Microaggressions in the general practice setting.

BACKGROUND: Microaggressions are pervasive problems in the workplace; the general practice setting is no exception. OBJECTIVE: This article examines what microaggressions are and outlines the key roles of protagonist, target, bystander and ally. It explores the effects of microaggressions on target persons (how microaggressions can affect their physical or mental health), and the implications microaggressions might also have for patient safety and broader workforce security. DISCUSSION: The article concludes by considering professional development strategies that can be adopted, including how to move from a position of bystander to ally.

Improving the nutrient quality of foods and beverages using product specific standards for positive nutrients and ingredients will help to increase mean population intakes toward dietary guidelines.

Background: A shift toward more sustainable diets, rich in plant-based foods and with fewer animal-derived foods, is needed and will lead to improved health and environmental benefits. Food industry needs to play a part and broaden the scope of product reformulation beyond the reduction of nutrients to limit to increasing ingredients and nutrients in line with dietary recommendations for a healthy sustainable diet. Methods: The Positive Nutrition Standards (PNS) were defined to increase the consumption of recommended ingredients and nutrients. The PNS were set by translating WHO and Codex guidance into product group standards, considering the role of the product group in the diet. The potential impact of the PNS for vegetables, wholegrain and fibre was modeled using data from the US NHANES 2017-2018 survey, assuming that, foods consumed would be reformulated to meet the standards where relevant. Results: The modeling showed that application of the PNS could increase mean population intakes by 30% for fibre, by more than 50% for vegetables and even double the intake of wholegrain. However, reformulation alone would not be sufficient to reach recommended intake levels. Conclusion: The PNS described in this paper can help to increase intakes of relevant positive nutrients and ingredients. However, a multistakeholder approach is needed to encourage consumers to make additionally required dietary shifts to meet the recommendations for positive nutrients and ingredients.

Pivoting in the pandemic: A regional tale of the rapid pivot to virtual continuing professional development for general practitioner supervisors during COVID-19.

BACKGROUND: The COVID-19 pandemic disrupted face-to-face delivery of general practitioner supervisor training in an unprecedented way. Simultaneously, the need for continuing professional development (CPD) amplified. The rapid pivot to virtual and blended learning solutions required great organisational agility, and a toolbox of solutions. OBJECTIVE: Against the backdrop of the COVID-19 restrictions on face-to-face learning, this article shares the strategies employed to achieve the pivot to virtual CPD. DISCUSSION: There was much trial and error, as well as successes and learning opportunities, as training organisations grappled with how to deliver virtual CPD during lockdowns.

Mental health of vulnerable groups experiencing a drought or bushfire: A systematic review.

Natural hazards are increasing because of climate change, and they disproportionately affect vulnerable populations. Prior reviews of the mental health consequences of natural hazard events have not focused on the particular experiences of vulnerable groups. Based on the expected increase in fires and droughts in the coming years, the aim of this systematic review is to synthesize the global evidence about the mental health of vulnerable populations after experiencing natural hazards. We searched databases such as Ovid MEDLINE, EMBASE, CINAHL and Ovid PsycInfo using a systematic strategy, which yielded 3,401 publications. We identified 18 eligible studies conducted in five different countries with 15,959 participants. The most common vulnerabilities were living in a rural area, occupying a low socioeconomic position, being a member of an ethnic minority and having a medical condition. Common experiences reported by vulnerable individuals affected by drought included worry, hopelessness, isolation and suicidal thoughts and behaviors. Those affected by fire reported experiencing posttraumatic stress disorder (PTSD) and anger. These mental health problems exacerbated existing health and socioeconomic challenges. The evidence base about mental health in vulnerable communities affected by natural hazards can be improved by including standardized measures and comparison groups, examining the role of intersectional vulnerabilities, and disaggregating data routinely to allow for analyses of the particular experiences of vulnerable communities. Such efforts will help ensure that programs are informed by an understanding of the unique needs of these communities.

Improving the Nutrient Quality of Foods and Beverages Using Product Specific Standards for Nutrients to Limit Will Substantially Reduce Mean Population Intakes of Energy, Sodium, Saturated Fat and Sugars towards WHO Guidelines.

BACKGROUND: International strategies to reduce chronic diseases have called for a reduction in the amounts of saturated fat (SAFA), trans fat (TFA), salt and sugars in the global food supply. This paper describes the development approach and potential impact of a set of standards for these nutrients to drive food (re)formulation. METHODS: To set the standards, WHO nutrient guidelines for daily intake were translated into product group specific standards. The impact of reformulation towards these standards on population nutrient intakes was modelled using the food consumption data of five countries: UK, France, US, Brazil and China. The impact of the TFA standards could not be modelled due to lack of data. RESULTS: (Re)formulation of foods and beverages towards these standards would substantially decrease mean population intakes of energy, sodium, SAFA and sugars, with reductions up to 30%. CONCLUSIONS: These science-based standards for nutrients to limit could drive impactful reductions in energy, sodium, SAFA and sugars in food and beverage products, enabling mean population intakes to move closer to WHO nutrient guidelines.

Remote general practice supervision with video cameras: Insights for the global COVID-19 pandemic.

BACKGROUND AND OBJECTIVES: There is growing evidence regarding the effectiveness of registrar training through video cameras, which has relevance for quality supervision during times of crises such as the global COVID-19 pandemic. METHOD: Interviews were conducted in 2012 with supervisors, registrars and patients evaluating video camera use for tele-supervision across six rural sites in Gippsland, Australia. Thematic analysis was employed in 2013 - and re-examined in 2021 in light of the global COVID-19 pandemic - to explore user experience with video technology. RESULTS: Participants identified advantages of video supervision addressing distance and temporal issues, also emphasising quality supervision and education. Challenges included patient confidentiality, internet stability and loss of serendipitous 'corridor conversations'. DISCUSSION: Remote supervision is no longer simply an issue for rural and remote training. During crises such as a global pandemic, tele-supervision becomes the purview of all. There are distinct merits and limitations in adopting video technology, warranting consideration of individual training contexts. These findings can help inform remote supervision via video in varied milieu.

'Where do I place my chair?': Considerations of chair placement in consultation observation.

BACKGROUND AND OBJECTIVES: In workplace-based training and assessment of registrars and supervised doctors, the influence of contextual factors such as consultation room layout, including placement of chairs, may be overlooked. The aim was to identify the room's seating arrangements in consultation observation between the assessor, the assessed and the patient. METHOD: Qualitative research was undertaken to explore the perceptions of consultation observation as a tool in workplace-based training and assessment through semi­structured one-on-one interviews. Thematic analysis was employed to analyse the data; secondary data analysis highlighted the use of metaphors to describe seating arrangements. RESULTS: Chair placement tended to be discussed by participants in terms of triangles - equilateral, isosceles and scalene. Other metaphors included curved lines, compasses or clock faces. Notions of agency in seating positions and constraints by room layout were also identified. DISCUSSION: There is a tension between the physical layout and structure of the consultation room, seating preferences of the observer and the agency of registrar as the observed.

A new framework for teaching the art of general practice consultation to registrars and supervised doctors.

BACKGROUND: Medicine is a science; conducting a consultation is an art form. Honing this art enhances patients' satisfaction and good medical outcomes and can also improve general practitioners' satisfaction in their role. A good consultation needs to be effective and efficient. Effectiveness occurs when the patient is heard, understood and acknowledged, and when the doctor is empathic, credible and delivers information and recommendations easily understood by the patient. Efficiency occurs when the consultation is time efficient and flows smoothly. OBJECTIVE: The aim of this article is to propose an adaptable, patient-centred consultation framework that is well suited to the modern context and practical for teaching to registrars and supervised doctors. DISCUSSION: The model for consultation presented articulates a structure of 10 components. The model can be the basis for teaching registrars and supervised doctors how to better structure their consultations. Later, it can be the basis for analysis and critique of reviewed consultations. While the model was developed for the face-to-face context, this article also includes recommendations for how the framework may be adopted for telehealth consultations.

Using organisational role theory and job analysis to identify and define the roles of an effective Australian general practice supervisor.

General practice (GP) supervisors - the key resource for training the future GP workforce - are often described as 'occupying a role' or enacting a series of roles. However, as much of the discourse uses a lay understanding of role, or merely hints at theory, a significant body of theoretical literature is underutilised. We reasoned that a more rigorous application of role theory might provide a conceptually clearer account of the GP-supervisor's job. To this end, we describe the use of organisational role theory and job analysis to identify and define the roles of the Australian GP-supervisor. Our search of the academic literature identified 64 role titles, which we condensed to an initial iteration of core roles, using inclusion and exclusion criteria. We analysed GP training organisations' documents to map embedded supervisory tasks against our list of roles to verify their presence, review our role titles and definitions, and look for additional roles that we may have missed. We used subject matter experts iteratively, to authenticate a final list of ten roles and their accompanying definitions, which can be used to support Australian GP-supervisors to perform effectively. We encourage those who support GP-supervisors in other countries and those who educate other health professionals in primary care settings to review the roles to judge whether they are transferable to their contexts.

Australian Aboriginal techniques for memorization: Translation into a medical and allied health education setting.

BACKGROUND: Writing and digital storage have largely replaced organic memory for encoding and retrieval of information in the modern era, with a corresponding decrease in emphasis on memorization in Western education. In health professional training, however, there remains a large corpus of information for which memorization is the most efficient means of ensuring: A) that the trainee has the required information readily available; and B) that a foundation of knowledge is laid, upon which the medical trainee builds multiple, complex layers of detailed information during advanced training. The carefully staged progression in early- to late- years' medical training from broad concepts (e.g. gross anatomy and pharmacology) to in-depth, specialised disciplinary knowledge (e.g. surgical interventions and follow-on care post-operatively) has clear parallels to the progression of training and knowledge exposure that Australian Aboriginal youths undergo in their progression from childhood to adulthood to Tribal Elders. METHODS: As part of the Rural Health curriculum and the undergraduate Nutrition and Dietetics program in the Monash University Faculty of Medicine, Nursing, and Health Sciences, we tested Australian Aboriginal techniques of memorization for acquisition and recall of novel word lists by first-year medical students (N = 76). We also examined undergraduate student evaluations (N = 49) of the use of the Australian Aboriginal memory technique for classroom study of foundational biomedical knowledge (the tricarboxylic acid cycle) using qualitative and quantitative analytic methods drawing from Bloom's taxonomy for orders of thinking and learning. Acquisition and recall of word lists were assessed without memory training, or after training in either the memory palace technique or the Australian Aboriginal narrative technique. RESULTS: Both types of memory training improved the number of correctly recalled items and reduced the frequency of specific error types relative to untrained performance. The Australian Aboriginal method resulted in approximately a 3-fold greater probability of improvement to accurate recall of the entire word list (odds ratio = 2.82; 95% c.i. = 1.15-6.90), vs. the memory palace technique (odds ratio = 2.03; 95% c.i. = 0.81-5.06) or no training (odds ratio = 1.5; 95% c.i. = 0.54-4.59) among students who did not correctly recall all list items at baseline. Student responses to learning the Australian Aboriginal memory technique in the context of biomedical science education were overwhelmingly favourable, and students found both the training and the technique enjoyable, interesting, and more useful than rote memorization. Our data indicate that this method has genuine utility and efficacy for study of biomedical sciences and in the foundation years of medical training.

Screening for type 2 diabetes in a high-risk population: effects of a negative screening test after 4 years follow-up.

BACKGROUND: A negative diabetes screening test may unintentionally provide reassurance, resulting in reduced incentive to follow a healthy lifestyle. PURPOSE: The purpose of this study is to assess negative test result effects on lifestyle and risk perception at 4 years follow-up. METHODS: Risk perception and changes in smoking, physical activity, body mass index (BMI), and waist circumference were compared between 706 high-risk participants with a negative test result and 706 high-risk participants not offered screening (controls) in a randomized controlled trial of diabetes screening. RESULTS: Negative-screened individuals experienced a small but significant increase in BMI and waist circumference, but there was no significant difference with controls. The negative-screened group had significantly higher perception of risk of developing diabetes (p = 0.009) than controls, but no differences were observed in perceived personal control, worry, and optimistic bias. CONCLUSION: Screening negative for diabetes did not lead to overt long-term changes in lifestyle, despite a high perception of risk of developing diabetes. (ISRCTN75983009.).

Results from a post-launch monitoring survey on consumer purchases of foods with added phytosterols in five European countries.

Phytosterols (plant sterols and stanols), in the form of phytosterol-esters, are used in food products as active ingredients to lower elevated blood low density lipoprotein-cholesterol concentrations. In Europe, plant sterol-esters gained Novel Foods authorisation in 2000. As a requirement of the authorisation, Unilever developed a post-launch monitoring program to monitor the use of products with added phytosterols. This paper reports findings from the 2011 post-launch monitoring survey on consumer purchase behaviour of foods with added phytosterols. 91,000 households in the Netherlands, Belgium, United Kingdom, France and Germany were included. 11,612 purchased foods with added phytosterols, including spreads, salad dressings, milk- and yoghurt-type products. The results show that 71-82% of households purchasing products with added phytosterols were 1-2 person households. These households were also purchasing the majority of the volume sold in each country (75-85%). The average phytosterol intakes per household were 0.35-0.86 g/day; well below the 1.5-3.0 g/day phytosterols needed to achieve a significant blood cholesterol lowering benefit. Post-launch monitoring is an accepted and useful tool to estimate the consumption behaviour amongst different consumer groups. Data show that average phytosterol intakes per household were well below 1g/day, suggesting that overconsumption is unlikely.