BackgroundThe numbers of learners seeking placements in general practice is rapidly increasing as an ageing workforce impacts on General Practitioner availability. The traditional master apprentice model that involves one-to-one teaching is therefore leading to supervision capacity constraints. Vertically integrated (VI) models may provide a solution. Shared learning, in which multiple levels of learners are taught together in the same session, is one such model. This study explored stakeholders’ perceptions of shared learning in general practices in northern NSW, Australia.MethodsA qualitative research method, involving individual semi-structured interviews with GP supervisors, GP registrars, Prevocational General Practice Placements Program trainees, medical students and practice managers situated in nine teaching practices, was used to investigate perceptions of shared learning practices. A thematic analysis was conducted on 33 transcripts by three researchers.ResultsParticipants perceived many benefits to shared learning including improved collegiality, morale, financial rewards, and better sharing of resources, knowledge and experience. Additional benefits included reduced social and professional isolation, and workload. Perceived risks of shared learning included failure to meet the individual needs of all learners. Shared learning models were considered unsuitable when learners need to: receive remediation, address a specific deficit or immediate learning needs, learn communication or procedural skills, be given personalised feedback or be observed by their supervisor during consultations. Learners’ acceptance of shared learning appeared partially dependent on their supervisors’ small group teaching and facilitation skills.ConclusionsShared learning models may partly address supervision capacity constraints in general practice, and bring multiple benefits to the teaching environment that are lacking in the one-to-one model. However, the risks need to be managed appropriately, to ensure learning needs are met for all levels of learners. Supervisors also need to consider that one-to-one teaching may be more suitable in some instances. Policy makers, medical educators and GP training providers need to ensure that quality learning outcomes are achieved for all levels of learners. A mixture of one-to-one and shared learning would address the benefits and downsides of each model thereby maximising learners’ learning outcomes and experiences.
Orthopaedic patients who smoke and/or drink heavily prior to surgery may have more non-medical complications than non-smokers and light or non-drinkers. All surgery patients should thus be screened for alcohol and tobacco use and alcohol withdrawal, which may cause other symptoms such as behavioural problems, non-compliance and verbal abuse post-surgery.
Adolescent and Young Adult (AYA) cancer patients have been described as being orphaned in the system. A major study, investigated the experiences of family members who had an adolescents or young adult who lived with and eventually died of cancer. The participants were a self-selected purposeful sample of 26 family members. Selected methods of narrative analysis were used to create themes in a meta-narrative of the family member's experience. One of the themes to emerge from the families meta-narrative was the change in the focus of care. Six of the family member's stories spoke of the palliative care transition. Specific to this was the experience of the transition to place of death with particular reference to dying at home. The results suggest that the transition into palliative should occur sooner rather than later for appropriate supports to be in place to facilitate this transition.
While on the whole the cancer was treated with state of the art medicine, the experiences of the hospitalisation repeated consistently throughout this narrative reveals a failure to meet the higher order needs specific to adolescents and young adults and their families As a result this cohort were exposed to a landscape which did not facilitate a therapeutic experience, as well as would be expected for children and older adults.
Research of AYAs with cancer has developed significantly over the last 20 years. The research has demonstrated that AYAs with cancer are a forgotten population, who require closer study in order to understand their unique issues. This paper examines family members' experiences of adolescents and young adults (AYAs) during the dying stage of their cancer trajectory. The results are drawn from a larger study titled 'From Go to Woe; Family Members' Stories of Adolescents and Young People Living with and Dying from Cancer, which storied the family members' experience of the diagnosis, treatment, dying and death of an AYA family member, utilizing Armstrong-Coster's (2004) four stages of the cancer trajectory. The principal researcher's motivation to understand and story these experiences was related to her own isolation and lack of information when her 16 year old son Anthony, was diagnosed with and eventually died of cancer at 17 years of age.The significance of this study is the contribution made to the identification of issues that can inform health policy/ guidelines. The findings have the potential to increase understanding of, and prepare family members and AYAs with cancer, for the experience of the death and dying stage of the cancer trajectory.Keywords: Adolescents and young adults; Cancer; Death and dying; End of life decision making Literature ReviewResearch over the last 20 years has indicated that AYAs with cancer are a forgotten population who require closer study in order to understand their unique problems [1][2][3][4][5][6][7][8][9] prompting Michelagnoli, Pritchard and Phillip [3] to describe this group of people as a lost tribe. One factor identified to account for this disadvantage is the fragmentation of services [1,[10][11][12].The fragmentation of services is a result of AYAs being cared for in two systems of care, the paediatric and the adult [13] with different goals and philosophies of care.The paediatric system has been described as mainly family focused and the adult system disease focused [14].This has implications not only for medical treatment of AYAs with cancer, but also presents problems in providing targeted support services. O'Brien, et al.,[15] identified the following issues that account for the lack of support services.Support services vary across adult hospitals and are fewer than those provided by specialist paediatric hospitals; support services provided both in paediatric or adult hospitals are not designed for the AYA age group, and the lack of critical mass in either system prevents optimal support service. These issues are amplified during the dying stage of the cancer journey.There is limited research on AYAs dying with cancer and their families. A review of literature found only four authors [16][17][18][19]. Wein, Pery and Zer [19] provided information specific to this group and their specific psychosocial needs whilst dying.Bisset et al. [16] identified the following needs for AYAs, their parents and siblings for palliative care services: "involvement in dec...
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