September (N = 38) or February (N = 41), with the latter being used as a control for the former. Communication skills were assessed at the pre- and post-intervention times and at the end of the academic year from the perspectives of student, standardized patient and external rater. Results Only the external rater, using an instrument designed to assess the students' empathy based on their written responses, showed a time × group interaction effect (p = 0.039), thereby partially supporting the hypothesis that TCom improved the students' communication skills. Students rated themselves less positively after participation in the program (p = 0.038), suggesting that self-evaluation was an ineffective measure of actual performance or that the program helped them learn to more accurately assess their abilities. Conclusion The lack of strong findings may be partly due to the study's small sample sizes. Further research at other medical or professional schools could assess the effectiveness of similar courses on students' communication skills and on other capacities that were not measured in this study, such as their understanding of and comfort with patients, their management of the doctor-patient relationship, and their ability to give and receive feedback

"What Do They Want Me To Say?" The hidden curriculum at work in the medical school selection process: a qualitative study

<p>Abstract</p> <p>Background</p> <p>There has been little study of the role of the essay question in selection for medical school. The purpose of this study was to obtain a better understanding of how applicants approached the essay questions used in selection at our medical school in 2007.</p> <p>Methods</p> <p>The authors conducted a qualitative analysis of 210 essays written as part of the medical school admissions process, and developed a conceptual framework to describe the relationships, ideas and concepts observed in the data.</p> <p>Results</p> <p>Findings of this analysis were confirmed in interviews with applicants and assessors. Analysis revealed a tension between "genuine" and "expected" responses that we believe applicants experience when choosing how to answer questions in the admissions process. A theory named "What do they want me to say?" was developed to describe the ways in which applicants modulate their responses to conform to their expectations of the selection process; the elements of this theory were confirmed in interviews with applicants and assessors.</p> <p>Conclusions</p> <p>This work suggests the existence of a "hidden curriculum of admissions" and demonstrates that the process of selection has a strong influence on applicant response. This paper suggests ways that selection might be modified to address this effect. Studies such as this can help us to appreciate the unintended consequences of admissions processes and can identify ways to make the selection process more consistent, transparent and fair.</p