Practitioner perceptions of the feasibility of common frailty screening instruments within general practice settings: a mixed methods study.

BACKGROUND: Frailty is a highly prevalent clinical syndrome increasing older people's vulnerability to risk of adverse outcomes. Better frailty identification through expanded screening implementation has been advocated within general practice settings, both internationally and within Australia. However, little is known about practitioner perceptions of the feasibility of specific instruments, and the underlying motivations behind those perceptions. Consequently, the purpose of this study was to explore the attitudes and perceptions of a convenience and volunteer sample of Australian general practitioners (GPs) and practice nurses (PNs) towards common frailty screening instruments. METHODS: The feasibility of several frailty screening instruments (PRISMA-7 [P7], Edmonton Frail Scale [EFS], FRAIL Questionnaire [FQ], Gait Speed Test [GST], Groningen Frailty Indicator [GFI], Kihon Checklist [KC] and Timed Up and Go [TUG]) to 43 Australian GPs and PNs was assessed. The study adopted a concurrent embedded mixed-methods design incorporating quantitative (ranking exercise) and qualitative (content analysis) data collection integrated during the analysis phase. RESULTS: Practitioners assessed multi-dimensional instruments (EFS, GFI, KC) as having relatively higher clinical utility, better integration into existing assessment processes and stronger links to intervention over uni-dimensional (GST, TUG) and simple (FQ, P7) instruments. CONCLUSIONS: While existing frailty screening instruments show promise as an initial step in supporting better care for older people, all the included instruments were associated with perceived advantages and disadvantages. Ultimately, clinicians will need to weigh several factors in their selection of the optimal screening instrument. Further translational research, with a focus on contextual fit, is needed to support clinical decision-making on the selection of instruments for frailty screening.

Diagnostic test accuracy of self-reported screening instruments in identifying frailty in community-dwelling older people: A systematic review.

Against a backdrop of aging populations worldwide, it has become increasingly important to identify frailty screening instruments suitable for community settings. Self-reported and/or administered instruments might offer significant simplicity and efficiency advantages over clinician-administered instruments, but their comparative diagnostic test accuracy has yet to be systematically examined. The aim of this systematic review was to determine the diagnostic test accuracy of self-reported and/or self-administered frailty screening instruments against two widely accepted frailty reference standards (the frailty phenotype and the Frailty Index) within community-dwelling older adult populations. We carried out a systematic search of the Embase, CINAHL, MEDLINE, PubMed, Web of Science, PEDro, PsycINFO, ProQuest Dissertations, Open Grey and GreyLit databases up to April 2017 (with an updated search carried out over May-July 2018) to identify studies reporting comparison of self-reported and/or self-administered frailty screening instruments against an appropriate reference standard, with a minimum sensitivity threshold of 80% and specificity threshold of 60%. We identified 24 studies that met our selection criteria. Four self-reported screening instruments across three studies met minimum sensitivity and specificity thresholds. However, in most cases, study design considerations limited the reliability and generalizability of the results. Additionally, meta-analysis was not carried out, because no more than three studies were available for any of the unique combinations of index tests and reference standards. Although the present study has shown that a number of self-reported frailty screening instruments reported sensitivity and specificity within a desirable range for community application, additional diagnostic test accuracy studies are required. Geriatr Gerontol Int 2020; 20: 14-24.

Diagnostic test accuracy of self-reported frailty screening instruments in identifying community-dwelling older people at risk of frailty and pre-frailty: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The question of this systematic review is: What is the diagnostic test accuracy of self-reported frailty screening instruments among community-dwelling older people against any of the following reference standard tests: the frailty phenotype, frailty index and comprehensive geriatric assessment?

Diversity and consistency: a case study of regionalised clinical placements for medical students.

OBJECTIVE: A major challenge for medical schools is the provision of clinical skills training for increasing student numbers. This case study describes the expansion of the clinical school network at The University of Queensland (UQ). The purpose of the study was to investigate consistency in medical education standards across a regional clinical teaching network, as measured by academic performance. METHODS: A retrospective analysis of academic records for UQ medical students (n = 1514) completing clinical rotations (2009-2012) was performed using analysis of covariance (ANCOVA) for comparisons between clinical school cohorts and linear mixed-effects modelling (LEM) to assess predictors of academic performance. RESULTS: In all, 13 036 individual clinical rotations were completed between 2009 and 2012. ANCOVA found no significant differences in rotation grades between the clinical schools except that Rural Clinical School (RCS) cohorts achieved marginally higher results than non-RCSs in the general practice rotation (5.22 vs 5.10-5.18; P = 0.03) and on the final clinical examination (objective structured clinical examination; 5.27 vs 5.01-5.09; P < 0.01). LEM indicated that the strongest predictor of academic performance on clinical rotations was academic performance in the preclinical years of medical school (= 0.38; 95% confidence interval 0.35-0.41; P < 0.001). CONCLUSIONS: The decentralised UQ clinical schools deliver a consistent standard of clinical training for medical students in all core clinical rotations across a range ofurban, regional and rural clinical settings. Further research is required to monitor the costs versus benefits of regionalised clinical schools for students, local communities and regional healthcare services.

Removing the interview for medical school selection is associated with gender bias among enrolled students.

OBJECTIVE: To report, and determine reasons for, a change in the gender ratio observed among enrolled medical students after removal of the interview from the selection process. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional study of 4051 students admitted to the medical program at the University of Queensland between 2004 and 2012. Students are enrolled either directly as graduates or via a school-leaver pathway. MAIN OUTCOME MEASURES: Change in proportions of male and female students over time, and gender-specific scores in the three sections of the GAMSAT (Graduate Medical School Admissions Test). RESULTS: Between 2004 and 2008 (when an interview was part of the selection process), 891 enrolled students (51.4%) were male, whereas between 2009 and 2012 (no interview), 1134 (57.7%; P < 0.001) were male. This change in gender ratio was limited to domestic direct graduate-entry students, and the male proportion in this group rose from 50.9% (705 students) before the interview was removed to 64.0% (514 students; P < 0.001) after removal of the interview (reaching 73.8% in 2012). Between 2004 and 2012, male students consistently performed better than female students on GAMSAT section III (mean score, 71.5 v 68.5; P < 0.001). CONCLUSION: The proportion of males enrolled in the medical program at this university increased markedly after removal of the interview from the selection process. This change is limited to domestic direct graduate-entry students, and seems to be due to higher scores by male students in section III of the GAMSAT. The interview may play an important role in ensuring gender equity in selection, and medical schools should carefully monitor the consequences of changes to selection policy.