Papers by Victoria Brazil
Medical Teacher, 2012
Background: The mini-clinical evaluation exercise (mini-CEX) has been proposed as a method to add... more Background: The mini-clinical evaluation exercise (mini-CEX) has been proposed as a method to address the deficiencies of intraining assessment for junior doctors. Aim: Our study aimed to determine the feasibility and value of adding mini-CEX assessments to the existing assessment processes for an intern cohort in the emergency department (ED). Methods: Interns undertook four mini-CEX assessments with senior ED medical officers, in addition to their standard in-training assessment processes. Assessment results and time taken to perform the mini-CEX assessments were recorded. Interns and assessors completed a survey regarding their perceptions of the mini-CEX assessment process. Results: The total time taken for mini-CEX assessments during the study period was 36.51 h. If extrapolated over a year this would represent an additional direct cost to the ED of more than $A 80,000 per year. No additional interns were identified as underperforming through the addition of the mini-CEX. The mini-CEX assessment process was perceived as generally positive. Both interns and assessors felt that it provided a valid assessment of intern performance, and enabled timely and specific feedback. Significant practical difficulties in arranging and conducting mini-CEX assessments in the workplace were identified. Conclusion: There was a significant cost to the ED as a result of adding mini-CEX encounters to interns' performance assessment. No change in summative outcome occurred for this study cohort.
Emergency Medicine Australasia, 2013
To determine the frequency and nature of intern underperformance as documented on in-training ass... more To determine the frequency and nature of intern underperformance as documented on in-training assessment forms. A retrospective review of intern assessment forms from a 2 year period (2009-2010) was conducted at a tertiary referral hospital in Brisbane, Queensland. The frequency of interns assessed as 'requiring substantial assistance' and/or 'requires further development' on mid- or end-of-term assessment forms was determined. Forms were analysed by the clinical rotation, time of year and domain(s) of clinical practice in which underperformance was documented. During 2009 and 2010 the overall documented incidence of intern underperformance was 2.4% (95% CI 1.5-3.9%). Clinical rotation in emergency medicine detected significantly more underperformance compared with other rotations (P < 0.01). Interns predominantly had difficulty with 'clinical judgment and decision-making skills', 'time management skills' and 'teamwork and colleagues' (62.5%, 55% and 32.5% of underperforming assessments, respectively). Time of the year did not affect frequency of underperformance. A proportion of 13.4% (95% CI 9.2-19.0%) of interns working at the institution over the study period received at least one assessment in which underperformance was documented. Seventy-six per cent of those interns who had underperformance identified by mid-term assessment successfully completed the term following remediation. The prevalence of underperformance among interns is low, although higher than previously suggested. Emergency medicine detects relatively more interns in difficulty than other rotations.
University of Queensland …, 2011
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Academy of Management Proceedings, 2014
Evidence-based management (EBM) has been subject to a number of persuasive critiques in recent ye... more Evidence-based management (EBM) has been subject to a number of persuasive critiques in recent years. Concerns have been raised that: EBM over-privileges rationality as a basis for decision-making; 'scientific' evidence is insufficient and incomplete as a basis for management practice; understanding of how EBM actually plays out in practice is limited ; and, although ideas were originally taken from evidence-based medicine, individual-situated expertise has been forgotten in the transfer. To address these concerns, the authors adopted an approach of 'opening up' the decision process, the decision-maker and the context (Langley et al. (1995). 'Opening up decision making: the view from the black stool', Organization Science, 6, pp. 260–279). The empirical investigation focuses on an EBM decision process involving an operations management problem in a hospital emergency department in Australia. Based on interview and archival research, it describes how an EBM decision process was enacted by a physician manager. It identifies the role of 'fit' between the decision-maker and the organizational context in enabling an evidence-based process and develops insights for EBM theory and practice.
Objectives: Patient safety has emerged as an important topic for inclusion in medical curricula. ... more Objectives: Patient safety has emerged as an important topic for inclusion in medical curricula. However, there is limited literature describing how medical students are taught, learn and self-assess patient safety skills. The present study aimed to seek pre-clinical medical students' perceptions of (i) their individual performance at a range of safety skills; and (ii) how they define patient safety in a simulated ED. Methods: Data were collected in the form of questionnaire responses at the end of the Bond University Simulated ED activity in October 2014. The simulated ED is a session for pre-clinical medical students prior to their clinical rotations, aimed at preparing them for the clinical environment. Likert scale and short answer responses were used to describe students' perceptions of their safety skills and to identify themes related to patient safety. Results: Seventy-eight out of 92 students completed the questionnaires (85% response rate). The majority of students thought their patients were safe from adverse events during their shift. However, students' perception of patient safety was wide-ranging and demonstrated a number of misconceptions. The most frequent strategies employed by students to ensure patient safety were asking for help from nursing staff or senior doctors, ensuring good communication with the patient and checking allergies before administering medication. Conclusion: Students had a favourable opinion of their own safety skills. However, answers to free text question revealed misconceptions about the nature of patient safety despite significant teaching on this topic.
Background: Problem-based learning (PBL) has been widely adopted in medical education. Learners b... more Background: Problem-based learning (PBL) has been widely adopted in medical education. Learners become bored with paper-based cases as they progress through their studies. Aim: To breathe life (i.e. develop virtual patients) into paper-based PBL cases. Methods: The ''patients'' in paper-based PBL cases in one Year 2 were transformed into virtual patients by simulated patients role-playing and the videos and associated patient data uploaded to Bond's Virtual Hospital, a mobile Application. In unsupervised ''clinical teams'', second-year students undertook ''ward rounds'' twice a week, prompted by a virtual consultant and registered nurse. Immediately following the ''ward rounds'', they met with a clinician facilitator to discuss their ''patients''. Results: Apart from some minor technical issues, the experience was rated positively by students and clinical facilitators. They claimed that it provided students with a sense of what happens in the real world of medicine. The group work skills students had developed during PBL stood them in good stead to self-manage their ''clinical teams''. Conclusions: This more authentic PBL experience will be extended to earlier semesters as well as later in the curriculum as the virtual hospital can be used to expose learners to a profile of patients that may not be guaranteed during hospital rounds.
Social media has been viewed by some as a threat to traditional medical education. In emergency c... more Social media has been viewed by some as a threat to traditional medical education. In emergency care, the underpinning educational principles of social media, while sometimes innovative in their delivery, are often no different than long-standing techniques and methods. This article aims to encourage discussion and debate that reduces the divide between these two communities of practice.
Handbook Contents, 2009
40 raise the red Blanket: rapid Transfer to Theatre for simulated Critically Ill Trauma patients ... more 40 raise the red Blanket: rapid Transfer to Theatre for simulated Critically Ill Trauma patients MarkBaldwin and Victoria Brazil Aim To ... 41 WORKSHOP 6 simulation evaluation Tools: an Imperative for the discipline Suzie Kardong-Edgren This presentation reviews a sample of ...
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Papers by Victoria Brazil