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Biomedical subjects

Amanda Howe

Publications and source records attributed to Amanda Howe.

At least 19 recordsLinked to original sources

Can the patient be on our team? An operational approach to patient involvement in interprofessional approaches to safe care.

This discussion paper brings together the concept of patient-centred practice with interprofessional working and the spectrum of preventive and restorative approaches to patient safety. I explore what might be involved in putting patients at the heart of a team-based approach to the prevention and management of potential clinical errors in their own care; and use the current literature to explore areas where interprofessional practice-based interventions may help to improve quality of care in ways that can prevent or minimize patient risk. I argue that involving patients in safety issues will only happen when staff are motivated by real rather than hypothetical needs, and will largely involve actions taken at an interpersonal level during routine health care. The paper describes a spectrum of practical approaches that can be implemented by teams and organizations, ranging from whole population prevention strategies to the learning that can be gained from avoidable deaths. It explores concrete examples of the ways in which individual patients might be included in a team approach to self protection, and addresses underpinning principles of effective interprofessional working which are needed to make such approaches effective.

Cultural Characteristics↗

Factors that influence the detection of psychological problems in adolescents attending general practices.

BACKGROUND: Epidemiological studies indicate that the prevalence of psychological problems in patients attending primary care services may be as high as 25%. AIM: To identify factors that influence the detection of psychological difficulties in adolescent patients receiving primary care in the UK. DESIGN OF STUDY: A prospective study of 13-16 year olds consecutively attending general practices. SETTING: General practices, Norfolk, UK. METHOD: Information was obtained from adolescents and parents using the validated Strengths and Difficulties Questionnaire (SDQ) and from GPs using the consultation assessment form. RESULTS: Ninety-eight adolescents were recruited by 13 GPs in Norfolk (mean age = 14.4 years, SD = 1.08; 38 males, 60 females). The study identified psychological difficulties in almost one-third of adolescents (31/98, 31.6%). Three factors significant to the detection of psychological disorders in adolescents were identified: adolescents' perceptions of difficulties according to the self-report SDQ, the severity of their problems as indicated by the self-report SDQ, and whether psychological issues were discussed in the consultation. GPs did not always explore psychological problems with adolescents, even if GPs perceived these to be present. Nineteen of 31 adolescents with psychological difficulties were identified by GPs (sensitivity = 61.2%, specificity = 85.1%). A management plan or follow-up was made for only seven of 19 adolescents identified, suggesting that ongoing psychological difficulties in many patients are not being addressed. CONCLUSIONS: GPs are in a good position to identify psychological issues in adolescents, but GPs and adolescents seem reluctant to explore these openly. Open discussion of psychological issues in GP consultations was found to be the most important factor in determining whether psychological difficulties in adolescents are detected by GPs.

Adolescent↗

Education in family medicine--gains and dangers.

This editorial discusses the emerging evidence base for using family medicine as a core setting for medical training, and evaluates the challenges and impacts of this role on family medicine practice. Substantive, well designed educational opportunities can be effectively delivered in family medicine, and this has positive impacts on learning of clinical medicine, student attitudes towards patients, their understanding of population health, their choice of careers, and their respect for family medicine as a discipline. However, a poor standard of clinical practice and a lack of capacity in community based health care facilities could militate against such results being sustained and replicated in all countries. Medical schools in all parts of the world should be considering whether their family medical system can sustain a useful input to their curricula, and seeking to support colleagues in family medicine to develop their disciplinary base, because of the valuable contribution they can make to education as well as patient care and research.

Education, Medical, Graduate↗

Emergency care. Change of pace.

A GP practice set up a new system of assessing patients, with an emphasis on appropriate immediate need. The aim is to speed up treatment and reduce inappropriate accident and emergency admissions. A new role of community paramedic on loan from the ambulance trust was a vital part of the team. The first eight months dramatically cut accident and emergency admissions and sped up category A response times.

Emergency Medical Services↗

Twelve tips for developing professional attitudes in training.

This article is based on a workshop run at AMEE Lisbon, building on work from previous conferences and reported in Medical Teacher (Howe, 2002a). The 30 workshop participants were particularly asked to address the question 'What would you consider essential to include in a medical education curriculum that wishes to teach and assess professional development?'. This question was posed without further constraints, ie. regardless of whether undergraduate or postgraduate, the country or situation of the participant, and the type of setting in which they worked. Participants were invited to consider all aspects of the question, and no assumption was made about the need to reach a consensus. The workshop divided into two groups and shared ideas. This paper presents the main emergent points from discussion, for interest and further collaboration; the level of agreement was considerable, consistent with the peer reviewed literature (Howe, 2002b). The conclusions are therefore shared in the 'Twelve Tips' format as a pragmatic framework for those wishing to review their own curriculum with reference to professional development (PD) issues, or when setting up new opportunities.

Attitude of Health Personnel↗

Professional development in undergraduate medical curricula--the key to the door of a new culture?

CONTEXT: One of the most pressing requirements for contemporary medical education is to develop a framework for theory and practice of professional development which results in the attainment of professional competencies suitably robust for a lifetime's practice. The proposed content of a professional development curriculum may be reasonably straightforward to establish from policy documents and public expectations, but the process of achieving the desired outcomes is more complex, because professional development is largely based on attitudinal learning. Attitudes are at the interface between the personal and public psyche, relying more on individual experience and the accumulated impact of social and cultural interpretations than on propositional knowledge, and are therefore less amenable to factual or didactic teaching. AIMS: The purpose of this discussion paper is to develop thinking on the conceptual frameworks which need to underpin curriculum decision-making for professional development, especially in undergraduate medical training where models of good practice are less well-established. It brings together work from educational, sociological and psychological perspectives to elucidate the key principles which are most likely to result in acquisition of desirable professional attributes. IMPLICATIONS: The literature suggests that successful professional development needs to be based on explicit values, which are repeatedly demonstrated in the learning environment, and modelled by senior colleagues and tutors; that the curriculum should incorporate a clear model of emotional as well as cognitive development; should be a major component of summative assessment; and needs to include formative mentorship at all stages of training.

Curriculum↗

Helping tomorrow's doctors to gain a population health perspective - good news for community stakeholders.

INTRODUCTION: The modernising agenda of the NHS and recommendations of professional bodies demand that all doctors achieve a basic understanding of a population health perspective. The principle of integrated learning and the logistics of provision make it inappropriate for such learning to be delivered solely by public health specialists, and community-based learning has been promoted as the best setting in which to assist this objective. However, there is little evidence from practice as to whether non-specialist staff are willing or able to play a role in orienting tomorrow's doctors to the needs of communities. METHODS: Semi-structured interviews, questionnaires and focus groups iterated the opinion of key stakeholders on their preferred contributions to community-oriented undergraduate medical education. Framework analysis was used to elicit key outcomes and process factors. RESULTS: There was consensus that community-based learning should be a core element of the medical curriculum as it can demonstrate the socioenvironmental context of care and the doctor's role in interagency working and preventive care. Effective academic/NHS partnerships were called for, with higher education leading the agenda on aims and objectives, creating collaborative structures, and reallocating resources to support new learning. Community-based stakeholders would offer the translation of theory into practice by demonstrating clinical and social diversity, models of teamworking, and a context for the application of prior learning. They also promoted recurrent contact with communities, and suggested an enhanced role in mentoring students through longer term relationships. CONCLUSION: Community-based personnel and NHS users are an under-used resource for medical education. Their proposed contributions strongly accord with the agenda for a population health perspective in basic training. Curriculum planners need to make long-term partnerships with community-based agencies, rather than using them as an intermittent provider of limited learning sessions with narrowly defined objectives.

Community Health Services↗

Twelve tips for community-based medical education.

Teaching and learning in primary care and community settings is now a very common aspect of most medical trainings, and there is a growing expertise and evidence base related to the contribution of primary care practice to the reform of medical education. This article in the '12 tips' series touches on both practical and political aspects of community-based medical education, addressing the context in which this contribution has developed, its impacts to date, and some core essentials of effective educational practice.

Clinical Clerkship↗

In our own image--a multidisciplinary qualitative analysis of medical education.

One aim of reform of undergraduate medical education is to achieve a better balance between an emphasis on scientific knowledge and an enhancement of desirable professional attitudes: for example, reducing the core curriculum in biochemistry in order to increase learning opportunities in ethics. This study was based on qualitative data collected from stakeholders involved in community- and primary care-based medical education. Its aim was to consider whether different participants agreed on the desired outcomes of basic medical training, and the contribution of community and primary care settings. Analysis of the data showed that the professional identity of the future doctor is contested, its goals reflective of the 'world view' of the stakeholder, and seen as being highly dependent on the contexts in which students learn. Themes which emerged suggest that medical education may not achieve its goals unless student experiences become less dominated by the context of secondary care and its predominantly technical practice of medicine, and more attention is paid to the personal development of the students. The discussion considers the implications for further reform, and emphasises the role of multidisciplinary tutoring in remodelling the world view of 'tomorrow's doctors'.

Attitude of Health Personnel↗