Preparedness for practice: the perceptions of graduates of a regional clinical school.

OBJECTIVE: To assess graduates' self-reported preparedness with reference to a range of clinical practice capabilities, including those related to patient-centred care. DESIGN: A retrospective survey of self-reported preparedness for practice, based on a survey developed by the Peninsula Medical School (United Kingdom) and adapted to account for Australian circumstances and to provide more information about patient-centred care-related capabilities. SETTING AND PARTICIPANTS: Launceston Clinical School, a regional clinical school for undergraduate medical students. Medical students who had graduated during 2005-2014 and were contactable by email were invited to participate in the study. MAIN OUTCOME MEASURES: Graduates' self-reported preparedness for practice in 44 practice areas, measured on a 5-point Likert scale. RESULTS: Responses from 135 graduates (50% of invited graduates, 38% of the eligible graduate population) were received. Most graduates felt prepared in 41 of the 44 practice areas; 80% felt at least well prepared in 17 areas. After clustering the 44 areas into six thematic groups, no differences were found between men and women who had graduated in the past 4 years. As male graduates become more experienced (5-10 years after graduation), retrospective perceptions of preparedness in some areas differed from those of more recent graduates; this was not found for female graduates. CONCLUSION: The survey identified strengths and weaknesses in the preparation of doctors for practice. It could be more broadly applied in Australia to obtain longitudinal data for assessing the quality of learning for curriculum planning purposes, and for aligning graduates' needs and expectations with those of the medical training and health care employment sectors.

A "messy ball of wool": a qualitative study of the dimensions of the lived experience of obesity.

BACKGROUND: Obesity is a multi-dimensional condition with causal factors beyond the physiological into the behavioural, dietetic and psychological. Understanding the lived experience of those who are overweight and obese and self-perceived barriers to access and engagement in intervention are imperative to formulating a systemic response to the complex problem of obesity. This study aims to identify the social, psychological and systemic factors impeding engagement with weight-loss behaviour and interventions, and to formulate a framework for responding to these. METHODS: We conducted an exploratory qualitative study using focus groups and interviews with people who have lived experienced of being overweight or obese. Data were analysed using an inductive thematic approach. Following the thematic analysis, further interpretation of the data was achieved by applying the epistemological foundations of the Lifeworld Led Care paradigm, recognising its philosophy of the person and of care based on the individual's experiences. Eight men and 17 women participated. RESULTS: Three overarching themes were identified: Complexity and Battle, Impediments, and Positive Re-orientation. The subthemes of these were found to represent the dimensions of the Lifeworld: Identify, Inter-subjectivity, Mood and Embodiment. Further interpretation of the themed data identified six polarised dichotomies representing the opposing lived dimensions of the obesity experience: Failure Double-Bind; Think-Feel Conflict; Negative-Positive Orientation; Impeding-Facilitating Health Professional; Knowledge as Deficit-Insight; and Internal-External Orientation. CONCLUSION: Obesity manifests as constraints and challenges across six polarised dichotomies, active in the lived experience of obesity. This study provides a unique way of conceptualising and understanding the complex and interacting meanings of the lived experience of obesity through the construction of polarised dichotomies. The polarities signify the oscillating experiences that people with obesity encounter, which may be either helpful or destructive in both their lifeworld experience and their capacity to address obesity towards improved social, psychological and physical outcomes. Understanding the dichotomies allows a reconceptualisation of obesity from a quantification of the individual to a more respectful, humane, compassionate and utilitarian conceptualisation of the experiencing person and the phenomenon itself. Further, these lived polarised dichotomies of obesity present the opportunity for health professionals to reconceptualise obesity in care and interventions.

Tissue donation: what does it mean to families?

CONTEXT: Previous research has described families' responses and experiences with the donation process; however, little attention has been paid to families linked to tissue banks that have no affiliation with hospitals or organ procurement agencies. OBJECTIVE: To assess the impact of approaches made to families who consented to tissue donation with the Donor Tissue Bank of Victoria, Australia, and to examine how this information could be used to improve the existing service. DESIGN: An evaluation questionnaire was developed and consisted of 15 questions. The questionnaire was part of a structured follow-up service and was given only to 339 families who consented to donation. SETTING AND PARTICIPANTS: Families who are approached about tissue donation are contacted within 24 hours of their family member's death. They are coping with the sudden unexpected death of a family member and have little knowledge of tissue donation or the donor tissue bank. MAIN OUTCOME MEASURES: Fifty-eight percent of participants completed the questionnaire. The data were quantitatively and qualitatively examined. RESULTS: The skills and procedures utilized by the transplant coordinators are affirmed by the results, and respondents appear to find contact with the donor tissue bank positive at a terrible time in their lives. Approaches to families must be made sensitively and sufficient information must be given to enable decision making.