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Background The autotransporter protein Burkholderia intracellular motility A (BimA) facilitates the entry of Burkholderia pseudomallei into the central nervous system (CNS) in mouse models of melioidosis. Its role in the pathogenesis of human cases of CNS melioidosis is incompletely defined. Methods Consecutive culture-confirmed cases of melioidosis at 2 sites in tropical Australia after 1989 were reviewed. Demographic, clinical, and radiological data of the patients with CNS melioidosis were recorded. The bimA allele (bimA Bm or bimA Bp ) of the B. pseudomallei isolated from each patient was determined. Results Of the 1587 cases diagnosed at the 2 sites during the study period, 52 (3.3%) had confirmed CNS melioidosis: 20 (38.5%) had a brain abscess, 18 (34.6%) had encephalomyelitis, 4 (7.7%) had isolated meningitis, and 10 (19.2%) had extra-meningeal disease. Among the 52 patients, there were 8 (15.4%) deaths; 17/44 (38.6%) survivors had residual disability. The bimA allele was characterized in 47/52; 17/47 (36.2%) had the bimA Bm allele and 30 (63.8%) had the bim A Bp allele. Patients with a bimA Bm variant were more likely to have a predominantly neurological presentation (odds ratio [OR]: 5.60; 95% confidence interval: 1.52–20.61; P  = .01), to have brainstem involvement (OR: 7.33; 1.92–27.95; P  = .004), and to have encephalomyelitis (OR: 4.69; 1.30–16.95; P  = .02). Patients with a bimA Bm variant were more likely to die or have residual disability (OR: 4.88; 1.28–18.57; P  = .01). Conclusions The bimA allele of B. pseudomallei has a significant impact on the clinical presentation and outcome of patients with CNS melioidosis. [ABSTRACT FROM AUTHOR]

Purpose: Since 2018, Australian paramedics have been regulated under the National Registration and Accreditation Scheme (NRAS) for health practitioners. Established professions have been regulated in Australia for some time, so there is limited knowledge of their entry to regulation. However, as paramedicine has not been previously centrally regulated, this provides a unique case study to explore the transition to regulated practice. Design/methodology/approach: Australian paramedics undertook two surveys: pre- and post-introduction of registration. The first survey was in the month leading up to the commencement of registration (N = 419), and the second survey took place 31 months after registration (N = 407). This paper presents the results of statistical analyses of the post-registration survey including comparisons to the pre-registration survey. Findings: Although support for regulation has increased over time, there remains strong dissent consistent with 2018 levels. After 31 months of regulation, respondents reported increasing knowledge of the scheme and greater ease of navigation. The impacts of regulation are more nuanced and less polarised than in the first survey. Identity is again canvassed, and results suggest a shift from employment status and qualifications as key elements of identity to a community of practice and registration. Originality/value: Paramedics' experiences and understanding of the rationale for registration are developing. Further support is needed to assist with the emerging professional identity and behaviours. Regulation is one of many occupational factors influencing professional identity and professionalism. Exploring the experience of regulation potentially assists regulators in better supporting practitioners and helps better understand professional evolution. [ABSTRACT FROM AUTHOR]

Much research has acknowledged the importance of self-concept for adolescents' academic behaviour, motivation and aspiration, but little is known about the role of self-concept underpinning the motivation and aspiration of higher education students in a specialised field such as medical education. This article draws upon a programme of research undertaken over the past three years examining the psychosocial determinants of success in educating home-grown doctors for regional communities. Interviews conducted with Australian medical students found that self-concept is a dynamic and multidimensional phenomenon that emerges through social activity and plays a crucial role in shaping their motivation and aspirations. For these students in a specialised field in higher education, self-concept not only influences their study performance, but also forms part of their personal and career development. Because of the significant level of interaction between the self and the social environment, the development of self-concept through a holistic and systemic facilitation of essential psychosocial drivers of success is essential in higher education.

A throat swab was collected, the microbiology laboratory notified, diphtheria antitoxin was requested from the nearest pharmacy where it was available (1600 km away), intravenous amoxicillin-clavulanate and azithromycin were commenced, and the patient was managed with standard plus droplet precautions. They were advised to monitor for symptoms, underwent nasal, throat and skin lesion swabs; received oral azithromycin; received vaccination (if required); and were advised not to interact with others until completion of 72 hours or more of antibiotics while swab results were pending. Keywords: Vaccine preventable disease; Vaccination EN Vaccine preventable disease Vaccination 446 448 3 06/06/23 20230601 NES 230601 Clinical record A 32-year-old woman from a remote Indigenous community in Far North Queensland presented to her local health clinic with a one-day history of odynophagia. [Extracted from the article]

Background: The epidemiology of central nervous system (CNS) infections in tropical Australia is incompletely defined. Methods: A retrospective study of all individuals in Far North Queensland, tropical Australia, who were diagnosed with a CNS infection between January 1, 2000, and December 31, 2019. The microbiological aetiology of the infection was correlated with patients' demographic characteristics and their clinical course. Results: There were 725 cases of CNS infection during the study period, meningitis (77.4%) was the most common, followed by brain abscess (11.6%), encephalitis (9.9%) and spinal infection (1.1%). Infants (24.3%, p<0.0001) and Aboriginal and Torres Strait Islander Australians (175/666 local residents, 26.3%, p<0.0001) were over-represented in the cohort. A pathogen was identified in 513 cases (70.8%); this was viral in 299 (41.2%), bacterial in 175 (24.1%) and fungal in 35 (4.8%). Cryptococcal meningitis (24 cases) was diagnosed as frequently as pneumococcal meningitis (24 cases). There were only 2 CNS infections with a S. pneumoniae serotype in the 13-valent pneumococcal vaccine after its addition to the National Immunisation schedule in 2011. Tropical pathogens–including Cryptococcus species (9/84, 11%), Mycobacterium tuberculosis (7/84, 8%) and Burkholderia pseudomallei (5/84, 6%)–were among the most common causes of brain abscess. However, arboviral CNS infections were rare, with only one locally acquired case—a dengue infection in 2009—diagnosed in the entire study period. Intensive Care Unit admission was necessary in 14.3%; the overall case fatality rate was 4.4%. Conclusion: Tropical pathogens cause CNS infections as commonly as traditional bacterial pathogens in this region of tropical Australia. However, despite being highlighted in the national consensus guidelines, arboviruses were identified very rarely. Prompt access to sophisticated diagnostic and supportive care in Australia's well-resourced public health system is likely to have contributed to the cohort's low case-fatality rate. [ABSTRACT FROM AUTHOR]

Objective: This study outlines development of an instrument for measuring attitudes of medical students towards older people, the Australian Ageing Semantic Differential (AASD). Methods: Words for AASD scales were derived from the reflections of 151 third year medical students attending two Australian medical schools. A pilot study of the AASD was then undertaken with third year students at another medical school to confirm usability and reliability of the instrument. After slight modification, a larger study using the AASD was then undertaken of medical students attending the three institutions, in order to obtain sufficient data for exploratory factor analysis. Results: n = 321 (response rate 73%). Mean AASD score 73.2/114. Cronbach's α = 0.86. There was no evidence of sequence bias. Exploratory factor analysis (EFA) demonstrated four factors: Instrumentality; Personal Appeal; Experience; and Sociability. A lower mean instrumentality subscore for all students and a higher mean experience subscore for female students were noted. Conclusions: The AASD instrument proved internally reliable, and its use was generalisable to different groups of medical students. Its design ensured construct and face validity, and responses were not affected by sequencing bias. This study has revealed positive student attitudes towards older people. Variation in attitudes requires further investigation. [ABSTRACT FROM AUTHOR]

Objective: The objective of this collaborative study was to compare current practices of conducting high-stake, exit-level Objective Structured Clinical Examinations (OSCEs) at all Australian medical schools. We aimed to document similarities and differences between schools, and compare existing practice against available gold standard, evidence-based practice. We also aimed to identify areas where gold standards do not currently exist, and could be developed in the future. Methods: A 72-item semi-structured questionnaire was sent to all 19 Australian medical schools with graduating students. Results: A total of 18/19 schools responded. Of these, 16/18 schools had summative exit-level OSCEs representing content from multiple medical specialties. The total number of OSCE stations varied from 8 to 16, with total OSCE testing time ranging from 70 to 160 min. All schools blueprinted their OSCE to their curriculum, and trained simulated patients and examiners. There was variation in the format of marking rubric used. Conclusions: This study has provided insight into the current OSCE practices of the majority of medical schools in Australia. Whilst the comparative data reveal a wide variation in OSCE practices between schools, many recommended "gold standard" OSCE practices are implemented. The collective awareness of our similarities and differences provides us with a baseline platform, as well as an impetus for iterative quality improvement. Such discourse also serves to develop new gold standards in practice where none have previously existed. [ABSTRACT FROM AUTHOR]

Objective: The aim of this article was to review the literature around Australian medical student attitudes towards older people. Methods: An Ovid cross-search and SCOPUS search were performed using keywords such as 'Attitude', 'Medical Student' and 'Aged or Older or Elderly'. Results: Several recent studies have investigated the attitudes of Australian medical students towards older people. Baseline attitudes at two medical schools were positive. Three studies quantified attitude improvement after curriculum intervention. All the studies used USdeveloped instruments, which have not been validated in Australia. Qualitative studies have described mixed attitudes towards older people: negative themes included nihilism, paternalism, communication issues, greater morbidity and reduced quality of life. Positively, students placed value on clinical decision-making and critical reflection during residential aged care placements. Conclusion: Australian medical students' attitudes towards older people are mixed and not well understood based on quantitative measures developed for use in the US and on qualitative evidence. Future research in this area requires a reliable and locally-validated instrument. [ABSTRACT FROM AUTHOR]

Background The extent to which clinical competency development is assessed throughout postgraduate training programmes in professional psychology in Australian universities is variable, with significant differences in assessment philosophies and methodologies across academic institutions, and between clinical and field supervisors. Few competency assessment tools exist, and those that do have demonstrated limited psychometric support to date. This study reports the results of a preliminary analysis of a competence assessment tool developed for use within cognitive-behaviourally oriented postgraduate training programmes of clinical and forensic psychology. Methods A working party of academics identified core competencies being taught within the programmes and articulated behavioural descriptions of each competency, graded across skill levels. Participants ( n = 43) were students enrolled in postgraduate training programmes of clinical and forensic psychology participating in a 1 day per week, year-long placement within a university-based psychology clinic. Students were assessed utilising the competence assessment tool at a point midway through their placement and again at the conclusion of the placement. Result Preliminary analyses demonstrated that the Clinical Skills Assessment Tool is a psychometrically sound assessment instrument. Conclusion The development of a clinical competence assessment tool for use within postgraduate training programmes of clinical and forensic psychology supports the assertion that such programmes enhance the competencies they are designed to develop. [ABSTRACT FROM AUTHOR]

Background: This study was undertaken to improve assessment practice on OSCEs through collaboration across geographically dispersed medical schools in Australia. Methods: A total of eleven OSCE stations were co-developed by four medical schools and used in summative 2011 and 2012 examinations for the assessment of clinical performance in the early clinical and exit OSCEs in each school’s medical course. Partial Credit Rasch Model was used to evaluate the psychometric properties of the shared OSCE data. Evaluation of the quality assurance reports was used to determine the beneficial impact of the collaborative benchmarking exercise on learning and teaching outcomes. Results: The data for each examination demonstrated sufficient fit to the Rasch model with infit mean square values ranging from 0.88 to 0.99. Person separation (1.25–1.63) indices indicated good reliability. Evaluation of perceived benefits showed that the benchmarking process was successful as it highlighted common curriculum areas requiring specific focus and provided comparable data on the quality of teaching at the participating medical schools. Conclusion: This research demonstrates the validity of the psychometric data and benefits of evaluating clinical competence across medical schools without the enforcement of a prescriptive national curriculum or assessment. [ABSTRACT FROM AUTHOR]

Australia has a well-accepted system of universal child and family health ( CFH) services. However, government reports and research indicate that these services vary across states and territories, and many children and families do not receive these services. The aim of this paper was to explore professionals' perceptions of the challenges and opportunities in implementing a national approach to universal CFH services across Australia. Qualitative data were collected between July 2010 and April 2011 in the first phase of a three-phase study designed to investigate the feasibility of implementing a national approach to CFH services in Australia. In total, 161 professionals participated in phase 1 consultations conducted either as discussion groups, teleconferences or through email conversation. Participants came from all Australian states and territories and included 60 CFH nurses, 45 midwives, 15 general practitioners ( GPs), 12 practice nurses, 14 allied health professionals, 7 early childhood education specialists, 6 staff from non-government organisations and 2 Australian government policy advisors. Data were analysed thematically. Participants supported the concept of a universal CFH service, but identified implementation barriers. Key challenges included the absence of a minimum data set and lack of aggregated national data to assist planning and determine outcomes; an inconsistent approach to transfer of information about mothers and newborns from maternity services to CFH nursing services or GPs; poor communication across disciplines and services; issues of access and equity of service delivery; workforce limitations and tensions around role boundaries. Directions for change were identified, including improved electronic data collection and communication systems, reporting of service delivery and outcomes between states and territories, professional collaboration, service co-location and interprofessional learning and development. [ABSTRACT FROM AUTHOR]

The woylie Bettongia penicillata is categorized as Critically Endangered, having declined by c. 90% between 1999 and 2006. The decline continues and the cause is not fully understood. Within a decline diagnosis framework we characterized the nature of the decline and identified potential causes, with a focus on the species’ largest populations, located in south-west Western Australia. We described the spatio-temporal pattern of the decline, and several attributes that are common across sites. We categorized the potential causes of the decline as resources, predators, disease and direct human interference. Based on the available evidence the leading hypothesis is that disease may be making woylies more vulnerable to predation but this remains to be tested. No substantial recoveries have been sustained to date, and one of the three remaining indigenous populations now appears to be extinct. Therefore, verifying the factors causing the decline and those limiting recovery is becoming increasingly urgent. Active adaptive management can be used to test putative agents, such as introduced predators. Insurance populations and ecological monitoring should also be included in an integrated conservation and management strategy for the species. [ABSTRACT FROM AUTHOR]

Previous research has pointed to the role television can play in informing health practices and beliefs. Within the academic setting in particular, some educators have raised concerns about the influence of medical dramas on students. Less research, however, draws on the perspectives of students, and this study therefore explores medical students’ perceptions of medical practice and professionalism in popular medical television programmes. Qualitative data from surveys of Australian undergraduate medical students showed that students perceived professionalism in dichotomous ways, with three main themes: cure–care, where a doctor’s skill is either technical or interpersonal; work–leisure, where a doctor is either dedicated to work or personal life; and clinical–administration, where work is either direct patient care or administration. There continue to be imagined divisions between curing and caring for students, who express concerns about balancing work and leisure, and expectations that doctors should have little administrative work. Given students were able to identify these important contemporary issues around professionalism on television, there is pedagogical value in using popular images of the medical world in medical education. [ABSTRACT FROM PUBLISHER]

Background: Empathy is an indispensable skill in medicine and is an integral part of 'professionalism'. Yet, there is still increasing concern among medical educators and medical professionals regarding the decline in medical students' empathy during medical education. Aims: This article aims at comparing the levels of empathy in medical school students across the different years of undergraduate medical education. It also aims at examining differences in empathy in relation to gender, year of study, cultural and religious backgrounds, previous tertiary education and certain programmes within the curriculum. Method: The Jefferson Scale of Physician Empathy, Student version (JSPE-S) was employed to measure empathy levels in medical students (years one to five) in a cross-sectional study. Attached to the scale was a survey containing questions on demographics, stage of medical education, previous education, and level of completion of particular programmes that aim at promoting personal and professional development (PPD). Results: Four hundred and four students participated in the study. The scores of the JSPE-S ranged from 34 to 135 with a mean score of 109.07 ± 14.937. Female medical students had significantly higher empathy scores than male medical students (111 vs. 106, p < 0.001) across all five years of the medical course. There was no significant difference in the total empathy scores in relation to year of medical education. Yet, the highest means were scored by year five students who had completed personal and professional development courses. Conclusions: Our findings suggest that there is a gender difference in the levels of empathy, favouring female medical students. They also suggest that, despite prior evidence of a decline, empathy may be preserved in medical school by careful student selection and/or personal and professional development courses. [ABSTRACT FROM AUTHOR]

Introduction: While there have been studies exploring the impact of personality on medical student selection and performance there has not been an investigation of the personality of students at different schools. Method: Demographic data and responses to the NEO measure of personality traits were collected from medical students in the first two weeks of their enrolment (2011) in seven medical schools in Australia. Personality traits were analysed by school features, gender and age using logistic regression. Results: Differences were detected between schools in the personality traits of Agreeableness and Conscientiousness. Higher Agreeableness and Conscientiousness were associated with attending an Undergraduate school (OR = 1.07 and 1.03, respectively) and a rural or community focussed school (1.06 and 1.03). Students attending a school that used interviews for selection had higher levels of Agreeableness (1.04) and lower levels of Neuroticism (0.96). Discussion: This is the first study to demonstrate that personality traits differ between students entering different medical schools. While there seems to be logic behind some differences, others are perplexing. Further research should expand on these findings and the implications to schools in regards to attracting students through selection processes, mission statements and their broader social focus. [ABSTRACT FROM AUTHOR]

Context Many studies indicate that increases in cognitive ability, maturity and educational experience lead to a general increase in moral reasoning skills. However, research has shown that moral development does not occur during medical school and that it may, in fact, plateau or even regress. There is no empirical evidence as to what might be the cause of such a result. Objectives The present study aimed to assess moral judgement competence in medical students and to investigate trends in moral judgement competence in relation to age, gender, culture, religion, year of medical course and different programmes within the medical curriculum. Methods We employed a cross-sectional and descriptive design over two consecutive years (2011 and 2012). Students completed Lind's Moral Judgement Test ( MJT), which is based on Kohlberg's stages of moral development and is used to measure moral judgement competence ( C- INDEX). C- INDEX results were analysed in relation to age, gender, cultural background, religion, cohort and specific programmes within the medical curriculum. Results The numbers of students who completed the MJT in 2011 and 2012 were 394 and 486, respectively. The two studies showed a significant difference and negative correlations between the moral judgement competence of medical students and both age and year of medical course (p < 0.001). The findings suggested the existence of a phenomenon known as 'moral segmentation', which increased significantly as students progressed through medical education, and were significantly linear between cohorts. Conclusions Students show a decline in moral judgement competence during medical education. This probably reflects an increase in moral segmentation rather than an inhibition in moral development. The challenge is to develop a curriculum that will enable medical students to maintain, or better, increase their moral judgement competence. [ABSTRACT FROM AUTHOR]

Background: The Undergraduate Medical and Health Sciences Admissions Test (UMAT) is used to select medical students in Australia and New Zealand but empirical evidence of its construct validity has never been reported. Aims: To identify the underlying constructs assessed in each of the three sections of the UMAT. Based on conclusions from an early qualitative study (Mercer & Chiavaroli 2006), it was expected that Section 1 scores would correlate with scores obtained from standard measures of cognitive ability (verbal and numeric reasoning), Section 2 scores would correlate with emotional intelligence, and Section 3 scores would be most strongly related to abstract or non-verbal reasoning ability. Method: Final year high school students ( n = 432) completed tests of numerical, verbal, and non-verbal cognitive ability, and emotional intelligence. Correlations and multiple regressions assessed the relationship of these tests with scores on each section of the UMAT. Results: UMAT Section 1 was significantly related to verbal, non-verbal, and numerical reasoning tests. Section 2 was significantly related to emotional intelligence and verbal reasoning, but the majority of variance in this section's scores remained unexplained. Section 3 scores significantly correlated with non-verbal and numerical reasoning. Conclusions: The UMAT Sections 1 and 3 appear to be tests of cognitive abilities. Further research is required to identify the constructs being measured by Section 2. [ABSTRACT FROM AUTHOR]

Introduction: We undertook a systematic review to identify the best evidence for how professionalism in medicine should be taught. Methods: Eligible studies included any articles published between 1999 and 2009 inclusive. We reviewed papers presenting viewpoints and opinions as well as empirical research. We performed a comparative and thematic synthesis on all papers meeting inclusion criteria in order to capture the best available evidence on how to teach professionalism. Results: We identified 217 papers on how to teach professionalism. Of these, we determined 43 to be best evidence. Few studies provided comprehensive evaluation or assessment data demonstrating success. As yet, there has not emerged a unifying theoretical or practical model to integrate the teaching of professionalism into the medical curriculum. Discussion: Evident themes in the literature are that role modelling and personal reflections, ideally guided by faculty, are the important elements in current teaching programmes, and are widely held to be the most effective techniques for developing professionalism. While it is generally held that professionalism should be part of the whole of a medical curriculum, the specifics of sequence, depth, detail, and the nature of how to integrate professionalism with other curriculum elements remain matters of evolving theory. [ABSTRACT FROM AUTHOR]

The phrase 'peace, order and good government,' common to the definition of federal powers in both the Australian and the Canadian constitutions, has defined the relationship of the Crown and the citizen for more than five centuries. The archival record is fundamental to that relationship, providing its authoritative legal basis, documenting its evolution and continuing as a reminder of both our proudest achievements and our most dismal failures as a society. This paper reflects on the role of archives in recent Canadian human rights issues, highlighting both the strengths and the weaknesses of the record, the perception of archives as an agency of the state and the role of archives in helping society address highly contentious issues. [ABSTRACT FROM AUTHOR]

Medical Education 2011: 45: 1220-1229 Objectives Medical students must develop not only their professional identity but also inclusive social attitudes for effective medical practice in the future. This study explores the elements that contribute to medical students' sense of professional identity and investigates the concept of social exclusivity and how this might relate to students' development of their identity as medical professionals. Methods The study is based on qualitative data gathered in telephone interviews with 13 medical students enrolled in Years 1 or 3 at an undergraduate medical school at a university in Australia. The questions were open-ended and asked students about their experiences in medical school, sense of identity and social connections. Results Two main components contributed to a strong sense of professional identity in medical students: professional inclusivity and social exclusivity. Students experienced professional inclusivity when they attended clinical placements and when they were treated as future medical professionals by lecturers, doctors and patients. Social exclusivity was demonstrated by participants' perceptions of themselves as socially separate from non-medical students and isolated from students in other disciplines. Students described a sense of peer unity and a shared sense of identity as medical students within the medical school. Conclusions It is important to understand how students develop their sense of identity as medical professionals and the ways in which medical education and clinical placements can influence this professional identity. Although this study noted a very strong sense of social exclusivity in its findings, there were also high levels of intra-discipline inclusivity. These results suggest that there is a reciprocal and reinforcing relationship between student experiences of professional inclusivity and social exclusivity that creates a defined sense of professional identity. [ABSTRACT FROM AUTHOR]

Objective: To evaluate outcomes and satisfaction with a consultation-liaison service to general practitioners (GPs), provided by a cohort of private and public psychiatrists. Methods: All SA psychiatrists were invited to participate in a project, funded by the Australian Government Department of Health and Ageing, which was operational for 9 months. Participating psychiatrists provided telephone advice in urgent cases to GPs, and where agreed by GP, patient and psychiatrist, a one-off assessment with rapid feedback to the GP. Evaluation was carried out by external evaluators on satisfaction rates of psychiatrists, and barriers to the use of such a service, and the project officers collected information on usage and satisfaction rates by GPs. Results: Thirty-one of the 203 SA psychiatrists undertook a 2 hour training package, with 27 joining the project and 100% of those completing the project. Both GPs and psychiatrists expressed high rates of satisfaction with this mode of service, the GPs reported increases in knowledge and confidence, and the psychiatrists enjoyed the consultant role. Conclusions: A shift towards a consultation-liaison mode with GPs has produced positive benefits for GPs and psychiatrists, and ways to sustain this should be explored. Effects on outcomes for consumers using this approach need evaluation. [ABSTRACT FROM AUTHOR]

Background: Medical student wellbeing–a consensus statement from Australia and New Zealand outlines recommendations for optimising medical student wellbeing within medical schools in our region. Worldwide, medical schools have responsibilities to respond to concerns about student psychological, social and physical wellbeing, but guidance for medical schools is limited. To address this gap, this statement clarifies key concepts and issues related to wellbeing and provides recommendations for educational program design to promote both learning and student wellbeing. The recommendations focus on student selection; learning, teaching and assessment; learning environment; and staff development. Examples of educational initiatives from the evidence-base are provided, emphasising proactive and preventive approaches to student wellbeing. Main recommendations: The consensus statement provides specific recommendations for medical schools to consider at all stages of program design and implementation. These are: Design curricula that promote peer support and progressive levels of challenge to students. Employ strategies to promote positive outcomes from stress and to help others in need. Design assessment tasks to foster wellbeing as well as learning. Provide mental health promotion and suicide prevention initiatives. Provide physical health promotion initiatives. Ensure safe and health-promoting cultures for learning in on-campus and clinical settings. Train staff on student wellbeing and how to manage wellbeing concerns. Conclusion: A broad integrated approach to improving student wellbeing within medical school programs is recommended. Medical schools should work cooperatively with student and trainee groups, and partner with clinical services and other training bodies to foster safe practices and cultures. Initiatives should aim to assist students to develop adaptive responses to stressful situations so that graduates are prepared for the realities of the workplace. Multi-institutional, longitudinal collaborative research in Australia and New Zealand is needed to close critical gaps in the evidence needed by medical schools in our region. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Getting the levers right: a way forward for rural medicine," by Kamerman regarding rural medicine focusing on Townsville, Queensland and Gundagai, New South Wales.

Objectives This prospective descriptive study aimed to test the validity and feasibility of the Team Emergency Assessment Measure ( TEAM™) for assessing real-world medical emergency teams' non-technical skills. Second, the present study aimed to explore the instrument's contribution to practice regarding teamwork and learning outcomes. Methods Registered nurses (RNs) and medical staff ( n = 104) in two hospital EDs in rural Victoria, Australia, participated. Over a 10 month period, the ( TEAM™) instrument was completed by multiple clinicians at medical emergency episodes. Results In 80 real-world medical emergency team resuscitation episodes (283 clinician assessments), non-technical skills ratings averaged 89% per episode (39 of a possible 44 points). Twenty-one episodes were rated in the lowest quartile (i.e. ≤37 points out of 44). Ratings differed by discipline, with significantly higher scores given by medical raters (mean: 41.1 ± 4.4) than RNs (38.7 ± 5.4) ( P = 0.001). This difference occurred in the Leadership domain. The tool was reliable with Cronbach's alpha 0.78, high uni-dimensional validity and mean inter-item correlation of 0.45. Concurrent validity was confirmed by strong correlation between TEAM™ score and the awarded Global Rating ( P < 0.001), with 38.4% of shared variance. RNs praised the instrument as it initiated staff reflection and debriefing discussions around performance improvement. Conclusion Non-technical skills of medical emergency teams are known to often be suboptimal; however, average ratings of 89% were achieved in this real-world study. TEAM™ is a valid, reliable and easy to use tool, for both training and clinical settings, with benefits for team performance when used as an assessment and/or debriefing tool. [ABSTRACT FROM AUTHOR]

The article discusses the need to more attention on technology-based crisis support services to prevent Australian suicide rates. Topics include failure of increased government spending on clinical services for suicide prevention; the need to adopt technology, telephone and online crisis services to have a key role in the national suicide prevention strategy; and the role of telephone and online crisis support services in reducing caller suicidality.

A letter to the editor is presented in response to the article "Rural clinical school outcomes: what is success and how long do we wait for it?" by Adam WR and colleagues in the November 17, 2014 issue.

The article examines the medical student selection system in Australia. The authors report that there has been a dramatic change in Australian medical school selection procedures, with the matriculation score of a school leaver now just one of a range of criteria. The authors note that most Australian medical schools use interviews to assess non-academic skills and attributes.

Background: A contemporary, porous-coated acetabular implant designed for uncemented insertion was introduced in Europe and Australia in 2007. A similar previous acetabular system was found in several studies at 10 to 15-year follow-up to demonstrate accelerated polyethylene wear, osteolysis, and early failure. The current study was conducted to determine the midterm safety and effectiveness of this contemporary acetabular system using highly crosslinked polyethylene and ceramic liners at 5-year follow-up., Methods: A prospective, nonrandomized study was conducted at 8 sites in Canada and the United States. All 148 study participants received a contemporary acetabular shell with proprietary porous coating. The primary outcome was the requirement for revision surgery at 5 years postoperatively. Secondary outcomes included a survival analysis, patient-reported outcome measures, radiographic failure, and postoperative adverse events., Results: At 5-year follow-up there was 1 cup revised for deep infection. No cups were revised for loosening and none were found to be radiographically loose. The overall survival rate with reoperation for any reason was 97.1%. The success rate was 96.8% for polyethylene and 100% for ceramic with no difference in the success rate between either bearing surface (P = 1.0). The mean patient-reported outcome measures all improved significantly between preoperative and 5-year postoperative scores (P < .001)., Conclusion: Results from this 5-year, multicenter, prospective study indicate excellent survivorship for this acetabular system when used with crosslinked polyethylene or ceramic bearing surfaces., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Research suggests that frequent empathic engagement with others in distress places helpers in registered professional roles (e.g. medical practitioners, psychologists) at risk of functional impairment related to symptoms of psychological distress, including the delivery of sub-optimal care to patients. Preliminary research suggests that telephone crisis support workers may also be impacted in a similar way. This repeated measures study is the first known research to examine telephone crisis support workers' functional impairment related to symptoms of psychological distress before and after speaking with callers in crisis. A representative sample of telephone crisis support workers from Lifeline Australia participated by completing three surveys: 1) directly before; 2) directly after; and 3) one week after completing a shift on the national crisis line. Surveys included standardised measures of functional impairment, psychological distress, lived experience of mental health issues and suicide, motivations for volunteering, coping strategies and help-seeking. Categorical items were used to assess personal and shift-related factors. Repeated measures analyses of variance were used to identify changes in symptoms of psychological distress and impairment across time points. Structural equation modelling was used to test relationships within a hypothesised model of impairment. A significant proportion of participants reported functional impairment related to symptoms of psychological distress. Significant differences in functional impairment and symptoms of psychological distress were detected, and were associated with different mechanisms, across time points. An important outcome of this study is empirically-supported models which explain how telephone crisis support workers come to experience functional impairment in relation to their TCS role, as well as other work/study, home/family and social/leisure activities. Results warrant the deliberate development and/or modification of existing service strategies to optimise telephone crisis support workers' psychological wellbeing and functioning, including by structuring the work environment and emphasising certain messages during training and supervision., Competing Interests: The authors have declared that no competing interests exist.

Background: Although patient safety is becoming widely taught in medical schools, its effect has been less rigorously evaluated. We describe a multicentre study to evaluate student changes in patient safety attitudes using a standardised instrument, the Attitudes to Patient Safety Questionnaire3 (APSQ3)., Methods: A patient safety training package designed for medical students was delivered in the first year and second year in four Australian medical schools. It comprises eight face-to-face modules, each of two hours. Seminars start with an interactive introduction using questions, video and role play, followed by small group break-outs to discuss a relevant case study. Groups are led by medical school tutors with no prior training in patient safety. Students and tutors then reassemble to give feedback and reinforce key concepts. Knowledge and attitudes to patient safety were measured using the APSQ3, delivered prior to safety teaching, at the end of the first and second years and 12 months after teaching ceased., Results: A significant improvement in attitude over time was demonstrated for four of nine key items measured by the APSQ3: value of patient safety teaching; danger of long working hours, value of team work and the contribution patients can make in reducing error. Informal feedback from students was very positive., Conclusion: We showed persistent, positive learning from a patient safety education intervention 12 months after teaching finished. Building on the introduction of patient safety teaching into medical schools, pathways for motivated students such as appropriate electives, option terms and team-based research projects would be of value.

Signs of suicide are commonly used in suicide intervention training to assist the identification of those at imminent risk for suicide. Signs of suicide may be particularly important to telephone crisis-line workers (TCWs), who have little background information to identify the presence of suicidality if the caller is unable or unwilling to express suicidal intent. Although signs of suicide are argued to be only meaningful as a pattern, there is a paucity of research that has examined whether TCWs use patterns of signs to decide whether a caller might be suicidal, and whether these are influenced by caller characteristics such as gender. The current study explored both possibilities. Data were collected using an online self-report survey in a Australian sample of 137 TCWs. Exploratory factor analysis uncovered three patterns of suicide signs that TCWs may use to identify if a caller might be at risk for suicide (mood, hopelessness, and anger), which were qualitatively different for male and female callers. These findings suggest that TCWs may recognise specific patterns of signs to identify suicide risk, which appear to be influenced to some extent by the callers' inferred gender. Implications for the training of telephone crisis workers and others including mental-health and medical professionals, as well as and future research in suicide prevention are discussed., Competing Interests: The authors declare no conflict of interest.

Objectives: We report the diagnostic validity of a selection algorithm for identifying epilepsy cases., Study Design and Setting: Retrospective validation study of International Classification of Diseases 10th Revision Australian Modification (ICD-10AM)-coded hospital records and pharmaceutical data sampled from 300 consecutive potential epilepsy-coded cases and 300 randomly chosen cases without epilepsy from 3/7/2012 to 10/7/2013. Two epilepsy specialists independently validated the diagnosis of epilepsy. A multivariable logistic regression model was fitted to identify the optimum coding algorithm for epilepsy and was internally validated., Results: One hundred fifty-eight out of three hundred (52.6%) epilepsy-coded records and 0/300 (0%) nonepilepsy records were confirmed to have epilepsy. The kappa for interrater agreement was 0.89 (95% CI=0.81-0.97). The model utilizing epilepsy (G40), status epilepticus (G41) and ≥1 antiepileptic drug (AED) conferred the highest positive predictive value of 81.4% (95% CI=73.1-87.9) and a specificity of 99.9% (95% CI=99.9-100.0). The area under the receiver operating curve was 0.90 (95% CI=0.88-0.93)., Conclusion: When combined with pharmaceutical data, the precision of case identification for epilepsy data linkage design was considerably improved and could provide considerable potential for efficient and reasonably accurate case ascertainment in epidemiological studies., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives: To report the level of participation of medical schools in the Australian Medical Schools Assessment Collaboration (AMSAC); and to measure differences in student performance related to medical school characteristics and implementation methods., Design: Retrospective analysis of data using the Rasch statistical model to correct for missing data and variability in item difficulty. Linear model analysis of variance was used to assess differences in student performance., Setting and Participants: 6401 preclinical students from 13 medical schools that participated in AMSAC from 2011 to 2013., Main Outcome Measures: Rasch estimates of preclinical basic and clinical science knowledge., Results: Representation of Australian medical schools and students in AMSAC more than doubled between 2009 and 2013. In 2013 it included 12 of 19 medical schools and 68% of medical students. Graduate-entry students scored higher than students entering straight from school. Students at large schools scored higher than students at small schools. Although the significance level was high (P < 0.001), the main effect sizes were small (4.5% and 2.3%, respectively). The time allowed per multiple choice question was not significantly associated with student performance. The effect on performance of multiple assessments compared with the test items as part of a single end-of-year examination was negligible. The variables investigated explain only 12% of the total variation in student performance., Conclusions: An increasing number of medical schools are participating in AMSAC to monitor student performance in preclinical sciences against an external benchmark. Medical school characteristics account for only a small part of overall variation in student performance. Student performance was not affected by the different methods of administering test items.

Aims: To compare health and science students' demographic characteristics and learning approaches across different disciplines, and to examine the relationship between learning approaches and academic performance., Background: While there is increasing recognition of a need to foster learning approaches that improve the quality of student learning, little is known about students' learning approaches across different disciplines, and their relationships with academic performance., Design: Prospective, correlational design., Methods: Using a survey design, a total of 919 first year health and science students studying in a university located in the western region of Sydney from the following disciplines were recruited to participate in the study - i) Nursing: n = 476, ii) Engineering: n = 75, iii) Medicine: n = 77, iv) Health Sciences: n = 204, and v) Medicinal Chemistry: n = 87., Results: Although there was no statistically significant difference in the use of surface learning among the five discipline groups, there were wide variations in the use of deep learning approach. Furthermore, older students and those with English as an additional language were more likely to use deep learning approach. Controlling for hours spent in paid work during term-time and English language usage, both surface learning approach (β = -0.13, p = 0.001) and deep learning approach (β = 0.11, p = 0.009) emerged as independent and significant predictors of academic performance., Conclusions: Findings from this study provide further empirical evidence that underscore the importance for faculty to use teaching methods that foster deep instead of surface learning approaches, to improve the quality of student learning and academic performance., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Aim: To investigate whether commercial coaching affects performance in the Undergraduate Medical and Health Sciences Admission Test (UMAT)., Method: The effect of coaching on the UMAT scores of 402 final high school students applying for medicine was examined using t-tests and multiple regression analyses that controlled for academic performance, high school type and gender., Results: Over half (56.2%) of the participants had enrolled in commercial coaching. Coaching had no influence on UMAT Section 1 or 2, even after controlling for academic performance, gender and type of high school. UMAT Section 3 was significantly higher for coached students, but this was only the case for high ability students. Coaching had a slight negative effect for lower ability students. Those attending academically selective high school also had higher UMAT scores., Conclusion: The results have implications for the fairness and validity of the UMAT. The differential effect of coaching possibly occurred because high academic ability students are able to learn solution rules for non-verbal tests. We propose that the effect of school type relates to a competitive culture that drives extended test practice in academically selective schools.

Objectives: The problem of dissimulation by applicants when self-report tests of personality are used for job selection has received considerable attention in non-medical contexts. Personality testing is not yet widely used in medical student selection, but this may change in the light of recent research demonstrating significant relationships between personality and performance in medical school. This study therefore aimed to assess the extent of self-enhancement in a sample of medical school applicants., Methods: A within-subjects design compared personality test scores collected in 2007 for 83 newly enrolled medical students with scores for the same students obtained on the same personality test administered during the selection process 4 months previously. Five factors of personality were measured using the International Personality Item Pool and mean differences in scores were assessed using paired t-tests., Results: At the time of selection, the personality scores of successful applicants were similar to those of candidates who were not accepted (n=271). Once selected, the medical students achieved significantly lower scores on four of the five personality factors (conscientiousness, extroversion, openness to experience, agreeableness) and higher scores on the fifth factor (neuroticism). Of the selected students, 62.7% appeared to have 'faked good' on at least one of the five factors measured., Conclusions: Applicants to medical school are likely to dissimulate when completing self-report tests of personality used for selection. The authors review the evidence as to whether such dissimulation reduces construct and predictive validity and summarise methods used to reduce self-enhancement in applicant samples., (© Blackwell Publishing Ltd 2012.)

Gaining clinical experience for an extended period of time in teaching hospitals is one of the enduring strengths of medical education. Teaching hospitals have recently faced significant challenges, with increasing specialisation of services and workload pressures reducing clinical learning opportunities. New clinical teaching environments have been established in Australia, particularly in rural and regional areas; these are proving to be ideal contexts for student learning. The new clinical teaching environments have shown the importance of developing symbiotic relationships between universities and health services. Symbiotic clinical learning is built around longitudinal, patient-based learning emphasising priority health concerns. The symbiotic framework provides a basis for reconstructing clinical teaching in teaching hospitals so th@they continue to play a vital role in Australian medical education, with additional clinical experience provided by primary care and community, rural and regional hospitals.

Background: Medical television programs offer students fictional representations of their chosen career. This study aimed to discover undergraduate medical students' viewing of medical television programs and students' perceptions of professionalism, ethics, realism and role models in the programs. The purpose was to consider implications for teaching strategies., Methods: A medical television survey was administered to 386 undergraduate medical students across Years 1 to 4 at a university in New South Wales, Australia. The survey collected data on demographics, year of course, viewing of medical television programs, perception of programs' realism, depiction of ethics, professionalism and role models., Results: The shows watched by most students were House, Scrubs, and Grey's Anatomy, and students nominated watching 30 different medical programs in total. There was no statistical association between year of enrolment and perceptions of accuracy. The majority of students reported that friends or family members had asked them for their opinion on an ethical or medical issue presented on a program, and that they discussed ethical and medical matters with their friends. Students had high recall of ethical topics portrayed on the shows, and most believed that medical programs generally portrayed ideals of professionalism well., Conclusions: Medical programs offer considerable currency and relevance with students and may be useful in teaching strategies that engage students in ethical lessons about practising medicine., (© 2011 Weaver and Wilson; licensee BioMed Central Ltd.)

Background: Big-fish-little-pond effect (BFLPE) research has demonstrated that students in high-ability environments have lower academic self-concepts than equally able students in low-ability settings. Research has shown low academic self-concepts to be associated with negative educational outcomes. Social comparison processes have been implicated as fundamental to the BFLPE., Methods: Twenty first-year students in an Australian medical school completed a survey that included academic self-concept and social comparison measures, before and after their first written assessments. Focus groups were also conducted with a separate group of students to explore students' perceptions of competence, the medical school environment, and social comparison processes., Results: The quantitative study did not reveal any changes in academic self-concept or self-evaluation. The qualitative study suggested that the attributions that students used when discussing performance were those that have been demonstrated to negatively affect self-concept. Students reported that the environment was slightly competitive and they used social comparison to evaluate their performance., Conclusions: Although the BFLPE was not evident in the quantitative study, results from the qualitative study suggest that the BFLPE might be operating In that students were using attributions that are associated with lower self-concepts, the environment was slightly competitive, and social comparisons were used for evaluation.

Objective: The aim of this research was to assess tertiary student distress levels with regards to (i) comparisons with normative population data, and (ii) the effects of discipline, year level, and student characteristics. Self-reported treatment rates and level of concern regarding perceived distress were also collected., Method: Students from all six years of an undergraduate medical course were compared with samples from Psychology, Law and Mechanical Engineering courses at the University of Adelaide, Australia. Students participated in one of three studies that were either web-based or paper-based. All studies included Kessler's Measure of Psychological Distress (K10), and questions pertaining to treatment for any mental health problems and concern regarding distress experienced., Results: Of the 955 tertiary students who completed the K10, 48% were psychologically distressed (a K10 score > or = 22) which equated to a rate 4.4 times that of age-matched peers. The non-health disciplines were significantly more distressed than the health disciplines. Distress levels were statistically equivalent across all six years of the medical degree. Of tertiary students, 11% had been treated for a mental health problem. Levels of concern correlated with the K10 score., Conclusion: The results from this research suggest that high distress levels among the tertiary student body may be a phenomenon more widely spread than first thought. Low treatment rates suggest that traditional models of support may be inadequate or not appropriate for tertiary cohorts.

Objective: To assess the practice effects from coaching on the Undergraduate Medicine and Health Sciences Admission Test (UMAT), and the effect of both coaching and repeat testing on the Multiple Mini Interview (MMI)., Design, Setting and Participants: Observational study based on a self-report survey of a cohort of 287 applicants for entry in 2008 to the new School of Medicine at the University of Western Sydney. Participants were asked about whether they had attended UMAT coaching or previous medical school interviews, and about their perceptions of the relative value of UMAT coaching, attending other interviews or having a "practice run" with an MMI question. UMAT and MMI results for participants were compared with respect to earlier attempts at the test, the degree of similarity between questions from one year to the next, and prior coaching., Main Outcome Measures: Effect of coaching on UMAT and MMI scores; effect of repeat testing on MMI scores; candidates' perceptions of the usefulness of coaching, previous interview experience and a practice run on the MMI., Results: 51.4% of interviewees had attended coaching. Coached candidates had slightly higher UMAT scores on one of three sections of the test (non-verbal reasoning), but this difference was not significant after controlling for Universities Admission Index, sex and age. Coaching was ineffective in improving MMI scores, with coached candidates actually having a significantly lower score on one of the nine interview tasks ("stations"). Candidates who repeated the MMI in 2007 (having been unsuccessful at their 2006 entry attempt) did not improve their score on stations that had new content, but showed a small increase in scores on stations that were either the same as or similar to previous stations., Conclusion: A substantial number of Australian medical school applicants attend coaching before undertaking entry selection tests, but our study shows that coaching does not assist and may even hinder their performance on an MMI. Nevertheless, as practice on similar MMI tasks does improve scores, tasks should be rotated each year. Further research is required on the predictive validity of the UMAT, given that coaching appeared to have a small positive effect on the non-verbal reasoning component of the test.

Objectives: To determine whether childhood physical and sexual abuse are associated with poor mental and physical health outcomes in older age., Design: Cross-sectional, postal questionnaire survey., Setting: Medical clinics of 383 general practitioners (GPs) in Australia., Participants: More than 21,000 older adults (aged > or = 60) currently under the care of GPs participating in the Depression and Early Prevention of Suicide in General Practice (DEPS-GP) Study. Participants were divided into two groups according to whether they acknowledged experiencing childhood physical or sexual abuse., Measurements: Main outcome measures targeted participants' current physical health (Medical Outcomes Study 12-item Short Form Survey, Version 2 and Common Medical Morbidities Inventory) and mental health (Patient Health Questionnaire-9 and Hospital Anxiety and Depression Scale)., Results: One thousand four hundred fifty-eight (6.7%) and 1,429 participants (6.5%) reported childhood physical and sexual abuse, respectively. Multivariate models of the associations with childhood abuse indicated that participants who had experienced either childhood sexual or physical abuse had a greater risk of poor physical (odds ratio (OR)=1.35, 95% confidence interval (CI)=1.21-1.50) and mental (OR=1.89, 95% CI=1.63-2.19) health, after adjustments. Older adults who reported both childhood sexual and physical abuse also had a higher risk of poor physical (OR=1.60, 95% CI=1.33-1.92) and mental (OR=2.40, 95% CI=1.97-2.94) health., Conclusion: The effects of childhood abuse appear to last a lifetime. Further research is required to improve understanding of the pathways that lead to such deleterious outcomes and ways to minimize its late-life effects.

Background: Measurement of burden of illness is rarely undertaken in general practice, although a specific tool [Duke University Severity of Illness DUSOI scale] has been incorporated in the International Classification in Primary Care. This measures the burden of illness in an individual at a point in time. There has not been any measure of the burden of illness in families. Such an instrument would allow measurement of the impact of events on the health of families., Objective: This pilot study aimed to modify the DUSOI to measure a family's burden of illness and to validate any changes., Methods: The DUSOI was modified to measure the mean burden of illness in a family over a 1 year period. The changes were then subject to a validation process using convenient samples of patients from the author's multidoctor practice in Australia. Reliability was examined by the test-re-test method. Inter-rater reliability could not be assessed. Responsiveness was measured by measuring changes in score in the years before and after four events: counselling for a minor mental health problem; referral to a psychiatrist; diagnosis and treatment of breast cancer; and the occurrence of an acute myocardial infarction., Results: The modifications made to the DUSOI have not altered the face or content validity of the original instrument. Construct validity and test-re-test reliability were satisfactory. Inter-rater reliability was not tested, but the original single patient score showed levels lower than are desirable. Responsiveness varied significantly. Families where a member was referred to a psychiatrist showed a decrease in burden after referral, while families where a member suffered an infarct showed a large increase. The other family groups did not show any change., Conclusion: A Family DUSOI will be of value in research when validated for individual conditions.