Australian National University Medical School Research Articles

Why do some medical graduates lose their intention to practise rurally?

Chronic medical workforce shortage and maldistribution continue to be a significant challenge in rural Australia. The Rural Clinical Schools (RCSs) program helps to alleviate this problem with evidence of increased rural location in graduates of rural training programs. However, rural work intent may change during the years after completing a rural placement. This qualitative study investigated the factors involved in the change of career intention from rural to urban work location among the Australian National University Medical School (ANUMS) Rural Stream (RS) alumni. A purposive sampling method was utilised to recruit ANUMS RS 2006-2016 graduates who expressed that their work plans had changed. Data collected with the use of in-depth, semi-structured interviews were transcribed verbatim. Transcripts were interpreted using thematic analysis and a modified version of I-poems, a component of Voice-Centred Relational Method or the Listening Guide. Thematic analysis produced three main themes. First, 'impacts of the working environment' highlighted some participants' views that career progression and sustenance, high-quality training and agreeable working conditions could not be achieved rurally. Second, 'ramifications of isolation' described the experienced or predicted feelings of social and professional isolation. Third, 'familial considerations' explained how the wishes and requirements of partners and families strongly influenced the participants' future work decisions. These findings were supplemented by the 'committed voice' and 'voice of uncertainty', heard through the use of I-poems. The 'committed voice' communicated the participants' dedication to their careers and partners. The 'voice of uncertainty' expressed confusion of intentions as participants attempted to balance the bidimensional needs of the 'committed voice'. The complex interaction between the availability of high-quality training positions, support issues and work-life balance is associated with the change of rural work intention of RCS graduates. Career and partner/family commitments are significant factors. Meanwhile, uncertainty towards future work location provides the opportunity for carefully developed and appropriate rural workforce strategies to intervene.

Rural clinical school students do come back: But it may take time

Rural clinical schools (RCSs) help address Australia’s rural workforce shortfall, but they require an investment by rural clinicians and communities. Our objective was to determine the location of RCS graduates as one measure of the effectiveness of RCSs. This cross-sectional study obtained work location data for Australian National University Medical School (ANUMS) graduates and analysed both RCS and non-RCS data. The percentage of graduates working in rural areas after their fifth postgraduate year (PGY6–11: 34.7%) was significantly greater than that of graduates in PGY1–5 (15.2%, P <0.001). Many graduates who trained in rural sites spend time in cities before returning to work in rural areas. This is encouraging for rural clinicians and communities, but it can take time for graduates to return.

A new graduate medical school curriculum in Psychiatry and Addiction Medicine: reflections on a decade of development.

The aim of this study is to reflect upon the rationale, design and development of the Psychiatry and Addiction Medicine curriculum at the Australian National University Medical School, Canberra, Australian Capital Territory, Australia. We conclude that the development of the fourth-year curriculum of a four-year graduate medical degree was a complex evolutionary process.

Clinical research in an academic psychiatry department: some general principles and case studies.

This paper gives guidance for developing collaborative clinical research within an academic psychiatry department. We describe the experience at the Australian National University Medical School, and present three case studies. The results reveal that general principles include, but are not limited to, intellectual curiosity, mentorship, collaboration and protected time. We conclude that a particular strength of a new research department at a medical school may be close collaborative research within clinical settings.

Salt in the soul, steel in the eye and caution towards the winds: a mariner's guide for navigating a new academic psychiatry department.

This paper describes principles and advice regarding the development of a new academic psychiatry department within a medical school for aspiring academic psychiatrists. We describe general principles based on the experience of the foundation of the Academic Unit of Psychiatry and Addiction Medicine at the Australian National University Medical School. Perspicacious leadership and organisation are the foundation for an academic psychiatry department which delivers teaching, research and broader intellectual engagement with the medical and broader community.

Patient Demographic and Clinician Factors in Antibiotic Prescribing for Upper Respiratory Tract Infections in the Australian Capital Territory from 2006-2015.

National antibiotic stewardship programs aim to mitigate rising antimicrobial resistance and associated healthcare costs by promoting safe and appropriate antibiotic prescribing. This study aimed to analyse patient and clinician demographic factors that may influence antibiotic prescribing for Upper Respiratory Tract Infections (URTIs). Trends in antibiotic prescribing patterns were also analysed over the study period. This retrospective cross-sectional study analysed data from the Australian National University Medical School Clinical Audit Project database, comprising data collected by students during patient encounters over a two week period each April-May between 2006 and 2015 (excluding 2013). Data was collected via standardised survey in multiple healthcare settings and locations in the Australian Capital Territory (ACT) and Southeast New South Wales. (NSW) URTI diagnosis and symptomatology were defined using the International Classification of Disease (ICD-10) and International Classification of Primary Care, version 2 PLUS (ICPC-2+) criteria. URTI accounted for 5.6% (n=698) of total patient encounters (n=12,468), and of these, 42.7% (n=289) were prescribed an antibiotic intervention. Antibiotics were significantly more likely to be prescribed in the hospital setting (44.2%; n=237) compared to community GP (32.1%; n=52; p<0.05) and for patients presenting with localised symptoms (65.9%; n=109) compared to generalised symptoms (33.7%; n=122; p<0.01). No significant association was observed for age, rurality, patient gender, clinical gender or Indigenous status. The most frequently prescribed antibiotic was penicillin (67.8%; n=196). Over the decade of study, antibiotic prescribing for URTIs showed decreasing trend both overall (R2=0.204) and with respect to all demographic factors assessed. This study supports the effectiveness to-date of antibiotic stewardship programs in Australia. While continued efforts are required to further mitigate antibiotic resistance, this study suggests target areas may include improving clinician resistance to patient demand for antibiotics and increasing confidence in prescribing for special populations such as Indigenous peoples and the extremes of age.

Basic Science Liver.

Basic Science Liver.

Psychotropic drug use in aged care facilities: a reflection of a systemic problem?

Medical Journal of AustraliaVolume 200, Issue 1 p. 13-14 Perspective Psychotropic drug use in aged care facilities: a reflection of a systemic problem? Jeffrey C L Looi MD, FRANZCP, AFRACMA, Corresponding Author Jeffrey C L Looi MD, FRANZCP, AFRACMA Associate Professor and Director [email protected] Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra, ACT.Correspondence: [email protected]Search for more papers by this authorStephen Macfarlane MB BS, MPM, FRANZCP, Stephen Macfarlane MB BS, MPM, FRANZCP Associate Professor; and Director Aged Psychiatry, Monash University, Melbourne, VIC. Caulfield Aged Psychiatry Service, Melbourne, VIC.Search for more papers by this author Jeffrey C L Looi MD, FRANZCP, AFRACMA, Corresponding Author Jeffrey C L Looi MD, FRANZCP, AFRACMA Associate Professor and Director [email protected] Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra, ACT.Correspondence: [email protected]Search for more papers by this authorStephen Macfarlane MB BS, MPM, FRANZCP, Stephen Macfarlane MB BS, MPM, FRANZCP Associate Professor; and Director Aged Psychiatry, Monash University, Melbourne, VIC. Caulfield Aged Psychiatry Service, Melbourne, VIC.Search for more papers by this author First published: 20 January 2014 https://doi.org/10.5694/mja13.10469Citations: 5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume200, Issue1January 2014Pages 13-14 RelatedInformation

Initial evaluation of rural programs at the Australian National University: understanding the effects of rural programs on intentions for rural and remote medical practice

Rural health workforce issues are a priority area for the Australian Government and substantial funding has been provided for rural education programs to address health workforce disparities across Australia's rural and remote communities. The Australian Government established a Rural Health Strategy in 2001 and as a result there are now 14 rural clinical schools in Australia. The 2008 Urbis Report highlighted the lack of research on rural programs and workforce outcomes, essential to ensuring that educational efforts, resources and funding are being concentrated appropriately. This study examined the Australian National University (ANU) Medical School's 4 year rural program to identify the impact of elective and compulsory program components on student intentions to practice in a rural and remote location post-graduation. The study also explores factors that affect student decisions to apply for year-long rural placements. METHODS; ANU Medical School's graduating cohort of 2008 fourth year medical students completed an anonymous and voluntary online survey questionnaire. Survey sections included student demographics, compulsory and elective components of the ANU rural program, and an overall evaluation of the ANU rural curriculum. The survey contained a mixture of forced-answer questions and open-ended commentary. Quantitative data were analyzed for descriptive and frequency statistics using EpiInfo V3.5.1 (<a href='http://wwwn.cdc.gov/epiinfo/' target='_blank'>http://wwwn.cdc.gov/epiinfo/). Qualitative data were reviewed and consistent themes among responses extracted. In total, 40 students from a cohort of 88 (45%) responded, with 26 respondents (65%) indicating that at medical school commencement they considered working in a rural or remote area. At the end of their medical education, 33 respondents (82%) indicated their intention to spend some time in their careers working in a rural or remote area. Students from non-rural backgrounds had greater positive change in their intentions to practice rurally as a direct effect of ANU rural programs when compared with students from rural backgrounds. More than 70% of students believed the amount of rural focus in the curriculum was correct, 75% believed that they will be better medical practitioners because of the program, and 85% found the curriculum was delivered effectively. Students who undertook elective rural programs such as a year-long rural placement were more likely to have future rural career intentions when compared with students undertaking compulsory rural components. Compulsory components, however, had a strong influence on students applying for elective programs. Regarding application for the year-long rural placement, students reported clinical exposure was the most encouraging factor, and time away from family and friends, and lack of spousal and family support were the most discouraging factors. Rural programs at the ANU, and medical school exposure to rural health experiences is important in influencing students' perceptions of a career in rural and remote health. This study provides evidence that both compulsory and elective components contribute to a successful holistic rural program which nurtures the rural interest of all students. Overall, students at the ANU medical school were satisfied with the rural curriculum. The results confirm that there is difficulty in recruiting students with family commitments into year-long rural placement programs, despite incentives. Those students who select long-term rural study for reasons other than an interest in a career in rural health end the program with positive rural intentions.

Tumor Necrosis Factor (–308A) Polymorphism in Preeclampsia: Meta-analysis of 16 Case-control Studies

Australian National University Medical School, The Canberra Hospital, Woden, Australian Capital Territory, Australia

Bench work and clinical relevance: a new strategy in pathology education

It is recognised that medical students' perceptions of pathology can be improved by presenting pathology curricula in a clinically oriented manner. This study investigated how pathology teaching could be made more clinically relevant, using the coagulation laboratory practical for Year 2 students at the Australian National University Medical School as a case study, with a particular focus on the role of laboratory bench work. An e-survey was posted to 80 medical students who participated in the coagulation practical in 2005, followed by in-depth interviews for four consenting students. Four teachers were also interviewed to obtain additional perspectives. Students and teachers showed markedly different views of the clinical relevance of the practical; however, most were in favour of bench work. Greater clinical orientation was the predominant objective identified to improve the practical. Incorporation of laboratory bench-work within case-based sessions, in small group settings, were the strategies recommended to achieve these. A model for a 2 hour laboratory practical is proposed, involving a case-based session incorporating bench work, followed by case discussion to integrate laboratory results with clinical management. This approach is likely to be effective in pathology teaching across all disciplines.

Discerning quality: using the multiple mini-interview in student selection for the Australian National University Medical School

To describe the development and pilot testing of a set of admissions instruments based on the McMaster University multiple mini-interview (MMI) and designed to assess desirable, non-cognitive characteristics in order to inform final decisions on candidate selection for entry to medical school. Community and faculty consultation on desirable, non-cognitive characteristics of medical students informed the development of a 10-station interview. Two stations occurred as part of a group problem-based learning scenario and 8 occurred as individual observations. All interviewers were trained. Interviews were offered to 115 candidates on an academic merit list. Interview performance was used to exclude candidates considered unsuitable, but not to re-order the academic merit list. Admissions decisions were examined in terms of individual interview station performance. This method proved to be an efficient process by which to interview candidates and to determine suitability. Retained and rejected candidates had significantly different total scores and mean scores for each station. Ten independent observations contributed to each decision, without significant interviewer or logistic burden. Candidates reported high levels of satisfaction with the interview process. Admissions interviews can be streamlined and efficient, yet remain informative. A longitudinal study is in progress to evaluate the value of the admissions processes in predicting successful graduation to medical practice.

8. 'STAMP OUT CHLAMYDIA' PROJECT - BRINGING CHLAMYDIA SCREENING TO TERTIARY STUDENTS IN THE AUSTRALIAN CAPITAL TERRITORY

Study's objective: Stamp Out Chlamydia (SOC) is a pilot research project funded by the Commonwealth Department of Health &amp; Aging to devise and implement a cost effective program for education and chlamydia screening for ACT tertiary students aged 16-26 years at The Australian National University (ANU), University of Canberra and Canberra Institutes of Technology, that may be suitable for national implementation. Methodology: A collaborative clinical outreach project between Canberra Sexual Health Centre, Sexual Health and Family Planning ACT and ANU Medical School, whereby the SOC team attends student-initiated events on ACT tertiary campuses to educate and test young people, using self-obtained urine specimens. Summary of Results: The majority of these outreach events were attended by two Registered Nurses and the Health Promotion Officer. To date they have attended 19 events including Orientation Week activities, BBQ's, Easter Scavenger Hunt, Gay Pride Week events and sports events. Promoting the SOC project has been through word of mouth, SOC 'Champions', convenience and media advertising and a dedicated web site. By May 2007 the SOC project had: Interfaced with 1512 tertiary students and offered them the opportunity to participate in the research Screened 445 for chlamydia Found a chlamydia prevalence of 1.8% Treated eight cases and their contacts Of those screened: Male 240 Female 205 Target group 412 Conclusion: ACT tertiary students accept this outreach approach. Of students approached, over a quarter agreed to have screening. The high profile of the SOC project is leading to an increased awareness of chlamydia. Many students are unaware of the high incidence and/or the consequences of chlamydia, if left untreated and report that they would not have attended mainstream services for screening. Ongoing data analysis will determine if this project is cost effective and feasible.