Person-centered clinical practice

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The Sydney Conservatorium Early Music Ensemble: An activity-theoretical study of the impact of period instruments, historically-informed performance and a unique pedagogy on tertiary group-learning experiences

This PhD thesis is focused on the learning experiences of students in the Sydney Conservatorium Early Music Ensemble (EME). It sheds light on an area that remains relatively under-researched to date: the group-learning experiences of tertiary-level music students. EME provides its members with an opportunity to experiment with period instruments and to explore repertoire from the late Renaissance to early Classical periods with a historically-informed approach to music making. The tutors of the ensemble, all of whom are expert practitioners in the field of historically-informed performance (HIP), have nurtured a pedagogy that embraces elements of informal peer learning and stimulates active participation and collaboration. The main claim of the thesis is that period instruments, HIP, a broadly constructivist tutor approach and collaborative peer learning all play a significant role in stimulating deeper learning and actively engaged music making. As part of the purely qualitative research design twelve EME students are interviewed about their experiences of learning to play period instruments and their perceptions of a collaborative learning environment, including the role of peers and tutors. A series of open-ended interview questions serves to gain insights into the principal research questions: what learning possibilities do the instruments offer and how do the students experience this alongside the mental and physical rigours of HIP, the unique approach of the tutors and interactions with peers? In seeking a theoretical framework to help explore the interrelationships between the materials and the 'actors' in EME, Cultural-Historical Activity Theory (CHAT) offers a particularly helpful perspective. This research approach incorporates both ‘tools’ and the learning community as integral influences in the learning process. As such it facilitates a holistic investigation of the learning and teaching relationships in the specific EME environment and the ‘affordances’ or learning potential of the materials involved. My research claim is firmly supported by the findings in this study. The students provide ample evidence of a broad range of deep learning experiences associated with period instruments and HIP. In addition the benefits of multiple elements of group-learning are identified: a continuum of formal and informal learning, collaborative peer learning, and a reflective tutor approach that embraces active participation. The study contributes to CHAT in the realm of the arts and has positive implications for the role of period instruments, HIP and the value of group-learning situations in western-style conservatoires and other tertiary music institutions

Medicalization of Eating and Feeding

reference articleA variety of developments over the past century have produced the conditions in which eating and feeding are transformed from practices embedded in social or cultural relations into explicit medical practices. The rise of medical science, expansion of the pharmaceutical and food industries, escalating concern over diet‐related diseases and conditions, and growing anxiety over infant and childhood development have contributed to a process of medicalization. Medicalization is a sociological concept that analyses the expansion of medical terminology, interventions, or practitioners into areas of the life that were previously considered outside the medical sphere. For instance, under‐eating has previously been defined using theological language, as an act of fasting demonstrating a saintly character. Such practices are now understood through medical terms of anorexia nervosa, malnutrition, or general diagnoses such as “eating disorders not otherwise specified.” Individuals engaged in under‐ or over‐eating practices are increasingly defined by medical concepts (anorexia nervosa and obesity) and treated in medical spaces (hospitals, clinics, or rehabilitation centres) through medical interventions (pharmaceuticals, surgery, psychotherapy, or dietary regimens). Likewise, infant feeding (breast or formula) is understood as a practice that requires monitoring and instruction from medical practitioners. Further, eating in general is progressively invested with medical significance. Foods and diets are touted as possessing a therapeutic or health enhancing capacity that indicates an individual’s or population’s present and future health. Due to the high regard for, and influence of, medical science in the West, medicalization studies primarily focus on Western contexts. Medicalization does have an impact on non‐Western societies and the developing world, however its influence emanates from Western biomedicine, industries, and policies. There is important work to be done in examining the process of medicalization in non‐Western contexts, however this article is limited to the Western context ( Hunt, 1999). To analyse the medicalization of eating and feeding it is important to first sketch the theoretical and historical background of medicalization as a sociological concept. The relationship between eating and medicine is extensive. In order to focus the discussion, three examples are used – under‐eating, over‐ eating and infant feeding. This background focuses the analysis of the forces driving the medicalization of eating and feeding. Finally, in elaborating the influences and consequences of the medicalization of eating and feeding, some of the central ethical implications are identified and discusse

Mental health problems of undocumented migrants (UMs) in the Netherlands: a qualitative exploration of help-seeking behaviour and experiences with primary care

OBJECTIVE To explore health-seeking behaviour and experiences of undocumented migrants (UMs) in general practice in relation to mental health problems. DESIGN Qualitative study using semistructured interviews and thematic analysis. PARTICIPANTS 15 UMs in The Netherlands, varying in age, gender, country of origin and education; inclusion until theoretical saturation was reached. SETTING 4 cities in The Netherlands. RESULTS UMs consider mental health problems to be directly related to their precarious living conditions. For support, they refer to friends and religion first, the general practitioner (GP) is their last resort. Barriers for seeking help include taboo on mental health problems, lack of knowledge of and trust in GPs competencies regarding mental health and general barriers in accessing healthcare as an UM (lack of knowledge of the right to access healthcare, fear of prosecution, financial constraints and practical difficulties). Once access has been gained, satisfaction with care is high. This is primarily due to the attitude of the GPs and the effectiveness of the treatment. Reasons for dissatisfaction with GP care are an experienced lack of time, lack of personal attention and absence of physical examination. Expectations of the GP vary, medication for mental health problems is not necessarily seen as a good practice. CONCLUSIONS UMs often see their precarious living conditions as an important determinant of their mental health; they do not easily seek help for mental health problems and various barriers hamper access to healthcare for them. Rather than for medication, UMs are looking for encouragement and support from their GP. We recommend that barriers experienced in seeking professional care are tackled at an institutional level as well as at the level of GP.This qualitative study was funded by The Netherlands Organisation for Health Research and Development (ZonMw)

Essays on equity portfolio management

Essays on Equity Portfolio Management This dissertation contains three essays involving empirical research in the area of equity portfolio management. Specifically, two of the essays contribute to the existing funds management literature by examining issues concerning portfolio performance evaluation and asset allocations. These being, equity fund benchmark mismatching, and equity fund industry allocations during the Australian mining boom. The third essay investigates issues relating to socially responsible investing. The first essay uses Australian equity fund data to examine the appropriateness of equity funds’ self-reported benchmarks. Given the lack of regulation surrounding the benchmarking of Australian managed funds and the absence of publicly available equity style indices, this essay explores if fund benchmarks are able to adequately capture passive investment styles and whether funds are better suited to alternative benchmarks. This essay further explores if funds with inappropriate benchmarks are able to outperform relatively, on account of the strategic nature of managers to report underperforming benchmarks, and whether this influences asset flows. The final essay of this dissertation provides a measure for the value of this non-financial satisfaction that accrues to individuals from investing in a socially responsible manner. This non-financial benefit is referred to as the “psychic dividend” of SRI. Previous studies attempt to quantify this value as the difference in certainty equivalent returns of SRI and non-SRI portfolios. This chapter extends the definition of certainty equivalence to consider constant relative risk aversion and loss aversion

Assessing patient-centred communication in teaching: A systematic review of instruments

Context Patient-centred communication is a key component of patient centredness in medical care. Therefore, adequate education in and assessment of patient-centred communication skills are necessary. In general, feedback on communication skills is most effective when it is provided directly and is systematic. This calls for adequate measurement instruments. Objectives The aim of this study was to provide a systematic review of existing instruments that measure patient centredness in doctor–patient communication and can be used to provide direct feedback. Methods A systematic review was conducted using an extensive validated search strategy for measurement instruments in PubMed, EMBASE, PsycINFO and CINAHL. The databases were searched from their inception to 1 July 2016. Articles describing the development or evaluation of the measurement properties of instruments that measure patient centredness (by applying three or more of the six dimensions of a published definition of patient centredness) in doctor–patient communication and that can be used for the provision of direct feedback were included. The methodological quality of measurement properties was evaluated using the COSMIN checklist. Results Thirteen articles describing 14 instruments measuring patient centredness in doctor–patient communication were identified. These studies cover a wide range of settings and patient populations, and vary in the dimensions of patient centredness applied and in methodological quality on aspects of reliability and validity. Conclusions This review gives a comprehensive overview of all instruments available for the measurement of patient centredness in doctor–patient communication that can be used for the provision of direct feedback and are described in the literature. Despite the widely felt need for valid and reliable instruments for the measurement of patient-centred communication, most of the instruments currently available have not been thoroughly investigated. Therefore, we recommend further research into and enhancement of existing instruments in terms of validity and reliability, along with enhancement of their generalisability, responsiveness and aspects of interpretability in different contexts (real patients, simulated patients, doctors in different specialties, etc.). Comprehensibility and feasibility should also be taken into account.this study was supported by Radboud University Medical Centre (IWOO [EKO project R0002432]

Assessment of medical students' integrated clinical communication skills: Development of a tailor-made assessment tool

Background Since patient-centered communication is directly connected to clinical performance, it should be integrated with medical knowledge and clinical skills. Therefore, clinical communication skills should be trained and assessed as an integral part of the student’s clinical performance. We were unable to identify a tool, which helps when assessing patient-centered communication skills as an integrated component of medical history taking (‘the integrated medical interview’). Therefore, we decided to design a new tailor-made assessment tool, the BOCC (BeOordeling Communicatie en Consultvoering (Dutch), Assessment of Communication and Consultation (English) to help raters assess students’ integrated clinical communication skills with the emphasis on patient-centred communication combined with the correct medical content. This is a first initiative to develop such a tool, and this paper describes the first steps in this process. Methods We investigated the tool in a group of third-year medical students (n = 672) interviewing simulated patients. Internal structure and internal consistency were assessed. Regression analysis was conducted to investigate the relationship between scores on the instrument and general grading. Applicability to another context was tested in a group of fourth-year medical students (n = 374). Results PCA showed five components (Communication skills, Problem clarification, Specific History, Problem influence and Integration Skills) with various Cronbach’s alpha scores. The component Problem Clarification made the strongest unique contribution to the grade prediction. Applicability was good when investigated in another context. Conclusions The BOCC is designed to help raters assess students’ integrated communication skills. It was assessed on internal structure and internal consistency. This tool is the first step in the assessment of the integrated medical interview and a basis for further investigation to reform it into a true measurement instrument on clinical communication skills.This study was supported by the Radboud University Medical Center Nijmegen (EKO grant)

Communication in cross-cultural consultations in primary care in Europe: the case for improvement. The rationale for the RESTORE FP 7 project

The purpose of this paper is to substantiate the importance of research about barriers and levers to the implementation of supports for cross-cultural communication in primary care settings in Europe. After an overview of migrant health issues, with the focus on communication in cross-cultural consultations in primary care and the importance of language barriers, we highlight the fact that there are serious problems in routine practice that persist over time and across different European settings. Language and cultural barriers hamper communication in consultations between doctors and migrants, with a range of negative effects including poorer compliance and a greater propensity to access emergency services. It is well established that there is a need for skilled interpreters and for professionals who are culturally competent to address this problem. A range of professional guidelines and training initiatives exist that support the communication in cross-cultural consultations in primary care. However, these are commonly not implemented in daily practice. It is as yet unknown why professionals do not accept or implement these guidelines and interventions, or under what circumstances they would do so. A new study involving six European countries, RESTORE (REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings), aims to address these gaps in knowledge. It uses a unique combination of a contemporary social theory, normalisation process theory (NPT) and participatory learning and action (PLA) research. This should enhance understanding of the levers and barriers to implementation, as well as providing stakeholders, with the opportunity to generate creative solutions to problems experienced with the implementation of such interventions

Developing the International Association for Communication in Healthcare (EACH) to address current challenges of health communication

In 2017, EACH celebrated its change of name from European Association for Communication in Healthcare to EACH: International Association for Communication in Healthcare. This paper aims to present the developments and achievements of EACH over the past five years with a focus on its mission in promoting and advancing the field of communication in healthcare. Specifically, the paper focuses on how EACH, first, promotes research in the field of health communication, second, provides support, resources and sharing for healthcare communication teachers and, third, aims at influencing policy through dissemination of evidence. This paper also explores future challenges and directions for EACH to further strengthen its impact by designing activities in knowledge transfer and knowledge dissemination, engaging with patients and truly benefitting from their expertise, fostering active participation and networking among its members, targeting interventions to the needs of different countries around the world and refining knowledge-sharing and cooperation both within the membership of EACH and outside the association to as wide an audience as possible. Scholars, educators and practitioners active in the field of healthcare communication are invited to comment on this paper and to actively contribute towards the goals of EACH.PostprintPeer reviewe