Portfolio careers for medical graduates: implications for postgraduate training and workforce planning.

Portfolio careers in medicine can be defined as significant involvement in one or more portfolios of activity beyond a practitioner's primary clinical role, either concurrently or in sequence. Portfolio occupations may include medical education, research, administration, legal medicine, the arts, engineering, business and consulting, leadership, politics and entrepreneurship. Despite significant interest among junior doctors, portfolios are poorly integrated with prevocational and speciality training programs in Australia. The present paper seeks to explore this issue. More formal systems for portfolio careers in Australia have the potential to increase job satisfaction, flexibility and retention, as well as diversify trainee skill sets. Although there are numerous benefits from involvement in portfolio careers, there are also risks to the trainee, employing health service and workforce modelling. Formalising pathways to portfolio careers relies on assessing stakeholder interest, enhancing flexibility in training programs, developing support programs, mentorship and coaching schemes and improving support structures in health services.

Study protocol: the registrar clinical encounters in training (ReCEnT) study

Background
Patient encounters are the core learning activity of Australian general practice (family practice) training. Exposure to patient demographics and presentations may vary from one general practice registrar (vocational trainee) to another. This can affect comprehensiveness of training. Currently, there is no mechanism to systematically capture the content of GP registrar consultations. The aim of the Registrar Clinical Encounters in Training (ReCEnT) study is to document longitudinally the nature and associations of consultation-based clinical and educational experiences of general practice registrars.
Methods/design
This is an ongoing prospective multi-site cohort study of general practice registrars’ consultations, entailing paper-based recording of consultation data. The study setting is general practices affiliated with three geographically-based Australian general practice regional training providers. Registrars record details of 60 consecutive consultations. Data collected includes registrar demographics, details of the consultation, patient demographics, reasons for encounter and problems managed. Problems managed are coded with the International Classification of Primary Care (second edition) classification system. Additionally, registrars record educational factors related to the encounter. The study will follow the clinical exposure of each registrar six-monthly over the 18 months to two years (full-time equivalent) of their general practice training program.
Conclusions
The study will provide data on a range of factors (patient, registrar and consultation factors). This data will be used to inform a range of educational decisions as well as being used to answer educational research questions. We plan to use ReCEnT as a formative assessment tool for registrars and help identify and address educational needs. The study will facilitate program evaluation by the participating training providers and thus improve articulation of educational programs with practice experience. From the research point of view it will address an evidence gap – the in-practice clinical and educational experience of general practice trainees, determinants of these experiences, and the determinants of registrars’ patterns of practice (for example, prescribing practice) over the course of their training.

The development of knowledge about language in teacher training: what works?

Efforts have been made over many years by applied linguists in a number of English-speaking countries to raise awareness of language across the primary and secondary school curriculum, with varying degrees of success (see Denham & Lobeck, 2010). Many of these countries are sites of mass migration from non-English speaking countries, creating linguistic equity issues. In Australia, the new National Curriculum mandates that teachers of all disciplines will be required to provide pedagogy responsive to the language learning needs of English as an Additional Language (EAL) students. However, policy documents do not specify how this goal should be realized, and teachers and researchers are engaged in constant debate about what views of language could inform teacher training (e.g. structural and/or functional). This paper reports on a project which aimed to identify 1) the views of teacher educators on language in the curriculum, and 2) the language-related challenges faced by teachers in training. The current paper focuses on the language awareness of trainee teachers. Ten education students were interviewed about their understandings and experiences of language and language learning. It was found that many students experienced lack of confidence and knowledge about language (KAL), but that awareness of sociocultural elements of language provided them with ways to connect with a broader understanding of language issues. Results were analyzed from the perspective of sociocultural theory and will have implications for teacher training in any educational context where students are learning an additional language in order to integrate into a national schooling system.

Promoting clinical reasoning in general practice trainees: role of the clinical teacher

BACKGROUND: Clinical reasoning requires knowledge, cognition and metacognition, and is contextually bound. Clinical teachers can and should play a key role in explicitly promoting clinical reasoning.

CONTEXT: The aim of this article is to relate the clinical reasoning literature to the general practice or family medicine context, and to provide clinical teachers with strategies to promote clinical reasoning.

INNOVATION: It is important that the clinical teacher teaches trainees the specific skills sets of the expert general practitioner (e.g. synthesising skills, recognising prototypes, focusing on cues and clues, using community resources and dealing with uncertainty) in order to promote clinical reasoning in the context of general practice or family medicine. Clinical teachers need to understand their own reasoning processes as well as be able to convey that knowledge to their trainees. They also need to understand the developmental stages of clinical reasoning and be able to nurture each trainee's own expertise. Strategies for facilitating effective clinical reasoning in trainees include adequate exposure to patients, offering the trainees opportunity for reflection and feedback, and coaching on the techniques of reasoning in the general practice context.

IMPLICATIONS: The journey to expertise in clinical reasoning is unique to each clinician, with different skills developing at different rates, depending on content, context and past experience. Doctors enter into general practice training with the building blocks of biomedical and clinical knowledge and a desire to learn how to be a general practitioner. Clinical teachers are integral in the process of helping trainees learn how to 'think like a general practitioner'.

Child play therapists’ understanding and application of the United Nations Convention on the Rights of the Child: a narrative analysis

Narrative inquiry was used to explore the ways in which play therapy practitioners understand and uphold the UN Convention on the Rights of the Child in their practice. Seven play therapy practitioners responded to questions about their experiences of working within a rights-based framework. Analysis of their responses revealed 5 themes: Child play therapy upholds Article 39; respondents demonstrated an implicit rather than explicit understanding of children’s rights; children are sometimes perceived only in terms of their behaviors; there can be a tension between the rights of the child and adults’ rights; and therapists aim to support children’s right to choice, privacy, and confidentiality, but this is not always easy. These findings are intended to support further development of curriculum and course content for trainee therapists and professional development for practitioners. The results add further evidence regarding the need to engage a rights framework when developing policy for early years therapeutic support services.