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Biomedical subjects

M Kamien

Publications and source records attributed to M Kamien.

At least 37 records · Page 2Linked to original sources
PubMed1996

Consumer satisfaction in two small rural communities: a quick methodology to empower rural communities to assess their own healthcare needs.

This study was designed to develop a quick methodology to assess the healthcare needs of a rural community and to determine what factors make these communities 'happy' or 'unhappy' with respect to medical service provision. Two rural shires of approximately 4000 people each were chosen from different health regions of Western Australia. The methodology consisted of interviews with healthcare providers and key community informants as well as a community questionnaire. The interviewing process showed that key community informants offered no new information in addition to that already provided by the healthcare providers. Furthermore, all key points would have been covered by interviewing approximately 60% of all healthcare providers in each community. Hand delivery of the community questionnaire yielded the highest response rate. The level of community satisfaction with general practitioner (GP) and hospital services determines whether a community is medically 'happy' or 'unhappy'.

Consumer Behavior↗
PubMed1996

A comparison of medical student experiences in rural specialty and metropolitan teaching hospital practice.

One factor in solving the rural medical workforce shortage is to foster student interest by greater exposure to rural medicine. However, many medical school teachers are concerned that this may cause students to be disadvantaged by missing core lectures, tutorials and ward rounds in the setting of the high quality of teaching hospital medicine. This paper compares the rural specialty experience of 28 fifth-year volunteers with 28 'pairs' who remained in the city teaching hospitals. Rural students saw double the number of medical conditions, assisted in or performed six times as many procedures, and all but three students were sure that they had a better educational experience than their city counterparts. This is a strong academic argument for greater medical student exposure to rural specialty practice.

Clinical Competence↗
PubMed1996

Rural student clubs and the social responsibility of medical schools.

All faculty members agree that their medical school has an academic purpose and a research purpose, but few medical faculty members agree that a medical education has a social purpose. This is one of the main reasons why there is a serious disjunction between rural societal needs and doctors' education. Rural student clubs are part of a rural counterculture within the orthodoxy of the medical school. Members of these clubs are thus potential agents of curricular change in the field of rural medicine. They are also one of the most potentially influential forces in reminding and helping medical schools to fulfil their social responsibility to the populations of rural Australia. Most rural student clubs are multidisciplinary, and the principles underlying their role in changing the direction and ethos of medical schools also apply to schools of nursing and health sciences.

Australia↗
PubMed1996

From novice to proficient general practitioner: a critical incident study.

OBJECTIVE: To obtain information about any change in the performance or perceptions of doctors undertaking the Royal Australian College of General Practitioners (RACGP) Training Program, with advancing general practice experience. DESIGN: The critical incident technique' was used, which is a comparative qualitative analysis. It involved interviews at 12 to 18 months after the basic term interview. SUBJECTS: Eighteen Western Australian doctors, who had been interviewed in 1992, at the end of their first 6 months of general practice training and were now completing their advanced or mentor terms in the RACGP Training Program took part in the study. RESULTS: Doctors reported an average of 4.4 critical incidents in their first interview and 5.0 in their second interview. The major areas of positive change included relationships with patients and other health care professionals, including supervisors; paediatrics and orthopaedics skills; the skills of developing a therapeutic relationship to enhance patient compliance and the ability to manage complex cardiovascular and psychiatric problems without reliance on specialist referral; attitudes of responsibility for and enjoyment of long term care of patients and families; and reduced levels of anxiety over difficult problems. New or continuing areas of difficulty were found in gynaecology; pharmacotherapy and dermatology; the diagnosis of common complaints with uncommon presentations; the skill of managing difficult or angry patients; the organisation for the follow-up of patients with potentially severe disorders; and in managing feelings of guilt over missed diagnoses or poor management. CONCLUSION: An analysis of commonly occurring positive and negative critical incidents shows that RACGP Training Program doctors develop competence, confidence and reduced levels of performance anxiety with advancing experience. All but one doctor found the Training Program helpful in achieving these proficiencies. However, many ongoing areas of difficulty remain. The Critical Incident method is a useful tool for learning and assessment in a vocational training program.

Adult↗
PubMed1996

Lifestyle and health habits of fourth year medical students at the University of Western Australia.

OBJECTIVE: To examine the lifestyle and health habits of two classes of fourth year medical students at the University of Western Australia. DESIGN: Anonymous completion of the Fantastic Lifestyle Assessment Inventory (FLAI) by 173 medical students in 1987 and 1992. RESULTS: Seventy-seven per cent of students had good health habits, but 23% did not. The most common areas of negative health habits were; lack of exercise, frequent consumption of junk food and skipping breakfast. Twenty per cent of students were almost always impatient, 13% always anxious, and 30% reported more than three stressful events in the first year. CONCLUSION: Medical students are taught and examined about healthy lifestyle and health promotion. Those who personally ignore what they know may also be predisposed to ignore health promotion opportunities with their patients. The FLAI can be a useful instrument in raising students' consciousness about these two issues.

Adult↗
PubMed1995

A critical incident study of general practice trainees in their basic general practice term.

OBJECTIVE: To obtain information on the experiences of general practice (GP) trainees during their first general practice (GP) attachment. DESIGN: Critical incident technique--a qualitative analysis of open-ended interviews about incidents which describe competent or poor professional practice. SUBJECTS: Thirty-nine Western Australian doctors from the Royal Australian College of General Practitioners' (RACGP) Family Medicine Program who were completing their first six months of general practice in 1992. RESULTS: Doctors reported 180 critical incidents, of which just over 50% involved problems (and sometimes successes) with: difficult patients; paediatrics; the doctor-patient relationship; counselling skills; obstetrics and gynaecology; relationships with other health professionals and practice staff; and cardiovascular disorders. The major skills associated with both positive and negative critical incidents were: the interpersonal skills of rapport and listening; the diagnostic skills of thorough clinical assessment and the appropriate use of investigations; and the management skills of knowing when and how to obtain help from supervisors, hospitals and specialists. Doctors reported high levels of anxiety over difficult management decisions and feelings of guilt over missed diagnoses and inadequate management. CONCLUSION: The initial GP term is a crucial transition period in the development of the future general practitioner. An analysis of commonly recurring positive and negative critical incidents can be used by the RACGP Training Program to accelerate the learning process of doctors in vocational training and has implications for the planning of undergraduate curricula.

Adult↗
PubMed1995

Type 2 diabetes. Patient practices, and satisfaction with GP care.

OBJECTIVE: To document patients' practices and management of DM2, their satisfaction with diabetes care and their quality of life and functional status. DESIGN: Anonymous questionnaire completed by 467 patients recruited by 204 GPs in 124 practices in the Perth metropolitan area. RESULTS: Patients reported an adequate amount of monitoring for stable DM2. However, they lacked awareness of diabetes risk factors and complications from which they already suffered. Some 90% of patients reported a high level of satisfaction with GP care and only 2.4% of patients had more than a moderate degree of functional disability. CONCLUSION: Patients have a high level of satisfaction about the diabetes care received from their general practitioner. However, they lack awareness of their risk factors and complications of diabetes. A simple strategy is proposed to improve these deficits and to share the responsibility for diabetes care between patient and doctor.

Adult↗
PubMed1995

Selection and prediction of performance of entrants to GP training.

There are currently more applicants than available positions in The Royal Australian College of General Practitioners Vocational Training Program. This already entails a process to select entrants into the Program. Furthermore, any vocational program should be interested in attracting entrants who will complete their training and be successful practitioners. This paper aims to contribute to the debate on methods of selection and prediction in vocational programs for general practice.

Australia↗
PubMed1994

Management of type 2 diabetes in Western Australian metropolitan general practice.

The purpose of this study was: (1) to record GP opinions, practices and outcomes for the care of Type 2 Diabetes Mellitus (DM2), (2) compare practice facilities and process of care with a criterion of recommended competent care and (3) determine if there were any differences between vocationally registered and non-vocationally registered GPs. A random sample of 204 metropolitan doctors from 124 practices was selected and an audit performed on 467 of their patient records. GPs pursued good blood sugar control and advocated lifestyle changes before hypoglycaemic drugs. Over 80% regard uncomplicated DM2 as a condition for general practice management. However, only 15% conducted an annual diabetes check, 9% had a diabetic register, 6% a diabetic recall system and 8% used a diabetic health care checklist for monitoring their patients. The most commonly recorded processes of medical audit in the previous 12 months were: blood pressure (94%), duration of diabetes (72%), blood glucose (70%), diet (66%), body weight (56%), HBA1c (52%) and ophthalmoscopy (50%). The least commonly recorded processes of care were body mass index (5%), inspection of the feet (18%), enquiries about vaginitis or impotence (23%). The amount of exercise, alcohol and tobacco was recorded in only 34% of records. Hypoglycaemic drugs were used appropriately but the most commonly used drugs for treating hypertension in DM2 patients were thiazide diuretics and beta-blockers. Vocationally registered (VR) doctors had better records, higher process of care scores and more were willing to participate in the study than non-vocationally registered (NVR) doctors. However, there was no difference in metabolic control between patients from either group. The use of a Diabetic Health Care Checklist would improve diabetes care especially in the search for early complications and in the recording of HBA1c and other metabolic parameters. The drugs commonly used to control hypertension can have adverse effects on glucose and lipid metabolism and should be replaced with glucose and lipid neutral drugs.

Adult↗
PubMed1994

The reading habits of RACGP Training Program doctors.

AIM: To describe the reading habits of a cohort of Western Australian RACGP Training Program doctors undertaking general practice terms in 1992. METHOD: A questionnaire that included a list of journals and books relevant to general practice was distributed to trainees. Information obtained included demographic data, the frequency of journal reading and the number of books read. RESULTS: There were 68 respondents from a total of 100. Time spent in medical reading ranged from one to 12 hours per week, with a mean of 3.3. The number of journal titles read in the past six months ranged from three to 16. The number of books actually read (from the 39 titles presented) ranged from zero to 17. The most frequently read were the reference type books. Very few of the 'core' books about the nature, scope and philosophy of general practice had been read. CONCLUSIONS: RACGPTP doctors read mainly for information. To produce educated doctors knowledgeable about their chosen discipline, the Training Program will need to place greater emphasis on introducing their vocational trainees to the writings of the thinkers and philosophers of general practice and family medicine.

Adult↗
PubMed1993

The contribution of the undergraduate rural attachment to the learning of basic practical and emergency procedural skills.

OBJECTIVE: To assess the effect of a four-week rural attachment on the knowledge and competency of medical students in basic practical and emergency procedures. DESIGN: A before and after comparison of self-reported level of competence in 72 basic, emergency, diagnostic and therapeutic procedural skills. PARTICIPANTS: Eighty-five final year medical students at the University of Western Australia in 1991. OUTCOME MEASURE: A student was considered competent if he or she claimed to be able to do a procedure either alone or with assistance. RESULTS: Over 50% of students were competent in 57 procedures after the attachment compared with 37 procedures before it. There were 26 procedures in which more than 20% of students increased their competence. CONCLUSION: A higher priority needs to be paid to the undergraduate teaching of procedural skills. Rural attachments can play an important part in training medical students in the practical skills required of interns.

Adult↗