Exploring beliefs of the four major ethnic groups in Melbourne regarding healthcare and treatment.

OBJECTIVES: To explore and compare beliefs about healthcare and treatment of four ethnic groups attending a Melbourne emergency department (ED), and the corresponding perceptions held by emergency clinicians. METHOD: Prospective survey of ED doctors and patients from Greek, Italian, Vietnamese and Anglo-Saxon backgrounds. RESULTS: Vietnamese patients were least likely to believe their ethnic group received the best available care but less likely to believe in the existence of ethnic healthcare disparities. They were most likely to have an ethnically concordant GP and preferred most strongly to raise sensitive issues with an ethnically concordant doctor. Anglo-Saxon patients placed less importance on family support and older Anglo-Saxons were less likely than other groups to turn to God for comfort. Doctors perceived the existence of ethnic healthcare disparity, which was not perceived by the ethnic groups themselves. They underestimated the extent of patient-perceived disease control, external supports for coping, or use of complementary practitioners. Doctors overestimated patient perceived importance of doctor-patient ethnic concordance for Anglo-Saxons but underestimated the importance this has for Vietnamese patients. They also underestimated importance of clinician-demonstrated cultural understanding. CONCLUSIONS: Beliefs about healthcare and treatment differ across the four major ethnic groups attending a Melbourne ED. Doctors' misperceptions of patients' beliefs suggest that cultural competence amongst ED doctors could be improved.

Verbal dyspnoea score predicts emergency department departure status in patients with shortness of breath.

OBJECTIVES: We examined whether a previously validated verbal dyspnoea rating scale, and/or other demographic and clinical parameters, could predict ED departure status, among ED patients presenting with shortness of breath. METHODS: In this prospective observational study, a convenience sample of patients presenting to an inner urban adult tertiary hospital ED with shortness of breath were assessed at triage using objective and subjective breathlessness parameters. These included respiratory rate, oxygen saturation, heart rate, systolic blood pressure and verbal dyspnoea scores. A verbal dyspnoea score for worst dyspnoea during the current episode and basic demographic and presentation characteristics were also collected. These variables were assessed as predictors of ED departure status (inpatient admission or ED discharge) using logistic regression. RESULTS: From a sample of 253 participants, verbal dyspnoea scores > or =8 predicted inpatient admission 89% specificity (95% confidence interval [CI] 82.1-93.4), and scores < or =3 predicted discharge with 95% specificity (95% CI 89.5-98.0). For patients with shortness of breath as the primary complaint, the combination of verbal dyspnoea score > or =6, heart rate > or =94 bpm at triage and ambulance arrival predicted admission with 90% sensitivity (95% CI 82-95%) and 84% specificity (95% CI 73-92%). These same variables predicted admission for all patients with 84% sensitivity (95% CI 75.8-89.2) and 79% specificity (95% CI 71.5-85.5). CONCLUSION: Verbal dyspnoea score, alone and in combination with heart rate and arrival transport, can accurately predict admission. Once validated they might be useful in assessing, prioritizing and making rapid site of care decisions for breathless patients presenting to the ED.

Health smart cards: differing perceptions of emergency department patients and staff.

An analytical, cross-sectional survey of 270 emergency department patients and 92 staff undertaken in three tertiary referral hospital emergency departments was completed to compare the perceptions of patients and staff regarding the use of health smart cards containing patient medical records. The study recorded data on a range of health smart card issues including awareness, privacy, confidentiality, security, advantages and disadvantages, and willingness to use. A significantly higher proportion of staff had heard of the card. The perceived disadvantages reported by patients and staff were, overall, significantly different, with the staff reporting more disadvantages. A significantly higher proportion of patients believed that they should choose what information is on the card and who should have access to the information. Patients were more conservative regarding what information should be included, but staff were more conservative regarding who should have access to the information. Significantly fewer staff believed that patients could reliably handle the cards. Overall, however, the cards were considered acceptable and useful, and their introduction would be supported.

Australasian emergency physicians: A learning and educational needs analysis. Part six: differences in confidence, exposure to learning and expressed learning needs by subgroups of Australasian emergency physicians.

OBJECTIVE: To determine differences in the confidence and learning needs between subgroups of Fellows of the Australasian College for Emergency Medicine (FACEM), according to sex, type of hospital of principal employment, region of practice in Australasia, year of obtaining the fellowship and percentage of hours worked clinically. METHOD: Mailed survey of all FACEM with multiple Likert scale options. RESULTS: Male emergency physicians (EP) more often expressed confidence in 14 of 58 tasks, but female EP more often expressed a strong desire for continuing professional development (CPD) in 8. EP working in private hospitals were more likely to find lack of conference in their contracts a barrier to participation in CPD (28% [CI 14.1-47.8]vs 7.3% [CI 5.2-10.1]; P = 0.003). EP obtaining their fellowship before 1990 were more confident in 13 of 25 non-clinical tasks than others but had similar confidence in clinical skills. Although EP who spent 30% or less on clinical work expressed confidence more frequently in a range of non-clinical skills, they were less confident for paediatric emergencies, central lines, orthopaedics and tube thoracostomy. There were few variations between Australian states and territories and New Zealand in confidence of EP. EP in regional and rural centres nominated geographical factors (31.3% [CI 21.2-43.4]vs 17.2% [CI 13.9-21.3]; P = 0.012), other colleagues being at the same conference (46.9% [CI 35.2-58.9]vs 28.3% [CI 24.2-32.9]; P = 0.005) and inability to use their conference leave (48.4% [CI 36.6-60.4]vs 33.1% [CI 28.7-37.8]; P = 0.024) as significant barriers more frequently than their city colleagues. CONCLUSION: These findings might assist planning CPD for EP.

Triage presenting complaint descriptions bias emergency department waiting times.

OBJECTIVES: The authors aimed to determine whether certain emergency department (ED) triage "presenting complaint" descriptions are associated with shorter or longer waiting times, when compared with matched controls. METHODS: This was a retrospective, analytical study in three tertiary referral EDs. Data relating to adult patients with Australasian National Triage Scale (NTS) Category 3-5 complaints, who presented over 1 year, were accessed. A pilot study of 25 emergency physicians (EPs) identified five most liked and five most disliked presenting complaints. For each liked or disliked complaint, "cases" were identified using key words and phrases in the triage presentation description. For each case, the previous presentation at that institution with the same NTS category was used as a "control." Cases and controls were compared for waiting time and proportions seen within the Australasian College for Emergency Medicine (ACEM)-recommended waiting times. RESULTS: Data on 28,566 case-control pairs were examined. Compared to their controls, three of the five most liked complaints (dislocations, fractures, and palpitations) had significantly shorter waiting times, and significantly more were seen within the recommended waiting times (p < 0.05). In contrast, three of the five most disliked complaints (dizziness, constipation, and back pain) had significantly longer waiting times, and significantly fewer were seen within the recommended waiting times (p < 0.05). Other presenting complaints showed similar, although nonsignificant, trends. CONCLUSIONS: Waiting times for patients with certain presenting complaints are significantly associated with triage presenting complaint descriptions. It is likely that these descriptions allow EPs to selectively seek or avoid patients with liked or disliked complaints, respectively. The impact of this for patients and ED flow needs investigation.

Barriers to continuing medical education in Australian prevocational doctors.

To determine perceived barriers to continuing education for Australian hospital-based prevocational doctors, a cross sectional cohort survey was distributed to medical administrators for secondary redistribution to 2607 prevocational doctors from August 2003 to October 2004. Four hundred and seventy valid questionnaires (18.1%) were returned. Only seven per cent (33/470) did not identify any barriers to continuing education. Barriers identified the most were lack of time (85% [371/437]), clinical commitment (65% [284/437]), resistance from registrars (13% [57/437]) and resistance from consultant staff (10% [44/437]). Other barriers included workload issues (27% [27/98]), teaching program inadequacies (26% [25/98]), lack of protected time for education (17% [17/98]), motivational issues (11% [10/98]) and geographic remoteness (10% [10/98]). Australian graduates (87%) identified lack of time more frequently than international medical graduates (77%) (P = 0.036). Perceived barriers did not differ significantly between doctors of differing postgraduate years.

An observational study of emergency department intern activities.

OBJECTIVES: To describe how intern time is spent, and the frequency of activities performed by interns during emergency department (ED) rotations. DESIGN AND SETTING: Prospective observational study of 42 ED interns from three Melbourne city teaching hospitals during 5 months in 2006. Direct observations were made by a single researcher for 390.8 hours, sampling all days of the week and all hours of the day. MAIN OUTCOME MEASURES: Proportion of time spent on tasks and number of procedures performed or observed by interns. RESULTS: Direct patient-related tasks accounted for 86.6% of total intern time, including 43.9% spent on liaising and documentation, 17.5% obtaining patient histories, 9.3% on physical examinations, 5.6% on procedures, 4.8% ordering or interpreting investigations, 3.0% on handover and 4.9% on other clinical activities. Intern time spent on non-clinical activities included 4.2% on breaks, 3.7% on downtime, 1.7% on education, and 1.3% on teaching others. Adjusted for an 8-week term, the ED intern would take 253 patient histories, consult more senior ED staff on 683 occasions, perform 237 intravenous cannulations/phlebotomies, 39 arterial punctures, 12 wound repairs and apply 16 plasters. They would perform chest compressions under supervision on seven occasions, observe defibrillation twice and intubation once, but may not see a thoracostomy. CONCLUSIONS: The ED exposes interns to a broad range of activities. With the anticipated increase in intern numbers, dilution of the emergency medicine experience may occur, and requirements for supervision may increase. Substitution of ED rotations may deprive interns of a valuable learning experience.

Opportunistic screening and clinician-delivered brief intervention for high-risk alcohol use among emergency department attendees: a randomized controlled trial.

OBJECTIVE: To evaluate the feasibility and efficacy of routine opportunistic screening and brief intervention (BI) by ED staff to reduce high-risk alcohol consumption. METHODS: This was an open, randomized controlled trial with allocation blinding performed over 12 months. Using the Paddington Alcohol Test, adult patients were screened for high-risk alcohol use. Consenting patients who were screened positive were eligible for randomization to no counselling (standard care, SC), same-day BI by an emergency nurse or doctor or motivational intervention (MI) within 1 week by off-site drug and alcohol counsellors. Telephone follow up was performed at 1 and 3 months. The primary outcome was maximum self-reported daily standard drinks consumed. Analysis was by intention to treat. RESULTS: Of 32,965 eligible patients, 10,274 were screened, 1043 were positive, 468 consented to the study, and 161, 159 and 148 were allocated to SC, BI and MI, respectively. In the MI group, 133 declined intervention or failed to attend. At 3 months, 96, 81 and 74 participants in the SC, BI and MI groups, respectively, were contactable and consented to telephone interview. Overall, maximum daily alcohol consumption decreased from a median of 13.5 standard drinks at enrolment to 9.25 drinks at 3 months. At 3 months, SC participants reported fewer drinks than those randomized to MI. CONCLUSION: In the present study, neither BI nor MI was better than SC in reducing high-risk alcohol consumption. Uptake of opportunistic screening by ED staff was poor, as was patient compliance with off-site counselling.

Emergency clinician-delivered screening and intervention for high-risk alcohol use: a qualitative analysis.

OBJECTIVES: To evaluate qualitative feedback from patients who received opportunistic screening and brief intervention for harmful alcohol use during an ED attendance; to evaluate emergency staff attitudes to performing alcohol screening and delivering opportunistic brief intervention; and to document process issues associated with the introduction of routine clinician-initiated opportunistic screening and training and administration of brief intervention. METHODS: Structured and semi-structured interviews with emergency staff and recipients of brief intervention. RESULTS: Sixty-nine patients were interviewed 3 months after an ED attendance where they received emergency clinician-delivered brief intervention for high-risk alcohol use. Twenty-two (32%; 95% CI 21-43%) reported a positive effect of brief intervention on thoughts or behaviour, but 29% (95% CI 18-40%) felt the intervention was not relevant for them or could not recall it. Four people (6%; 95% CI 1-12%) felt confronted or embarrassed, and 17 (25%; 95% CI 15-36%) felt timing or delivery could be improved. Staff had a positive attitude to delivering brief intervention, but nominated lack of time as the main barrier. Fourteen of 15 staff felt brief intervention should become routine in emergency care. CONCLUSION: Emergency clinicians can be trained to provide brief intervention for high-risk alcohol in an ED. The use of emergency clinician brief intervention is acceptable to most staff and patients.

Australasian emergency physicians: a learning and educational needs analysis. Part five: barriers to CPD experienced by FACEM, and attitudes to the ACEM MOPS programme.

OBJECT: To determine the barriers to continuous professional development (CPD) perceived by Fellows of the Australasian College for Emergency Medicine (FACEM), their opinions on the maintenance of professional standards programme (MOPS), and other aspects of education. METHOD: Mailed survey offering 12 factors that could prevent them from participating in CPD. FACEM were asked to rate the items on Likert from 1, no barrier, through to 5, insurmountable barrier. Qualitative comments on barriers, MOPS and other education were grouped. RESULTS: Nearly 47% of FACEM nominated lack of time with too many other priorities as significant of insurmountable barriers to CPD whilst 41% cited their ED as being too busy to leave and 35% had family commitments preventing CPD. While commitments, resistance from colleagues or employers (7%), lack of personal motivation or interest, (7.5%) lack of conference leave (8%) or financial restraint (14.5%) were lesser barriers for FACEM. Scheduling at inconvenient times (25%) and geographical factors (19%) were also perceived as significant barriers. Analysis of qualitative responses highlighted staff shortages, family reasons, personal fatigue, lack of interest in available CPD, cost and limited nonclinical time as being important barriers for some FACEM. Less than 50% of FACEM agreed that current allocation of MOPS points was appropriate or that the website spot diagnoses and scenarios kept their knowledge current. Nearly 28% did not find online MOPS easy to comprehend. CONCLUSION: These findings may assist in facilitating increased participation in CPD by FACEM.

Australasian emergency physicians: a learning and educational needs analysis. Part Four: CPD topics desired by emergency physicians.

OBJECTIVE: To report the preferences of Fellows of the Australasian College for Emergency Medicine for topics they would desire for their continuing professional development (CPD). METHOD: A mailed survey of Fellows of the Australasian College for Emergency Medicine asked for Likert type responses on the desirability of CPD on 15 procedural skills, 13 management skills, 11 clinical emergency topics, 9 topics related to teaching, 7 related to diagnostics and 5 evidence based practice topics. RESULTS: CPD in procedural skills of advanced and surgical airways, ED ultrasound, ventilation, skills, plastic procedures and regional anaesthesia were nominated as desirable by 85% of emergency physicians (EP). More than 90% desired CPD in ophthalmological, otorhinolaryngeal, neonatal and paediatric emergencies. Of diagnostic skills, more than 80% considered CPD on computerized tomography, electrocardiography and plain X-ray interpretation as desirable, well as CPD about teaching in general, simulation and preparing candidates for fellowship exams. Of the 12 management skills, 11 were seen as desirable topics by more than 70%, with counter disaster planning, giving feedback and dealing with complaints the most popular. All evidence based practice related skills, including interpreting statistics and undertaking literature searches were seen as desirable topics by more than 80% of EP. CONCLUSION: This information may assist in the planning of future educational interventions for emergency physicians. EP seek CPD on management, educational and other non clinical skills, as well as topics relating directly to patient care.

Australasian emergency physicians: a learning and educational needs analysis. Part three: participation by FACEM in available CPD: what do they do and do they like it?

OBJECTIVE: To determine the participation of Emergency Physicians (EP) in currently available continuing professional development opportunities (CPD), their perception of the usefulness of available CPD and their preferred format or method of CPD desired in the future. METHOD: A mailed survey of Fellows of the Australasian College for Emergency Medicine with 17 Likert type options on educational methods and qualitative analysis grouping volunteered free text responses. RESULTS: The most frequent learning methods reported by EP are on the job contact with other clinicians, formal ED based teaching and reading journals, which were also perceived as useful or very useful learning methods by more than 90% of EP. Less than 15% often or always participate on hospital grand rounds, high fidelity simulation, computer programmes or commercially sponsored events. Increased exposure was desired to high-fidelity simulation center skills training by 58% of respondents with nearly 49% of fellows also wanting more participation in international conferences with around 44% of fellows also wanting more participation in international conferences with around 44% desiring more formal teaching in the ED, more formal feedback on performance, and more meetings with other hospital departments. Over 50% of EP want less or no exposure to commercially sponsored dinners or events. CONCLUSION: Whilst emergency physicians currently participate in a wide variety of learning methods, the results of this survey suggest EP most appreciate ED based teaching, would like more contact with other departments, along with increased opportunities for simulation based learning and attendance at international conferences.

Australasian emergency physicians: a learning and educational needs analysis. Part two: confidence of FACEM for tasks and skills.

OBJECTIVE: To determine the degree of confidence perceived by Fellows of the Australasian College for Emergency Medicine for a variety of procedural, patient management, educational and research skills, and tasks that may be required of them. METHOD: Mailed survey with Likert scales and grouped qualitative responses. RESULTS: More than 90% of emergency physicians (EP) feel usually or always confident of their skills for peripheral vascular access, procedural sedation, fluid resuscitation, tube thoracostomy, managing patients with altered conscious state, cardiac emergencies, behavioural disturbance, and interpreting acid base and other blood tests. Less than 50% felt confident performing surgical airways, ED ultrasound, managing neonatal emergencies or interpreting MRI. Of non-clinical skills, while most EP were confident of their ability to write references, debrief staff, lead group tutorials and prepare slides, a minority felt usually or always confident about budgeting and finance, preparing submissions, dealing with the media, appearing in court or marking examination papers. Whilst nearly 75% were confident about the information technology skills required of them for clinical practice, less than 25% of EP felt confident about conducting research and less than 15% were confident applying or interpreting statistics. CONCLUSION: This information may assist in the planning of future educational interventions for EP.

Australasian emergency physicians: a learning and educational needs analysis. Part one: background and methodology. Profile of FACEM.

OBJECTIVE: Fellows of the Australasian College for Emergency Medicine (FACEM) have opportunities to participate in a range of continuing professional development activities. To inform FACEM and assist those involved in planning continuing professional development interventions for FACEM, we undertook a learning needs analysis of emergency physicians. METHOD: Exploratory study using survey methodology. Following questionnaire development by iterative feedback with emergency physicians and researchers, a mailed survey was distributed to all FACEM. The survey comprised eight items on work and demographic characteristics of FACEM, and 194 items on attitudes to existing learning opportunities, barriers to learning, and perceived learning needs and preferences. RESULTS: Fifty-eight percent (503/854) of all FACEM surveyed responded to the questionnaire, almost half of whom attained their FACEM after year 2000. The sample comprised mostly males (72.8%) with mean age of the sample 41.6 years, similar to ACEM database. Most respondents reported working in ACEM accredited hospitals (89%), major referral hospitals (54%), and practiced on both children and adults (78%). FACEM reported working on average 26.7 clinical hours per week with those at private hospitals working a greater proportion of clinical hours than other hospital types. CONCLUSION: As the first of six related reports, this paper documents the methodology used, including questionnaire development, and provides the demographics of responding FACEM, including the clinical and non-clinical hours worked and type of hospital of principal employment.

Handover from paramedics: observations and emergency department clinician perceptions.

OBJECTIVES: 1. To evaluate emergency clinician attitudes towards handover from prehospital paramedics. 2. To determine the content and methods of paramedic handover delivery to emergency clinicians. METHODS: Exploratory study comprising questionnaire of emergency clinicians and observation of paramedic-to-emergency clinician handover with associated survey at an adult tertiary referral hospital with approximately 12,000 ambulance arrivals of 37,000 annual attendances. RESULTS: Emergency staff found handover from paramedics on patient conditions relevant, especially for altered consciousness (94%, 95% CI 83.5-98.6), trauma (90%, 95% CI 82.0-98.4) and chest pain (88%, 95% CI 79.0-97.0), but less so for behavioural disturbance (67%, 95% CI 53.7-79.5). A total of 621 handovers from 311 ambulance arrivals were observed. Most arrivals (81%, 95% CI 76.4-85.4) were not preceded by prehospital communication. Paramedics handed over twice 91% of the time (95% CI 88.2-94.4). Doctors received direct paramedic handover for 12% (95% CI 8.0-15.1) of ambulance arrivals, including 19 team handovers, whereas triage nurses took 97% (95% CI 95.6-99.2) and attending nurses, 91% (95% CI 87.5-93.9). Fifty per cent (95% CI 42.7-57.3) of emergency clinicians referred to ambulance sheets. Handover information was perceived to be useful and accurate in more than 80% of instances. Verbal handover occurred before ambulance sheet completion for 78% (95% CI 73.5-82.7). CONCLUSION: Although there is satisfaction in paramedic handover, prehospital notification and emergency physician contact with paramedics is uncommon for low acuity patients, who constitute the majority of ambulance attendances and hospital admissions. Scope for improved direct doctor-paramedic communication exists.

Gamma-hydroxybutyrate: a 30 month emergency department review.

OBJECTIVES: To describe epidemiology, symptomatology, resource use and complications in patients attending the ED following gamma-hydroxybutyrate (GHB) ingestion. METHODS: Retrospective chart review of GHB-related emergency attendances over 30 months. RESULTS: One hundred and seventy emergency attendances attributed to GHB ingestion occurred. Monthly attendance rate doubled during the study, and was highest on public holidays and weekends between 04.00 and 08.00 hours. The majority (63%, 95% CI 55.7-70.3) were young men (median 22 years). GHB was ingested alone in 62 cases (36%, 95% CI 29.6-43.9). Poly-substance ingestion was common (108 cases; 64%; 95% CI 56.1-70.4). The commonest presenting symptom was altered conscious state (89%, 95% CI 84.1-93.5) with 54% (95% CI 46.6-61.6) having low Glasgow Coma Score (GCS 3-8) on arrival at the ED. Eight per cent (95% CI 3.6-11.6) were intubated. Eighty-seven per cent (95% CI 79.8-93.8) with low GCS were not intubated. There were no serious adverse outcomes or fatalities. Recovery time from ED arrival to high GCS (9-15) was rapid (median 76 min, interquartile range 80). Overall median length of stay was 199 min (interquartile range 162). CONCLUSIONS: This is the largest GHB-related case series to date. Attendance rate doubled during the study, and peaked at times of lowest staffing. Poly-substance ingestion is common. Attendances are of high acuity with decreased conscious state and airway threat. With close conservative management, most recover quickly without adverse sequelae.

Can medical admission and length of stay be accurately predicted by emergency staff, patients or relatives?

OBJECTIVES: To determine the accuracy of predictions of the need for hospital admission and, if admitted, length of stay (LOS) made early in an emergency attendance by emergency department (ED) doctors, nurses, patients and relatives, and the characteristics of ED presentations predictive of admission and short stays (

The effect of multidisciplinary case management on selected outcomes for frequent attenders at an emergency department.

OBJECTIVE: To evaluate the effects of multidisciplinary case management (CM) on emergency department (ED) utilisation and psychosocial variables for frequent attenders at the ED. DESIGN: Retrospective cohort analysis, with the study population as historical controls and data analysed 12 months before and after CM intervention in the period 1 January 2000 - 31 December 2004. Subgroup analyses were performed according to primary problem categories: general medical, drug and alcohol, and psychosocial. SETTING: Inner urban tertiary hospital ED. PARTICIPANTS: Frequent ED attenders who received CM. MAIN OUTCOME MEASURES: ED attendances: length of stay, triage category, ambulance transport, disposition, attendances at the only two EDs nearby. Psychosocial factors: housing status, drug and alcohol use, and primary and community care engagement. RESULTS: 60 CM patients attended the ED on 1387 occasions. Total attendances increased after CM for the whole group (610 v 777, P = 0.055). Mean average length of stay (minutes) of the total study population and each subgroup was unaffected by CM (297 v 300, P = 0.8). Admissions for ED overnight observation increased as a result of CM (P = 0.025). CM increased scores for housing stability (P = 0.007), primary care linkage (P = 0.003), and community care engagement (P < 0.001) for the whole group and variously within subgroups. Drug and alcohol use was unaffected by CM. CONCLUSION: ED-initiated, multidisciplinary CM appears to increase ED utilisation and have a positive effect on some psychosocial factors for frequent attenders. A trend towards increased ED attendance and utilisation with CM may have implications for policies that seek to divert frequent attenders away from hospitals.

Learning opportunities for Australian prevocational hospital doctors: exposure, perceived quality and desired methods of learning.

OBJECTIVE: To survey prevocational doctors working in Australian hospitals on aspects of postgraduate learning. PARTICIPANTS AND SETTING: 470 prevocational doctors in 36 health services in Australia, August 2003 to October 2004. DESIGN: Cross-sectional cohort survey with a mix of ordinal multicategory questions and free text. MAIN OUTCOME MEASURES: Perceived preparedness for aspects of clinical practice; perceptions of the quantity and usefulness of current teaching and learning methods and desired future exposure to learning methods. RESULTS: 64% (299/467) of responding doctors felt generally prepared for their job, 91% (425/469) felt prepared for dealing with patients, and 70% (325/467) for dealing with relatives. A minority felt prepared for medicolegal problems (23%, 106/468), clinical emergencies (31%, 146/469), choosing a career (40%, 188/468), or performing procedures (45%, 213/469). Adequate contact with registrars was reported by 90% (418/465) and adequate contact with consultants by 56% (257/466); 20% (94/467) reported exposure to clinical skills training and 11% (38/356) to high-fidelity simulation. Informal registrar contact was described as useful or very useful by 94% (433/463), and high-fidelity simulation by 83% (179/216). Most prevocational doctors would prefer more formal instruction from their registrars (84%, 383/456) and consultants (81%, 362/447); 84% (265/316) want increased exposure to high-fidelity simulation and 81% (283/350) to professional college tutorials. CONCLUSION: Our findings should assist planning and development of training programs for prevocational doctors in Australian hospitals.