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Biomedical subjects

Craig Veitch

Publications and source records attributed to Craig Veitch.

11 recordsLinked to original sources
PubMed2006

The career aspirations and location intentions of James Cook University's first cohort of medical students: a longitudinal study at course entry and graduation.

INTRODUCTION: James Cook University's School of Medicine enrolled its first cohort of 64 students in 2000. The School was established with the aim of increasing the number of medical graduates who understand rural, remote, Indigenous and tropical health issues and who would subsequently choose rural (non-metropolitan) practice. In December 2005, 58 students graduated the course. Several students left the cohort (either left the course or repeated earlier years of the course). In the early years, students who left the course were replaced by accelerated entry students. METHOD: A student-initiated survey, involving questionnaire and interview components, conducted in 2001 sought information on students' career aspirations and practice location intentions, as well as why students had chosen medicine and the James Cook University course in particular. A brief follow-up survey focused on career aspirations, location of internship and longer term practice location intentions was conducted in October 2005 (2 months before the students graduated). In each instance, participation was anonymous and no identifying information was recorded. Accelerated entry students' responses to the 2005 survey were included. RESULTS: In 2001, 57 (89%) of the 64 students participated in the study; and in 2005, 50 (86%) of the 58 graduating students responded to the questionnaire survey. Overall, the demographic composition of the 'cohort' changed little. In 2001, 66% of respondents intended to practice in non-metropolitan areas, with 64% so intending at graduation. This was reinforced by 64% choosing internship positions in non-metropolitan areas of Queensland; 56% in north Queensland. Career aspirations changed appreciably between 2001 and 2005: the number of undecided students had halved, the numbers interested in general practice had reduced by one-third, the numbers considering surgery had reduced to one-third, and none was considering paediatrics at exit. Conversely, the number considering emergency medicine had almost doubled and more than doubled for obstetrics and gynaecology. DISCUSSION: Given that the majority of intern positions in Queensland are in the south-east of the state, it is noteworthy that two-thirds of students sought and accepted posts elsewhere, predominantly in northern Queensland. Changes in career aspirations reflect two issues. First, respondents' 2005 recollections of what their aspirations were in 2001 varied, reinforcing the value of the longitudinal process. Second, the change of intentions across time possibly reflects exposure to various disciplines and perhaps positive/negative experiences during clinical rotations in the final years of the course. The consistency across time with respect to intention to practice in rural (non-metropolitan) areas suggests that most respondents had eyes on rural practice from early in the course. The findings are in line with other studies that have demonstrated two important factors influence clinicians' decisions to take up non-metropolitan practice: (1) non-metropolitan background; and (ii) substantial and meaningful exposure to non-metropolitan practice during the course. CONCLUSION: The findings support the School's contention and that of others around the world that medical education undertaken in non-metropolitan settings is the best vehicle for increasing the rural medical workforce. This study provides support for the development of regional medical schools that focus on local recruitment and health care need issues.

Adolescent↗
PubMed2005

The determinants of quality in procedural rural medical care.

INTRODUCTION: A substantial proportion of health services for rural Australians is provided in rural health facilities by rurally based generalist health professionals. These services include procedural care within smaller rural hospitals, where teams of health professionals--medical practitioners, nurses and other support staff--work in teams to deliver a range of procedural services, both elective and urgent, that reduce the need for rural people to travel to major centres. Recent debate over the training of rural medical practitioners has focused on whether or not they need to provide procedural services, because current health service management policy appears to support the rationalisation and centralisation of service delivery in larger centres to contain costs and ensure high quality. Hence there is an assumption, without much evidence, that the quality of care in rural hospitals is lower than that provided in larger urban hospitals, although there is little agreement on just what aspects of care should be measured to indicate its quality. This article reports an exploration of multiple perspectives on what constitutes quality of care in rural procedural medical practice, as part of a broader study of the quality of care of a series of real clinical cases. METHODS: During the collection of a series of 91 individual patient cases involving anaesthetic, obstetric or surgical procedures conducted in small rural hospitals, interviews were conducted with several participants in each case: the rural doctors; rural nurses; the rural patients; and family members of those patients. In addition to issues pertaining to each case, interviews explored the perspectives of individuals in each group on the broader question of what constitutes quality of care in a general sense. Their comments were subjected to qualitative thematic analysis using Atlas.ti software (Muhr T, ATLAS.ti Scientific Software Development; Berlin, Germany). In order to consider how to measure rural health care, the thematic comments were then applied to a Donabedian structure/process/outcome model. RESULTS: The different groups produced different views on what might determine the quality of health care in rural hospitals. The health professionals tended to focus on technical aspects of care, although the doctors and nurses had some different emphases, while the patients and their families were more concerned with access, interpersonal communication, convenience and cost. These themes appeared to be consistent with previous literature from general healthcare settings. A list of indicators is suggested for measuring the quality of rural health care. CONCLUSION: This study has improved understanding of the differing views held by rural health professionals and rural patients in thinking about the quality of care provided in rural hospitals. Consideration of the quality of procedural rural medical care should include the needs and expectations of those living and working in a smaller, more familiar environment. This has implications for health planners, and suggests that there is a continuing need for rural health professionals to be trained to provide procedural medical services in rural hospitals, and for rural hospitals to be maintained at a standard necessary to support quality service provision.

Adult↗
PubMed2005

Medical family support needs and experiences in rural Queensland.

INTRODUCTION: Family issues have been recognised as major contributors to both rural GP retention in, and loss to, rural practice. This qualitative interview survey of rural medical spouses sought to identify and understand the support requirements and experiences that could be used to formulate strategies that may positively influence rural medical family retention. A concurrent key informant interview of 14 agencies associated with rural medical practitioner support sought information on those agencies' specific spouse/family support strategies. AIMS: The study's specific aims were to: investigate the experiences and needs of families in terms of support to settle and remain in rural and remote areas; and identify the range and type of formal and informal support strategies available to, and used by, rural medical families. METHODS: This was a qualitative study with two independent, but complementary, components: (1) in-depth, semi-structured interviews with families of 15 purposively selected rural GPs; and (2) information provided by 14 support organisations. RESULTS AND DISCUSSION: Medical family support needs and experiences varied with time in a rural setting. The most frequently mentioned early difficulties included integrating into a community (9/15); childcare and schooling (8/15); being seen as the 'doctors spouse' (ie, loss of own identity) (7/15); and housing and housing maintenance (7/15). Support needs changed over time as respondents established their own support networks. Increasingly, support was required for timeout from the community (5/15), and to keep abreast of changing practice management requirements (4/15). Few formal support strategies were reported as known or used by spouses. Informal support strategies included partners of other GPs; hospital functions and informal social gatherings; clubs and organisations; local church groups, and friendships with other itinerants in the community. Spouses indicated important potential sources of support (both when new to community and later on) as a need for a 'head start' with local and regional networks (14/15); ability to talk to other spouses in similar situations (12/15); support for timeout or leave (12/15); access to a GP other than the GP spouse (10/15); information about childcare (9/15); practice and business management (8/15); and dealing with housing issues (6/15). Additionally, an orientation package was seen as a means of assisting new arrivals to get settled (12/15). The survey of agencies/organisations providing direct and indirect support revealed that there is little directly-funded family support in Queensland, although a number of bodies either have support activities in place or planned. The potential number of players presents a risk of duplication of effort unless there is effective inter-agency dialogue. CONCLUSIONS: Like their medical partners, spouses appreciate and value peer support and understanding. Strategies aimed at rural GP retention should consider the rural medical family as a unit for support purposes. Support organisations and rural communities must recognise and cater for changing support needs over time. The agency interviews provided some hope for the future, although funding for support activities appears to be limited. Perhaps of greater concern is the possibility for duplication of effort and activity, particularly in some areas, and potentially at the risk of ignoring others.

Data Collection↗
PubMed2005

The quality of procedural rural medical practice in Australia.

INTRODUCTION: While rural Australians receive much of their procedural medical care from local health professionals in local hospitals, the current workforce shortages, rural economic decline and poor rural health care status all pose challenges to the quality of care they receive. Rural doctors struggle to receive appropriate procedural skills training, rural hospitals struggle to maintain experienced procedurally skilled nurses and other health professionals, and medical equipment, and patients are increasingly referred by clinical protocols to larger urban hospitals. On the other hand, many rural communities value highly their local rural hospital, and advocate the maintenance of hospital services close to home, even though they will have to travel for more specialised services. This article reports an exploration of the quality of a range of clinical cases gathered from rural procedural medical practice. METHODS: The Australian College of Rural and Remote Medicine (ACRRM) approached all trained and procedurally practising rural doctors among their membership. A total of 49 agreed to participate, but only 24 were successful in the prospective recruitment of patients and contribution of patient material (operating theatre notes, anaesthetic records etc) from cases involving general surgery, anaesthetics and obstetrics, the three commonest procedural disciplines in rural medical practice. One of the researchers interviewed patients before and after their procedures and, where available, a family member and a nurse at the hospital. Thus a series of 91 detailed patient case studies was available for analysis These case studies were reviewed from up to four different perspectives: (i) rural doctor peers; (ii) regionalist specialists in the respective discipline; (iii) a medical administrator; and (iv) a rural consumer representative. A thematic analysis of transcribed interviews was conducted. RESULTS: The collected cases represented a range of procedures commonly provided in rural hospitals, although there were relatively few surgical procedures and there was a bias in all three specialty areas towards relatively simple procedures. No adverse outcomes were reported, although some comments, particularly from the rural doctor peers, were made about the need for further information and, in a small number of cases, possible variance from accepted practice. The views of the reviewers substantially agreed that the cases were of average to high quality, although the specialist reviewers were less likely to rate care as 'excellent' than other reviewers. While the comments of the medical reviewers were more technical in nature, the comments of patients and their families, and of the rural consumer reviewer, focussed more on issues such as accessibility, cost and interpersonal communication. Many patients and some nursing staff expressed concern about the sustainability of friendly and accessible local services in the face of workforce shortages and pressure to downgrade rural hospitals. CONCLUSION: This study shows that, where staff and facilities in rural hospitals are accredited for procedural care, there is little evidence of any difference in the quality of that care provided when compared with care expected in urban hospitals.

Australia↗
PubMed2005

Faecal incontinence: an unrecognised epidemic in rural North Queensland? Results of a hospital-based outpatient study.

OBJECTIVES: We explored the prevalence of faecal incontinence (FI) in a referral hospital outpatient population, to explore suspicions that FI is inadequately studied, underestimated and poorly appreciated in the rural North Queensland (NQ) community. DESIGN: Prospective cross-sectional study using a specifically designed questionnaire. SETTING: The Townsville Hospital, a referral centre serving rural NQ. SUBJECTS: A total of 435 consecutive patients attending the gynaecology (n = 261) and colorectal clinics (n = 174) between 31 January and 12 June 2003 were enrolled (participating proportion 96.5%). MAIN OUTCOME MEASURES: FI prevalence, severity, impact on patients' lives, and risk factors. RESULTS: The prevalence of FI in the study population (median age 53 years) was 20.7%. Amongst affected patients (n = 90) the median duration of FI was 2 years with more than half of those affected soiling themselves at least once a month. Many patients with FI (42%) reported feeling hopeless at least some of the time. Rectal prolapse, chronic constipation, psychiatric problems, colon disease, and urinary incontinence were all significantly associated with FI. A CART analysis revealed that many patients (45%) with urinary incontinence and chronic constipation also experienced FI. CONCLUSIONS: This FI prevalence in a clinical setting in NQ is, apart from nursing home studies, the highest reported in the literature. FI negatively impacted on affected persons' lives. In patients presenting with urinary incontinence and chronic constipation, physicians should specifically enquire whether FI is also present. Definitive community studies to determine the scale of this 'silent epidemic' in northern Australia are now required.

Adaptation, Psychological↗
PubMed2004

Isolation, flexibility and change in vocational training for general practice: personal and educational problems experienced by general practice registrars in Australia.

BACKGROUND: GP registrars, in common with other doctors, frequently experience high levels of stress; however, little is known about the nature and outcomes of personal and educational problems experienced during vocational training for general practice. OBJECTIVES: The purpose of our study was to elicit the nature, causes and effects of more severe problems experienced during vocational training for general practice from the registrar's viewpoint and put these into the context of their personal circumstances and background. METHODS: This qualitative study used detailed semi-structured telephone interviews with a selected subgroup of 33 of the 1999 entry cohort of general practice registrars in Australia who had reported serious self-defined problems during an earlier longitudinal questionnaire study. Registrars were asked about the nature, antecedents and outcomes of problems experienced during GP training, actions taken to resolve the problem, and their perceptions of what might have helped prevent or minimize the problem. RESULTS: Problems reported by registrars fell into five major themes: isolation (structural isolation, social isolation and professional isolation); flexibility and choice (administrative issues and balancing work with personal life); change and uncertainty (within general practice and training, intergenerational changes); teaching problems; and work conditions. Actions taken and effects of problems are also discussed in the light of workforce imperatives. Results have been used to develop a list of suggestions for the providers of general practice training. CONCLUSIONS: Registrars commonly experience problems during vocational training. These may be related to structural, social and professional isolation, or a lack of flexibility in training arrangements and balancing work and other commitments. Some of these problems may be amenable to relatively simple solutions involving term placements, selection of training practices and administrative adjustments.

Attitude of Health Personnel↗
PubMed2003

Professional and social support networks of rural general practitioners.

This study explored the nature of rural general practitioners' (GPs) professional and personal support networks. A qualitative design was employed, using in-depth interviews with a diverse sample of GPs in rural Queensland. The support network of the rural GPs in this study incorporated the domains of clinical, workforce and social support, with clinical support as the most important domain. There was a preference for face-to-face contact wherever possible. Such contact was particularly important in the process of developing the network and for personal support. Despite this, many network contacts were by telephone out of necessity. There were few notable differences between male and female rural GPs on the issues explored in the present study. General Practitioners' satisfaction with their professional interactions was varied across the sample. The findings suggest that level of satisfaction may be associated with intentions to leave or stay for this group.

Adult↗
PubMed2003

Getting the balance right? GPs who chose to stay in rural practice.

BACKGROUND: Despite major challenges to the retention of rural GPs in Australia, little is known about why some rural GPs stay long-term within their communities. METHOD: A group of rural GPs interviewed as part of another study about 10 years ago were re-interviewed to explore their attitudes to their reasons for staying. RESULTS: Eighteen of the original group of 23 could be contacted and 13 were interviewed. Factors that appeared to promote staying in rural practice were: strong attachment to the community; and practice arrangements that allow for adequate time off-call and for holidays. However, several GPs were stressed and some had considered leaving. The stressors were similar to those identified in earlier research, including overwork and having to send children to boarding school. CONCLUSION: Personal and professional support arrangements within the community appear to be associated with decisions by rural GPs to remain in practice for substantial periods of time. Retention strategies should focus on facilitation of local integration. WHAT IS ALREADY KNOWN: Some doctors stay for prolonged periods of time in rural practice, although most leave after a few months or years. The reasons why rural doctors stay have until now not been explored. WHAT THIS STUDY ADDS: Rural doctors who stay for prolonged periods of time, defined in this study as 10 or more years, have established personal and professional support networks that have provided protection from the more negative aspects of rural professional life.

Adult↗
PubMed2002

Screening for chlamydia in general practice.

OBJECTIVE: To determine the prevalence of genital Chlamydia trachomatis infection in young patients presenting to general practitioners and to evaluate selective screening, based on risk factors, including gender. METHODS: A cross sectional survey of 508 consecutive patients aged 18-24, presenting to six general practices and one youth clinic in Mackay, North Queensland. We screened urine for chlamydia using Ligase chain reaction. RESULTS: Of 508 samples, 25 were positive (5%). The only factors with increased risks of infection were attendance at a youth clinic and recent change in sexual partner. It was as high in men as in women. CONCLUSION: Prevalence of chlamydia infection may be high enough to support screening of all patients aged 18-24, depending on cost effectiveness studies.

Adolescent↗