Procedural trained, procedural remain : the first report from 'A census of doctors who have been awarded the Graduate Diploma in Rural General Practice (GDRGP)'

Aims & rationale/Objectives : To document the practice of initial cohorts receiving the Graduate Diploma in Rural General Practice
Methods : With the co-operation of the National Rural Faculty (NRF) of Royal Australian College of General Practitioners (RACGP), a census by questionnaire was conducted on 279 graduates. The response rate was 70%.
Principal findings : The target doctors are young (65% < 40 years old). Under half (42.3%) have completed Advanced Rural Skills terms in >1 discipline. Of the total 272 posts recorded from 174 respondents, the most popular advanced skill is anaesthetics, followed by obstetrics. The ARSP increased confidence in 96.3% of respondents. Two thirds of doctors trained in a procedural skill remain practicing procedural General Practice.
Discussion : The GDRGP was the qualification developed to recognise competency gained as a result of a series of rural training initiatives begun within the RACGP Training Program in 1992. Its delivery has continued under the new GPET Training Program. Outcomes from the range of initiatives leading to the GDRGP are currently emerging in an environment which has seen significant changes within vocational training, and within the context of a rising focus on indemnity. Doctors who undertook this training have mostly retained procedural practice. In addition, RACGP rural initiatives successfully achieved increase confidence prior to rural work in advanced areas of practice, with >95% reporting an increase.
Implications : Changes within vocational training were accelerated without analysis of existing initiatives such as the GDRGP. Funding for the GDRGP was, as a result, withdrawn prematurely. These changes also saw the entrant of a second College with an interest in rural procedural practice. This research show that the GDRGP offers, and offered, a clear vocational pathway that will guide a doctor to a career as a rural doctor, and provide them with the advanced skills they need to practice confidently in the bush. It is important to capitalise on past success before deconstructing professional concepts of practice further.
Presentation type : Paper

Heterogeneity in service delivery and inequity in access are common characteristics of chronic heart failure management programs

Background: The prevalence of heart failure in Australia is similar to that of Europe. In Australia, chronic heart failure management programs (CHF-MPs) have become part of standard care for patients with Chronic Heart Failure (CHF). However, heterogeneity among programs is common which can result in variable patient outcomes.

Method: A national survey was undertaken of 59 post-discharge CHF-MPs identified from within the Australian health care system. Two had ceased operating and one centre declined to participate in the study. A 33-item investigator-developed questionnaire, examining the characteristics and interventions used within each CHF-MP, was sent to the remaining 56 CHF-MPs. A response rate of 100% was achieved.

Results: Our survey revealed a disproportional distribution of CHF-MPs across the Australian continent: the State of Victoria had 3.6 CHF-MPs/million population, New South Wales had 3.7 CHF-MPs/million population, Queensland had 1 program/million population, South Australia had 0.3 CHF-MPs/million population and Western Australia had 1 program/million population.Overall, 8000 postdischarge CHF pts (median: 126; IQR: 26-260) were managed via CHF-MPs. Approximately 40,000 CHF pts are discharged from metropolitan institutions nationally, this represents only 22% of the potential caseload for these cost-effective CHF-MPs. Only 8% of these programs were located within rural regions. The majority of CHF-MPs were located within an acute metropolitan hospital (52%) and 36% were community based (all associated with a hospital). Heterogeneity of CHF-MPs in applied models of care was evident with 75% of CHF-MPs offering CHF outpatient clinics and 77% conducting home visits. Of the programs offering home visits 78% were funded by regional government (p<0.048). There were no nurse-led CHF outpatient clinics. A hybrid approach to CHF-MPs was common with many CHF-MPs comprising an outpatient clinic, home visits and inpatient visits. Various medications were titrated by nurses in 43% of CHF-MPs. In the programs that allowed nurses to titrate medications 79% were located in an acute hospital (p<0.011).

Conclusion: Variability of service availability is of concern within the context of universal coverage. In addition, heterogeneity between programs and the diversity in models of care delivery highlights the inconsistency and questions the quality of health related outcomes. We are currently analysing health outcome data from the 1015 patients managed in these CHF-MPs to describe the relationship between quality of care and health outcomes.

Marketing students' perception of traditional and intensive delivery : an exploratory study

The study investigated how undergraduate marketing students perceived intensive delivery of subjects over summer school as compared to traditional semester delivery. The results suggest that students did not perceive there were substantial differences in learning, but preferred the more intensive nature of the learning. The results also indicate that summer school students found the subject more interesting and rated the subject higher overall as compared with the traditional mode. Individual assessment grades for students in the intensive mode did differ to those in the traditional mode, but examination results and final grades were not statistically different. Intensive modes may be viable alternatives to traditional semester long classes, although they do potentially have increased costs.

Vocational education and training at a distance : transformation to flexible delivery

This chapter will explore the position that distance education has held in the past in Australian vocational education and training (VET) and how that position has developed and transformed over the past couple of decades. It is argued here that after a period of VET provision through distance education that was largely based around an earlier centralised model, VET was early to recognise the potential that new technologies in distance education had for VET learners and learning. Concurrently there was recognition of the substantial limitations a centralised model of distance education posed for new demands on VET. Economic imperatives also contributed to what became a revolution in VET and its delivery to learners.
The chapter identifies these developments and the factors that have contributed to them, and tracks the transition of Australian VET distance education as it transformed away from centralised distance education provision towards its more recent forms of locally provided flexible delivery and blended learning.

Knowledge management : the fundamental component for delivery

This paper seeks to examine the link between Knowledge Management (KM) and Quality Management (QM) with a particular focus on the role of a Quality Culture. The authors propose that as Knowledge Management reaches its maturity in terms of acceptance as an important part of doing business in the modern world, that quality will again become the mantra of successful companies. This time, however, quality will not only be defined in terms of the properties of the product and/or services that the organisation provides, but in a more holistic manner that is subject to rapid change and shifting customer preferences. This increasingly dynamic knowledge-driven environment will require companies to pay close adherence to quality in order to satisfy demand and stay ahead of the competition. A national survey of 1000 quality certified organisations in Australia was distributed with a 23% response rate. The survey asked questions pertaining to the organisations' use of Knowledge Management, their quality culture, as well as their quality performance measures. As a result of an analysis of the data, the authors suggest that, in order to survive in such a dynamic environment, organisations will have to embrace Knowledge Management as a fundamental component of delivery of a quality culture.

The influence of delivery mode on consumer choice of university

This paper reports on an empirical investigation into the importance of study mode in the choice of university by Australian student-consumers, using conjoint methods. Traditional approaches to investigating student choice have overlooked study mode because they assume a norm of face-to-face attendance on-campus. Three segments were identified based on the relative importance which students placed on the university, study mode and tuition fees in making their choice, and the segments were distinguishable on some demographic and situational variables. The findings have relevance to universities across national and reputational markets in making their decisions about how to deliver educational products.

Business 2.0 : a novel model for delivery of business services

Web 2.0, regardless of the exact definition, has proven to bring about significant changes to the way the Internet was used. Evident by key innovations such as Wikipedia, FaceBook, YouTube, and Blog sites, these community-based Website in which contents are generated and consumed by the same group of users are changing the way businesses operate. Advertisements are no longer dasiaforcedpsila upon the viewers but are instead dasiaintelligentlypsila targeted based on the contents of interest. In this paper, we investigate the concept of Web 2.0 in the context of business entities. We asked if Web 2.0 concepts could potentially lead to a change of paradigm or the way businesses operate today. We conclude with a discussion of a Web 2.0 application we recently developed that we think is an indication that businesses will ultimately be affected by these community-based technologies; thus bringing about Business 2.0 - a paradigm for businesses to cooperate with one another to deliver improved products and services to their own customers.