Impact of clinical placement sites on general practice as a career preference for Australian medical students.

OBJECTIVE: This study investigates whether General Practice placement experience or locations (urban/metropolitan vs non-metropolitan) promote student interest in pursuing general practice. DESIGN: SurveyMonkey was used in the design of the survey. SETTING: The study was conducted online. PARTICIPANTS: A total of 520 and 705 clinical-year students were surveyed in 2009 and 2019, respectively. The study was conducted online, using SurveyMonkey, and the participants were mostly non-indigenous Australian medical students, between the ages of 18 and 30. INTERVENTIONS: Students were recruited from the General Practice Students' Network membership database to complete the survey online. Chi-squared testing, Pearson's correlation and a multivariate logistic regression analysis were used to investigate the correlation between general practice placements and intention to become a general practice. MAIN OUTCOME MEASURES: The association and causation between general practice placement location, student experience and students' intended career outcomes. RESULTS: In 2009, majority of students rated their general practice experience 'mostly positive' while most metropolitan participants and majority of non-metropolitan placement participants in the 2019 survey responded with 'mostly positive' in 2019. Based on 2009 and 2019 data, general practice placement location had no association with the likelihood of pursuing general practice as a career, while student experience had a stronger positive correlation with the likelihood of pursuing general practice as a career. CONCLUSION: Our study shows that students' overall experience with their general practice placements significantly encourages medical students to pursue the general practice pathway. As such, increasing both metropolitan and non-metropolitan placement experiences can potentially overcome general practice shortage.

Perceptions of Australasian emergency department staff of the impact of alcohol-related presentations.

OBJECTIVES: To survey emergency department (ED) clinical staff about their perceptions of alcohol-related presentations. DESIGN, SETTING AND PARTICIPANTS: A mixed methods online survey of ED clinicians in Australia and New Zealand, conducted from 30 May to 7 July 2014. MAIN OUTCOME MEASURES: The frequency of aggression from alcohol-affected patients or their carers experienced by ED staff; the perceived impact of alcohol-related presentations on ED function, waiting times, other patients and staff. RESULTS: In total, 2002 ED clinical staff completed the survey, including 904 ED nurses (45.2%) and 1016 ED doctors (50.7%). Alcohol-related verbal aggression from patients had been experienced in the past 12 months by 97.9% of respondents, and physical aggression by 92.2%. ED nurses were the group most likely to have felt unsafe because of the behaviour of these patients (92% reported such feelings). Alcohol-related presentations were perceived to negatively or very negatively affect waiting times (noted by 85.5% of respondents), other patients in the waiting room (94.4%), and the care of other patients (88.3%). Alcohol-affected patients were perceived to have a negative or very negative impact on staff workload (94.2%), wellbeing (74.1%) and job satisfaction (80.9%). CONCLUSIONS: Verbal and physical aggression by alcohol-affected patients is commonly experienced by ED clinical staff. This has a negative impact on the care of other patients, as well as on staff wellbeing. Managers of health services must ensure a safe environment for staff and patients. More importantly, a comprehensive public health approach to changing the prevailing culture that tolerates alcohol-induced unacceptable behaviour is required.

The Medical Boomerang: will it come back?

OBJECTIVES: To explore the increasing numbers of emergency medicine (EM) registrars that obtained their primary medical degree from UK or Irish universities, who work in emergency departments (ED) throughout Australia and New Zealand. METHODS: The Victorian Emergency Registrar Study was published at the Australasian College for Emergency Medicine (ACEM) annual scientific meeting in Adelaide in November 2013. As a follow on, ACEM provided the authors with data regarding country of primary degree for international medical graduates (IMG) working as registrars in Australasian EDs. RESULTS: UK and Irish EM registrars make up the largest proportion of IMGs working in Australian and New Zealand EDs. These figures have increased from 34% in 2008 to 45% in 2013. In 2013, there was the highest yearly intake of UK and Irish ED IMG registrars, representing 41% of registrars joining the Australasian EM training programme. Current data show that >25% of all ED registrars working in Australasian EDs studied for their primary medical degree in a university either in Ireland or the UK. CONCLUSIONS: While there have been anecdotal reports of increased outflow of junior EM doctors from the UK and Ireland, we provide quantitative data on the extent of the recent (5-year trend data) emigration of UK/Irish EM trainees to Australia and New Zealand and discuss the impact of this on both the UK/Irish and Australasian health systems.

Survey of alcohol-related presentations to Australasian emergency departments.

OBJECTIVE: To determine the proportion of alcohol-related presentations to emergency departments (EDs) in Australia and New Zealand, at a single time point on a weekend night shift. DESIGN, SETTING AND PARTICIPANTS: A point prevalence survey of ED patients either waiting to be seen or currently being seen conducted at 02:00 local time on 14 December 2013 in 106 EDs in Australia and New Zealand. MAIN OUTCOME MEASURES: The number of ED presentations that were alcohol-related, defined using World Health Organization ICD-10 codes. RESULTS: At the 106 hospitals (92 Australia, 14 New Zealand) that provided data, 395 (14.3%; 95% CI, 13.0%-15.6%) of 2766 patients in EDs at the study time were presenting for alcohol-related reasons; 13.8% (95% CI, 12.5%-15.2%) in Australia and 17.9% (95% CI, 13.9%-22.8%) in New Zealand. The distribution was skewed left, with proportions ranging from 0 to 50% and a median of 12.5%. Nine Australian hospitals and one New Zealand hospital reported that more than a third of their ED patients had alcohol-related presentations; the Northern Territory (38.1%) and Western Australia (21.1%) reported the highest proportions of alcohol-related presentations. CONCLUSIONS: One in seven ED presentations in Australian and New Zealand at this 02:00 snapshot were alcohol-related, with some EDs seeing more than one in three alcohol-related presentations. This confirms that alcohol-related presentations to EDs are currently underreported and makes a strong case for public health initiatives.

Quantifying the proportion of general practice and low-acuity patients in the emergency department.

OBJECTIVE: To accurately estimate the proportion of patients presenting to the emergency department (ED) who may have been suitable to be seen in general practice. DESIGN: Using data sourced from the Emergency Department Information Systems for the calendar 2013s 2009 to 2011 at three major tertiary hospitals in Perth, Western Australia, we compared four methods for calculating general practice-type patients. These were the validated Sprivulis method, the widely used Australasian College for Emergency Medicine method, a discharge diagnosis method developed by the Tasmanian Department of Human and Health Services, and the Australian Institute of Health and Welfare (AIHW) method. MAIN OUTCOME MEASURE: General practice-type patient attendances to EDs, estimated using the four methods. RESULTS: All methods except the AIHW method showed that 10%-12% of patients attending tertiary EDs in Perth may have been suitable for general practice. These attendances comprised 3%-5% of total ED length of stay. The AIHW method produced different results (general practice-type patients accounted for about 25% of attendances, comprising 10%-11% of total ED length of stay). General practice-type patient attendances were not evenly distributed across the week, with proportionally more patients presenting during weekday daytime (08:00-17:00) and proportionally fewer overnight (00:00-08:00). This suggests that it is not a lack of general practitioners that drives patients to the ED, as weekday working hours are the time of greatest GP availability. CONCLUSION: The estimated proportion of general practice-type patients attending the EDs of Perth's major hospitals is 10%-12%, and this accounts for < 5% of the total ED length of stay. The AIHW methodology overestimates the actual proportion of general practice-type patient attendances.

Trajectory to fellowship: an analysis of the current pathway to becoming a psychiatrist.

OBJECTIVE: This study sought to examine the pathway and barriers to attaining The Royal Australian and New Zealand College of Psychiatrists'(RANZCP) Fellowship for those undergoing the current training program, which was implemented in November 2003. This program involved a new training structure, with basic (years 1-3) and advanced (years 4-5) requirements. All formal assessments occur during Basic Training, while either generalist or sub-specialty streams are available during Advanced Training. We assessed 3 years' intake of trainees who had commenced with the current program and have reached the minimum time to attain RANZCP Fellowship. METHODS: Data were extracted from the College's database for all trainees who commenced training between December 2003 and February 2006; we analysed data on assessments, rotations, breaks in training, part-time status, and other items. The key elements evaluated were the time to complete mandatory training requirements and outcomes. CONCLUSIONS: For those attaining RANZCP Fellowship within this cohort, the median Training time was consistent with the structure of the 5-year training program. It was clear that the RANZCP Fellowship Training Program is flexible, because 43% of the trainees studied undertook periods of part-time training and/or breaks in training, plus a range of sub-speciality programs were commenced in the Advanced Training.

Australian medical student expectations of work-life balance as a doctor.

This article was migrated. The article was marked as recommended. Objectives: To explore the perceptions of medical students on achieving good work-life balance after graduation, and their opinions on parenting having an impact on their future careers. Methods: Cross-sectional cohort study of an online survey was distributed to students from all medical schools in Australia through the General Practice Students Network. Main outcome measures: Medical student perceptions on the effects of their future careers on the ability to maintain work-life balance and whether future parenting would impact their careers. Both quantitative and qualitative responses were collected. Results:The majority of survey respondents believed their careers would have a moderate or significant impact on the ability to achieve work-life balance. Thematic analysis revealed medical students perceived medical careers as lacking flexibility, being time-consuming, and potentially detrimental to health. Surveyed students indicated both parenting goals and specialty choice needed to be considered when planning their career. Conclusions: Australian medical students expressed significant concerns about their ability to juggle parenting and achieve work-life balance within the realities of a medical career.

Alcohol-related harm in emergency departments: a prospective, multi-centre study.

BACKGROUND AND AIMS: Emergency department (ED) alcohol-related presentation data are not routinely collected in Australia and New Zealand. It is likely that previous research has underestimated the numbers of patients presenting with alcohol-related conditions. This study aimed to quantify the level of alcohol harm presenting to EDs in Australia and New Zealand [Correction added on 23 Jan 2018, after first online publication: The 'aims' section was missing and is updated in this version]. DESIGN: Multi-centre, prospective study. Patients were screened prospectively for alcohol-related presentations during a 7-day period in December 2014. Part 1 involved screening to determine alcohol-positive ED presentations and data collection of patient demographic and clinical information. Part 2 involved a consent-based survey conducted with patients aged ≥ 14 years to perform Alcohol Use Disorders Identification Test (AUDIT) scores. SETTING: Eight EDs in Australia and New Zealand, representing differing hospital role delineations. PARTICIPANTS: A total of 8652 patients aged ≥ 14 years attended and 8435 (97.5%) were screened. MEASUREMENTS: The main outcome measure was the proportion of patients who had an alcohol-related presentation termed 'alcohol-positive', using pre-defined criteria. It included injuries, intoxication, medical conditions and injuries caused by an alcohol-affected third party. Secondary outcomes included demographic and clinical information, the type of alcohol-related presentations and AUDIT scores. FINDINGS: A total of 801 [9.5%; 95% confidence interval (CI) = 8.9-10.1%] presentations were identified as alcohol-positive, ranging between 4.9 and 15.2% throughout sites. Compared with alcohol-negative patients, alcohol-positive patients were more likely to be male [odds ratio (OR) = 1.90, 95% CI = 1.63-2.21], younger (median age 37 versus 46 years, P < 0.0001), arrive by ambulance (OR = 1.94, 95% CI = 1.68-2.25) or police/correctional vehicle (OR = 4.56, 95% CI = 3.05-6.81) and require immediate treatment (OR = 3.20, 95% CI = 2.03-05.06). The median AUDIT score was 16 (interquartile range = 10-24). CONCLUSIONS: Almost one in 10 presentations to emergency departments in Australia and New Zealand are alcohol related.

Retinal light damage: structural and functional effects of the antioxidant glutathione peroxidase-1.

PURPOSE: The role of the antioxidant enzyme glutathione peroxidase-1 (GPx1) in protecting the retina against photo-oxidative damage was investigated in GPx1-deficient and wild-type mice. METHOD: Albino GPx1-deficient and age-matched wild-type mice were examined. Baseline electroretinograms (ERGs) were recorded. Thereafter, mice were exposed to intense light for 12 hours. After a 24-hour recovery in darkness, post-light-insult ERGs were recorded and compared with baseline. Structural effects of light insult were evaluated by retinal histology. Antioxidant expression was investigated by quantitative reverse transcription-PCR (qRT-PCR). RESULTS: Light insult significantly affected ERG responses, with reduced a- and b-wave amplitudes. Structurally, photoreceptor layers were predominantly affected. As expected, GPx1 expression was negligible in GPx1-deficient mice but was upregulated in wild-type mice in response to light insult. Similarly, hemeoxygenase-1 and thioredoxin-1 expression increased significantly in wild-type retinas after light exposure. Catalase, GPx isoforms (GPx2 to -4), peroxiredoxin-6, glutaredoxin-1, and thioredoxin-2 expression was unaffected by GPx1 deficiency and light insult, whereas significant increases in glutaredoxin-2 occurred in non-light-exposed (baseline) GPx1-deficient retinas. Compared with baseline wild-type retinas, lipid peroxidation (TBARS assay), an indicator of oxidative stress, was elevated in baseline GPx1-deficient retinas. Unexpectedly, the light insult induced diminution of retinal function, in terms of ERG amplitude, and structural damage was significantly greater in wild-type than in with GPx1-deficient retinas. CONCLUSIONS: The data showing increased oxidative damage in baseline GPx-deficient retina give rise to the hypothesis that increased oxidative stress provides a "preconditioning" environment in which protective mechanisms paradoxically render GPx1-deficient retinas less vulnerable to light-induced oxidative damage. This study identified glutaredoxin-2 as a potential candidate.

The Emergency Medicine Events Register: An analysis of the first 150 incidents entered into a novel, online incident reporting registry.

OBJECTIVE: Incident reporting systems are critical to understanding adverse events, in order to create preventative and corrective strategies. There are very few systems dedicated to Emergency Medicine with published results. All EDs in Australia and New Zealand were contacted to encourage the use of an Emergency Medicine - specific online reporting system called the Emergency Medicine Events Register (EMER). METHODS: We conducted an analysis of the first 150 incidents entered into EMER. EMER captures Emergency-medicine-specific details including triage score, clinical presentation, outcome, contributing factors, mitigating factors, other specialities involved and patient journey stage. These details were analysed by an expert panel. RESULTS: Over the first 26 months, 150 incidents were reported into EMER. The most common categories reported, in order, were diagnostic error, procedural complication and investigation errors. Most incidents contained more than one category of error. The most common stage of the patient's journey in which an incident was detected was after discharge from the ED. CONCLUSION: A focus on correct diagnosis, procedure performance and investigation interpretation may reduce errors in the ED. The ability to learn from incidents and make system changes to enhance patient safety in healthcare organisations is an inherent part of providing a proactive, quality culture.

Development of a productive research culture in emergency medicine: Report of the outcomes of a research forum.

In recent years, the Australasian College for Emergency Medicine (ACEM) has increasingly focused on the need for high-quality research in emergency medicine (EM). One important initiative was the establishment of the ACEM Foundation, which among other responsibilities, is required to support clinical research through the provision of research funding and other measures. In February 2015, the Foundation held a Research Forum that was attended by the leading EM researchers from Australasia. The Forum aimed to determine how a productive research culture could be developed within the ACEM. Nine key objectives were determined including that research should be a core business of the ACEM and a core activity of the EM workforce, and that EM research should be sustainable and adequately supported. This report describes the background and conduct of the Forum, its recommendations and the way in which they could be implemented.

Public health in Australasian emergency departments: Attitudes, barriers and current practices.

OBJECTIVE: To understand the attitudes of consultant emergency medicine physicians and advanced trainees and the perceived barriers to public health interventions in Australasian EDs. METHODS: This was a voluntary cross-sectional, mixed-methods online survey of consultant emergency physicians and advanced trainees of the ACEM, conducted between December 2011 and March 2012. RESULTS: Eight hundred and fifty-six ACEM members responded to the survey - a response rate of 33%. A similar number of consultants (70%) and trainees (75%) believed public health initiatives should be provided in the ED. Barriers identified by a similar majority of consultants and trainees to the implementation of public health interventions in EDs included dedicated time available for staff to be involved; available public health resources; available funding; clinical staff skills and expertise in public health; and the availability of staff training. CONCLUSIONS: Public health and health promotion are perceived by the majority of emergency medicine physicians as important in emergency medicine; however, substantial barriers exists to their implementation. Development of an evidence-based approach to public health interventions, which are effective and feasible in the ED environment, will facilitate a more comprehensive approach to public health initiatives in emergency medicine.

Piloting an online incident reporting system in Australasian emergency medicine.

BACKGROUND: Medical-specific incident reporting systems are critical to understanding error in healthcare but underreporting by doctors reduces their value. OBJECTIVE: We conducted a pilot study of the implementation of an online ED-specific incident reporting system in Australasian hospitals and evaluated its use. METHODS: The reporting system was based on the literature and input of experts. Thirty-one hospital EDs were approached to pilot the Emergency Medicine Events Register (EMER). The pilot evaluated: website usage and analytics, reporting behaviours and rates, the quality of information collected in EMER. Semi-structured interviews of three site champions responsible for implementing EMER were conducted. RESULTS: Seventeen EDs expressed interest; however, due to delays and other barriers reporting only occurred at three sites. Over 354 days, the website received 362 unique visitors and 77 incidents. The median time to report was 4.6 min. The reporting rate was 0.07 reports per doctor month, suggesting a reporting rate of 0.08% of ED presentations. Data quality, as measured by the number of completed non-mandatory fields and ability to classify incidents, was very high. The interviews identified enablers (the EMER system, site champions) and barriers (chiefly the context of EM) to EMER uptake. CONCLUSIONS: Collecting patient safety information by frontline doctors is essential to actively engage the profession in patent safety. Although the EMER system allowed easy online reporting of high quality incident data by doctors, site recruitment and system uptake proved difficult. System use by ED doctors requires dedicated and conscious effort from the profession.