A systematic review of stakeholder views of selection methods for medical schools admission.

BACKGROUND: The purpose of this paper is to systematically review the literature with respect to stakeholder views of selection methods for medical school admissions. METHODS: An electronic search of nine databases was conducted between January 2000-July 2014. Two reviewers independently assessed all titles (n = 1017) and retained abstracts (n = 233) for relevance. Methodological quality of quantitative papers was assessed using the MERSQI instrument. The overall quality of evidence in this field was low. Evidence was synthesised in a narrative review. RESULTS: Applicants support interviews, and multiple mini interviews (MMIs). There is emerging evidence that situational judgement tests (SJTs) and selection centres (SCs) are also well regarded, but aptitude tests less so. Selectors endorse the use of interviews in general and in particular MMIs judging them to be fair, relevant and appropriate, with emerging evidence of similarly positive reactions to SCs. Aptitude tests and academic records were valued in decisions of whom to call to interview. Medical students prefer interviews based selection to cognitive aptitude tests. They are unconvinced about the transparency and veracity of written applications. Perceptions of organisational justice, which describe views of fairness in organisational processes, appear to be highly influential on stakeholders' views of the acceptability of selection methods. In particular procedural justice (perceived fairness of selection tools in terms of job relevance and characteristics of the test) and distributive justice (perceived fairness of selection outcomes in terms of equal opportunity and equity), appear to be important considerations when deciding on acceptability of selection methods. There were significant gaps with respect to both key stakeholder groups and the range of selection tools assessed. CONCLUSIONS: Notwithstanding the observed limitations in the quality of research in this field, there appears to be broad concordance of views on the various selection methods, across the diverse stakeholders groups. This review highlights the need for better standards, more appropriate methodologies and for broadening the scope of stakeholder research.

Correction to: A systematic review of stakeholder views of selection methods for medical schools admission.

Following publication of the original article [1], the author report typographical errors in the.

Medical Student and General Practitioner Perceptions of Challenges in General Practice in Ireland.

In Ireland, there is a critical shortage in the supply of general practitioners that is projected to worsen. One possible response is to attempt to increase medical student interest in pursuing a career in general practice. Our study aimed to describe the challenges that medical students and general practitioners perceive in the field of general practice. A cross-sectional online survey of 96 medical students (10.5% response rate) enrolled at the National University of Ireland, Galway and 35 general practitioners (24.6% response rate) who attended the Vasco da Gama Movement (VdGM) Forum in February 2015. VdGM is the WONCA Europe Network for new and future general practitioner. The most commonly perceived challenges included remuneration, stress, access to imaging, respect from fellow medical professionals, treating the ageing population, and complexity of patients. These challenges were also generally rated as of high priority. There was large congruence between students and practitioners as to the challenges and what priority they represented. Of medical student participants, 18% indicated that general practice was their career of choice. Medical students and general practitioner have identified several challenges in the Irish general practice setting. Addressing these concerns is crucial to attract and retain future general practitioners.

A Survey of GPs Awareness and Use of Risk Assessment Tools and Cardiovascular Disease Prevention Guidelines.

Cardiovascular disease (CVD) is the leading cause of death worldwide. This study aimed to benchmark awareness and use of CVD risk assessment (RA) tools and prevention guidelines in Irish general practice. 493 (18%) Irish general practitioners (GPs) were invited to participate in a cross-sectional study in 2011. 213 (43%) GPs responded with most being male (n = 128, 58.2%) and aged ≥ 45 years (n = 124, 56.8%). While 197 (92.5%) GPs were aware of at least one RA tool, only 69 (32.4%) GPs reported frequent use. 187 (87.8%) GPs were aware of one or more CVD prevention guidelines with 115 (54.0%) GPs reporting frequent use of at least one guideline. No age or gender difference observed. Barriers to implementation of CVD prevention guidelines were lack of remuneration, too many CVD guidelines and time constraints. Most Irish GPs were aware of RA tools and CVD prevention guidelines with half reporting frequent use of guidelines.

Can Multiple Mini Interviews work in an Irish setting? A feasibility study.

Multiple Mini Interview (MMI) is a new selection tool for medical school applicants. Developed at McMaster University in 2004 it comprises a series of interview stations designed to measure performance across a range of competencies including communication skills, team work, and ethical reasoning. In September 2012, 109 First Year Medical students underwent the MMI. It consisted of 10 stations. The median total score, out of 150, was 100 (min 63, max 129). Cronbach Alphas for the 10 individual stations range from 0.74 to 0.80. Overall Cronbach Alpha of MMI items was 0.78. Staff and student feedback was positive. The outline cost per student was estimated at Euro 145. This study demonstrates that it is feasible to hold a MMI with acceptable levels of reliability and stakeholder approval in an Irish setting. Further work is ongoing to establish the concurrent and predictive validity of MMI in this cohort of medica students.

Patients' views about the use of their personal information from general practice medical records in health research: a qualitative study in Ireland.

BACKGROUND: National policies are being developed, which may limit access to patients' records for health research. This could reduce the ability of health research to benefit society as a whole. It is important to develop an in-depth understanding of people's views across demographic groups to inform such policy development. Aims. To explore patients' views about the use of their general practice records in health research with attention to gender and age. Design of study. Qualitative study using focus groups. SETTING: Six General Practices in the west of Ireland. METHOD: Focus Group interviews with 35 people who were patients at the practices. RESULTS: Overall, participants were positively inclined towards the idea of information from their records (anonymous and identifiable) being used in research for the 'greater good' although there were some concerns about personal information being 'leaked'. Males emphasized risks in relation to employment and finances, whereas females emphasized risks in relation to social discomfort and embarrassment. Participants were supportive of consent models that enable patients to give prior ongoing consent for specific agreed 'levels' of data use, affording patients self-determination without the need for consent request on study-by-study basis. CONCLUSION: Overall male and female patients of different ages are supportive of the use of their general practice records in health research and of general practitioners as data protectors.

A national house-staff audit of medical prophylaxis in medical patients for the PREVENTion of Venous ThromboEmbolism (PREVENT-VTE).

We established a national audit to assess the thromboprophylaxis rate for venous thromoembolism (VTE) in at risk medical patients in acute hospitals in the Republic of Ireland and to determine whether the use of stickers to alert physicians regarding thromboprophylaxis would double the rate prophylaxis in a follow-up audit. 651 acute medical admission patients in the first audit and 524 in the second re-audit were recruited. The mean age was 66.5 yrs with similar numbers of male and female patients and 265 (22.6%) patients were active smokers. The first and second audits identified 549 (84%) and 487 (93%) of patients at-risk for VTE respectively. Of the at-risk patients, 163 (29.7%) and 132 (27.1%) received LMWH in the first and second audit respectively. Mechanical thromboprophylaxis was instigated in 75 (13.6%) patients in the first and 86 (17.7%) patients in the second audit. The placement of stickers in patient charts didn't produce a significant increase in the number of at risk patients treated in the second audit. There is unacceptably low adherence to the ACCP guidelines in Ireland and more complex intervention than chart reminders are required to improve compliance.

Undertaking a face-to-face objective structured clinical examination for medical students during the COVID-19 pandemic.

INTRODUCTION AND AIMS: Objective structured clinical examinations (OSCEs) play a pivotal role in medical education assessment. The Advanced Clinical Skills (ACS) OSCE examines clinical skills in psychiatry, general practice, obstetrics and gynaecology and paediatrics. This study examined if the 2020 ACS OSCE for fourth year medical students attending the National University of Ireland, Galway, was associated with any significant result differences compared to the equivalent 2019 OSCE. Additionally, we assessed students' satisfaction and explored any organisational difficulties in conducting a face-to-face OSCE during the COVID-19 pandemic. MATERIALS AND METHODS: This study compared anonymised data between the 2019 and 2020 ACS OSCEs and analysed anonymised student feedback pertaining to the modified 2020 OSCE. RESULTS: The mean total ACS OSCE result achieved in 2020 was statistically higher compared to the 2019 OSCE [62.95% (SD = 6.21) v. 59.35% (SD = 5.54), t = 6.092, p < 0.01], with higher marks noted in psychiatry (p = 0.001), paediatrics (p = 0.001) and general practice (p < 0.001) with more students attaining honours grades (χ2 = 27.257, df = 3, p < 0.001). No difference in failure rates were found. Students reported feeling safe performing the 2020 OSCE (89.2%), but some expressed face-mask wearing impeded their communication skills (47.8%). CONCLUSION: This study demonstrates that conducting a face-to-face OSCE during the pandemic is feasible and associated with positive student feedback. Exam validity has been demonstrated as there was no difference in the overall pass rate.

Current management of adults receiving oral anti-cancer medications: A scoping review.

PURPOSE: Oral anti-cancer medication (OAM) has revolutionised oncology care. Due to their potential toxicities and associated safety challenges ongoing assessment and monitoring is essential; currently generally performed in acute care settings. Internationally there exists a transformative vision to shift patient care from acute to primary care. A nurse-led integrated model of care could be developed for OAM patient management in primary care. The aim of this study was to examine international literature regarding current clinical management practices for assessment and monitoring of patients receiving OAM. METHODS: Following PRISMA-ScR guidelines, databases MEDLINE, CINAHL and Web of Science were searched for English studies published between 2010 and 2020 using keywords: assessment, cancer, care, management, oral anticancer medications. Articles were screened and assessed for eligibility. From eligible studies, data were extracted to summarize, collate and make a narrative account of the findings. RESULTS: 2261 papers were reviewed, 14 met inclusion criteria. Three phases of management are reported: 1. Patient treatment plan development; 2. Patient education; 3. Patient monitoring. Within these phases seven specific stages of care were identified broadly representing the patient's journey: (1) treatment decision, (2) prescribing of OAM, (3) OAM dispensing and administration, (4) maximising patient safety (5) ongoing patient assessment (6) patient support (7) communication with other health-care professionals. CONCLUSIONS: Despite a paucity of international literature, a dedicated OAM clinic was endorsed as a means to achieve improved care. Nurses and pharmacists were identified as being of particular importance especially in education and ongoing management of patients receiving OAMs.

Chronic kidney disease in general practice: prevalence, diagnosis, and standards of care.

There is little prevalence data for chronic kidney disease (CKD) in Ireland and it has been suggested that rates of diagnosis of CKD in primary care are low. The aim of this cross sectional study was to examine the prevalence, diagnosis and standards of care for CKD. All patient records in three general practices in the West of Ireland were reviewed. In 2602 patients > 50 years in the community, 435 (16.7%) had chronic kidney disease defined as eGFR <60 ml/min/1.73 m2. Of these 435 individuals, only 58 (13.3%) had a diagnosis of CKD documented in their patient record. Among all patients with an eGFR <60 ml/min/1.73 m2, those with a documented diagnosis of CKD were significantly more likely to be prescribed an ACE/ARB and a lipid-lowering agent and were more likely to have had an ACR/PCR checked in the previous twelve months. Blood pressure was being appropriately monitored in the majority of patients but irrespective of eGFR level or a documented diagnosis of CKD, less than a fifth of patients had achieved a target of <130/80 mmHg. CKD is common in primary care but remains largely undiagnosed and blood pressure control remains suboptimal. A key step in improving care appears to be documenting the diagnosis which in turn appears to lead to improved standards of care and risk factor management.

Attitudes of general practitioners to prehospital thrombolysis.

The aim of the study was to investigate attitudes of rural Irish General Practitioners (GPs) to prehospital thrombolysis. Postal questionnaires were sent to all General Medical Service (GMS) GPs in the former Western and North Western Health Board regions of Ireland, whose practices were 20km or greater from the nearest acute hospital with a coronary care unit. The response rate was 61% (117/191). 95% were convinced of the benefits of thrombolytic treatment in acute myocardial infarction. 92%/ believed that there were additional benefits of thrombolysing in the community at the earliest opportunity. 89% were not willing to use prehospital thrombolysis without further training. The study demonstrated that the majority of rural Irish GPs are convinced of the benefits of prehospital thrombolysis and are willing to administer it. The need for further training on prehospital thrombolysis is a key issue that must be addressed before rural Irish GPs are willing to provide more widespread prehospital thrombolysis.

A survey of asylum seekers' general practice service utilisation and morbidity patterns.

To compare Irish asylum seekers to other General Medical Scheme (GMS) patients possessing Irish citizenship in terms of their utilisation of GP services, morbidity patterns and consultation outcomes. A retrospective 1 year study on patient records in two Galway City practices was performed. All asylum seekers who were patients of the two practices were compared with two controls each from a population of GMS patients with Irish citizenship matched for age, sex, and GMS status. Demographic information was recorded. For each consultation over the 12 months the diagnosis using the ICPC coding system' and consultation outcomes were recorded. Data was collected on 171 asylum seekers and 342 Irish citizens. The majority of asylum seekers registered in the two practices were from Nigeria (43.9%). The age of cases ranged from 1 month to 60 years of age with a median of 26. 45.8% were female and 54% male. The mean number of visits per asylum seeker per year was 5.16 (SD 3.12) whereas the mean for Irish Citizens was 2.31 (SD 2.33) (p = 0.0001). Asylum seekers had a significantly higher likelihood of being assigned diagnoses in the disease systems of psychiatry, dermatology, neurology, muscuioskeletal disease, urology, respiratory, ENT, Obstetrics and Gynaecology and gastroenterology. Asylum seekers were five times more likely to be diagnosed with psychiatric illness than Irish citizens. Specifically they had a significantly higher chance of being diagnosed with anxiety (odds ratio = 3.17 [95% CI 1.1,8.68]). Overall, the frequency of prescription as a consultation outcome was higher for asylum seekers. Asylum seekers were prescribed more antibiotics and psychiatric medications but Irish GMS had higher prescription rates for drugs outside of these categories. Referral rates were higher in the asylum seeker group. Asylum seekers attended the GP more frequently than their Irish counterparts. They were more likely to be diagnosed with psychological problems than the Irish. Studies have shown a strong link between psychological illness and being a "frequent attender" in general practice. This could explain the higher than average frequency of attendance in this group. They were more likely to be prescribed antibiotics and psychiatric medications. This study provides the first quantitative data to inform debate regarding the appropriate supply of resources to Irish practices with significant numbers of asylum seekers.

The Lifeways Cross-Generation Study: design, recruitment and data management considerations.

The Lifeways Cross-Generation Cohort Study was first established in 2001 and is a unique longitudinal database in Ireland, with currently over three and a half thousand family participants derived from 1124 mothers recruited initially during pregnancy, mainly during 2002. The database comprises a) baseline self-reported health data for all mothers, a third of fathers and at least one grandparent b) clinical hospital data at recruitment, c) three year follow-up data from the families' General Practitioners, and d) linkage to hospital and vaccination databases. Data collection for the five-year follow-up with parents is underway, continuing through 2007. Because there is at present no single national/regional health information system in Ireland, original data instruments were designed to capture data directly from family members and through their hospitals and healthcare providers. A system of relational databases was designed to coordinate data capture for a complex array of study instruments and to facilitate tracking of family members at different time points.

Socio-demographic, lifestyle and cross-generation predictors of self-rated health in mothers during pregnancy.

The Lifeways Cross-generation study was established to assess the influence of socio-economic and familial characteristics on the health status and early development of children. Between October 2001 and June 2002, 1124 women were recruited to the Lifeways study at booking or first visit to maternity hospital. Lifeways mothers were 29.4 (SD 5.9) years old at recruitment, two-thirds from greater Dublin area, 17.9% held a General Medical Services (GMS) card, 64.3% were married and 40.8% were third level educated. At uni-variate level, GMS eligibility, own and parents' education and marital status all predicted mother's self rated health during pregnancy, whilst in the final multivariate logistic regression model, GMS status, household-adjusted income, marital status and grand-maternal education were each independently predictors. The Lifeways cohort confirms the importance of social position in predicting health in pregnant Irish women.

The risk factor profile of grandparents.

In the Lifeways Cross Generation Cohort Study, mothers were asked to recruit at least one of 4 potential living grandparents to the study, and 1177 grandparents became active participants who either completed a health status questionnaire only (n = 707), or subsequently underwent a cardiovascular risk assessment examination at home (n = 958). Mean age of grandfathers at baseline was 61.5 years (SD 10.3), of grandmothers 59.2 years (SD 9.1), with a range of 40-83 years, 21% of grandmothers and 16% of grandfathers were third level educated. Risk factor profile of grandparents tended to be more adverse than the general population as assessed by the standard cardiovascular risk factor SCORE. Grandparents' socio-demographic characteristics were similar, whether maternal or paternal in origin. Predictors of positive self-rated health were non smoking (OR 1.5, p = 0.06) and non GMS eligibility (OR 1.99, p < 0.001). At four year follow-up, complete general practice data were available for 285 of 488 respondents with full recruitment data (58.4%). Increased GP utilisation pattern was predicted by baseline morbidity characteristics, though heavier male drinkers were less likely to attend.

Mothers' dietary patterns during pregnancy and risk of asthma symptoms in children at 3 years.

There is increasing evidence that dietary factors in early life play a role in the aetiology of childhood asthma. Our objective in this analysis was to assess whether maternal dietary patterns during pregnancy, as measured by a validated food frequency questionnaire, influenced general practitioner diagnosis of asthma by the age of 3 years in the Life-ways cohort of children. General Practice follow-up records were available for 631 of 1001 singleton children, twins having been excluded (63% follow-up rate). Overall 10.4% of children had diagnosed asthma, a prevalence rate comparable with other studies. In logistic regression models, based on quartiles of intake, which adjusted for maternal lifestyle and socio-economic circumstances, relatively higher maternal fruit and vegetable intake and oily fish consumption were associated with lower risk of children developing asthma, whilst those with relatively higher spreadable fat intake had a higher risk of asthma. These findings warrant further investigation as they imply an important role for maternal diet in childhood asthma, though the confounding effect of other social and lifestyle factors should be assessed as the children get older.

Perceived and reported access to the general practitioner: an international comparison of universal access and mixed private/public systems.

Timely and convenient access to primary healthcare is essential for the health of the population as delays can incur additional health and financial costs. Access to health care is under increasing scrutiny as part of the drive to contain escalating costs, while attempting to maintain equity in service provision. The objective was to compare primary care services in Republic of Ireland and Northern Ireland, and to report on perceived and reported access to GP services in universal access and mixed private/public systems. A questionnaire study was performed in Northern Ireland (NI) and the Republic of Ireland (ROI). Patients of 20 practices in the ROI and NI were contacted (n = 22,796). Main outcome measures were overall satisfaction and the access to GP services. Individual responses and scale scores were derived using the General Practice Assessment Questionnaire (G-PAQ). The response rate was 52% (n = 11,870). Overall satisfaction with GP practices was higher in ROI than in NI (84.2% and 80.9% respectively). Access scores were higher in ROI than in NI (69.2% and 57.0% respectively) Less than 1 in 10 patients in ROI waited two or more working days to see a doctor of choice (8.1%) compared to almost half (45.0%) in NI. In NI overall satisfaction decreased as practice size increased; 82.8%, 80.4%, and 75.8%. In both systems, in large practices, accessibility is reduced when compared to smaller practices. The faster access to GP services in ROI may be due to the deterrent effect of the consultation charge freeing up services although, as it is the poorest and sickest who are deterred by the charge this improved accessibility may come at a significant cost in terms of equity. The underlying concern for policy makers centres around provision of equitable services.

Dietary habits of pregnant women in Ireland.

This analysis of the Lifeways Cohort study mothers during pregnancy (n = 1124), utilises information from a standard food frequency questionnaire completed at baseline recruitment during early pregnancy. We demonstrate that 76% of women achieved recommended intakes of 5 plus portions of fruit and vegetables daily, though this is strongly socially patterned, inversely associated with age and positively associated with level of education. Achievement of the other recommended shelf intakes of the Food Pyramid is much lower, ranging from 12% achieving the recommended sparing intake of foods high in fat, salt or sugar, to 45% consuming the recommended 3 portions per day of meat and poultry. General medical services eligible respondents are generally less likely to achieve recommended intakes. While 61% of women under 25 years old stopped drinking during pregnancy, this dropped to 38% of expectant mothers over 35 years. Less than half (45%) of those (n = 860) who responded specifically to the question reported peri-conceptual folate supplement intake, again strongly socially patterned. These findings both provide important prevalence data and highlight the need for more concerted and supportive health promotion interventions during pregnancy.