You kind of want to fix it don’t you? Exploring general practice trainees’ experiences of managing patients with medically unexplained symptoms

Background
Much of a General Practitioner’s (GP) workload consists of managing patients with medically unexplained symptoms (MUS). GP trainees are often taking responsibility for looking after people with MUS for the first time and so are well placed to reflect on this and the preparation they have had for it; their views have not been documented in detail in the literature. This study aimed to explore GP trainees’ clinical and educational experiences of managing people presenting with MUS.
Method
A mixed methods approach was adopted. All trainees from four London GP vocational training schemes were invited to take part in a questionnaire and in-depth semi-structured interviews. The questionnaire explored educational and clinical experiences and attitudes towards MUS using Likert scales and free text responses. The interviews explored the origins of these views and experiences in more detail and documented ideas about optimising training about MUS. Interviews were analysed using the framework analysis approach.


Results

Eighty questionnaires out of 120 (67 %) were returned and a purposive sample of 15 trainees interviewed. Results suggested most trainees struggled to manage the uncertainty inherent in MUS consultations, feeling they often over-investigated or referred for their own reassurance. They described difficulty in broaching possible psychological aspects and/or providing appropriate explanations to patients for their symptoms. They thought that more preparation was needed throughout their training. Some had more positive experiences and found such consultations rewarding, usually after several consultations and developing a relationship with the patient.
Conclusion
Managing MUS is a common problem for GP trainees and results in a disproportionate amount of anxiety, frustration and uncertainty. Their training needs to better reflect their clinical experience to prepare them for managing such scenarios, which should also improve patient care.

Teaching about the Holocaust : essays by college and university teachers

This collection of fourteen essays by renowned scholars in the field of Holocaust studies seeks to reflect on the experience of teaching and researching this complicated and emotional topic. Contained within are the pioneering stories of those presently engaged in the work of Holocaust education. Separately, they represent a variety of disciplines and orientations. Collectively, they give evidence of the strong commitment to continue this important work, and the moral and ethical demands such teaching, writing, and research place upon all who engage in it. Different perspectives from historical, philosophical, and religious frameworks come together to create a unique contribution to the literature on the Holocaust. Educators discuss what they teach, their methodologies and theoretical orientations and reflect on their own journeys that brought them to this field. The unique nature of these stories bring needed background to the field of Holocaust studies and also serve to inspire others to enlarge their thinking and understanding of previous work on this topic. The stories of these committed Holocaust educators will serve to inspire a new generation of thinkers, writers, and activists to engage in such work. In reading their stories, their collective commitment to make a difference today and tomorrow shines through. This volume will be a valuable resource for courses in the Holocaust, contemporary post-Holocaust realities, as well as courses in genocide. Scholars and anyone with an interest in enriching their understanding of the Holocaust will find much within to inspire them and provoke new ideas.

Teaching general practitioners and doctors-in-training to discuss advance care planning : evaluation of a brief multimodality education programme

To develop and evaluate an interactive advance care planning (ACP) educational programme for general practitioners and doctors-in-training.

New criminal sanctions-inflicting pain through the denial of employment and education

Imprisonments and fines are the standard sanctions employed by most western countries in punishing offenders.  Where neither of these penalties is appropriate, the courts normally have a variety of indeterminate sanctions at their disposal.  However the general effectiveness of these sanctions is questionable.  This paper argues that the criminal justice system has been too slow and unimaginative in developing efficient and effective methods of punishing offenders.  There are ways of inflicting pain on offenders that do not encroach on their liberty or affect their material wealth.  It is suggested that new sentencing options should include the annulment or suspension of an offenders academic qualifications and the making of orders preventing an offender from working or being enrolled in an educational or vocational pursuit.

Football-as-war, coach-as-general: analogy, metaphor and management implications

Sporting terms have been used as metaphor and analogy to describe and prescribe life experiences. It has been suggested that the use of sport terminology can assist in the general understanding of complex terms and situations, however, the use of sport as metaphor and analogy for many aspects of social understanding can have negative consequences. The analogy of sport and war seems to be particularly prevalent within football, irrespective of the code or culture in which it is played. This article demonstrates the popular understanding of Australian Rules ‘football as war’ through two complementary studies. The first study investigates the representation of Australian Rules football as war, specifically through the analysis of both images and text on the front covers of the sport ‘lift-out’ sections of two prominent Melbourne newspapers, The Herald Sun and The Age. The second study examines whether people interpret non-war-like images of Australian Rules football in war-like terms. Forty-five undergraduate sport marketing and management students were asked to write about one of four different images of football players and coaches interacting, which revealed that football is understood as war. Further, when prompted by an image of football players and coaches interacting, people in this study interpreted the interactions as consistently war-like. Coaches were portrayed as militaristic generals and the athletes as soldiers. Implications for management, education and practice are discussed.

Learners' perceptions about the relationship between music education and generic skills development : a case study within the Australian higher education sector

A major issue emerging from the research and debate concerning quality in higher education has been an emphasis on the value of the acquisition of generic skills by undergraduate students, as indicators of quality in education. Music educators have long recognised the contribution music makes to the general education of learners. Learning in and through music can present varied and complex means for the acquisition of generic life skills such as: problem solving, decision-making, critical thinking, oral and written communication and teamwork. This paper documents one particular course of action that was implemented within a university undergraduate primary teacher education program, to systematically gauge learner perceptions about generic skill development/enhancement before and after participation in the music component of the core arts education subject.

Development, implementation, and evaluation of a continence education package in acute and subacute care settings

OBJECTIVE: The objective of the study was to trial and evaluate the effect that a discharge Continence Education Package (CEP) had on patients' continence awareness and management preferences.
DESIGN: An exploratory descriptive design was used.
SETTINGS AND SUBJECTS: A total of 631 participants were included in the study: 352 females (55.8%) and 279 males (44.2%) from 4 rural and regional settings in Victoria, Australia.
INSTRUMENTS AND METHODS: A specifically designed questionnaire was used to assess participants' knowledge of incontinence and its management and also to investigate their treatment preferences and intentions if they experienced this type of problem. Data were collected at 2 time periods. Specifically, patients were interviewed before discharge from acute and subacute settings identified as Time 1 (T1). Then the participants were given the CEP and asked to complete a similar questionnaire.
RESULTS: The findings revealed that fewer than 25% of participants had received information on continence before the study being conducted, yet the majority had indicated that they had experienced continence symptoms. The majority of participants found the CEP easy to understand (98.2%) and helpful (95.3%). Most participants said it provided them with information about types of actions to take and/or treatment options for incontinence problems. It also raised their awareness of the signs and symptoms associated with incontinence and provided them with a useful self-administered gauge with which to assess their continence status.
CONCLUSIONS: These findings suggest that the CEP may be a useful educational tool for use in the general population.

Outdoor education and bush adventure therapy: A social-ecological approach to health and wellbeing.

Together, outdoor education and bush adventure therapy can be seen to constitute a population-wide health intervention strategy. Whether in educational or therapeutic settings, the intentional use of contact with nature, small groups, and adventure provides a unique approach in the promotion of health and wellbeing for the general population, and for individuals with identified health vulnerabilities. This paper explicitly emphasises human and social health, however, an integral assumption is that a healthy and sustainable environment is dependent on healthy human relationships with nature. We invite outdoor educators and bush adventure therapy practitioners to examine the proposition that healthy interactions with nature can create a unique stream of socio-ecological interventions. A spectrum of outdoor adventure programs is provided, allowing outdoor educators and bush adventure therapy practitioners to locate their work according to program context and aims, and participant aims and needs.

Emergency nurses' opinions regarding paediatric fever: the effect of an evidence-based education program

Introduction: The beliefs and opinions of individual nurses are key factors in clinical decisions. Emergency nurses’ clinical decisions related to paediatric fever establish emergency department norms, provide role-modelling for both peers and parents, underpin clinical management of febrile children, and influence fever management advice given to parents. Aim: This study aimed to examine: (i) the opinions of emergency nurses regarding paediatric fever, and (ii) the effect of an evidence-based education program on the opinions of emergency nurses regarding paediatric fever. Method: This study used a prospective pre-test/post-test design. The primary outcome measure was emergency nurses’ opinions measured using the ‘General Opinions about Fever Management in Children’ survey. The intervention for the study was two tutorials. Pre-test data was collected in June 2005 and post-test data was collected during August 2005. Results: Thirty-one emergency nurses participated in the study. There were a number of positive changes in emergency nurses’ opinions regarding paediatric fever as a function of an evidence-based educational intervention. Major domains of change were relationship between temperature and illness severity/risk of harm, use and effects of antipyretic medication and febrile convulsions.  Conclusion: Emergency nurses are an important source of information for parents leaving the emergency department with a febrile child. Opinions can be a major influence in nurses’ clinical decisions and many fever  management strategies used by health care professionals are reflective of individual beliefs rather than the best available evidence. The results of this study showed a number of positive changes in emergency nurses’ opinions regarding paediatric fever as a function of an evidence-based educational intervention.

Teacher attitudes and perceptions of primary school music education at independent schools in South Africa

As South Africa enters the new millennium and is currently in its second term of democracy, the question remains: is outcomes-based education preliminary the way forward for learners in South Africa. The new education system recognises the importance of arts education and specifically music education at the primary school level. This article focuses on music education at independent schools in Gauteng, South Africa. The reporting of this article is based on the author's doctoral thesis entitled "Outcomes-based music education in the foundation phase at independent schools in Gauteng, South Africa". The principal form of research was a questionnaire sent to music teachers at primary schools registered with the Independent Schools Council (ISC). The purpose of the questionnaires was to contribute to a study on teachers' perceptions, attitudes and opinions regarding music education and outcomes-based education. The questionnaire was divided into three main sections, namely: personal and professional details, outcomes-based education and general information. Both open and closed types of questions were employed. The questionnaire yielded both ambivalent views about the change of the education system as well as the inclusion of music as an area of learning within "Arts and Culture". It also identified current teaching trends and exposed areas of weakness that call for attention.

Engineering education down under : distance teaching at Deakin University, Australia

Deakin University in Australia is one of the leading providers of distance education in the South Pacific region. The School of Engineering offers four-year professional engineering-degree programs and three-year technologist programs. The over 600 total students studying engineering at Deakin fall into four categories:

• 18-19 year-old students fresh from high school, who largely study on-campus,
• older students in the technical workforce, seeking a university degree to upgrade their qualifications,
• industry-based students studying in university-industry partnership programs,
• overseas students studying either on-campus, or off-campus through education partners in Malaysia and Singapore.

Geographically these students form a very wide student base. The study programs are designed to produce multi-skilled, broadly focused engineers and technologists with multi-disciplinary technical competence, and the ability to take a systems approach to design and operational performance. A team of around 25 academic staff deliver courses in seven different majors in the general fields of manufacturing, environmental engineering, mechatronics, and computer systems. We discuss here the history of the School, its teaching philosophy, and its unique methods in delivering engineering education to a widely scattered student body.

The diversity of critical care nursing education in Australian universities

A range of critical care nursing educational courses exist throughout Australia. These courses vary in level of award, integration of clinical and academic competence and desired educational outcomes; this variability potentially leads to confuson by stakeholders regarding educational and clinical outcomes. The study objective was to describe the range of critical care nursing courses in Australia. Following institutional ethics approval, all relevant higher education providers (n=18) were invited to complete a questionnaire about course structure, content and nomenclature. Information about desired professional and general graduate characteristics and clinical competency was also sought.

A total of 89% of providers (n=16) responded to the questionnaire. There was little consistency in course structure in regard to the proportion of each programme devoted to core, speciality or generic subjects. In general, graduate certificate courses concentrated on core aspects of critical care, graduate diploma courses provided similar amounts of critical care core and speciality content, while master's level courses concentrated on generic nursing issues. The majority of courses had employment requirements, although only a small proportion specified the minimum level of critical care unit required for clinical experience. The competency standards developed by the Australian College of Critical Care Nurses (ACCCN) were used by 83% of providers, albeit in an adapted form, to assess competency. However, only 60% of programmes used personnel with a combined clinical and educational role to assess such competence.

In conclusion, stakeholders should not assume consistency in educational and clinical outcomes from critical care nursing education programmes, despite similar nomenclature or level of programme. However, consistency in the framework for speciality nurse education has the potential to prove beneficial for all stakeholders.