Absolute cardiovascular risk assessment by Australian early-career general practitioners: a cross-sectional study.

OBJECTIVE: To determine the prevalence and associations of general practice registrars' performing absolute cardio-vascular risk (ACVR) assessment (ACVRa). DESIGN: A cross-sectional study employing data (2017-2018) from the Registrar Clinical Encounters in Training project, an ongoing inception cohort study of Australian GP registrars. The outcome measure was whether an ACVRa was performed. Analyses employed univariable and multivariable regression. Analysis was conducted for all patient problems/diagnoses, then for an 'at-risk' population (specific problems/diagnoses for which ACVRa is indicated). SETTING: Three GP regional training organisations (RTOs) across three Australian states. PARTICIPANTS: GP registrars training within participating RTOs. RESULTS: 1003 registrars (response rate 96.8%) recorded details of 69 105 problems either with Aboriginal and/or Torres Strait patients aged 35 years and older or with non-Indigenous patients aged 45 years and older. Of these problems/diagnoses, 1721 (2.5% (95% CI 2.4% to 2.6%)) involved an ACVRa. An ACVRa was 'plausibly indicated' in 10 384 problems/diagnoses. Of these, 1228 (11.8% (95% CI 11.2% to 12.4%)) involved ACVRa. For 'all problems/diagnoses', on multivariable analysis female gender was associated with reduced odds of ACVRa (OR 0.61 (95% CI 0.54 to 0.68)). There was some evidence for Aboriginal and/or Torres Strait Islander people being more likely to receive ACVRa (OR 1.40 (95% CI 0.94 to 2.08), p=0.10). There were associations with variables related to continuity of care, with reduced odds of ACVRa: if the patient was new to the registrar (OR 0.65 (95% CI 0.57 to 0.75)), new to the practice (OR 0.24 (95% CI 0.15 to 0.38)) or the problem was new (OR 0.68 (95% CI 0.59 to 0.78)); and increased odds if personal follow-up was organised (OR 1.43 (95% CI 1.24 to 1.66)). For 'ACVRa indicated' problems/diagnoses, findings were similar to those for 'all problems/diagnoses'. Association with Aboriginal and/or Torres Strait Islander status, however, was significant at p<0.05 (OR 1.60 (95% CI 1.04 to 2.46)) and association with female gender was attenuated (OR 0.88 (95% CI 0.77 to 1.01)). CONCLUSION: Continuity of care is associated with registrars assessing ACVR, reinforcing the importance of care continuity in general practice. Registrars' assessment of an individual patient's ACVR is targeted to patients with individual risk factors, but this may entail ACVRa underutilisation in female patients and younger age groups.

Medical students value-adding to general practice.

BACKGROUND AND OBJECTIVES: Medical students can make valuable contributions to patient care during clinical placements. The aim of this study was to investigate student perceptions of the value of general practice placements for their learning, and their sense of contribution during their placements. METHOD: The study used a qualitative design to gather in-depth student perspectives on learning and contributions, using focus groups of final-year medical students on general practice placement. RESULTS: Thirteen students participated in one of three focus groups. Students reported valuable learning affordances in general practice and identified contributions to improved workflow, rapport-building, patient education, encouraging clinician reflection and shared learning between general practitioner and student. DISCUSSION: Student perspectives of value-adding on general practice placements, and a deeper understanding of these learning environments, may enable general practice supervisors to facilitate placements that maximise these benefits.

Student contributions in residential aged care.

BACKGROUND: Health care professional students can develop knowledge and skills to care for elderly patients during placements in residential aged care facilities (RACF). Enabling student contribution during clinical placements can enhance student learning and quality of care. Our medical student RACF placement includes a learning task where students recommend improvements to resident care. This study aimed to identify these recommendations and measure how many were adopted. METHODS: Students completed a medical assessment of a resident during their RACF placement, summarising their recommendations in a letter to the resident's general practitioner (GP). Recommendations were categorised for quantification and audit. Three months after the time of recommendation residents' files were audited. Definitions and descriptive statistics of the types of recommendations, and whether they had been implemented, are reported. RESULTS: Forty residents and 43 students participated in the study. In total, 391 recommendations were made. Medication recommendations were most common (47%), followed by allied health referrals (12%), lifestyle changes (10%) and GP review (10%). Smaller numbers of recommendations for nursing care, investigations, specialist review and patient education were made. Seventy-seven recommendations were adopted. DISCUSSION: Student learning is enhanced when contributing to resident care, and educators can structure clinical placements to support this. Using an existing student learning task to feed into genuine quality improvements for care is one example of how this might be implemented. This study gives insight into types of recommendations students make, suggesting further research to explore barriers and enablers to maximise the benefits of student contributions.

Gambling Behaviour, Problem Gambling and Reasons for Gambling Among International Students in Tasmania, Australia.

Individuals who undertake tertiary study outside their home countries ("international students") may be at increased risk of problem gambling behaviour. To inform this issue, we examined gambling behaviour, problem gambling behaviour and reasons for gambling among international students, primarily from Asian countries, attending university in Tasmania, Australia. Online surveys that included established measures of each outcome were completed by these students (n = 382) along with a comparison group of domestic students (n = 1013). While most forms of gambling assessed were less common among international students than among domestic students, rates of problem gambling were higher among international students (2.6%) than among domestic (1.4%) students. Further, whereas rates of problem gambling did not differ by sex among domestic students, problem gambling among international students was confined to males. Hence, rates of problem gambling were markedly elevated in this subgroup (5% of all male international students, 15% of male international students who reported any form of gambling in the past 12 months). International students were more likely than domestic students to report engaging in gambling as a means of regulating their internal states and for a challenge and these and other reasons for gambling were positively correlated with problem gambling behaviour. The findings support the need for population- and campus-based health promotion and early intervention programs targeting international students, male students in particular. Information concerning individuals' reasons for gambling might usefully be included in these programs.

Early career GPs, mental health training and clinical complexity: a cross-sectional analysis.

Patients with mental health conditions commonly present in General Practice. Mental health curricula are broad. We do not know that trainees are exposed to the learning they require. This study aimed to establish the prevalence, characteristics and associations of GP trainees' management of mental health problems. This paper presents a cross-sectional analysis of the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing multisite cohort study of Australian GP trainees (registrars) documenting their clinical experiences over 60 consecutive consultations. Univariate and multivariable logistic regression analyses were conducted with outcome of the problem/diagnosis being a mental health condition. 1659 trainees provided data on 218,325 consultations and 340,453 problems/diagnoses. Mental health conditions were associated with patients being male, of Aboriginal or Torres Strait Islander or English-speaking background. Trainee characteristics were being more senior and having trained in Australia. Practice characteristics included being in low socioeconomic areas. Trainees sought less help for mental health concerns than they did for other problems. While early-career GPs see a broad range of mental health conditions, they may benefit from training to manage patients from cross-cultural contexts. They may also need support to generate appropriate learning goals and seek assistance if they are to continue to deepen competence.

Health and Well-Being of International University Students, and Comparison with Domestic Students, in Tasmania, Australia.

International students comprise an increasingly larger proportion of higher education students globally. Empirical evidence about the health and well-being of these students is, however, limited. We sought to examine the health and well-being of international students, primarily from Asian countries, attending the University of Tasmania, Australia, using domestic students as a comparison group. Ethics approval was given to invite (via email) all currently enrolled students to participate in the study by completing a pilot-tested, online survey. The survey was completed by 382 international students (response rate = 8.9%) and 1013 domestic students (9.2%). Independent samples t-tests, analysis of variance (ANOVA) and chi-square tests were used for bivariate comparisons between international and domestic students, and between subgroups of international students. Regression models were used to examine the associations between student status (international vs. domestic) and health outcomes, controlling for demographic and enrolment variables. International students, particularly male students, were found to be at increased risk of several adverse health outcomes while also being less likely to seek help for mental health and related problems. The findings indicate the need for accessible, targeted, culturally-sensitive health promotion and early intervention programs.

Chronic disease management.

Stifling a yawn is sometimes one's first reaction to talk of chronic disease management. While at a student tutorial the other day, I noticed there was a definite glazing over of eyes when the talk turned to care plans and Medicare item numbers. But, what really did engage the students was the discussion that followed on the broad spectrum of exactly what chronic disease management entails.