Sixteen Months “From Square One”: The Process of Forming an Interprofessional Clinical Teaching Team

Background: Descriptions of interprofessional education (IPE) programs and teacher competencies exist, but limited research has been undertaken about the process of IPE teaching team formation. This research project examined how pedagogically naïve clinicians of different disciplines initially formed an IPE teaching team.Methods and Findings: A case study approach was undertaken with data collected over the first sixteen months of an IPE program. Data included: audio recordings, transcripts, and field notes from nine individual teacher interviews, two teaching team focus groups, five student focus groups, and eight summary reports. Data analysis using a grounded theory constant comparison approach revealed themes relating to the formation, development, and evolving sophistication of the teaching team from functioning, to co-ordinating, to co-operating, and finally to collaborating. These stages were influenced by four external factors: remote rural context, Hauora Māori principles, personal attributes, and teacher development.Conclusions: Formation of interprofessional clinical teaching teams requires educational preparation, time learning to work with each other, and trust development, with a number of local contextual factors influencing this process. Teaching team formation paralleled Wegner’s Community of Practice model where shared vision supported the adoption of an increasingly complex IPE pedagogy

Genital examination training: assessing the effectiveness of an integrated female and male teaching programme

Abstract Background Learning to undertake intimate female and male examinations is an important part of medical student training but opportunities to participate in practical, supervised learning in a safe environment can be limited. A collaborative, integrated training programme to provide such learning was developed by two university teaching departments and a specialist sexual health service, utilising teaching associates trained for intimate examinations in a simulated clinical educational setting. The objective of this research was to determine changes in senior medical students’ self- reported experience and confidence in performing male and female genital examinations, before and after participating in a new clinical teaching programme. Methods A quasi-experimental mixed methods design, using pre and post programme questionnaires and focus groups, was used to assess the effectiveness of the programme. Results The students reported greatly improved skill, confidence and comfort levels for both male and female genital examination following the teaching programme. Skill, confidence and comfort regarding male examinations were rated particularly low on the pre-teaching programme self- assessment, but post-programme was rated at similar levels to the female examination. Conclusions This integrated female–male teaching programme (utilising trained teaching associates as simulated patients in a supervised clinical teaching environment) was successful in increasing senior medical students’ skills and levels of confidence in performing genital examinations. There were differences between female and male medical students in their learning. Suggestions for improvement included providing more detailed instruction to some clinical supervisors about their facilitation role in the session

Retesting and repeat positivity following diagnosis of Chlamydia trachomatis and Neisseria gonorrhoea in New Zealand: a retrospective cohort study

Abstract Background Testing for reinfection at 3 to 6 months following treatment for Chlamydia Trachomatis or Neisseria gonorrhoea is recommended in best practice sexual health management guidelines. This study aimed to describe rates of retesting and repeat positivity following diagnosis of chlamydia or gonorrhoea in a defined geographic region of New Zealand. Methods Retrospective cohort study in Wellington, New Zealand involving analysis of laboratory data for chlamydia and gonorrhoea tests performed in primary care and sexual health clinics (July 2012–July 2015). Outcome measures: rate of retesting and rate of repeat positivity 6 weeks to 6 months after a positive result (index event). Kaplan-Meier curves were used to plot time from first index event to retest. Logistic regression modelling was used to determine the odds of retesting and repeat positivity between 6 weeks and 6 months of follow-up, adjusting for potential confounders (age, gender, ethnicity and socioeconomic deprivation). Results Overall 29.4% (1919/6530) of the cohort was retested between 6 weeks and 6 months, with 18% (347/1919) of those retested returning positive results. Lower odds of retesting were observed for males (OR 0.4, 95% CI 0.34–0.48), and individuals of NZ Maori (OR 0.72, 0.61–0.85) and Pacific ethnicities (OR 0.49, 0.39–0.62, reference European). Factors associated with higher odds of repeat positivity on retesting included male gender (OR 2.0, 1.14–2.82), age 15–19 years (OR 1.78, 1.32–2.41, reference 20–24 years), chlamydia/gonorrhoea co-infection (OR 2.39, 1.32–4.35, reference chlamydia only), Maori (OR 1.6, 1.18–2.17) and Pacific ethnicities (OR 1.88, 1.22–2.9, reference European). Conclusions We observed low adherence to STI retesting guidelines, and marked gender and ethnic disparities in rates of retesting and repeat positivity. Low retesting rates are suggestive of low levels of awareness of this aspect of patient management, and an absence of a systematic approach to retesting. High rates of repeat positivity reinforce the importance of advising patients about reducing their risk of reinfection, including notification and treatment of all recent sexual partners. Greater priority needs to be placed on increasing retesting and reducing rates of reinfection, with strategies implemented to improve these important aspects of patient care and population STI control

Additional file 2: of Genital examination training: assessing the effectiveness of an integrated female and male teaching programme

Evaluation survey of student experience with genital examination (Post). This is the questionnaire administered to the students after the teaching programme. (DOC 58 kb

"What sort of health promotion are you talking about?": a discourse analysis of the talk of general practitioners

In New Zealand, health promotion is now expected to be an integral part of the work of a general practitioner, and in the recently implemented New Zealand Primary Health Organisation structure, specific funding is available to undertake health promotion activities in primary care. Eighteen general practitioners recruited to take part in two focus groups discussing men's health, talked extensively about health promotion. This talk was analysed through a discourse analysis. This study of the 'talk' of general practitioners suggests that there are problems in transferring the concept, which must be recognised and addressed if health promotion is going to be taken up effectively within general practice. The meaning given to health promotion in the consultation is unclear and general practitioners were unsure about its value in 'health checks' and screening. Lack of time and lack of confidence in the evidence appeared to be barriers to undertaking health promotion within general practice consultations. In the current climate general practitioners are uncertain, to the point of ambivalence, about health promotion in their work. Further work will be required to ensure this ambivalence does not result in covert resistance.General practitioners Health promotion New Zealand