Objective: To assess the effect of home‐based health assessments for older Australians on health‐related quality of life, hospital and nursing home admissions, and death.
Design: Randomised controlled trial of the effect of health assessments over 3 years.
Participants and setting: 1569 community‐living veterans and war widows receiving full benefits from the Department of Veterans’ Affairs and aged 70 years or over were randomly selected in 1997 from 10 regions of New South Wales and Queensland and randomly allocated to receive either usual care (n = 627) or health assessments (n = 942).
Intervention: Annual or 6‐monthly home‐based health assessments by health professionals, with telephone follow‐up, and written report to a nominated general practitioner.
Main outcome measures: Differences in health‐related quality of life, admission to hospital and nursing home, and death over 3 years of follow‐up.
Results: 3‐year follow‐up interviews were conducted for 1031 participants. Intervention‐group participants who remained in the study reported higher quality of life than control‐group participants (difference in Physical Component Summary score, 0.90; 95% CI, 0.05–1.76; difference in Mental Component Summary score, 1.36; 95% CI, 0.40–2.32). There was no significant difference in the probability of hospital admission or death between intervention and control groups over the study period. Significantly more participants in the intervention group were admitted to nursing homes compared with the control group (30 v 7; P < 0.01).
Conclusions: Health assessments for older people may have small positive effects on quality of life for those who remain resident in the community, but do not prevent deaths. Assessments may increase the probability of nursing‐home placement.
Objective: To evaluate the feasibility, reliability and acceptability of the mini clinical evaluation exercise (mini‐CEX) for performance assessment among international medical graduates (IMGs).
Design, setting and participants: Observational study of 209 patient encounters involving 28 IMGs and 35 examiners at three metropolitan teaching hospitals in New South Wales, Victoria and Queensland, September–December 2006.
Main outcome measures: The reliability of the mini‐CEX was estimated using generalisability (G) analysis, and its acceptability was evaluated by a written survey of the examiners and IMGs.
Results: The G coefficient for eight encounters was 0.88, suggesting that the reliability of the mini‐CEX was 0.90 for 10 encounters. Almost half of the IMGs (7/16) and most examiners (14/18) were satisfied with the mini‐CEX as a learning tool. Most of the IMGs and examiners enjoyed the immediate feedback, which is a strong component of the tool.
Conclusion: The mini‐CEX is a reliable tool for performance assessment of IMGs, and is acceptable to and well received by both learners and supervisors.
Opportunities for using inpatients for learning physical examination skills have decreased.
In peer physical examination (PPE), students act as models for each other to learn skills in physical examination and other non‐invasive procedures.
PPE is extensively used and has high acceptability, but nevertheless poses some challenges.
PPE may be less acceptable among culturally and linguistically diverse students.
In the light of our findings and the published literature, best practice points are described.
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