Audit of consultant physicians' reply letters for referrals to clinics in a tertiary teaching hospital

Background: Doctors referring patients to consultant physicians seek reply letters which both educate and assist in ongoing patient management. Highly desirable attributes in specialist letters include clearly stated and justified: (i) diagnostic formulations, (ii) management regimens, (iii) use of clinical investigations, (iv) prog-nostic statements, (v) contingency plans and (vi) follow-up arrangements. Aim: To explicitly evaluate the quality of reply letters for new patients referred to clinics at a tertiary teaching hospital. Methods: Letters were sampled from outpatient clinics of 10 different medical specialties at Princess Alexandra Hospital in Brisbane, Australia. Reply letters for new patient referrals between 1 August 2000 and 31 October 2000 were retrieved, from which data were abstracted to calculate the proportion of letters satisfying prespecified quality attributes. Results: Of 297 new patient referrals, reply letters were retrieved for 204 (69%). Of these, 147 (72%) referrals were accompanied by a referral letter, mostly (113/147; 77%) from general practitioners. For 120 referrals involving diagnostic issues, 69 (56%) letters stated a diagnostic formulation. Of 114 letters recommending further clinical investigations, 61 (53%) described a rationale for such testing. In 125 cases where therapy was a key issue, 83 (66%) letters recommended changes to current treatment for which reasons were specified in 46 (55%) cases, and contingency plans provided in 13 (16%). Prognosis was mentioned in only 18 (9%) cases. Follow-up arrangements were detailed in 123 (60%) letters. Assessments of patient understanding and likely adherence to therapy were stated in less than 15% of -letters. Conclusions: Opportunities exist for improving quality of consultant physicians' reply letters in terms of greater use of problem lists, contingency plans, prognostic statements and patient-centred assessments, as well as more frequent enunciation of consultants' reasoning behind requests for further tests and changes to current management. Use of structured letter templates may facilitate more consistent inclusion of key information to referring doctors.

From a Vicious Circle of Anxiety to a Virtuous Circle of Learning: Experience of Teaching to a Heterogenous Clientele

A considerable body of literature suggests that significant psychological barrier and anxiety characterize the teaching and learning process in statistics. This study investigates the incidence of statistics anxiety, the extent to which it can be overcome and the factors that contribute to the process of overcoming it. Self-study and overall teaching quality, amongst others, significantly contributed to this outcome. This study identifies factors contributing to overall teaching quality. The teaching and learning process typified a highly effective communication mechanism based on an appropriate diagnosis of individual needs. This cumulative change resulted from circular causation. It is argued that given appropriate conditions the vicious circle of anxiety can be transformed into a virtuous circle of learning.

Attracting, recruiting and retaining male teachers: policy issues in the male teacher debate

Frequent calls for more male teachers are being made in English-speaking countries. Many of these calls are based upon the fact that the teaching profession has become (even more) 'feminized' and the presumption that this has had negative effects for the education of boys. The employment of more male teachers is sometimes suggested as a way to re-masculinize schools so they become more 'boy-friendly' and thus contribute to improving boys' school performance. The focus of this paper is on an Australian education policy document in the state of Queensland that is concerned with the attraction, recruitment and retention of male teachers in the government education system. It considers the failure of this document, as with many of the calls for more male teachers, to take into account complex matters of gender raised by feminism and the sociology of masculinities. The paper then critiques the primary argument given for the need for more male teachers: that is, that male teachers provide boys with much needed role models.

Understanding sociocognitive space of written discourse: Implications for teaching business writing to Chinese students

Confronted with various issues in teaching business writing to Chinese students in New Zealand, this paper sees the need for bridging the gap between genre-based research and teaching in an intercultural context. Specifically, it develops an intercultural reflective model in the light of Bhatia's sociocognitive genre study as well as cross-cultural persuasion. As an important part of the model, New Zealand and Chinese experts' intracultural and intercultural reflections on business writing are solicited and compared and the theoretical implications for teaching and learning business writing are discussed. It has been found, through a case study of analysing English and Chinese business faxes, this model can offer an in-depth understanding about discursive competence across cultures, and provide a link between genre-based theory, teaching practice and professional expertise.

Is economic philosophy a subject worth teaching?

Economic philosophy is anything but a part of the mainstream diet in the course of an economics education. Yet there are those – including occasional Nobel prizewinners – who argue that an understanding of economic philosophy is absolutely fundamental to an understanding of economics, of why economists disagree and of why “economic rationalists” are often derided by those from other professional backgrounds. The argument put in this paper is that many social science debates hinge more on the values or social philosophy implicitly involved than on technical matters of economic 'science', and that a nuanced understanding of economics requires that each school of thought be traced back to its foundations in terms of its implicit economic philosophy a prioris.

Teaching economic philosophy: Economics, ethics and the search for the right maximand

Economic philosophy is not often taught, and is not necessarily easily taught. It involves enquiry into implicit assumptions within orthodox economics and within alternatives to it. It seeks to highlight why it is that some critics object that neoclassical economics is too atomistic, hedonistic, and rationalistic, or why others lament that there is much hidden metaphysics in Friedman and his Chicago School colleagues. It addresses the issue of whether - in a reversal of the view that economics is the imperialistic social science - significant philosophical assumptions have been silently but inescapably imported into orthodox economics. This paper seeks to facilitate the presentation of such material with illustrations selected from social economics, development economics, and critiques of utilitarianism.

It's all in the game: Teaching software process concepts

A major challenge in teaching software engineering to undergraduates is that most students have limited industry experience, so the problems addressed are unknown and hence unappreciated. Issues of scope prevent a realistic software engineering experience, and students often graduate with a simplistic view of software engineering’s challenges. Problems and Programmers (PnP) is a competitive, physical card game that simulates the software engineering process from requirements specification to product delivery. Deliverables are abstracted, allowing a focus on process issues and for lessons to be learned in a relatively short time. The rules are easy to understand and the game’s physical nature allows for face-to-face interaction between players. The game’s developers have described PnP in previous publications, but this paper reports the game’s use within a larger educational scheme. Students learn and play PnP, and then are required to create a software requirements specification based on the game. Finally, students reflect on the game’s strengths and weaknesses and their experiences in an individual essay. The paper discusses this approach, students’ experiences and overall outcomes, and offers an independent, critical look at the game, its use, and potential improvements.

Teaching principles of genetics through SNP analysis

An understanding of inheritance requires comprehension of genetic processes at all levels, from molecules to populations. Frequently genetics courses are separated into molecular and organismal genetics and students may fail to see the relationships between them. This is particularly true with human genetics, because of the difficulties in designing experimental approaches which are consistent with ethical restrictions, student abilities and background knowledge, and available time and materials. During 2005 we used analysis of single nucleotide polymorphisms (SNPs) in two genetic regions to enhance student learning and provide a practical experience in human genetics. Students scanned databases to discover SNPs in a gene of interest, used software to design PCR primers and a restriction enzyme based assay for the alleles, and carried out an analysis of the SNP on anonymous individual and family DNAs. The project occupied eight to ten hours per week for one semester, with some time spent in the laboratory and some spent in database searching, reading and writing the report. In completing their projects, students acquired a knowledge of Mendel’s first law (through looking at inheritance patterns), Mendel’s second law and the exceptions (the concepts of linkage and linkage disequilibrium), DNA structure (primer design and restriction enzyme analysis) and function (SNPs in coding and non-coding regions), population genetics and the statistical analysis of allele frequencies, genomics, bioinformatics and the ethical issues associated with the use of human samples. They also developed skills in presentation of results by publication and conference participation. Deficiencies in their understanding (for example of inheritance patterns, gene structure, statistical approaches and report writing) were detected and guidance given during the project. SNP analysis was found to be a powerful approach to enhance and integrate student understanding of genetic concepts.