RESUMEN
Clinical leadership is necessary to improve the performance of large public hospitals. Trainee medical officers (TMOs) are important stakeholders in organisation-wide initiatives that affect the medical workforce and support clinician engagement. This case study describes the development of a representative body known as the 'TMO Forum' within the Central Adelaide Local Health Network as a mechanism to promote engagement between medical trainees and the hospital executive to facilitate escalation and discussion of system-based issues. Over the past 8 years, this group has evolved into a community of practice with steady and sustained growth since inception. Trainees have fostered relationships with the executive, and have engaged in leadership and quality improvement initiatives. Here we explore the evolution, value and barriers to success of the TMO Forum. Our discussion is supplemented with findings from anonymous online evaluation surveys of both the TMO and executive stakeholder groups. We propose that initiatives such as the described may offer reciprocal benefits to both constituent groups regarding communication, and that the development of a dedicated community of practice will enhance engagement of TMOs in health service improvement initiatives and advocacy. However, there are obstacles to overcome in order to attract a greater number of trainees and maximise the benefits from this initiative.
Asunto(s)
Liderazgo , Humanos , Personal de Salud , Servicios de Salud , Mejoramiento de la CalidadRESUMEN
OBJECTIVE: This paper describes the introduction of formative feedback into a psychiatry attachment at an Australian university and evaluates students' responses to that initiative. METHOD: Students were provided with formative feedback sessions employing a standardized instrument, also used at the end of the attachment for summative assessment. They were asked to both define formative feedback and rate its usefulness on a questionnaire, providing open-ended written comments where appropriate. RESULTS: The concept and purpose of formative feedback were understood by 91.9% of the students who completed a questionnaire. The vast majority considered it to be useful, but some identified the need for constructive criticism and structured feedback as important characteristics of formative sessions. CONCLUSIONS: Rigorous research is needed to establish whether formative feedback impacts summative assessments. However, it is clear that such feedback is desirable, in that it increases student confidence and direction. We encourage our colleagues to consider introducing and evaluating formative feedback into psychiatry curricula.
Asunto(s)
Educación de Pregrado en Medicina/organización & administración , Retroalimentación , Psiquiatría/educación , Enseñanza/métodos , Actitud , Australia , Educación de Pregrado en Medicina/normas , Humanos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Although the two political systems cannot be equated, the psychiatric and psychosocial issues raised by people detained under the migration regulations of the present Australian government, and those detained under the security legislation of the last apartheid government in South Africa, are similar in many aspects. METHOD: We present two case scenarios representative of the cumulative clinical experience of the authors in their work (as part of their routine clinical practice and medical school experience) with asylum seekers and political detainees in acute psychiatric units in both South Africa and Australia. RESULTS: Similar issues raised included the validity of a psychiatric diagnosis in these patients and the debate this conundrum provoked among the multidisciplinary teams. The pressures placed on clinicians by politicians in terms of clinical management of hospitalized detainees raised similar ethical questions across both countries. The clinical syndromes of depression and posttraumatic stress disorder were similar. The effect of the 'non-person' status conferred upon refugees by the 'temporary protection visa' could be equated with the effect of 'banning orders' imposed on opponents of the Apartheid regime. CONCLUSIONS: In South Africa, political detainees entered into the struggle expecting to face hardship and torture at the hands of the government of the time. Asylum seekers flee to Australia expecting support from a democratic system and generally had not prepared themselves for further incarceration and yet another political struggle. Despite this seemingly fundamental difference, the experiences of detainees across two very different political systems are remarkably similar.
Asunto(s)
Ansiedad/psicología , Depresión/psicología , Prisioneros/psicología , Prisiones , Adulto , Ansiedad/diagnóstico , Ansiedad/etnología , Australia , Depresión/diagnóstico , Depresión/etnología , Diagnóstico Diferencial , Emigración e Inmigración/legislación & jurisprudencia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Política , Prisiones/ética , Prisiones/legislación & jurisprudencia , Religión , Reproducibilidad de los Resultados , Sudáfrica/etnologíaRESUMEN
OBJECTIVE: The aim of this study was to assess an electroconvulsive therapy (ECT) rating scale by studying the intraictal electroencephalograph parameters induced by the seizure, and determine the clinical utility of such a scale in terms of time, application and ease of use. METHOD: This naturalistic study of 55 depressed patients over a 2-year period examined specific parameters of the intraictal electroencephalograph seizure morphology and computer printout, and their association with overall clinical outcome. The rating scale was developed and evaluated in terms of clinical reliability and ease of use. RESULTS: Overall, 1076 individual ECT treatments were given. Using multiple regression analysis, overall seizure adequacy correlated most closely with abrupt seizure endpoint, a high amplitude rhythmic spike and wave phase of >13 s, a seizure energy index of >1000 u, and an electroencephalograph seizure length of > 24 s. "Adequate" overall ratings as determined by the rating scale were shown to correlate significantly with overall clinical improvement. The rating scale had extremely high interrater and test-retest reliability; and was relatively easy to use and time efficient. CONCLUSIONS: The use of the rating scale has the potential to help clinicians optimize ECT. While not perfect in any sense, it still gives clinicians good predictive qualities when used as a clinical guide. It is important that larger studies look at all the potential variables that may interact with seizure adequacy and clinical outcome.