Promoting better use of the PSA test in general practice: Randomized controlled trial of educational strategies based on outreach visits and mailout

Background. Prostate-specific antigen (PSA) testing for prostate cancer is controversial. Demand for PSA testing is likely to rise in the UK, Australia and other western countries. Primary care needs to develop appropriate strategies to respond to this demand. Objectives. Our aim was to compare the effectiveness of educational outreach visits (EOVs) and mailout strategies targeting PSA testing in Australian primary care. Methods. A randomized controlled trial was conducted in general practices in southern Adelaide. The main outcome measures at baseline, 6 months and 12 months post-intervention were PSA testing rates and GP knowledge in key areas relating to prostate cancer and PSA testing. Results. The interventions were able to demonstrate a change in clinical practice. In the 6 months post-intervention, median PSA testing rate in the EOV group was significantly lower than in the postal group, which in turn was significantly lower than the control group (P < 0.001). Statistically significant differences were not, however, maintained in the 6-12 month post-intervention period. The EOV group, at 6 months follow-up, had a significantly greater proportion of 'correct' responses than the control group to questions about prostate cancer treatment effectiveness (P = 0.004) and endorsement of PSA screening by professional bodies (P = 0.041). Conclusions. Primary care has a central role in PSA testing for prostate cancer. Clinical practice in this area is receptive to evidence-based interventions.

Understanding professional practice: investigations before and after an educational programme

During preparation for professional practice, the professional skill being developed is typically measured in the form of specific knowledge and skills. This study proposes an alternative to such measures, drawing upon research which demonstrates that our understanding of professional practice is central to how we both perform and develop that practice. The study investigates understanding of medical practice prior to and following a pre-medical programme. On commencing the programme, students showed substantial variation in their understanding of medical practice. At the end of the programme much of this variation remained, indicating the students had developed varying forms of professional skill. The study calls into question the adequacy of a focus on detailed knowledge and skills as a base for professional practice. In line with previous research, an important implication of the study is that developing skilful practice requires focusing on understanding of that practice in and through its performance.

Leading theory: Bourdieu and the field of educational leadership. An introduction and overview to this special issue

Bourdieu … makes it possible to explain how the actions of principals are always contextual, since their interests vary with issue, location, time, school mix, composition of staff and so on. This 'identity' perspective points at a different kind of research about principal practice: to understand the game and its logic requires an analysis of the situated everyday rather than abstractions that claim truth in all instances and places. (Thomson 2001a: 14)

Electronic patient records: Achieving best practice in information transfer between hospital and community providers - an integration success story

Effective healthcare integration is underpinned by clinical information transfer that is timely, legible and relevant. The aim of this study was to describe and evaluate a method for best practice information exchange. This was achieved based on the generic Mater integration methodology. Using this model the Mater Health Services have increased effective community fax discharge from 34% in 1999 to 86% in 2002. These results were predicated on applied information technology excellence involving the development of the Mater Electronic Health Referral Summary and effective change management methodology, which included addressing issues around patient consent, engaging clinicians, provision of timely and appropriate education and training, executive leadership and commitment and adequate resourcing. The challenge in achieving best practice information transfer is not solely in the technology but also in implementing the change process and engaging clinicians. General practitioners valued the intervention highly. Hospital and community providers now have an inexpensive, effective product for critical information exchange in a timely and relevant manner, enhancing the quality and safety of patient care.

Medical student radiology training: What are the objectives for contemporary medical practice?

Rationale and Objectives. The authors attempt to provide a set of objectives for medical student training in radiology for contemporary medical practice. Materials and Methods. A questionnaire containing a list of educational objectives was sent to 32 radiologists in charge of medical student training in radiology at accredited residency programs in Australia and New Zealand. The importance of including each preselected objective in the curriculum was measured by respondents' agreement or disagreement on a scale of 1-6. Opportunity also was given to respondents to suggest objectives other than those presented on the questionnaire. Results. Twenty of the 32 questionnaires were returned, and a set of educational objectives was established based on the responses. The objectives were ranked in importance according to the mean score assigned to each objective by the respondents. Conclusion. This new set of educational objectives for medical student radiology training reflects recent changes in radiologic and medical practice and points to potential future developments.

Diagnosis of autistic spectrum disorders in Queensland: Variations in practice

Objective: For both paediatricians and child psychiatrists, referrals to assess possible autistic spectrum disorders (ASD) are increasing. This study examines current practices of medical specialists in the assessment of these disorders. Methods: An anonymous, self-report questionnaire was sent to all Queensland paediatricians and child psychiatrists. The survey elicited frequencies of consultation for ASD, diagnostic method, advice provided and perceived adequacy of training for this work. Results: Responses were received from 79 (85%) eligible paediatricians and 26 (58%) eligible child psychiatrists. For one-third of all clinicians, new consultations for possible ASD occurred as often as 2-3 times per week. Most specialists approached the clinical diagnosis of ASD by considering history from different sources and professional assessments. Paediatricians (86%) were more likely than child psychiatrists (62%) to request genetic studies for children with severe autism (P = 0.01). Both general paediatricians and developmental paediatricians perceived level of training for possible ASD consultations was significantly worse than child psychiatrists (P < 0.001 and P = 0.02, respectively), but no difference was found between paediatric groups (P = 0.27). Perceived adequacy of specialist training was not associated with length of experience in clinical practice. Conclusion: Medical practice in Queensland around diagnosis of ASD is characterized by considerable variability. There is still a long way to go if we are to achieve consistency around medical issues of organic diagnosis and practices impacting on health as well as consideration of differential developmental diagnoses. The finding that recently trained paediatricians felt just as unprepared for this work as their older colleagues suggests that the graduate training response to this 'new morbidity' has not been adequate.

An educational workshop on the early detection of prostate cancer

The authors have developed an education program for GPs to facilitate informed choice about PSA testing.

Agency as discursive practice: From nobody to somebody as an international student in Australia

As more and more students pursue an international education, there is a need to investigate how these students deal with the demands of their study programs in the new academic context. This paper introduces one such student, a Thai English teacher named Woody,2 and looks at the ways that he engaged with a Master of Education program in Australia. I analyse the transcripts of two interviews that I conducted with Woody in his first semester using Fairclough's model of Critical Discourse Analysis (CDA). The analysis is interested in the social and institutional demands that Woody identified as impacting on the course, and the strategic action that he took in response to them. I argue that by undertaking this action, Woody was “working” as an agent of his own change. The analysis highlights a proactive and strategic engagement on Woody's part, a point that has been missed in much of the literature on the international student experience in Australia.

A pragmatic 2 × 2 × 2 factorial cluster randomized controlled trial of educational outreach visiting and case conferencing in palliative care—methodology of the Palliative Care Trial [ISRCTN 81117481]

The demand for palliative care is increasing, yet there are few data on the best models of care nor well-validated interventions that translate current evidence into clinical practice. Supporting multidisciplinary patient-centered palliative care while successfully conducting a large clinical trial is a challenge. The Palliative Care Trial (PCT) is a pragmatic 2 x 2 x 2 factorial cluster randomized controlled trial that tests the ability of educational outreach visiting and case conferencing to improve patient-based outcomes such as performance status and pain intensity. Four hundred sixty-one consenting patients and their general practitioners (GPs) were randomized to the following: (1) GP educational outreach visiting versus usual care, (2) Structured patient and caregiver educational outreach visiting versus usual care and (3) A coordinated palliative care model of case conferencing versus the standard model of palliative care in Adelaide, South Australia (3:1 randomization). Main outcome measures included patient functional status over time, pain intensity, and resource utilization. Participants were followed longitudinally until death or November 30, 2004. The interventions are aimed at translating current evidence into clinical practice and there was particular attention in the trial's design to addressing common pitfalls for clinical studies in palliative care. Given the need for evidence about optimal interventions and service delivery models that improve the care of people with life-limiting illness, the results of this rigorous, high quality clinical trial will inform practice. Initial results are expected in mid 2005. (c) 2005 Elsevier Inc. All rights reserved.

Doing educational development ambivalently: Applying post-colonial metaphors to educational development?

Post‐colonial theories about liminality, hybridity, unhomeliness, and identity form a novel lens through which to re‐theorise educational development work. Applying these conceptual frameworks allows practitioners and the academics they work with the opportunity to problematise some of educational development’s colonial underpinnings and assumptions. They also enable an exploration of the states of betweenness that form educational developers’ identities and impact implicitly and explicitly upon the nature of their changing practices. This paper seeks to read educational development and research supervisor development in particular “against the grain”. It also seeks to illustrate these concepts through some vignettes of my academic development practice.

Developing interdisciplinary research graduates: educational opportunities and dilemmas

Attempting to solve the complex problems of the 21st century requires research graduates that have developed a sophisticated array of interdisciplinary teamwork and communication skills. Although universities, governments, industry and the professions have emphasised the need to break down disciplinary silos in order to produce graduates, who can respond more effectively to the needs of the knowledge economy, much of this work has centred on undergraduate programs. While there are some research higher degree students who choose to work on interdisciplinary research topics, very little has been done to develop interdisciplinary research education systematically. This paper explores the educational opportunities and dilemmas involved in developing systematic programs of interdisciplinary research activities in two research centres at the University of Queensland. Framed by Bruhn's (2000, p. 58) theoretical discourse about interdisciplinary research as 'a philosophy, an art form, an artifact, and an antidote', this paper emphasises the need for such programs to embed the development of students' interdisciplinary research skills and attitudes within their research projects. The two diverse programs also emphasise experiential, active and interactive learning techniques and are centred upon the development of students' reflective practice skills.