Stepping Back and Listening: Staff Experiences of Using a Coaching Approach in an Acute Rehabilitation Ward for Older Adults.

Previous research has highlighted that acute care provision can lead to a loss of confidence, control, and independent functioning in older adult patients. In addition, it is recognized that interactions between patients and health care staff are central to the prevention of functional decline in patients. In this study, we aimed to affect the staff-patient relationship by implementing a coaching intervention in an older adult acute care setting. Here, we report on staff experiences of this coaching approach. Data were collected from 16 members of staff via semi-structured interviews, which were analyzed using thematic analysis. Four themes were identified: Putting a Label on It, Stepping Back and Listening, Identifying the Opportunities, and Working as Team. Our findings show that a coaching approach can be successful in getting staff to reconsider their interactions with patients and to focus on strategies that foster the independence and autonomy of older adult patients.

Doctors with dyslexia: strategies and support.

BACKGROUND: Looking beyond dyslexia as an individual doctor's issue requires adjusting a working environment to better serve the needs of doctors with dyslexia. With an increasing number of doctors disclosing dyslexia at medical school, how can educators best provide this support? Our research looks at the impact of dyslexia on clinical practice and the coping strategies used by doctors to minimise the effect. METHODS: Qualitative data were collected from 14 doctors with dyslexia using semi-structured interviews and by survey. 'In situ' demonstration interviews were conducted in order to understand how dyslexia is managed in the workplace from first-hand experience. Employers and educators who have responsibility for meeting the needs of this group were also consulted. RESULTS: Even in cases of doctors who had a diagnosis, they often did not disclose their dyslexia to their employer. Study participants reported having developed individual ways of coping and devised useful 'workarounds'. Support from employers comes in the form of 'reasonable adjustments', although from our data we cannot be sure that such adjustments contribute to an 'enabling' work environment. Supportive characteristics included the opportunity to shadow others and the time and space to complete paperwork on a busy ward. How can educators best provide support [for doctors with dyslexia]? DISCUSSION: Doctors with dyslexia need to be helped to feel comfortable enough to disclose. Educators need to challenge any negative assumptions that exist as well as promote understanding about the elements that contribute to a positive working environment. As a result of the research there is now practice available for educators to identify evidence-based strategies and resources.

Does experience in general practice influence the clinical thinking of foundation trainees?

The aim of this exploratory study was to capture and identify changes in clinical thinking amongst foundation trainees after a four-month attachment in general practice, and to develop a means of analysing the data collected to inform understanding about how clinical thinking develops and changes for a trainee - the learner - in the context of clinical experience. We use the term 'clinical thinking' consistently throughout our paper to refer to the trainees' general thinking about a case, and do so in the same way as other academics. Through the innovative use of Mind Maps, we have sought to demonstrate whether there was a significant change in the themes and key features contained in maps drawn by foundation year 2 trainees before and after an attachment in general practice, and to locate the nature of the change if present. Being able to identify such change is potentially valuable as it can assist in revealing a trainee's learning needs and shape future learning.

Recovery coaching in an acute older people rehabiliation ward.

Our patient, carer, and staff feedback clearly tells us that elderly patients are frequently disempowered by acute care provision, environments, and attitudes. This debilitates individuals mentally and physically, reducing their independent functioning, and may mean that they require prolonged care or are unfit to return home. We developed the concept of "recovery coaching" to support acute inpatient elderly care rehabilitation. We designed a training intervention to achieve "coaching conversations" between our staff and our patients. Data were collected from 46 participants; 22 in the pre-intervention stage and 24 in the post-intervention stage. For the post-intervention patients, mean scores indicated that there was slightly higher increase in the patient's independence in terms of their Barthel (ADL) scores and that they reported higher feelings of self-efficacy. For this patient group it was also found that more returned home with the same level of care as on their admission, and that fewer patients required residential care placements at discharge. This innovative intervention allowed us to challenge the fundamental basis of "I do it for you" to "I will do it with you", allowing the patient to become an integral partner in their health care.

Benefits of appraisal as perceived by general practitioners.

Appraisal for general practitioners (GPs) has been in place since 2002. We conducted a review of current literature on what benefits GPs perceived appraisal to offer. GPs recognised that appraisal offers the chance to reflect on their personal development, and promotes educational activity. Furthermore, there is a strong perception that appraisal encourages changes in clinical practice and offers additional benefits such as mentorship and motivational support for the doctor. The conclusion we draw is that GPs, and the patients that they treat, should continue to benefit from outputs of medical appraisal after the introduction of medical revalidation.

The application process for general practitioner trainers in United Kingdom deaneries: similarities and differences.

A survey was undertaken of the application and reapplication forms used by all the UK deaneries for general practice (GP) specialty training. The aim of the survey was to identify similarities and differences between deaneries in terms of the content and nature of the information requested, and the relationship of that information to the Postgraduate Medical Education and Training Board's (PMETB) Quality Assurance Framework (QAF). The details requested on the application forms were compared to the guidance set out in Generic Standards for Training, in order to see if they reflected the areas and standards required by the PMETB for the quality assurance of medical education and training. Although many similar areas of information were requested in the application process, great variation was found across some items which were not attributable to regional or contextual differences. The survey also found that the majority of domains of Generic Standards for Training are not well covered in the paper application process. Although deaneries may view their application processes for trainer approval as robust, this paper makes a number of recommendations and argues for the development of a standardised form for the appointment of general practice specialty training (GPST) trainers across the UK, based upon the PMETB QAF.