Cesarean section rates in teaching hospitals: a national survey.

This survey investigated the cesarean section rate in teaching hospitals in the United States and the factors that may influence it. A national survey was performed by mailing a questionnaire to 277 accredited residency programs in obstetrics and gynecology. The estimated cesarean rate in all hospitals with residencies in obstetrics and gynecology in the United States in 1990 was 20.3 percent, compared with an overall national rate of 23.5 percent. Women delivering in teaching hospitals were less likely to have a cesarean section than those delivering in hospitals without residency programs (odds ratio = 0.77, 95% CI 0.77-0.78, p = 0.0001). As centers for training and research, teaching hospitals represent an appropriate setting to begin the process of lowering the United States cesarean section rate.

Continuing medical education needs for local general practitioners.

A survey was conducted of the expressed continuing medical education needs of a group of 64 suburban general practitioners attached to a South Australian Hospital. The top five stated urgent and necessary training needs were acute and emergency disease management, diabetes management, terminal care, dermatology and medicine. The form of CME most preferred was patient/clinical practice and the greatest barriers to CME were stated as lack of time and loss of income. Practitioners with less than 10 years experience significantly chose training in ear, nose and throat (p < 0.01), rheumatology (p < 0.01) (Fisher's exact test, two-sided), compared with more experienced practitioners. Those in group practice significantly chose training in orthopaedics (p < 0.01, Fisher's exact test, two-sided) and the management of change (p = 0.037, Fisher's exact test, one-sided) more than solo practitioners while female practitioners significantly expressed the need for ante natal care training (Chi square = 8.85; df = 1; p < 0.01).

Traumatic wound management.

A review of the treatment options for traumatic injuries, particularly those caused by bullets and bombs.

A pattern of decline in general practice obstetric care in Adelaide.

Some educational, training and politico-economic reasons for the decline in GP obstetrics in Adelaide, South Australia, are described. It is recommended that similar studies be done in other centres in Australia to evaluate the general nature of the findings.

Who do people talk to about healthy lifestyles? A South Australian survey.

To investigate who people talk to about healthy lifestyle a personal interview of people in a representative sample of South Australians was carried out. The information was collected by interview from all occupants of selected private dwellings who were aged 15 years or older. The interviewer used a prompt card with nine possible responses and the question asked was "which one of these would you be most likely to talk about healthy lifestyle changes?" Forty-four per cent nominated the general practitioner and 22% a family member. People who were either married or in a de facto relationship (30%) significantly chose a general practitioner more than others (14%) (P < 0.05). In the 30-59 age group more men (12%) than women (6%) chose a family member as a healthy lifestyle adviser (P < 0.05). There was no statistically significant difference in interest in healthy lifestyle in people born in Australia and outside Australia, or in the employed or unemployed. It is suggested that further attention needs to be paid to training in preventive medicine at all levels of general practice education and more needs to be known about the role of family members as healthy lifestyle advisers.

Health of a team competing in the 1990 World Solar Car Challenge.

The health of a team participating in the 1990 World Solar Car Challenge was recorded for 10 of the 11 race days. Morbidity was collected during daily consultations with the team doctor and the diagnoses were later converted to the ICPC code. Team members' self-perceived health status was also recorded daily, using the Nottingham Health Profile. Team drivers consulted the doctor more often than the support staff and the three full-time drivers had significantly more diagnoses than the support staff. The Nottingham Health Profile scores on sleep, energy and emotional reactions showed correlations between higher minimum temperatures and sleep for all team members and for the three full-time drivers, there were significant correlations between increasing maximum temperatures and emotional reaction scores. The morbidity records and perceived health scores reflect the conditions of the race. Twenty-five per cent of full-time driver consultations dealt with skin, eyelid or finger infections probably caused by the lack of washing water. The scores on sleep and emotional reactions were affected by temperature and previous research reports degradation in concentration and dual tasks with increasing temperature. This may account for the difficulty some drivers had in continuing their shifts. Close supervision of the drivers and the recording of their perceived health status helped reduce the health problems of the team.

Communication skills training for general practice.

The value of the practitioner's communication skills in the consultation is widely recognised. Many authors support communication skills training for general practice in such areas as public health, patient satisfaction, malpractice litigation, compliance, somatisation and clinical outcomes in chronic illness. There are many reports of the success of communication skills training worldwide for medical students, general practice trainees and experienced general practitioners.

Teaching counselling skills to fourth-year medical students: a dilemma concerning goals.

Advocacy of communication skills training in medical curricula is common, but this paper highlights some paradoxes which become apparent when such training is instituted. Fourth-year medical students completed a standardized questionnaire measure of empathy, before and after intensive training in counselling and communication in general practice. Low rates of empathetic responding were shown, and no increase occurred after training. The results are discussed in terms of an emerging dilemma within medical education and practice, namely the conflict between the traditional view of the doctor as problem-solver and recent evidence of the health benefits of a more patient-centred style of medical practice.

Signs, symptoms, and the new descriptors.

Data from 143 consultations in general practice were assessed by factors relevant to the four-category descriptive system developed by the Royal Australian College of General Practitioners. It seems that there is no relationship between consultation length, apparent symptom seriousness or the occurrence of a physical examination. Suggestions are offered for improving the clarity of consultation descriptor categories.

A new hospital general practice teaching unit.

The formation of the latest General Practice Teaching Unit in an Australian hospital is part of a national trend to teach undergraduates and post-graduates about some parts of general practice using patients separated at triage from the accident and emergency departments. Planning this unit required much negotiating between several institutions and a set of guidelines on organisational relationships was created. Innovative features of the Modbury General Practice Teaching Unit include payment of teachers to attend compulsory medical education workshops, dividing the Family Medicine Programme trainee's time between the unit and a neighbouring practice and payment of non-academic general practitioner teachers by the South Australian Government, which eliminates the risk that service interferes with teaching. The Modbury General Practice Teaching Unit is currently the only hospital based unit of this kind in South Australia.

The role of the GP in the management of chronic disease. Diabetes as a model.

Chronic disease is increasing as a percentage of all illnesses in Australia's health care system, in part because of the ageing of the population. New strategies are required to help manage these often incurable diseases. The general practitioner is well equipped to provide management expertise for chronic disease, provided he or she has access to community based allied health professionals.

The proposed general practice descriptors--will they influence preventive medicine?

The proposed descriptor bill to change Medicare rebates to general practice patients could have a benefit to general practice preventive medicine. This seems possible through rewarding practitioners who spend more time with their patients and the positive effects of continuing medical education. However, the potential exists for whittling away any rewards for these practitioners by future governments and the audit of general practices could become a method of political control of Australian general practice.

The experiences of students and their teachers in a general practice preceptorship scheme.

This article is the result of assessing 140 paired student and preceptor reports from the University of NSW Preceptorship Scheme. Its aim is to present, in an organised and readable form, the feelings of students and preceptors about their experiences in this scheme.