Residents with mild cognitive decline and family members report health students 'enhance capacity of care' and bring 'a new breath of life' in two aged care facilities in Tasmania.

BACKGROUND: Care provided by student doctors and nurses is well received by patients in hospital and primary care settings. Whether the same is true for aged care residents of nursing homes with mild cognitive decline and their family members is unknown. OBJECTIVE: To investigate the perspectives of aged care residents with mild cognitive decline and their family members on interdisciplinary student placements in two residential aged care facilities (RACF) in Tasmania. DESIGN, SETTING AND PARTICIPANTS: A mixed methods design was employed with both qualitative and quantitative data collected. All participants were interviewed and completed a questionnaire on residents' quality of life, during or after a period of student placements in each facility (October-November, 2012). Qualitative data were coded for themes following a grounded theory approach, and quantitative data were analysed using SPSS. RESULTS: Twenty-one participants (13 residents and 8 family members) were recruited. Four themes were identified from the qualitative data and included (i) increased social interaction and facility vibrancy; (ii) community service and personal development, (iii) vulnerability and sensitivity (learning to care) and (iv) increased capacity and the confidence of enhanced care. Residents' quality of life was reported to be mostly good in the presence of the students, despite their high care needs. CONCLUSION: Residents with mild cognitive decline and their family members perceive a wide array of benefits of student provided care in RACFs including increased social interaction. Future quantitative research should focus on whether changes in care occur for residents as a result of student involvement.

Developing rural community health risk assessments for climate change: a Tasmanian pilot study.

INTRODUCTION: This article examines the development and pilot implementation of an approach to support local community decision-makers to plan health adaptation responses to climate change. The approach involves health and wellbeing risk assessment supported through the use of an electronic tool. While climate change is a major foreseeable public health threat, the extent to which health services are prepared for, or able to adequately respond to, climate change impact-related risks remains unclear. Building health decision-support mechanisms in order to involve and empower local stakeholders to help create the basis for agreement on these adaptive actions is an important first step. The primary research question was 'What can be learned from pilot implementation of a community health and well-being risk assessment (CHWRA) information technology-based tool designed to support understanding of, and decision-making on, local community challenges and opportunities associated with health risks posed by climate change? METHODS: The article examines the complexity of climate change science to adaptation translational processes, with reference to existing research literature on community development. This is done in the context of addressing human health risks for rural and remote communities in Tasmania, Australia. This process is further examined through the pilot implementation of an electronic tool designed to support the translation of physically based climate change impact information into community-level assessments of health risks and adaptation priorities. The procedural and technical nature of the CHWRA tool is described, and the implications of the data gathered from stakeholder workshops held at three rural Tasmanian local government sites are considered and discussed. RESULTS: Bushfire, depression and waterborne diseases were identified by community stakeholders as being potentially 'catastrophic' health effects 'likely' to 'almost certain' to occur at one or more Tasmanian rural sites - based on an Intergovernmental Panel on Climate Change style of assessment. Consensus statements from stakeholders also suggested concern with health sector adaptation capacity and community resilience, and what community stakeholders defined as 'last straw' climate effects in already stressed communities. Preventative action and community engagement were also seen as important, especially with regard to managing the ways that climate change can multiply socioeconomic and health outcome inequality. Above all, stakeholder responses emphasised the importance of an applied, complexity-oriented understanding of how climate and climate change impacts affect local communities and local services to compromise the overall quality of human health in these communities. CONCLUSIONS: Complex community-level assessments about climate change and related health risks and responses can be captured electronically in ways that offer potentially actionable information about priorities for health sector adaptation, as a first step in planning. What is valuable about these community judgements is the creation of shared values and commitments. Future iteration of the IT tool could include decision-support modules to support best practice health sector adaptation scenarios, providing participants with opportunities to develop their know-how about health sector adaptation to climate change. If managed carefully, such tools could work within a balanced portfolio of measures to help reduce the rising health burden from climate change.

Climate change and health research: has it served rural communities?

INTRODUCTION: If climate change is the 21st Century's biggest public health threat, research faces the major challenge of providing adequate evidence for vulnerable communities to adapt to the health effects of climate change. Available information about best practice in climate adaptation suggests it is inclusive of socio-economic disadvantage and local community factors such as access to health services. Since 1995, at least 19 164 papers have been published on climate change in the health sciences and social sciences. This body of literature has not yet been systematically examined for how well it serves rural communities. METHODS: The ultimate aim of the study was to contribute to better understandings about what climate adaptation research has been done and is needed for rural communities. The two research questions were: 'What kinds of content define climate change research in disciplines that could potentially contribute to adaptation for health?' and 'How is content about rural and Aboriginal communities and best practice in adaptation related to this content?' A quantitative content analysis was performed using 'computational linguistics' Leximancer software. The analysis included 19 164 health and social sciences abstracts, batched by years, from 1 January 1995 to 31 July 2012. The relative frequency and co-occurrence of 52 concepts in these abstracts were mapped, as well as associations with positive or negative sentiment for selected concepts. RESULTS: Aboriginal' concepts tend to be relatively infrequent (3% and 5% overall likelihood of occurrence, respectively) and are more associated with socio-economic concepts in the social sciences than the health sciences. Multiple concepts in the health sciences literature are typically connected with 'disease' and ultimately 'science' storylines, with a 38% likelihood of paired co-occurrence of 'health' and 'disease' concepts alone. The social sciences appear more focused on the local and particular issues of community in climate change than the health sciences. 'Rural' and 'Aboriginal' concepts have increased by 1% across both discipline areas, since 2011 for the 'rural' concept and since 2004 for the 'Aboriginal' concept. 'Health' concepts in the health sciences and 'economic' concepts in the social sciences, as well as 'urban' concepts, are referred to more positively than either the 'rural' or 'Aboriginal' concepts. CONCLUSIONS: While care needs to be taken in interpreting the results of this study too negatively for rural and Aboriginal communities, they suggest that a disease focus dominates climate and health research typically unconnected to wider socio-economic and human system factors. This finding needs to be considered in light of the accumulating evidence of the importance of such contextual systemic factors in understanding climate and health effects and responses. The study adds some support to the view that a key priority is bringing the learnings of applied community-based researchers, from those in rural health to those in the social sciences, to climate research. There is a need to build confidence, including in the rural health sector which has arguably been slow to participate in programs of climate change research, that community-based research could make a difference to rural health in a climate-changing world.

Climate change: what competencies and which medical education and training approaches?

BACKGROUND: Much research has been devoted to identifying healthcare needs in a climate-changing world. However, while there are now global and national policy statements about the importance of health workforce development for climate change, little has been published about what competencies might be demanded of practitioners in a climate-changing world. In such a context, this debate and discussion paper aims to explore the nature of key competencies and related opportunities for teaching climate change in medical education and training. Particular emphasis is made on preparation for practice in rural and remote regions likely to be greatly affected by climate change. DISCUSSION: The paper describes what kinds of competencies for climate change might be included in medical education and training. It explores which curricula, teaching, learning and assessment approaches might be involved. Rather than arguing for major changes to medical education and training, this paper explores well established precedents to offer practical suggestions for where a particular kind of literacy--eco-medical literacy--and related competencies could be naturally integrated into existing elements of medical education and training. SUMMARY: The health effects of climate change have, generally, not yet been integrated into medical education and training systems. However, the necessary competencies could be taught by building on existing models, best practice and innovative traditions in medicine. Even in crowded curricula, climate change offers an opportunity to reinforce and extend understandings of how interactions between people and place affect health.

'Lost in translation'? Developing assessment criteria that value rural practice.

INTRODUCTION: Rural workforce preparation is often discussed in terms of specific interventions such as rural placements. More technical discussions of education matters seem to belong in the realm of education experts. However, this issues article argues that a focus on quality assessment techniques is important to the rural health agenda. Making connections between the medical education literature and the broader education literature, it explores elements of a qualitative decision-making model as an alternative to narrow competency-based and norm-referenced approaches. In the process it explores assessment techniques that may help educators better translate their intentions to value rural practice into the learning of students. BACKGROUND: Research suggests that, in Australia at least, many university educators have different and conflicting understanding of assessment criteria. At the same time, the literature on the development of assessment criteria is relatively small in a context in which the medical education literature takes a quantitative, reliability-driven approach. This has important implications for how we ensure that rural practice is given enough emphasis at the level of education that most strongly drives student learning-assessment. METHODS: This article explores such matters by examining the steps needed to develop assessment criteria in undergraduate medical education courses. It draws on key writings from the past, as well as current debates, in the medical education and broader education literature. It focuses on the detail of assessment techniques to show how the intention to value rural practice can be 'lost in translation' with narrow norm-referenced and competency-based assessment models. CONCLUSIONS: Rural health has a stake in technical debates about education in health sciences courses. Like other knowledge and skills, the knowledge and skills important to rural practice cannot be valued at the coalface of student learning if our assessment techniques subvert intentions. Developing the quality of assessment techniques involves scrutiny of not only the medical education literature, but also the broader education literature, including writings about working models of criteria-and-standards-based assessment. This scrutiny suggests assessment techniques are not equal in terms of how well they translate intentions. More than that, it suggests the value to rural health education of shifting from narrow norm-referenced models to best practice in criteria-and-standards-based assessment.