Australian Family Physician January/February - Teaching in general practice
Vol 41, (1/2) 1 - 80
The theme for the January/February issue of AFP is teaching in general
practice.
This month's articles include clinical reasoning, teaching medical
students, patient safety and trainees in the practice, practical issues,
access to primary care, acute rheumatic fever, and HbA1c and
glycaemia.
Reflection, resolutions and renewal
Carolyn O'Shea
A new year – an opportunity for reflection,
resolutions and looking forward, a time of
change and renewal.
Improving medicine selection for older people - Do we need an Australian classification for inappropriate medicines use?
J Simon Bell, David G Le Couteur, Andrew J McLachlan, Timothy F Chen, Rebekah J Moles, Benjamin J Basger, Sarah N Hilmer
General practitioners manage complex
medicine regimens and multiple
comorbidities in older people. While
medicine use usually leads to benefits for
older people, the process of prescribing
medicines is becoming increasingly
complex.
Letters to the editor
The opinions expressed by correspondents in this column are in no way endorsed by either the Editors or The Royal Australian College of General Practitioners
GPs in teaching practices
Janice Charles, Lisa Valenti, Graeme Miller
From April 2010 to March 2011, 956 general practitioners
took part in BEACH (Bettering the Evaluation and Care
of Health). Five hundred and ninety-four (62%) worked in
a teaching practice for undergraduates, junior doctors or
general practice registrars.
Trainees in the practice - Practical issues
Caroline Laurence, Deb Docking, Danny Haydon, Carolyn Cheah
The demand for clinical placements in Australian general
practice is on the rise. There are more medical students,
more places available for junior doctors to undertake
rotations in general practice (975 places by 2014) and more
general practice registrar positions (1200 entry places by
2014).
Clinical reasoning - A guide to improving teaching and practice
Andrew Linn, Carole Khaw, Hugh Kildea, Anne Tonkin
Clinical reasoning is seemingly as difficult to define as
it is to teach. Clinicians generally ‘know it when they
see it’, but rarely stop to consider what is meant by
it, and more importantly, how to teach it to the next
generation of clinicians.
Teaching medical students - Tips from the frontline
James Best
Medical student teaching in the general practice setting
in Australia is increasing at an exponential rate. Many
experienced general practitioners who are motivated to teach
have little or no training in teaching, and can feel intimidated
by the process.
Are they safe in there? - Patient safety and trainees in the practice
Patrick D Byrnes, Margaret Crawford, Brittany Wong
Due to the projected increase of medical graduates and
general practice registrars, a rapid increase in new trainers
and practices is required. The resulting mix of relatively
inexperienced trainers and trainees makes the examination of
the important question of patient safety even more pertinent.
Rheumatic fever - Identification, management and secondary prevention
Michael T Smith, Yvonne Zurynski, David Lester-Smith, Elizabeth Elliott, Jonathan Carapetis
Acute rheumatic fever is a rare multisystem disease caused by an immunological
response to Group A streptococcus infection. Acute rheumatic fever usually has
onset in childhood and is most prevalent in Aboriginal and Maori populations and
other disadvantaged groups.
HbA1c and monitoring glycaemia
Patrick J Phillips
This article forms part of our ‘Tests and results’ series for 2012, which aims to provide
information about common tests that general practitioners order regularly. It considers areas
such as indications, what to tell the patient, what the test can and cannot tell you, and
interpretation of results.
A skin lesion and fever of unknown origin - A case study
Stalia Wong, Chirk-Jenn Ng
Case study - Mr A, a Malay man, 31 years of age,
presented with 2 months of fever and a
skin lesion on his right flank
Anticholinergic and sedative medicines - Prescribing considerations for people with dementia
J Simon Bell, Carmel Mezrani, Natalie Blacker, Tammy LeBlanc, Oliver Frank, Christopher P Alderman, Simone Rossi, Debra Rowett, Russell Shute
Older people with dementia may be particularly susceptible to cognitive
impairment associated with anticholinergic and sedative medicines. This
impairment may be misattributed to the disease process itself.
Ring-like lesions on the hand - A case study
Lawrence Leung
Case study - Pat, 55 years of age, is a librarian. She
presented with a 5 month history of
multiple red, ring-like lesions on her
hands, elbows and the back of her knees.
Her husband died 10 months ago from
disseminated cancer.
Broken heart syndrome – a case study
Atifur Rahman, David Liu
Edith, aged 65 years of age, lives in a
rural township. She experienced sudden
onset severe chest pain and dyspnoea
after learning that her husband had
died. Edith’s daughter drove her to the
local hospital where investigations were
performed.
Key findings on ECGs – level of agreement between GPs and cardiologists
Mark Whitman, Danielle Layt, Michael Yelland
Electrocardiogram (ECG) recordings are
central to the diagnosis and management
of patients with cardiac complaints
in primary care, although some
concerns remain about the diagnostic
accuracy of the general practitioners
interpreting them.
Microbiological contamination of spirometers – an exploratory study in general practice
Kerry L Hancock, Tjard R Schermer, Christine Holton, Alan J Crockett
Spirometry has become an important tool
for general practitioners to diagnose and
monitor chronic respiratory conditions.
About 65% of Australian practices
own a spirometer. Colonisation of
respiratory pathogens in laboratory
spirometers has been reported but
no such data are available for general
practice.
StreetHealth – improving access to primary care
Susan J Hookey
This article forms part of our ‘Access series’ for 2012, profiling organisations that provide primary
healthcare to groups who are disadvantaged or have difficulty accessing mainstream services.
The aim of this series is describe the area of need, the innovative strategies that have been
developed by specific organisations to address this need and make recommendations to help GPs
improve access to disadvantaged populations in their own communities.
Revalidation for relicensing – reflections on the proposed British model
Jill Thistlethwaite, Rodger Charlton, Jane Coomber
The United Kingdom General Medical
Council (GMC) is responsible for
accrediting the training and registration
of doctors and monitoring their fitness to
practise medicine in the United Kingdom.
Until 1999, once doctors were GMC
registered this was for life, unless they were removed for unprofessional behaviour, including criminal misconduct, following a complaint.
Management of type 2 diabetes – a community partnership approach
Susan Harch, David Reeve, Carole Reeve
The impact of type 2 diabetes is severe
in Aboriginal and Torres Strait Islander
people. Compared with non-Indigenous
Australians, type 2 diabetes in Indigenous
Australians is four times more prevalent,
associated with an earlier age of onset
and 12–17 times more deaths.1–4 The
Department of Health and Ageing
estimate 80% of the total burden of
disease in Australia is due to chronic
diseases when measured in disability
adjusted life years.
Clinical challenge
Questions for this month’s clinical challenge are based on articles in this issue. The style and scope of questions is in keeping with the multiple choice questions of the RACGP Fellowship exam. The quiz is endorsed by the RACGP Quality Improvement and Continuing Professional Development Program and has been allocated 4 Category 2 points per issue.