Virtual WIL clinics in medicine: overcoming the COVID-19 challenge

In the current context of COVID-19 restrictions, the perceived infection risk in healthcare facilities has resulted in limited opportunities for clinical placements. This paper aims to demonstrate how virtual WIL clinics (virtual simulated general practice clinics), provide an authentic clinical experience and to ascertain whether these virtual clinics allow the practice of generic WIL competencies. The clinics provide students with WIL experience without the face-to-face contact of a physical clinic via telehealth. The practice of WIL through virtual WIL clinics at James Cook University, Australia, is assessed using the Work Skill Development (WSD) framework via GoSoapBox surveys. Students surveyed (N=66) expressed a high level of motivation to engage, reflect and learn through this medium. The survey also highlighted some possible areas of improvement in time management and communication. Virtual WIL clinics are a suitable substitution for WIL clinical activity and ideally suited to the COVID-19 context

Music and dance in clinical skills - a teaching and learning perspective

Since 2008, the Gait, Arms, legs and Spine (GALS) Screening Tool is taught to year one undergraduate medicine students at James Cook University (JCU), as part of the clinical skills Musculoskeletal (MSK) examination. 'GALS' is a sequence of concise movements that assesses the range of motion of the major joints of the body. The strategies of small group teaching, instructional video, practical demonstration and simulated volunteer patients are utilised to teach 'GALS' in the two hour workshops. Written and audio visual resources are available to the students on JCU's online learning platform. Post workshops, students are assessed in an OSCE style assessment. With the dual intention to enhance student learning, and improve short and long term recall, educators created a 'GALS music and dance' video

Experiences of JCU MBBS graduates in remote northern Australian towns: preliminary findings

Over 65% of all James Cook University (JCU) medical graduates practise outside of major cities (compared to 20% of all Australian clinicians), including 5% who choose to practice in remote northern Australian towns such as Mount Isa, Darwin, and Palm and Thursday Islands. Many remote towns have high proportional Aboriginal and Torres Strait Islander populations. Little is known about the challenges and pressures for Australian doctors practising in remote locations; including community expectations around advocacy and leadership roles for graduates from Aboriginal or Torres Strait Islander cultures

Bridging the gap in health professionals from novice to advanced practitioner: a practical framework

The objective of the AHCD was to facilitate the successful transition of an allied health professional from novice to advanced practitioner while focussing on key competencies and levels of autonomy through reflective practice and emotional and social sensitivity to the workplace. The AHCD facilitates this transition via self-directed learning and reflective practice. The philosophy presented in the framework may be applicable to all health care professionals

Does music and dance construct bridges in the brain to enhance learning? pilot longitudinal study

Since 2008, the Gait, Arms, Legs and Spine (GALS) Screening Tool is taught to Year one undergraduate medical students at James Cook University (JCU), as part of the clinical skills Musculoskeletal (MSK) examinatin. 'GALS' is a sequence of concise movement that asseses the range of motion of the major joints of the body. The strategies of small group teaching, instructional video, practical demonstration and simulatedvolunteer patients are utilised to teach 'GALS' in the two hour workshop. Written and audio visual resources are available to the students on JCU's online learning platform. Post workshop, students are assessed in an OSCE style assessment. With the dual intention to enhance student learning, and improve short and long term recall, educators created a 'GALS music and dance' video

Undergraduate student led clinical skills events

Background: Undergraduate medical students frequently face limited opportunities to practice clinical skills and integrate these into patient encounters. They actively seek out practice opportunities for skills they perceive as integral to the practice of medicine. The current landscape of restricted patient access due to COVID 19, increasing competition for clinical placements with other health professional students, sicker patients and shorter inpatient stays all result in students looking for alternatives to improve their knowledge and skills. James Cook University (JCU) student associations and special interest groups offer student support and external opportunities for skills practice through guest speaker nights and student led clinical skills events. Summary of work: Development of these student skills events over the past 8+ years initially focused on providing practical skills exposure such as suturing using synthetic substitutes and urinary catheterisation using simulation trainers. With encouragement and academic staff expertise, these events have introduced high fidelity simulation in the form of case-based scenarios. These vary from simple ED management of chest pain through to paediatric near drowning scenarios. To support these events, a structured planning process incorporating regular meetings between academic, technical and student group representatives, staged completion of online documentation and full risk assessments is done. Formalising this process and integrating with student and university requirements fosters safe events, and just as importantly, mentors those student leaders with an interest in education. Summary of results: Students surveyed about their priorities for learning consistently score ‘increased opportunities for clinical skills practice’, and ‘participation in case-based simulation scenarios’ very highly in their feedback. Following a JCU Surgical Society event, (with staff supported practice sessions) JCU students earned third place in a state-wide competition involving theory, laparoscopic and suturing skill stations. Due to the multidisciplinary nature of some student interest groups, simulation scenarios have encouraged inter-professional interactions in an authentic, safe, and supported environment. This has helped students develop an understanding of different health professional roles without ‘real world’ stressors. Over the timeframe described, the number and variety of student led events has risen from 3 – 4 annually, to ten events in 2019. With the restrictions of COVID, that number is slowly returning with students very focussed on recouping some of the lost opportunities in clinical skills. Indicating their wish to be included in simulated patient focused, hybrid and high-fidelity simulation activities

Characterisation of Venom Induced Consumption Coagulopathy (VICC) in patients with Haemotoxic Snake Bite and the effects of Blood Products on Coagulation Parameters

INTRODUCTION: Snake bite is one of the most important “Neglected Tropical Diseases.” Venom-Induced Consumption Coagulopathy (VICC) is the core pathogenic mechanism in haemotoxic snake bites. VICC is characterized by reduction of coagulation factors and the absence of systemic microthrombi and end-organ damage. The time course in VICC is rapid- occurring within a few hours of envenomation and resolution within 24-48 hours, if treated appropriately. OBJECTIVES: The primary objective of this study was to identify patients with haemotoxic snake bite and to characterize Venom Induced Consumption Coagulopathy (VICC) in these patients. The secondary objectives were to study the coagulation profile in patients with haemotoxic snake bite and their response to treatment with Anti Snake Venom (ASV) and/or blood products. Comparison of sensitivity and specificity of the new test Vellore Manually Activated Clotting Time (Vemac Time) against a composite diagnosis of VICC. A review of retrospective data spanning a five-year period of the clinical and lab parameters of patients with haemotoxic snake who received blood products transfusion has also been undertaken. METHODS AND MATERIALS: This was an observational study with a retrospective arm comprising patients who were admitted between year 2012-2017 and a prospective arm for patients admitted between 2017 – 2018 at Christian Medical College, Vellore. RESULTS: Data from 280 patients who had a haemotoxic snake bite were analysed. There was a male preponderance among patients (71.07%). Pure haemotoxicity were seen in 32.9% (n=92) patients. Combinations of haemotoxicity with renal and/or neurological manifestations were seen in 67.1% (n=188). An abnormal INR (≥1.2) was seen in 94.38%.The average dose of ASV received per patient was 18.9 ±7.75 vials. Transfusions with blood and/or plasma products were needed for 47(16.8%) patients. All components were transfused: platelet concentrates (29.8%), FFP (65.9%), cryoprecipitate (31.9%) and cryosupernatant (10.6%). Among patients in prospective group pure haemotoxicity was seen in 24.3% (n=9) patients. Combinations of haemotoxicity with renal and/or neurological manifestations were seen in 75.7% (n=28). The newly designed screening test Vellore Manually Activated Clotting Time (Vemac Time) was compared against Prothrombin Time and also a composite diagnosis of VICC. The sensitivity of the test was found to be 81.82% and specificity was 100% when compared with PT. Positive predictive value of the test was 100% when compared with PT. When compared to a composite diagnosis of VICC it was found to have positive predictive value of 100%. DISCUSSION AND CONCLUSION: Snake bite was and still remains a problem that can easily be tackled, if diagnosis and treatment is given in a timely manner. The role of a good haemostasis laboratory in detecting VICC and management of the patient is emphasized by this study. Antivenom is the major treatment for VICC. Treatment focuses on neutralization of venom effects with antivenom and waiting for the replenishment of coagulation factors. Antivenom is not risk free and adverse reactions can be quite common and potentially severe. Patients should be observed in hospital until clotting function has normalised

Contribution of simulation-based medical education to work-readiness of JCU graduates

The College of Medicine and Dentistry (CMD) at James Cook University (JCU) was established in regional north Queensland in 1999 with the mandate to select and educate medical graduates to work in underserviced areas, specifically rural, remote, and tropical locations. In 2006, the second graduating cohort at JCU were surveyed to determine if they felt ‘work ready‘. Results showed only 66% of students felt well or very well prepared for their first week of internship, and 13% of students felt inadequately prepared. The need for more CS activities within the curriculum was identified when the College underwent course accreditation in 2006

Saxagliptin in combination with Metformin or Sulfonylurea achieved HbA1c goals

Diabetes affects over 1.2 million people in Australia. Saxagliptin (SAXA) is a potent, selective dipeptidyl peptidase-4 (DPP-4) inhibitor. Three 24-week phase 3 studies assessed efficacy and safety of SAXA as add-on to Metformin (MET), as initial combination therapy with MET, or as add-on to the sulfonylurea (SU) glyburide (GLY) in patients (pts) with type 2 diabetes (T2D) and inadequate glycaemic control. In the add-on to MET study, 743 pts inadequately controlled on MET alone (HbA1c 7.0%–10.0%; mean baseline (BL) HbA1c 8.0%; mean T2D duration 6.5 yrs) were randomised to SAXA or placebo (PBO) with ongoing dose of MET. In the initial combination study, 1306 drug naïve pts (HbA1c8.0%–12.0%; mean BL HbA1c 9.5%; mean T2D duration 1.7 yrs) were randomised to SAXA + MET, SAXA + PBO, or MET + PBO. In the add-on to SU study, 768 pts inadequately controlled on SU alone (HbA 1c7.5%–10.0%; mean BL HbA1c 8.4%; mean T2D duration 6.9 yrs) were randomised to SAXA or uptitrated GLY + PBO in addition to open-label GLY. Efficacy analyses used ANCOVA model. The proportion of patients reaching HbA1c goals used Fisher exact test. HbA1c goals were predefined for each study. In all three studies, statistically significantly greater proportions of SAXA-treated pts achieved HbA1c goals of <7.0% and ≤6.5% vs. control at 24 wks (Table). Twice as many pts treated with SAXA added to MET or GLY achieved the HbA1c goal of <7% and ≤6.5% relative to control at 24 wks. For all three studies, the frequency of adverse events (AEs) was generally similar for SAXA vs. control (Table). SAXA 5 mg + MET as either add-on or initial combination therapy, and SAXA 5 mg + SU significantly improved glycaemic control, was well tolerated and achieved predefined HbA1c goals vs. control in more patients

A multi-disciplinary approach to simulation training in healthcare: James Cook University’s collaborative experience

The use of simulation as an educational tool is becoming increasingly popular in healthcare training as increasing student numbers and concerns with patient safety challenge opportunities for traditional bedside teaching. Healthcare training centres face many challenges when implementing a simulation training program. Available guidance for successful program implementation is limited, and adaptation for each institution’s unique setting is often required. This study describes the approach taken by James Cook University’s (JCU) Division of Tropical health and Medicine’s (Townsville campus) approach for developing a multi-disciplinary, simulation-based training program with shared resources and centralised asset management