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In Australia, doctors undertaking advanced training to become general practitioners work under the supervision of clinical educators. Primarily clinicians, these clinical educators participate in one day of teaching-related professional development annually, generally a workshop. Shortcomings with this form of professional development led to the development of a quality improvement focused intervention that is facilitated in the workplace and based on the clinical educator's self-identified concerns. Drawing on teacher action research and feasibility study methodologies we explored this novel form of professional development by asking 'Can this intervention work?' We employed an embedded multiple case study design, trialling the intervention in four settings. The intervention's constituent activities were acceptable to participants; including a preparedness to experience discomfort for the purpose of improving their teaching practices. They perceived the intervention as convenient and the workload manageable. Participants were motivated to experiment with new teaching behaviours, but measuring outcomes was challenging. Medical educators facilitating the intervention perceived their tasks as cognitively 'hard work'. The findings provide support for this workplace-based intervention as a feasible form of professional development, which should be implemented on a larger scale and evaluated for impact. [ABSTRACT FROM AUTHOR]

Background: General practitioners (GPs) have played an integral role in Australia's coronavirus disease 2019 (COVID-19) pandemic response. However, little is known about how GPs themselves have been impacted by the COVID-19 pandemic. This study aimed to increase our understanding of the experiences of GPs working during the COVID-19 pandemic. Methods: A qualitative study was conducted using semi-structured interviews. Using purposive sampling, 15 GPs from South-Eastern Australia were asked to reflect on their experiences during the first year of the COVID-19 pandemic. Interview transcripts underwent thematic analysis. Results: Five main themes were identified: fear of infection; uncertainty and information overload; impacts on the government–GP relationship; impacts on the patient–doctor relationship; and teamwork within practices and among GPs. Conclusions: The 15 GPs interviewed in this study provided valuable insights into their experiences working during the first year of the COVID-19 pandemic. From these insights, four recommendations propose what could be done to help support GPs to respond to a pandemic while continuing to deliver primary health care. Although general practitioners (GPs) have played a crucial role in Australia's COVID-19 pandemic response, few studies have explored the impact of the COVID-19 pandemic on GPs themselves. In this qualitative study, 15 GPs from South-Eastern Australia were asked to reflect on their experiences working during the first year of the COVID-19 pandemic in semi-structured interviews. Their reflections enhance our understanding of the experience of GPs working during the COVID-19 pandemic and may help guide future research and work to support GPs. [ABSTRACT FROM AUTHOR]

The article identifies the key factors relating to care staff that lead to good quality of care and quality of life for residents with dementia. Topics discussed include importance of the quality of care provided by staff to the quality of residents' lives, the need to scrutinize the focus, timeliness and quality of the qualifications or training courses, and recommendations to the Royal Commission into Aged Care Quality and Safety.

This paper reports the impact of a major life event–death–on the physical, psychological and social well-being of the deceased’s close friends. We utilised data from a large longitudinal survey covering a period of 14 years (2002–2015) consisting a cohort of 26,515 individuals in Australia, of whom 9,586 had experienced the death of at least one close friend. This longitudinal cohort dataset comprises responses to the SF-36 (health related quality of life measure) and allowed for analysis of the short and longer-term impacts of bereavement. In order to manage the heterogeneity of the socio-demographics of respondents who did/not experience a death event, we use a new and robust approach known as the Entropy Balancing method to construct a set of weights applied to the bereaved group and the control group (the group that did not experience death). This approach enables us to match the two groups so that the distribution of socio-demographic variables between the two groups are balanced. These variables included gender, age, marital status, ethnicity, personality traits, religion, relative socio-economic disadvantage, economic resources, and education and occupation and where they resided. The data show, for the first time, a range of negative and enduring consequences experienced by people following the death of a close friend. Significant adverse physical and psychological well-being, poorer mental health and social functioning occur up to four years following bereavement. Bereaved females experienced a sharper fall in vitality, suffered greater deterioration in mental health, impaired emotional and social functioning than the male counterparts up to four years after the death. The data show that the level of social connectedness plays an important role in bereavement outcomes. Specifically, we found that less socially active respondents experienced a longer deterioration in physical and psychological health. Finally, we found evidence that the death of a close friend lowered the respondent’s satisfaction with their health. Since death of friends is a universal phenomenon, we conclude the paper by reflecting on the need to recognise the death of a close friend as a substantial experience, and to offer support and services to address this disenfranchised grief. Recognising bereaved friends as a group experiencing adverse outcomes can be used internationally to prompt health and psychological services to assist this specific group, noting that there may be substantial longevity to the negative sequelae of the death of a friend. Facilitating bereaved people’s support networks may be a fruitful approach to minimising these negative outcomes. [ABSTRACT FROM AUTHOR]

Objective: We present reflections on student evaluation of teaching (SET) in the context of recent higher educational research that assesses SET, as well as concurrent and/or subsequent student performance.Conclusions: In a sense, there is in-built cynicism in SET, with more favourable SET for easier assessment. There is emerging evidence that SET is inversely proportional to the performance of students in subsequent courses, i.e. the higher the ratings, the poorer the students perform in subsequent studies. It is proposed that SET should be combined with contemporaneous formative and summative assessments of student performance in medical school settings, especially in psychiatry education. [ABSTRACT FROM AUTHOR]

Background The Prevocational General Practice Placement programme ( PGPPP) aims to provide junior doctors with professional, well-supervised, educational rotations in general practice. There is a paucity of literature evaluating the educational effectiveness of the PGPPP. This study aims to compare general practice rotations with hospital rotations, with respect to teaching and support, acquisition of skills and knowledge, and role autonomy. Methods All junior doctors who participated in a PGPPP rotation were invited to complete a voluntary anonymous online survey using the Postgraduate Hospital Educational Environment Measure ( PHEEM) inventory. The PHEEM presents Likert scales grouped into four subscales for participants to rate statements about their rotations. Surveys were completed at the end of the year in which doctors undertook a PGPPP rotation, and covered all rotations. These survey findings were used to compare general practice and hospital rotations. Results In all four subscales of teaching, clinical skills, social support and role autonomy, the general practice rotation performed as well as, or better than, hospital rotations in the areas of emergency, medicine, and surgery. General practice outperformed all other rotations in 15 out of 20 statements across all subscales. Discussion This study demonstrates the educational value of a general practice placement in comparison with hospital placements. Expansion of the PGPPP should be considered to provide all junior doctors with the benefits of exposure to generalist skills in the community. [ABSTRACT FROM AUTHOR]

Background: The Royal Australian College of General Practitioners' Standards for general practice training require supervisor continuing professional development (PD) to meet the needs of the individual supervisors and develop the supervisory team., Objective: The aim of this article is to explore current supervisor PD and consider how it might better meet the outcomes described in the standards., Discussion: General practitioner supervisor PD delivered by regional training organisations (RTOs) continues to operate without a national curriculum. It is predominantly workshop based and is complemented in some RTOs by online modules. Workshop learning is important for supervisor identity formation and establishing and maintaining communities of practice. Current programs are not structured to deliver individualised supervisor PD or develop the in-practice supervision team. Supervisors may struggle to translate workshop learning into changes in their practice. An in-practice quality improvement intervention facilitated by a visiting medical educator has been developed to address weaknesses in current supervisor PD. This intervention is ready to be trialled and further evaluated.

Purpose: Fever and associated neutropenia presentations are frequent occurrences for children with cancer. Prompt treatment is required to prevent adverse outcomes; however, delays are common. In Australia's vast landscape, presentations occur in both tertiary metropolitan sites and smaller regional sites. Management and experiences differ between sites. Our primary aim was to identify the barriers to optimal management of febrile neutropenia in children with cancer from patient/parent and clinician perspectives., Methods: A mixed methods approach was used where quantitative data was supplemented by qualitative data. Data were prospectively collected from parents (n=81) and clinicians (n=42) about all children who presented with fever across multiple diverse hospital locations. A subset of parents (n=9) and clinicians (n=19) completed semi-structured interviews., Results: Delays in assessment and treatment were reported by 31% of parents and up to 36% of clinicians. Four distinct time points where delays occurred were identified: 1) pre-presentation; 2) initial assessment; 3) blood collection and establishing intravenous access, and 4) preparation and administration of antibiotics. Although reasons for delay were diverse, they were primarily related to clinician's knowledge and awareness of fever management, and intravenous access device factors. Interventions were formulated to target these barriers and streamline processes., Conclusion: We identified multifactorial reasons for delays at different time points in care. Regional centres and families have unique needs which require considerations and tailored interventions. Ongoing education, monitoring compliance with initiation of practice changes and identifying and overcoming barriers as they arise are strategies for improving management of the febrile child with cancer., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Febrile neutropenia requires prompt assessment and antibiotic administration and is the most common reason for unexpected hospital admission in pediatric oncology. Parents are expected to be vigilant and "drop everything" to take their child to their nearest hospital for assessment if fever occurs. Delays in antibiotic administration are associated with poorer outcomes; however, delays are common. Our aim was to understand and describe the lived experience of parents of children with cancer who received treatment for fever with confirmed/suspected neutropenia. We used descriptive phenomenological concepts to undertake and analyze interviews with parents, who were asked to describe their recent experience of hospitalization in Queensland, Australia. Nine participants were interviewed. Five children were treated in the tertiary treating center and four were treated in smaller regional towns. Three main categories were identified that shaped and characterized parents' experiences: being heard, confidence in capabilities of health care professionals, and living with anticipated distress and uncertainty. Parents' experiences were related to the level they needed to advocate for their child's care across all themes. Familiarity with health care professionals increased confidence and improved parents' experiences. Maintaining vigilance and managing the child and family's response to an unexpected admission had a substantial negative effect on parents. Understanding parents' experiences and perceptions of the management of febrile neutropenia adds to the current body of knowledge and offers potential new insights to improve clinical practice.

A common method of managing challenging behaviour associated with dementia is long-stay special care units, though models are very diverse. In New South Wales, Australia, the five remaining state-run long-stay special care units for this population were funded to adopt a shorter-term model which had been trialled by one of the units. Transitional Behavioural Assessment and Intervention Service Units, incorporating an integrated outreach team, were to provide multi-disciplinary assessments, develop individualised bio-psychosocial management plans for, and appropriately discharge people with significant levels of Behavioural and Psychological Symptoms in Dementia. The current study assessed both the effects of the change and the clinical effectiveness of the model., Method: A repeated measures design, supplemented by multiple one-time measures. A range of standard instruments were administered, patient data from other types of inpatient units were obtained, interviews conducted, and medical records examined., Results: Transitional Behaviour Assessment and Intervention Service units were admitting patients with dementia and a variety of significant challenging behaviours. Length of stay was shortened in all units, patients turnover greatly increased, and there was a low re-admission rate. The model was substantially cheaper than psychiatric care in two units where it was fully implemented; one unit cost the same as psychiatric care, and two units were not cost-effective because of low occupancy - related to not fully implementing the model. Referring facilities reported that in the absence of the units, their main strategy would have been to increase sedation. In the Transitional Behavioural Assessment and Intervention Service units, behavioural incidents were primarily managed through psychosocial means. It is not known whether behaviour is reduced over time, staff become better at managing the behaviour when it occurs, or both., Conclusion: The evaluation showed that the model can be transferred to other units and is a cost-effective way of assessing, managing, and successfully discharging people with complex challenging behaviours, though only when fully implemented., (© The Author(s) 2014.)