The lack of representation of people from low socio-economic and socio-educational backgrounds in... more The lack of representation of people from low socio-economic and socio-educational backgrounds in the medical profession is of growing concern and yet research investigating the problem typically studies recruitment and selection in isolation. This study examines the impacts of home and school socio-economic status (SES) from application to selection in an undergraduate medical degree. Socio-cognitive career theory and stereotype bias are used to explain why those from backgrounds of low SES may be disadvantaged, especially if they are female. Home and high school SES information for 2955 applicants and 202 medical students at one Australian medical school was related to application rates and performance on three selection tests (high school matriculation, the Undergraduate Medical and Health Sciences Admissions Test [UMAT] cognitive ability test, a multiple mini-interview) and academic performance in medical school. Interactions between gender and SES were assessed using moderated ...
General practitioner (GP) supervisors have a central role in GP training. Despite critical thinki... more General practitioner (GP) supervisors have a central role in GP training. Despite critical thinking, research and evidence-based medicine being part of the GP training curriculum, GP supervisors are unlikely to have had much training or practical support to increase their use of research evidence or participate in research themselves, nor to model research activity to their registrars. This article discusses the needs, motivators and barriers to using and participating in research identified by 31 GP supervisors who attended research skills workshops in western Sydney, and potential strategies to increase their research engagement. GP supervisors reported interest in increased research engagement, particularly through efficient use of research evidence to guide practice and teaching, and through input into regional research priority setting. They believed training and practical support through regional training providers, universities and Medicare Locals was needed and would allow i...
Collaboration between general practitioners (GPs) and practice nurses (PNs) can enhance health ca... more Collaboration between general practitioners (GPs) and practice nurses (PNs) can enhance health care delivery. However, despite evidenced shortfalls in general practice-based sexual health care, the PN role in sexual health appears underdeveloped. Evaluation of New South Wales Sexually Transmissible Infections Programs Unit GP Project provided an opportunity to canvass views of GPs and PNs regarding PNs and sexual health care. A purposively sampled group of 10 PNs and nine GPs were interviewed. Interviews were transcribed and analysed thematically. The extent and nature of PN-GP teamwork in sexual health care was variable, influenced largely by GP recognition and support of the PN role in sexual health care. Other important factors were personal PN interest and supportive practice systems. The role played by PNs and a team approach to sexual health care in Australian general practice is underdeveloped. Increased recognition and support of PN roles in sexual health is needed, includin...
General Practitioner (GP) Supervisors have a key yet poorly defined role in promoting the cultura... more General Practitioner (GP) Supervisors have a key yet poorly defined role in promoting the cultural competence of GP Registrars who provide healthcare to Aboriginal and Torres Strait Islander people during their training placements. Given the markedly poorer health of Indigenous Australians, it is important that GP training and supervision of Registrars includes assessment and teaching which address the well documented barriers to accessing health care. A simulated consultation between a GP Registrar and an Aboriginal patient, which illustrated inadequacies in communication and cultural awareness, was viewed by GP Supervisors and Medical Educators during two workshops in 2012. Participants documented teaching points arising from the consultation which they would prioritise in supervision provided to the Registrar. Content analysis was performed to determine the type and detail of the planned feedback. Field notes from workshop discussions and participant evaluations were used to gain insight into participant confidence in cross cultural supervision. Sixty four of 75 GPs who attended the workshops participated in the research. Although all documented plans for detailed teaching on the Registrar's generic communication and consultation skills, only 72% referred to culture or to the patient's Aboriginality. Few GPs (8%) documented a plan to advise on national health initiatives supporting access for Aboriginal and Torres Strait Islander people. A lack of Supervisor confidence in providing guidance on cross cultural consulting with Aboriginal patients was identified. The role of GP Supervisors in promoting the cultural competence of GP Registrars consulting with Aboriginal and Torres Strait Islander patients could be strengthened. A sole focus on generic communication and consultation skills may lead to inadequate consideration of the health disparities faced by Indigenous peoples and of the need to ensure Registrars utilise health supports designed to decrease the disadvantage faced by vulnerable populations.
Dental emergencies often present to primary care providers in general practice and Emergency Depa... more Dental emergencies often present to primary care providers in general practice and Emergency Departments (ED), who may be unable to manage them effectively due to limited knowledge, skills and available resources. This may impact negatively on patient outcomes. Provision of a short educational workshop intervention in the management of such emergencies, including education in supporting resources, may provide a practical strategy for assisting clinicians to provide this aspect of comprehensive primary care. This descriptive study used a validated questionnaire survey instrument to measure the effectiveness of a short multimodal educational intervention through the uptake and perceived usefulness of supporting resources at 6 months following the intervention. Between 2009 and 2010, 15 workshops, of which eight were for regional and rural hospital ED doctors, were conducted by the same presenter using the same educational materials and training techniques. A sample of 181 workshop par...
Food allergies in children are becoming more common causing concern for parents, child carers, te... more Food allergies in children are becoming more common causing concern for parents, child carers, teachers and school principals. This article aims to provide practical information on childhood food allergies and their ongoing management including assessment, prescription of self or carer administered adrenaline, emergency action plans, patient education, school based strategies, and family support. With most schools, preschools and child care centres having at least one child with food allergies, general practitioners are increasingly likely to be involved in school liaison and education, as well as caring for families with food allergic children.
Allergic rhinitis is a common condition associated with significant effects on quality of life. R... more Allergic rhinitis is a common condition associated with significant effects on quality of life. Readily available treatments can improve outcomes in rhinitis as well as associated allergic diseases such as asthma. Yet allergic rhinitis remains underdiagnosed and undertreated. This article outlines practical strategies and evidence based management of allergic rhinitis. Allergic and nonallergic rhinitis often co-exist. Thorough history of allergen exposure and its relationship to symptoms is vital for the ordering and interpretation of investigations and for management decisions. Some allergen avoidance measures may be ineffective and may cause an unnecessary burden. Demonstrated effective strategies are patient education, intranasal steroids and immunotherapy ('desensitisation'). General practitioners play a vital role in all three strategies, and in supporting patients and families to self manage what is often a chronic condition.
Reducing the growing burden of food allergy requires a chronic disease management model, clarific... more Reducing the growing burden of food allergy requires a chronic disease management model, clarification of responsibilities, and better communication of both risks and uncertainties.
The Australasian Society for Clinical Immunology and Allergy has developed new anaphylaxis action... more The Australasian Society for Clinical Immunology and Allergy has developed new anaphylaxis action plans intended for use across Australasia. These educational tools aim to give patients and carers easily accessible information about key steps in the emergency treatment of acute allergic reactions and anaphylaxis. This article outlines the rationale for these plans, introduces two new action plans and key practice points to consider when providing these plans. Action plans are primarily an educational tool for patients considered to be at risk of anaphylaxis. They also function in a similar fashion to a doctor's letter, providing written information that patients and parents can give to child care centres, schools and employers to assist in the provision of appropriate care.
Abstract Background: Benchmarking among medical schools is essential, but may result in unwanted ... more Abstract Background: Benchmarking among medical schools is essential, but may result in unwanted effects. To apply a conceptual framework to selected benchmarking activities of medical schools. We present an analogy between the effects of assessment on student learning and the effects of benchmarking on medical school educational activities. A framework by which benchmarking can be evaluated was developed and applied to key current benchmarking activities in Australia and New Zealand. The analogy generated a conceptual framework that tested five questions to be considered in relation to benchmarking: what is the purpose? what are the attributes of value? what are the best tools to assess the attributes of value? what happens to the results? and, what is the likely "institutional impact" of the results? If the activities were compared against a blueprint of desirable medical graduate outcomes, notable omissions would emerge. Medical schools should benchmark their performance on a range of educational activities to ensure quality improvement and to assure stakeholders that standards are being met. Although benchmarking potentially has positive benefits, it could also result in perverse incentives with unforeseen and detrimental effects on learning if it is undertaken using only a few selected assessment tools.
Background: Tympanometry and pneumatic otoscopy are recommended for diagnosis of otitis media, bu... more Background: Tympanometry and pneumatic otoscopy are recommended for diagnosis of otitis media, but are not frequently used by general practitioners (GPs). We examined how, after targeted short training, GP diagnosis and management of childhood ear disease was changed by the addition of these techniques to non-pneumatic otoscopy. We further explored factors influencing the uptake of these techniques. Methods: Between 2011 and 2012, we used a crossover experimental design to determine associations between tympanometry and pneumatic otoscopy and the GP diagnosis and management of ear disease in children aged 6 months to 6 years. GPs recorded a diagnosis and management plan after examining ears using non-pneumatic otoscopy, and another after using either tympanometry or pneumatic otoscopy. We compared diagnosis, prescription of oral antibiotics and planned GP follow-up at these two steps between the tympanometry and pneumatic otoscopy groups. We interviewed participants about their views regarding these techniques and analysed these data thematically. Results: Thirteen GPs recorded 694 ear examinations on 347 children: 347 examinations with non-pneumatic otoscopy; then 196 using tympanometry; and 151 using pneumatic otoscopy. Tympanometry was more likely to be associated with changes in diagnosis (χ 2 = 28.64, df 1, p < 0.001) and planned GP follow-up (χ 2 = 9.24, df 1, p < 0.01) than pneumatic otoscopy. Change in oral antibiotic prescription was no different between the two techniques. GPs preferred tympanometry to pneumatic otoscopy, but cost was a barrier to ongoing use. Pneumatic otoscopy was considered the more difficult skill. GPs were not convinced that the increased detection of middle ear effusion afforded by tympanometry and pneumatic otoscopy resulted in benefit to general practice patients.
A significant body of food allergy research has been conducted with families recruited from consu... more A significant body of food allergy research has been conducted with families recruited from consumer organizations (COs). However, there has been no systematic comparison of the characteristics of such families with those attending specialist allergy clinics (ACs), nor have parental views on food allergy COs been examined in detail. To address these questions, 44 families with food allergic children recruited from hospital clinics and 25 families recruited from a CO: (i) completed a survey with items concerning demographic details, allergy features, and sources of allergy information, and (ii) participated in qualitative interviews and focus groups concerning their experiences. Significant differences were found in reported number of food allergies and nut allergy, seeking of second opinions, adrenaline autoinjector possession (but not use) and sources of food allergy information. Parents valued COs as sources of practical information and emotional support, but viewed advice which did not acknowledge their individual circumstances and heightened anxiety from contact with other anxious parents as being unhelpful. Research conducted with CO members is valuable, but may have limited generalizability to other populations. To supplement the information and support provided by ACs, all parents should be given the opportunity to join a CO, with guidance from their clinician towards those aspects of membership which are most likely to be helpful.
Dimensions in small capitals were the dominant focus of talk; attributes in italics were not dire... more Dimensions in small capitals were the dominant focus of talk; attributes in italics were not directly named but were implied (e.g. altruism)
The lack of representation of people from low socio-economic and socio-educational backgrounds in... more The lack of representation of people from low socio-economic and socio-educational backgrounds in the medical profession is of growing concern and yet research investigating the problem typically studies recruitment and selection in isolation. This study examines the impacts of home and school socio-economic status (SES) from application to selection in an undergraduate medical degree. Socio-cognitive career theory and stereotype bias are used to explain why those from backgrounds of low SES may be disadvantaged, especially if they are female. Home and high school SES information for 2955 applicants and 202 medical students at one Australian medical school was related to application rates and performance on three selection tests (high school matriculation, the Undergraduate Medical and Health Sciences Admissions Test [UMAT] cognitive ability test, a multiple mini-interview) and academic performance in medical school. Interactions between gender and SES were assessed using moderated ...
General practitioner (GP) supervisors have a central role in GP training. Despite critical thinki... more General practitioner (GP) supervisors have a central role in GP training. Despite critical thinking, research and evidence-based medicine being part of the GP training curriculum, GP supervisors are unlikely to have had much training or practical support to increase their use of research evidence or participate in research themselves, nor to model research activity to their registrars. This article discusses the needs, motivators and barriers to using and participating in research identified by 31 GP supervisors who attended research skills workshops in western Sydney, and potential strategies to increase their research engagement. GP supervisors reported interest in increased research engagement, particularly through efficient use of research evidence to guide practice and teaching, and through input into regional research priority setting. They believed training and practical support through regional training providers, universities and Medicare Locals was needed and would allow i...
Collaboration between general practitioners (GPs) and practice nurses (PNs) can enhance health ca... more Collaboration between general practitioners (GPs) and practice nurses (PNs) can enhance health care delivery. However, despite evidenced shortfalls in general practice-based sexual health care, the PN role in sexual health appears underdeveloped. Evaluation of New South Wales Sexually Transmissible Infections Programs Unit GP Project provided an opportunity to canvass views of GPs and PNs regarding PNs and sexual health care. A purposively sampled group of 10 PNs and nine GPs were interviewed. Interviews were transcribed and analysed thematically. The extent and nature of PN-GP teamwork in sexual health care was variable, influenced largely by GP recognition and support of the PN role in sexual health care. Other important factors were personal PN interest and supportive practice systems. The role played by PNs and a team approach to sexual health care in Australian general practice is underdeveloped. Increased recognition and support of PN roles in sexual health is needed, includin...
General Practitioner (GP) Supervisors have a key yet poorly defined role in promoting the cultura... more General Practitioner (GP) Supervisors have a key yet poorly defined role in promoting the cultural competence of GP Registrars who provide healthcare to Aboriginal and Torres Strait Islander people during their training placements. Given the markedly poorer health of Indigenous Australians, it is important that GP training and supervision of Registrars includes assessment and teaching which address the well documented barriers to accessing health care. A simulated consultation between a GP Registrar and an Aboriginal patient, which illustrated inadequacies in communication and cultural awareness, was viewed by GP Supervisors and Medical Educators during two workshops in 2012. Participants documented teaching points arising from the consultation which they would prioritise in supervision provided to the Registrar. Content analysis was performed to determine the type and detail of the planned feedback. Field notes from workshop discussions and participant evaluations were used to gain insight into participant confidence in cross cultural supervision. Sixty four of 75 GPs who attended the workshops participated in the research. Although all documented plans for detailed teaching on the Registrar&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s generic communication and consultation skills, only 72% referred to culture or to the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Aboriginality. Few GPs (8%) documented a plan to advise on national health initiatives supporting access for Aboriginal and Torres Strait Islander people. A lack of Supervisor confidence in providing guidance on cross cultural consulting with Aboriginal patients was identified. The role of GP Supervisors in promoting the cultural competence of GP Registrars consulting with Aboriginal and Torres Strait Islander patients could be strengthened. A sole focus on generic communication and consultation skills may lead to inadequate consideration of the health disparities faced by Indigenous peoples and of the need to ensure Registrars utilise health supports designed to decrease the disadvantage faced by vulnerable populations.
Dental emergencies often present to primary care providers in general practice and Emergency Depa... more Dental emergencies often present to primary care providers in general practice and Emergency Departments (ED), who may be unable to manage them effectively due to limited knowledge, skills and available resources. This may impact negatively on patient outcomes. Provision of a short educational workshop intervention in the management of such emergencies, including education in supporting resources, may provide a practical strategy for assisting clinicians to provide this aspect of comprehensive primary care. This descriptive study used a validated questionnaire survey instrument to measure the effectiveness of a short multimodal educational intervention through the uptake and perceived usefulness of supporting resources at 6 months following the intervention. Between 2009 and 2010, 15 workshops, of which eight were for regional and rural hospital ED doctors, were conducted by the same presenter using the same educational materials and training techniques. A sample of 181 workshop par...
Food allergies in children are becoming more common causing concern for parents, child carers, te... more Food allergies in children are becoming more common causing concern for parents, child carers, teachers and school principals. This article aims to provide practical information on childhood food allergies and their ongoing management including assessment, prescription of self or carer administered adrenaline, emergency action plans, patient education, school based strategies, and family support. With most schools, preschools and child care centres having at least one child with food allergies, general practitioners are increasingly likely to be involved in school liaison and education, as well as caring for families with food allergic children.
Allergic rhinitis is a common condition associated with significant effects on quality of life. R... more Allergic rhinitis is a common condition associated with significant effects on quality of life. Readily available treatments can improve outcomes in rhinitis as well as associated allergic diseases such as asthma. Yet allergic rhinitis remains underdiagnosed and undertreated. This article outlines practical strategies and evidence based management of allergic rhinitis. Allergic and nonallergic rhinitis often co-exist. Thorough history of allergen exposure and its relationship to symptoms is vital for the ordering and interpretation of investigations and for management decisions. Some allergen avoidance measures may be ineffective and may cause an unnecessary burden. Demonstrated effective strategies are patient education, intranasal steroids and immunotherapy ('desensitisation'). General practitioners play a vital role in all three strategies, and in supporting patients and families to self manage what is often a chronic condition.
Reducing the growing burden of food allergy requires a chronic disease management model, clarific... more Reducing the growing burden of food allergy requires a chronic disease management model, clarification of responsibilities, and better communication of both risks and uncertainties.
The Australasian Society for Clinical Immunology and Allergy has developed new anaphylaxis action... more The Australasian Society for Clinical Immunology and Allergy has developed new anaphylaxis action plans intended for use across Australasia. These educational tools aim to give patients and carers easily accessible information about key steps in the emergency treatment of acute allergic reactions and anaphylaxis. This article outlines the rationale for these plans, introduces two new action plans and key practice points to consider when providing these plans. Action plans are primarily an educational tool for patients considered to be at risk of anaphylaxis. They also function in a similar fashion to a doctor's letter, providing written information that patients and parents can give to child care centres, schools and employers to assist in the provision of appropriate care.
Abstract Background: Benchmarking among medical schools is essential, but may result in unwanted ... more Abstract Background: Benchmarking among medical schools is essential, but may result in unwanted effects. To apply a conceptual framework to selected benchmarking activities of medical schools. We present an analogy between the effects of assessment on student learning and the effects of benchmarking on medical school educational activities. A framework by which benchmarking can be evaluated was developed and applied to key current benchmarking activities in Australia and New Zealand. The analogy generated a conceptual framework that tested five questions to be considered in relation to benchmarking: what is the purpose? what are the attributes of value? what are the best tools to assess the attributes of value? what happens to the results? and, what is the likely &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;institutional impact&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; of the results? If the activities were compared against a blueprint of desirable medical graduate outcomes, notable omissions would emerge. Medical schools should benchmark their performance on a range of educational activities to ensure quality improvement and to assure stakeholders that standards are being met. Although benchmarking potentially has positive benefits, it could also result in perverse incentives with unforeseen and detrimental effects on learning if it is undertaken using only a few selected assessment tools.
Background: Tympanometry and pneumatic otoscopy are recommended for diagnosis of otitis media, bu... more Background: Tympanometry and pneumatic otoscopy are recommended for diagnosis of otitis media, but are not frequently used by general practitioners (GPs). We examined how, after targeted short training, GP diagnosis and management of childhood ear disease was changed by the addition of these techniques to non-pneumatic otoscopy. We further explored factors influencing the uptake of these techniques. Methods: Between 2011 and 2012, we used a crossover experimental design to determine associations between tympanometry and pneumatic otoscopy and the GP diagnosis and management of ear disease in children aged 6 months to 6 years. GPs recorded a diagnosis and management plan after examining ears using non-pneumatic otoscopy, and another after using either tympanometry or pneumatic otoscopy. We compared diagnosis, prescription of oral antibiotics and planned GP follow-up at these two steps between the tympanometry and pneumatic otoscopy groups. We interviewed participants about their views regarding these techniques and analysed these data thematically. Results: Thirteen GPs recorded 694 ear examinations on 347 children: 347 examinations with non-pneumatic otoscopy; then 196 using tympanometry; and 151 using pneumatic otoscopy. Tympanometry was more likely to be associated with changes in diagnosis (χ 2 = 28.64, df 1, p < 0.001) and planned GP follow-up (χ 2 = 9.24, df 1, p < 0.01) than pneumatic otoscopy. Change in oral antibiotic prescription was no different between the two techniques. GPs preferred tympanometry to pneumatic otoscopy, but cost was a barrier to ongoing use. Pneumatic otoscopy was considered the more difficult skill. GPs were not convinced that the increased detection of middle ear effusion afforded by tympanometry and pneumatic otoscopy resulted in benefit to general practice patients.
A significant body of food allergy research has been conducted with families recruited from consu... more A significant body of food allergy research has been conducted with families recruited from consumer organizations (COs). However, there has been no systematic comparison of the characteristics of such families with those attending specialist allergy clinics (ACs), nor have parental views on food allergy COs been examined in detail. To address these questions, 44 families with food allergic children recruited from hospital clinics and 25 families recruited from a CO: (i) completed a survey with items concerning demographic details, allergy features, and sources of allergy information, and (ii) participated in qualitative interviews and focus groups concerning their experiences. Significant differences were found in reported number of food allergies and nut allergy, seeking of second opinions, adrenaline autoinjector possession (but not use) and sources of food allergy information. Parents valued COs as sources of practical information and emotional support, but viewed advice which did not acknowledge their individual circumstances and heightened anxiety from contact with other anxious parents as being unhelpful. Research conducted with CO members is valuable, but may have limited generalizability to other populations. To supplement the information and support provided by ACs, all parents should be given the opportunity to join a CO, with guidance from their clinician towards those aspects of membership which are most likely to be helpful.
Dimensions in small capitals were the dominant focus of talk; attributes in italics were not dire... more Dimensions in small capitals were the dominant focus of talk; attributes in italics were not directly named but were implied (e.g. altruism)
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Papers by Wendy Hu