Usability survey of an inpatient electronic clinical communication platform at a large New Zealand tertiary hospital.

BACKGROUND: Internationally, there is significant published literature indicating low levels of clinical satisfaction with the digital electronic clinical record. Many New Zealand hospitals are currently undergoing a process of digitisation. The aim of the current study was to determine the usability of the inpatient clinical documentation and communication platform known as Cortex approximately one year after full deployment at Christchurch Hospital. METHODS: Te Whatu Ora - Health New Zealand Waitaha Canterbury staff were invited via their work email to complete an online questionnaire. It was comprised of the System Usability Scale (SUS) survey (industry standard mean scores: 50-69 marginal, and ≥70 acceptable) and one additional question about the participant's clinical profession within the organisation. RESULTS: A total of 144 responses were received during the study period. The median SUS score was 75 with an interquartile range (IQR) of 60-87.5. The median IQR SUS scores did not significantly differ among the different occupation groups: 78 (65-90) for doctors; 70 (57.5-82.5) for nurses; and 73 (55.6-84.4) for allied health staff (p=0.268). Additionally, 70 qualitative responses were recorded. Three themes were identified through the analysis of the participants' responses. These were: the need for integration with other electronic systems; implementation issues; and fine-tuning the functionality of Cortex. CONCLUSIONS: The current study revealed good usability of Cortex. The user experience was equivalent among the various professions of the study's participants (doctors, nurses, and allied health staff). The present study provides a useful benchmark for Cortex at a point-of-time, and it sets up potential to periodically repeat this survey to see how new functionality has added to (or detracted from) its usability.

The landscape of research during post-graduate medical training in New Zealand.

Formalised research opportunities offered to junior doctors in Australasia, and specifically New Zealand, are few and far in between. This is especially evident for interns in the first 2 years after graduation. Academic internships are positioned not only to fill this gap but also provide interns with long-lasting skills beyond the confines of academia.

Is it time to relieve junior doctors from "relief rotations"?

Relief junior doctors provide cover for absent colleagues on leave. One of the main advantages of the relief system is the availability of covered leave for junior doctors. However, it also has several drawbacks, including the lack of time-accreditation by Training Colleges. This viewpoint identifies some of the problems with the current relief system in New Zealand and suggests potential solutions to improve the experiences for junior doctors, patients and employers.

From left to right: an unusual presentation of Tolosa-Hunt syndrome with bilateral eye involvement.

Here we discuss a presentation of Tolosa-Hunt syndrome (THS) in a 44-year-old female with new right-eye ptosis, ophthalmoplegia and headache. Four days prior, she had almost identical ptosis and ophthalmoplegia in her left eye, which resolved. Cavernous sinus inflammation and symptom improvement with glucocorticoid treatment indicated THS with bilateral eye involvement, a presentation which may be undervalued by the current THS classification.

The Case for Junior Doctor Academic Internships: A Narrative Review of the Published Literature.

INTRODUCTION: There is a growing concern with the dwindling academic workforce especially in medicine. Academic internships refer to a hybrid internship during which an intern spends a period of time (typically 3-6 months) in academic/research endeavours. These may serve as initial research experience for junior doctors. However, the merits of this programme have not been assessed to date. METHODS: Studies on integrated academic internships by junior doctors (ie, interns) were included in the present review. The identified articles were grouped into themes. For each article, the methodological approach (and subsequent implemented methods) was noted. The articles were also critically appraised for methodological soundness (both at the study-level, and the outcome-level). RESULTS: A total of 1621 publication titles were identified and screened, of which 8 publications were included in the final review. The major themes of the identified publications are: overview of the academic internship programme, evaluation of a programme's experience and outcomes, and other miscellaneous publications. DISCUSSION: The studies to date have only reported on "soft outcomes", but overall, interns and supervisors alike appear to be satisfied with the programme. Whether the programme increases the likelihood of future academic careers is difficult to establish at this juncture. The academic internship posts appear to be competitive, which reflect their popularity among graduating medical students.

Factors Predictive of Medical Student Involvement in Research: Results from a New Zealand Institution.

BACKGROUND: Previous studies have elucidated several benefits of engagement in research by medical students. The aim of the current study was to assess if any factors influenced the student's actual involvement (not mere interest) in scholarly activities during medical school. METHODS: All medical students at the University of Otago were invited via e-mail to complete an online questionnaire. The outcome was a substantial contribution to a research project. The predictors were prior research experience, student's entry route, and planned career type. Multiple regression analysis was undertaken to control for any confounding factors influencing medical students' involvement in research. RESULTS: Valid responses were gathered from 669 students (yielding a response rate of 44.8%). Of those, 254 students (38.3%) had engaged in one or more research activities. Students who engaged in research activities indicated a higher likelihood of future involvement in research but expressed less interest in internal medicine sub-specialties as potential future careers. CONCLUSION: A sizeable proportion of our samples has been involved in the research. Targeting medical students not yet involved in research may necessitate additional curricular and faculty support in order to stimulate their research curiosity.

Intrinsic vs Extrinsic Motivation as Drivers for Early Engagement in Research by Medical Students.

BACKGROUND: A student's motivation is a key factor in their success in undertaking an education endeavour. However, how this relates to involvement in research by medical students is unclear. METHODS: An electronic questionnaire was sent to all medical students at our institution. To ascertain students' motivation to undertake research, they were asked an open-ended question to describe the single major factor that would encourage them to get involved in research as a medical student. A framework of self-determination theory was used to deductively code the responses as intrinsic motivation ("IM"; e.g., interest/passion) or extrinsic motivation ("EM"; e.g. improving CV). The two groups were then contrasted in relation to their research engagement. RESULTS: A total of 348 students were included in the survey, of whom 204 were coded as IM responses, and 144 were coded as EM responses. Students who engaged in extra-curricular research activities were more likely to report an underlying EM (48% vs 36%, p = 0.03). They were also older (23.7 ± 3.5 vs 21.9 ± 3.7, p = 0.005), and more likely to have completed a prior research degree (15% vs 3%, p = 0.01). CONCLUSION: In this study, EM was a bigger influencer on research involvement by medical students than IM. Future studies should explore promoters of IM, and include longitudinal data in order to assess whether EM students continue to be involved in research long-term.

Clinician-scientist training in New Zealand: historical notes and current trends.

Clinician-scientist training most commonly refers to the concomitant undertaking of dual (medical and PhD) degrees by a medical student. While such training is relatively well-established in the US, Canada and many countries in Europe including the UK, uptake in Australasia has been slower and less successful. This brief piece explores this aspect, with some focus on the history of the intercalated programmes in New Zealand.

Understanding of medical students about predatory journals: A comparative study from KSA and New Zealand.

OBJECTIVE: This study examines the extent of understanding of medical students from KSA and New Zealand (NZ) about predatory journals. METHODS: From March to July 2019, self-administered questionnaires were sent to fourth- and fifth-year students of two medical schools in KSA and NZ. Between-group comparisons were carried out using the two-sided Student's t test and the Chi-square test. Statistical significance was determined at a p-value <0.05. RESULTS: A total of 263 students completed the questionnaire (response rate: 59.1 percent KSA; 31 percent NZ). Prior research experience was significantly higher among KSA students (56.6 percent) as compared to NZ students (32.3 percent; p = 0.0006). A significantly higher number of KSA students (75.6 percent) felt that they were under pressure to publish studies during their term at medical school as compared to only 12.3 percent of NZ medical students (p < 0.0001). While one-third of the students in both countries were familiar with 'open-access publishing' (30.8 percent KSA versus 42.2 percent NZ), only a few displayed awareness about 'predatory journals' (9.1 percent KSA versus 7.8 percent NZ; p = 0.7) or 'Beall's list' (2.5 percent KSA versus 0 percent NZ; p = 0.02). A small number of students from both countries had published in predatory journals (26.1 percent [n = 6/23] KSA versus 12.5 percent [n = 1/8] NZ, p = 0.4). A few students had received warnings or advice regarding predatory journals (4.5 percent KSA versus 1.5 percent NZ; p = 0.2). A majority of respondents from both the countries found it hard to identify predatory journals. CONCLUSION: This study identified that the understanding and knowledge of medical students regarding predatory journals is rather poor. This indicates that curricular, extracurricular, and institutional measures to promote awareness about predatory journals are warranted.

Research attitudes, barriers, and prior experience: Experience from interns working in Jeddah, Saudi Arabia.

OBJECTIVES: The aim of this study was to explore research productivity and attitudes by Saudi interns. MATERIALS AND METHODS: Interns from two hospitals in Jeddah, Saudi Arabia were invited to participate in an online survey. RESULTS: Fifty-seven interns responded to the survey. An accurate response rate is not possible because the invitation email reliably reached only a half of all 400 interns. Fifteen interns (26.3%) presented their research findings at a conference, and seven (12.3%) had managed to publish their findings. The main attractions to research were improving prospects of a successful residency/fellowship match (71.7%) and desire to learn more about the research subject (17%). CONCLUSION: Most interns in our sample expressed interest in being involved in research. The driving forces behind such eagerness, however, remain to be explicitly explored-although the majority of the sampled interns cited improved chances for a successful residency/fellowship match as the main reason.

Do medical interns publish findings of compulsory audit or research projects? Five-year experience from a single centre in New Zealand.

INTRODUCTION: There is a paucity of literature on research output of Australasian interns. We have previously shown great interest among interns rotating in our department to publish or present their findings from an audit or research project (ARP). The aim of this study was to examine the output of the intern ARP. METHODS: ARP titles over a five-year period were searched in academic databases. We compared the output rate from our institution to a rate estimated a priori from previously published literature. RESULTS: A total of 186 ARPs were conducted over the study period. Of these, only two were published (one original article and one letter) and one was presented at a national conference. The observed productivity rate was significantly lower than that of the estimated rate (χ2 = 4.49, p = 0.034). CONCLUSION: Despite potential limitations, our study remains the largest study to report on intern research productivity in Australasia. It provides evidence of the need for improvement in and encouragement of research conducted by junior doctors.

Exploring eye movements of Parkinson's disease patients performing the Judgement of line orientation test.

INTRODUCTION: Parkinson's disease (PD) patients are reported to score significantly lower on the Judgement of Line Orientation (JLO) test compared with controls. The traditional method of scoring JLO ignores potentially interesting information on the mechanism of errors made. AIM: The aim of the current study was to analyse the performance of PD patients on the JLO while monitoring eye movements. Employing eye tracking methods while PD participants attempt JLO items may prove valuable in further characterising error-patterns. METHODS: We recruited three groups, each comprising 16 participants: PD participants with normal cognition (PD-N), PD participants with mild cognitive impairment (PD-MCI) and matched controls. RESULTS: The mean correct response rates were high: 93% (±6) for controls, 88% (±12) for PD-N and 87% (±11) for PD-MCI; the difference did not reach statistical significance (p = 0.21). Participants made more errors as they progressed from easy to harder item (r = 0.7; p = 0.02). Using the Ska classification, error types QO1 and QO3 were by far and away the most common. The mean amplitudes of saccadic eye movements were 5.9° (±0.9) for controls, 5.7° (±1.1) for PD-N, and 5.5° (±1.0) for PD-MCI. The differences among the three groups did not reach statistical significance (p = 0.64). As a whole, participant fixation patterns were similar throughout the JLO task. For the reference lines, most fixations were made on the distal ends. Fixations on the test lines, on the other hand, appeared to vary among trials, dependent on whether the response was correct or incorrect. CONCLUSIONS: There were few differences among the study groups in test performance-eye movement associations. However, we gained important insights into oculomotor behaviour during JLO test completion in both healthy controls and PD patients which could reflect the underlying disease state as we hypothesised.

Career outcomes of students of an intercalated MBChB/PhD: experience from New Zealand.

BACKGROUND: Medium- and long-term outcomes of an intercalated medical/PhD degree are less well-characterised for non-North American programmes than North American ones. We report on the career choices and academic accomplishments of MBChB/PhD students at one university 17 years after the programme's introduction. METHODS: A list of all past and current intercalating students at the University of Otago was obtained. Participants were asked for details of their current position, scientific publications and career plans, as well as their opinions on the intercalated programme. RESULTS: A total of 25 students (of whom eight were current students) had enrolled in the intercalated programme between 2001 and 2018. Ten students (40%) were women. The rate of enrolment remained relatively steady through the years at 1.4±1.0 students/year. The rate of completion was high at 88.2% (15/17). The congruence between students' PhD research topic and clinical specialty of interest was 52.4%. Most students (72%) published their research findings in local and international journals. CONCLUSIONS: The programme is considered worthwhile by our students, most of whom continue (at various capacities) in academic work and produce a significant research output, although potentially in a field that is different to their PhD research.

Variations in the patterns of prevalence and therapy in Australasian Parkinson's disease patients of different ethnicities.

Parkinson's disease (PD) is the second most common neurodegenerative disease in the elderly after Alzheimer's disease. It is expected that PD cumulative incidence will increase in the future, as there are far more people surviving into late age than there ever used to be. While most commonly idiopathic, rare forms of PD can be familial/genetic. In addition, socioeconomic, cultural and genetic factors may influence the way in which anti-parkinsonian medications are prescribed, and how patients respond to them. This review aims to highlight the potential impact of genetic variation on the epidemiology and therapeutics of PD, focusing on data from New Zealand and Australia.