Medical Education - Research Publications

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    Continuing Professional Development programmes through the lens of Habermas’ Knowledge-Constitutive Interests: a novel approach to evaluating and (re)designing CPD
    Lavercombe, M ; Delany, C ; Kameniar, B (AMEE, 2024)
    Background: Clinician-educators are usually experienced clinicians seeking information and strategies to improve their teaching. Continuing Professional Development (CPD) programmes can address a range of learning requirements for clinician-educators if they can respond to the particular educational and contextual needs of participants. A critical review of a one-day postgraduate course was conducted. It focused on how the course was tailored to the learning needs and interests of participants and drew on the early work of Jürgen Habermas and his Knowledge-Constitutive Interests schema in its analysis. Habermas describes technical, practical and emancipatory interests. For clinician-educator CPD, ‘teaching tips that work’ align with the technical interest, while learning why certain teaching techniques suit specific situations or learners is a practical interest. Understanding the material so attendees can flexibly apply it in their context aligns with the emancipatory interest in autonomy. Summary of Work: Examination of the course through the lens of Habermas' interests was conducted by asking: What type of interest does each session target? How does it do this? How could the teaching method shift from fostering technical or practical knowledge towards meeting the participants' emancipatory interests?
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    More than another pair of hands? The impact of medical student placements on the healthcare service
    Molloy, E ; Woodward-Kron, R ; Lew, S ; Delany, C ; Lavercombe, M ; Dodds, A (AMEE, 2018)
    Background: Clinical placements are key to developing work-ready graduates. To date, the literature on workplace learning has focussed on learner-as-consumer, rather than learner-as-contributor. This study aimed to identify the impact of medical student clinical placements for multiple stakeholders in healthcare services. Method: This study was conducted at a large outer metropolitan healthcare service. Qualitative data collection included: observation of students on placement; activity profiling of supervisors and students; student and supervisor focus groups; and interviews with clinicians, academic and hospital leaders, and patient advocates. The data were analysed using Braun and Clarke’s (2006) thematic analysis. Results: The effects of medical students on the healthcare service were categorised into two higher order themes: ‘impact on workflow’; and ‘student presence amplifying quality of care’. In terms of affecting workflow, students in their earlier years reportedly absorbed clinicians’ time on account of direct teaching, task selection, and supervision of activities. As they approached graduation, students began to take on tasks independently (e.g. history taking, data entry, and coordinating patient discharge). Amplifying quality of care was observed through students’ prompting clinicians to reflect on their own practice. Students attended to different aspects of care, often responding to patient or family questions in the specialist’s absence. As one supervisor reported, “students often form an important, informed, but lay, connection between the patient and the medical staff so they can identify a mismatch of expectations.” Discussion: The results suggest that although students require an upfront investment of supervisor energy on clinical placement, they add value along a number of dimensions, particularly in the final year of their program. These contributions are beyond being “another set of hands”. The presence of students encouraged clinicians to reflect on their practice. Conclusion: The presence of students prompted clinicians to adopt a more critical gaze on their own work, and students focussed on humanistic elements of care – elements that can be missed or deprioritised when there is an attending expert only. The role of students as a bridge between patients and experienced staff, and how this can be optimised, warrants further exploration,
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    Gathering evidence for medical students’ contribution to health services: A communities of practice informed methodology
    Molloy, E ; Woodward-Kron, R ; Hughson, J-A ; Delany, C ; Lew, S ; Dodds, A ; Lavercombe, M (Australian & New Zealand Association for Health Professional Educators, 2018)
    Introduction: Immersion in clinical environments is key to developing work-ready graduates. Workplace learning literature has focused on the benefits of clinical placements for students and the burden for health services, such as the cost of supervisor time away from patient care. There has been little focus on mapping the benefits (obvious and hidden) of clinical placements to multiple stakeholders. Aim: To develop a methodology for capturing the benefits of clinical placements for multiple stakeholders. Methods: Using ethnographic methods of observation and interviews, as well as surveys, and drawing from the concept of legitimate peripheral participation within a Community of Practice, we charted student activities on clinical placements at an outer metropolitan health service. Results: The multiple data collection methods helped to identify how students learn through work as their expertise develops. The activity logs, survey and interviews prior to the observation phase, helped sensitise researchers to the less visible student contributions. Students in their final year contributed like a junior team member: taking patient histories, completing discharge planning and taking on ‘busy jobs’ that freed up senior team members. Discussion: The multiple data collection methods and variety of stakeholder participants allowed for triangulation of the findings, and the phased approach sharpened the focus for the student observations. Capturing the patient perspective presents challenges, as does taking into account differences in student year levels, and different levels of student engagement. Conclusions: A multi-phased, mixed methods approach can identify bi-directional benefits, mapping student contributions along a number of dimensions.
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    Burden or bonus? The impact of medical student placements on health services
    Molloy, E ; Woodward-Kron, R ; Hughson, J ; Delany, C ; Lew, S ; Dodds, A ; Lavercombe, M (Australian & New Zealand Association for Health Professional Educators (ANZAHPE), 2018)
    Introduction: Workplace learning plays a key role in developing work-ready medical graduates. The literature has focussed on how students learn in these complex settings with little research exploring the costs and benefits of student placements for different stakeholders. Aim: This study identified the perceived costs and benefits of medical student clinical placements for multiple stakeholders in the healthcare system. Methods: The study, funded by the Medical Deans of Australia and New Zealand, was conducted at a large outer metropolitan healthcare service. Data collection included observation of students, activity profiling, focus groups, and interviews with a range of stakeholders. Quantitative data were analysed using descriptive statistics and qualitative data were thematically analysed. Results: Multiple data sets identified the time cost in hosting medical students including briefing and debriefing with students, questioning/explanation, and more formalised teaching such as tutorials. Benefits identified included students contributing to clinical work, increasing reflective practice of clinicians, workforce recruitment, and improving patient experience through education. The extent of student contribution depended on clinical domain, student proactivity and level of experience. Discussion: The degree to which medical students contribute to healthcare depends on the characteristics of the clinical context, as well as the experience and engagement of learner and supervisor. Further research across programs and contexts is warranted, including extended ethnographic approaches to capture the less visible contributions. Conclusions: This multi-phased study identified that students do more than complete ‘busy tasks’ on clinical placements. Their presence as observers was reported to heighten clinicians’ reflective practice.
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    Meeting Halfway: Engaging Clinician-Educators
    Lavercombe, M (ANZAHPE, 2024)
    Introduction/Background: Clinician-educators form a significant component of the health professional education workforce and deliver a substantial amount of teaching and supervision, especially in placement sites. There are many challenges clinician-educators face in contributing to educational activities such as programme development, evaluation and educational research and scholarship, yet experience in these areas can be critical to their professional development. Are health professional education programmes doing enough to encourage the contribution of their clinician-educator workforce? Methods: In this PeArLS, I will briefly introduce the issue outlined in the Introduction and then engage the participants in a discussion across several questions listed below in ‘Issues or questions for exploration’. These questions will explore the experience of participants in working with clinician-educators outside of their usual teaching or supervisory activity and the ways in which those educators might best be utilised to enhance the programmes into which they teach. Strategies for engaging clinician-educators will form an important part of this discussion and will focus on ways in which participants have successfully overcome barriers to clinician-educator contribution. Results/Evaluation: This session will be a success if both the presenters and participants identify ways to engage their clinician-educator staff in broader participation in their educational programmes. These could be in areas such as programme design, evaluation, faculty development or scholarship. Insights from participants who have successfully developed professional development programmes or scholarly collaborations with their clinician-educator workforce will be particularly valuable. Discussion: Opportunities for shared understanding and problem-solving are critical to the ongoing development of health professional education programmes and practitioners. Greater involvement of clinician-educators in the academic programmes to which they contribute will be of benefit to all health professional education practitioners.
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    Utility of the STOP and STOP-BANG Questionnaires in a Pre-Screened Population Presenting for Overnight Polysomnography
    Lavercombe, M ; Hocking, V ; Clarence, M ; Thien, F (Sleep and Biological Rhythms, 2009)
    Obstructive Sleep Apnoea (OSA) is a common condition, the diagnosis of which is often delayed by prolonged waiting lists at the point of referral or in the sleep laboratory. Clinical prediction tools may become useful in triaging assessment and management of this condition. Recent publications have proposed and validated two new pre-operative screening tools for Obstructive Sleep Apnoea (OSA) in surgical patients (STOP and STOP-BANG). These screening tools have not been examined in a general sleep population. Methods: All patients attending for in-laboratory polysomnography at Box Hill Hospital during the study period were asked to complete the STOP questionnaire, and sleep scientists recorded the biometric data required for the BANG component. Polysomnography proceeded with sleep staging and event scoring performed according to the Chicago Criteria. Risk stratification by the STOP and STOP-BANG tools was combined with total Respiratory Disturbance Index from polysomnogram reports. Results: 69 patients have been recruited, although data continues to be collected. As expected, there is a predominance of moderate and severe OSA in this cohort (45/69, 65%). The STOP-BANG tool maintains higher sensitivity, negative predictive value and odds ratios than the STOP tool at each degree of OSA severity examined. Receiver operating characteristic curves demonstrate superiority of the STOP-BANG tool for RDI > 15, when compared with STOP-BANG for RDI > 30 and STOP at both RDI cut-offs. Conclusions: With ongoing data collection we hope to confirm trends seen in predictive values with these tools. Removal of less discriminatory criteria may improve their statistical usefulness, perhaps allowing development into risk stratification tools that will assist in triaging investigation and management of patients with suspected OSA.
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    Utility of the STOP and STOP-BANG Questionnaires in a Pre-screened Population Presenting for Overnight Polysomnography
    Lavercombe, M ; Hocking, V ; Clarence, M ; Thien, F (Wiley, 2009)
    Obstructive Sleep Apnoea (OSA) is a common condition, the diagnosis of which is often delayed by prolonged waiting lists at the point of referral or in the sleep laboratory. Clinical prediction tools may become useful in triaging assessment and management of this condition. Recent publications have proposed and validated two new pre-operative screening tools for Obstructive Sleep Apnoea (OSA) in surgical patients (STOP and STOP-BANG). These screening tools have not been examined in a general sleep population. Methods: All patients attending for in-laboratory polysomnography at Box Hill Hospital during the study period were asked to complete the STOP question-naire, and sleep scientists recorded the biometric data required for the BANG component. Polysomnography proceeded with sleep staging and event scoring performed according to the Chicago Criteria. Risk stratification by the STOP and STOP-BANG tools was combined with total Respiratory Disturbance Index from polysomnogram reports. Results: 25 patients have been reviewed, although data continues to be collected. There is a high prevalence of moderate or severe OSA within this population (22/25, 88%). The STOP-BANG tool maintains higher sensitivity, negative predictive value and odds ratios than the STOP tool at each degree of OSA severity examined. Conclusions: With ongoing data collection we hope to confirm trends seen in predictive values with these tools. Removal of less discriminatory criteria may improve their statistical usefulness, perhaps allowing development into risk stratification tools that will assist in triaging investigation and management of patients with suspected OSA.
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    Malignant pleural effusion management: An audit of current practice
    Roberts, J ; Lavercombe, M (Wiley, 2024)
    Introduction/Aim: Malignant pleural effusion (MPE) is a complication of advanced cancer that can result in limited life expectancy and significant morbidity. Recurrence of MPE is common and definitive management with either pleurodesis or indwelling pleural catheter (IPC) insertion is often required. This study aimed to review the management of MPE at two tertiary hospitals to identify potential areas for improvement with an emphasis on the hospital length of stay, frequency of non-definitive pleural procedures and frequency of unplanned pleural related admissions. Methods: Retrospective audit of all patients diagnosed with MPE at Western Health over a 3-year period. Results: Of 79 patients with MPE were identified during the time period (mean age 66.1 years, 59% female). 25 patients (13.1%) had a non-definitive pleural procedure following diagnosis, including 16 (38.1%) of the 42 patients who subsequently went on to have a definitive procedure. The median hospital length of stay for pleural effusion related hospitalisations was 9 days. 22 of the 42 pleural effusion-related admissions occurred after a presentation via the emergency department (ED). When compared with planned admissions, those who presented via ED had a higher rate of non-definitive procedures (77% vs 25%) and a longer length of stay (12 vs 7 days). Conclusion: The pleural effusion-related hospital length of stay was in line with previously published Australasian data. Despite this, our data suggests that there might still be scope for improvement. In particular, our data has suggested that interventions to reduce the number of unplanned admissions via ED might result in a reduced rate of non-definitive procedures and a reduced hospital length of stay. Future research could assess the impact of interventions such as the introduction of dedicated pleural clinic or a streamlined admissions pathway on these measures.
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    Recommendations from The Medical Education Editor
    Lavercombe, M (WILEY, 2024-04)
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    Insulin icodec use in hospital settings: Considerations for once-weekly basal insulin therapy in hospital glycaemic management practice
    Barmanray, RD ; Kyi, M ; Rayman, G ; Rushakoff, R ; Newland-Jones, P ; Fourlanos, S (Elsevier, 2024-05)
    Diabetes management has benefitted greatly from novel insulin analogues with action profiles that better match individual’s requirements. However, the increased complexity of hospital insulin administration involving multiple practitioners, rapidly changing clinical situations, and therapies causing hyperglycaemia, demands specific consideration for their use. Insulin icodec has an extended duration of action and is beginning to be used in the ambulatory setting. A reassuring early trial experience observed no substantial dysglycaemia in 135 hospitalised participants [ 1 ]. However, the limited glucose measurements informing this observation under intensive clinical trial conditions warrants further consideration of insulin icodec’s implications for real-world hospital settings.