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.

Teaching medical students using role play: Twelve tips for successful role plays

Engaging students in role play promotes active learning. Planned and structured role plays can be used to deliver components of the curriculum in clinical rotations of a medical programme. Role plays are most effective if learning objectives are defined, and the cases are challenging. All students should be involved and ground rules should be set. Allow adequate time for the role play, feedback and reflection. Let the students enjoy themselves. This paper provides 12 tips to create a meaningful learning experience for students using role play.

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 software engineering fundamentals to practicing engineers

This paper describes an ongoing collaboration between Boeing Australia Limited and the University of Queensland to develop and deliver an introductory course on software engineering for Boeing Australia. The aim of the course is to provide a common understanding for all Boeing Australia's engineering staff of the nature of software engineering and the practices used throughout Boeing Australia. It is meant as an introductory course that can be presented to people with varying backgrounds, such as recent software engineering graduates, systems engineers, quality assurance personnel, etc. The paper describes the structure and content of the course, and the evaluation techniques used to collect feedback from the participants and the corresponding results. The course has been well-received by the participants, but the feedback from the course has indicated a need for more advanced courses in specific areas.