Medicine and Health Sciences Commons^™

General Practitioners And Euthanasia: Strong Opinions And Unexpected Views, Ian Wilson, B Kay, I Steven

Ian G Wilson

No abstract provided.

Does Psychological Status Influence Clinical Outcomes In Patients With Inflammatory Bowel Disease (Ibd) And Other Chronic Gastroenterological Diseases: An Observational Cohort Prospective Study, Antonina A. Mikocka-Walus, Deborah Turnbull, Nicole T. Moulding, Ian G. Wilson, Gerald J. Holtmann, Jane M. Andrews

Ian G Wilson

Background: Whether there is a temporal relationship between psychological problems and clinical outcomes in patients with diseases of the digestive tract has not been widely researched. Thus, our aims were 1) To observe and compare prospectively clinical outcomes in relation to psychological co-morbidity in patients with inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and chronic hepatitis C (HCV) and, 2) To test the hypothesis that patients with psychological co-morbidities are less likely to have a satisfactory response to standard treatment at 12 months. Methods: Overall, 139 patients were enrolled in this observational cohort prospective study. Over the ensuing year, …

Faking Good: Self Enhancement In Medical School Applicants, Barbara Griffin, Ian Wilson

Ian G Wilson

OBJECTIVES The problem of dissimulation by applicants when self-report tests of personality are used for job selection has received considerable attention in non-medical contexts. Personality testing is not yet widely used in medical student selection, but this may change in the light of recent research demonstrating significant relationships between personality and performance in medical school. This study therefore aimed to assess the extent of self-enhancement in a sample of medical school applicants. METHODS A within-subjects design compared personality test scores collected in 2007 for 83 newly enrolled medical students with scores for the same students obtained on the same personality …

I Will Only Work From 2.00 To 5.00..., Ian Wilson, David Harding

Ian G Wilson

A few years ago a colleague, Mike, was interviewing a young family doctor, Bob, who wanted to work on a part-time basis in the family practice run byMike. Mike wanted a fulltime partner prepared to undertake home visits and after-hours consulting. The young doctor, Bob, was about to commence a diploma in creative writing and only wanted to work on a part-time basis. Because of the shortage of family doctors in the region, Mike agreed to explore the part-time options. The interview seemed to be going well until Mike registered that Bob wanted to finish work at exactly 5.00 pm …

Does Practice Make Perfect? The Effect Of Coaching And Retesting On Selection Tests Used For Admission To An Australian Medical School, Barbara Griffin, David Harding, Ian Wilson, Neville Yeomans

Ian G Wilson

Objective: To assess the practice effects from coaching on the Undergraduate Medicine and Health Sciences Admission Test (UMAT), and the effect of both coaching and repeat testing on the Multiple Mini Interview (MMI). Design, setting and participants: Observational study based on a self-report survey of a cohort of 287 applicants for entry in 2008 to the new School of Medicine at the University of Western Sydney. Participants were asked about whether they had attended UMAT coaching or previous medical school interviews, and about their perceptions of the relative value of UMAT coaching, attending other interviews or having a “practice run” …

Psychiatric Comorbidity In General Practice, David Pierce, Ian Wilson

Ian G Wilson

BACKGROUND Much of teachlng and resean:h has concentrated on single disease entities. In general practice, however, many patients suffer from a number of Interacting Ulnesses at the same time. It is unlikely we' wll1 ever have randomlsed controlled trlaIs to gulde the management of such patients. OBJECTIVE This article alms to develop a framework that will assist general practitioners In day·to-day cllnlcal work with patients presenting with concurrent multiple physical and mental health problems. DISCUSSION A positive, caring, patient centred approach is requIred and ~ultiple diagnoses need to be managed within an IntegratOd'treatment plan. The quality of the therapeutic relationship …

General Practitioners' Views On Patient Care Research., Ian Wilson, B Mcgrath, G Russell, C Bridges-Webb, C Hogan

Ian G Wilson

BACKGROUND: Little research has been undertaken into the factors affecting recruitment by Australian general practitioners of patients for clinical trials. Understanding the differences between recruiters and non-recruiters will assist researchers in better supporting general practitioners involved in such research. METHOD: A survey of general practitioners involved in recruiting patients for clinical trials for the RACGP Research Program was undertaken. RESULTS: Recruiters were more likely to be interested in learning more about research, to perceive involvement as worthwhile, to desire a good relationship with Research Program staff and to feel the doctor-patient relationship assists recruitment. DISCUSSION: Recruiters in general are average …

Clinical Guidance On The Use Of Antidepressant Medications In Children And Adolescents, Bill Lyndon, Leanne Rowe, Allen Fraser, Daryl Efron, Garry Walter, Ian Wilson, Louise Newman, Natalie Silove

Ian G Wilson

This statement is addressed to prescribers, especially general practitioners, and is intended to provide clinical guidance on the use of selective serotonin reuptake inhibitors (SSRIs) when treating children and adolescents. While treatment of psychiatric and developmental disorders in children may include multiple modalities of therapy, this statement is focussed on medication.

Controversies Surrounding The Comorbidity Of Depression And Anxiety In Inflammatory Bowel Disease Patients: A Literature Review, Antonina Mikocka-Walus, Deborah Turnbull, Nicole Moulding, Ian Wilson, Jane Andrews, Gerald Holtmann

Ian G Wilson

Psychological disorders are highly prevalent in patients with inflammatory bowel disease (IBD). Anxiety and depression are known to independently affect quality of life and may additionally impair quality of life in IBD over and above the IBD itself. Some researchers have further proposed that anxiety and depression may influence the clinical course of IBD. However, despite the potential for anxiety and depression to play an important role in the clinical picture of IBD, there is little prospective well-controlled research in this area. Probably because of this lack of clear data, researchers dispute the actual role of these psychological disorders in …

Developing A Process Of Continuous Quality Improvement In Medical School Assessment Processes: Lessons From One School, Alison Jones, Ian Wilson, Dorothy Keefe

Ian G Wilson

Introduction: Setting high quality assessments for medical students can be a resource intensive exercise. This study explored the feasibility of coordinating and rationalising the use of expertise to set assessments and to raise the standard of those assessments. Method: A literature review on staff development for assessment was undertaken and the governance structure for assessment design and monitoring in our institution was explored. A manual was developed to outline issues around assessment and processes for improving assessments and this was distributed to key personnel involved in the assessment setting process. A two-day examination setting workshop was organised and evaluated. A …

Medical Schools Can Cooperate: A New Joint Venture To Provide Medical Education In The Northern Rivers Region Of New South Wales, Sue Page, Hudson Birden, Judith Hudson, Jill Thistlethwaite, Chris Roberts, Ian Wilson, John Bushnell, John Hogg, Ben Freedman, Neville Yeomans

Ian G Wilson

The medical schools at the University of Western Sydney, University of Wollongong and University of Sydney have developed a joint program for training medical students through placements of up to 40 weeks on the New South Wales North Coast.

The new partnership agency - the North Coast Medical Education Collaboration - builds on the experience of regional doctors and their academic partners.

A steering comm ittee has identified the availability and support requireme nts of local practitioners to provide training, and has undertaken a comparative mapping of learning objectives and assessments from the courses of the three universities.

The goals …

Primary Health Care Responses To Onsite Psychologist Support, Helen Winefield, John Marley, John Taplin, Justin Beilby, Deborah Turnbull, Ian Wilson, Brian Williams

Ian G Wilson

With the aim of improving early intervention for mental disorders, the 'Better Outcomes in Mental Health Care' initiative is now providing funding for mental health specialists to work in Divisions of General Practice. A key determinant of how this innovation is received is likely to be the readiness on the part of General Practitioners (GPs) and their patients to accept psychological interventions. This paper reports a baseline study of the attitudes to integrated onsite psychological services, held by GPs, nonmedical staff, and patients at one large suburban family practice. An anonymous brief questionnaire was used to gather both ratings and …

Asthma And Depression: A Pragmatic Review Of The Literature And Recommendations For Future Research, Melissa Opolski, Ian Wilson

Ian G Wilson

Background: Although the association between asthma and psychosocial factors has long been recognised, it is only in the last decade that the impact of coexisting asthma and depression has become the focus of considerable research interest. However, the findings so far have been confusing and often contradictory. This paper sets out a methodical review and appraisal of the literature to date, including suggestions for future research. Method: PubMed and PsycINFO databases were used to search for English-language articles relating to asthma and depression research. The resulting articles were then reviewed and summarised, creating a report that was used to develop …

Screening For Social Anxiety Disorder In First Year University Students: A Pilot Study, Ian Wilson

Ian G Wilson

Social anxiety disorder (SAD) is characterised by fear of negative evaluation.1 Sufferers become anxious when they perceive themselves as the centre of attention, finding it difficult to speak in public, attend social events and deal with authority figures. It is common, with an annual prevalence of 2.7% in Australia, but elsewhere in the western world it is higher (3–4%) and has a lifetime incidence of 7–13%. It has significant impact on education and employment, with lower levels of educational achievement and lower incomes.There are several screening tests for social anxiety disorder. The 24 question Liebowitz Social Anxiety Scale is reliable, …

A Pilot Study To Validate Modification Of The Duke University Severity Of Illness Scale To Measure A Family's Burden Of Illness, Ian Wilson

Ian G Wilson

Background. Measurement of burden of illness is rarely undertaken in general practice, although a specific tool [Duke University Severity of Illness DUSOI scale] has been incorporated in the International Classification in Primary Care. This measures the burden of illness in an individual at a point in time. There has not been any measure of the burden of illness in families. Such an instrument would allow measurement of the impact of events on the health of families. Objective. This pilot study aimed to modify the DUSOI to measure a family's burden of illness and to validate any changes. Methods. The DUSOI …

The Impact Of Mental Illness On Family Members, Ian Wilson

Ian G Wilson

Background: Mental illness is a common problem managed in general practice. It is often not appreciated that the effects of mental illness extend beyond the patient to the family. The effect of a serious mental illness on the health of family members has been studied, but not in relation to the types of mental illnesses seen in general practice. Objective: The author uses the literature to examine his experiences of factors which affect families who contain a mentally ill member. In doing so he examines issues relating to the care of such families. Some means by which assistance may be …

Distress Levels And Self-Reported Treatment Rates For Medicine, Law, Psychology And Mechanical Engineering Tertiary Students: A Cross-Sectional Study, Catherine Leahy, Ray Peterson, Ian Wilson, Jonathon Newbury, Anne Tonkin, Deborah Turnbull

Ian G Wilson

Objective: The aim of this research was to assess tertiary student distress levels with regards to (i) comparisons with normative population data, and (ii) the effects of discipline, year level, and student characteristics. Self-reported treatment rates and level of concern regarding perceived distress were also collected. Method: Students from all six years of an undergraduate medical course were compared with samples from Psychology, Law and Mechanical Engineering courses at the University of Adelaide, Australia. Students participated in one of three studies that were either webbased or paper-based. All studies included Kessler ’ s Measure of Psychological Distress (K10), and questions …

Post-Traumatic Stress Disorder In A Group Of Australian General Practices., Charis Gauvin, Ian Wilson

Ian G Wilson

Some authorities regard post-traumatic stress disorder (PTSD) as a well characterised condition that is under diagnosed in general practice. We aimed to explore its prevalence in Australian general practice. METHOD: 'Medic-GP' contains the records of 58,941 patients over a period of six years. We searched the database for PTSD and synonyms in individual records, looking for diagnostic criteria and comorbidities. RESULTS: Post-traumatic stress disorder was diagnosed in 337 patients, an annual incidence of 88/100,000 patients over a 6.5 year period. Specialists diagnosed 312 (93%) after referral by general practitioners. The GPs diagnosed 25 (7%) themselves, of whom only five patients …

A 5-Year Follow-Up Of General Practice Patients Experiencing Depression, Ian Wilson, Katherine Duszynski, Andrea Mant

Ian G Wilson

Background. Depression is a common disease in primary care and produces significant morbidity in the community. Little is known about the outcomes of depression in general practice. Objectives. This research set out to explore both the longitudinal management and outcomes of depression as seen in general practice. Methods. The Medic-GP database is a collection of the medical records of 50 000 people seen in nine Australian general practices. It was used to follow the management of depressed patients over 4-5 years. Records from 1994-1995 were searched for depression or similar words. Individual records of patients whose notes mentioned depression were …

Depression In The Patient With Copd, Ian G. Wilson

Ian G Wilson

This paper explores the recent literature surrounding comorbid depression and COPD. The literature reveals a high prevalence of depression in patients with COPD and some evidence that the depression is a result of the disease. The literature highlights the negative impact of depression on quality of life and a possible impact on mortality. Depression also negatively impacts on compliance and smoking cessation. Treatment of depression in COPD, particularly by cognitive behavioral therapy, has positive impact on quality of life. Tricyclic antidepressants have a positive impact on mood and COPD, but side effects limit their use. The advent of the new …

The Management Of Bipolar Disorder In General Practice, Phillip Mitchell, Jillian Ball, James Best, Bronwyn Gould, Gin Malhi, Geoffrey Riley, Ian Wilson

Ian G Wilson

•General practitioners have a key role in managing patients with bipolar disorder, a condition which affects at least one in 200 Australians each year and is the sixth leading cause of disability in the population. • Although diagnosis and treatment of the illness is complex, effective treatment can lead to good outcomes for many patients. • GPs can contribute significantly to early recognition of bipolar disorder, avoiding the long delays in accurate diagnosis that have been reported. As in other complex recurrent or persistent illnesses, GPs are well placed to coordinate multidisciplinary "shared care" with specialists and other health care …

Interviewer Bias In Medical Student Selection: (With Updated Correction), Barbara Griffin, Ian Wilson

Ian G Wilson

Objective: To investigate whether interviewer personality, sex or being of the same sex as the interviewee, and training account for variance between interviewers’ ratings in a medical student selection interview. Design, setting and participants: In 2006 and 2007, data were collected from cohorts of each year’s interviewers (by survey) and interviewees (by interview) participating in a multiple mini-interview (MMI) process to select students for an undergraduate medical degree in Australia. MMI scores were analysed and, to account for the nested nature of the data, multilevel modelling was used. Main outcome measures: Interviewer ratings; variance in interviewee scores. Results: In 2006, …

Psychogastroenterology: A Call For Psychological Input In Australian Gastroenterology Clinics, Antonina Mikocka-Walus, Deborah Turnbull, Jane Andrews, Nicole Moulding, Ian Wilson, Gerald Holtmann

Ian G Wilson

Gastroenterologists should be able to refer patients directly to psychologists with full Medicare reimbursement. Psychological comorbidities are frequently seen in patients with gastrointestinal conditions. However, time pressure and lack of expertise in non-medical therapies of psychological problems prevent gastroenterologists from initiating psychological treatment although such treatment may improve patients’ outcomes and reduce health-care utilization. Psychologists are needed as part of the multidisciplinary team in gastroenterology clinics in Australia to take the leading role in the psychological management of those patients by contributing to screening, faster diagnosis and treatment of depression and anxiety disorders in particular.

Learning Strategies Of First Year Nursing And Medical Students: A Comparative Study, Yenna Salamonson, Bronwyn Everett, Jane Koch, Ian Wilson, Patricia Davidson

Ian G Wilson

Background: Interprofessional education (IPE), where two or more professions learn with, from, and about each other to improve collaboration and the quality of care, has been proposed as a curriculum strategy to promote mutual understanding between professions, thus helping to prepare health professionals to work in challenging contemporary health systems. Although there is support for IPE initiatives within health professional education, differences in student motivation and learning strategies are likely to contribute to the success of these initiatives. Objective: To explore self-regulated learning strategies used by first year medical and nursing students, and to determine if these strategies were different …

The Context Of Clinical Teaching And Learning In Australia: Towards A Reconstruction Of The Relationship Between Medical Schools And Health Services, Julie Ash, Lucie Walters, David Prideaux, Ian Wilson

Ian G Wilson

• Gaining clinical experience for an extended period of time in teaching hospitals is one of the enduring strengths of medical education. • Teaching hospitals have recently faced significant challenges, with increasing specialisation of services and workload pressures reducing clinical learning opportunities. • New clinical teaching environments have been established in Australia, particularly in rural and regional areas; these are proving to be ideal contexts for student learning. • The new clinical teaching environments have shown the importance of developing symbiotic relationships between universities and health services. Symbiotic clinical learning is built around longitudinal, patientbased learning emphasising priority health concerns. …

Big Fish In A Big Pond: A Study Of Academic Self Concept In First Year Medical Students, Kirsty Jackman, Ian G. Wilson, Marjorie Seaton, Rhonda G. Craven

Ian G Wilson

Background: Big-fish-little-pond effect (BFLPE) research has demonstrated that students in high-ability environments have lower academic self-concepts than equally able students in low-ability settings. Research has shown low academic self-concepts to be associated with negative educational outcomes. Social comparison processes have been implicated as fundamental to the BFLPE. Methods: Twenty first-year students in an Australian medical school completed a survey that included academic self-concept and social comparison measures, before and after their first written assessments. Focus groups were also conducted with a separate group of students to explore students’ perceptions of competence, the medical school environment, and social comparison processes. Results: …

Small Group Peer Support For Gps Treating Mental Health Problems., C Howell, Ian Wilson

Ian G Wilson

Peer support groups are a mutual aid system in which the facilitator helps group members to help each other. General practice peer support is seen as the provision of support in small groups by general practitioner colleagues. As part of the Better Outcomes in Mental Health Care Initiative, funding was made available to develop a unique model of peer support for GPs involved in mental health care. It aimed to meet the needs of GPs for support, sharing of knowledge and skills, ongoing education and skills development, while fostering self care. The model involved a GP facilitator training program and …

Searching The Literature - A Beginners' Guide, Ian Wilson

Ian G Wilson

A number of questions will arise as you develop a research question. Has the question you are asking already been answered? Have other attempts been made to answer the question? If so, what techniques have been tried and what problems have arisen? Is there work in this area that will assist in developing your proposal? To find out you need to review the literature, that is, conduct a literature search. The idea of sitting in a medical library reading a few journal articles sounds interesting and easy. It is, but it is not a literature search. With so many medical …

'Part Of The Team': Professional Identity And Social Exclusivity In Medical Students, Roslyn Weaver, Kath Peters, Jane Koch, Ian Wilson

Ian G Wilson

OBJECTIVES Medical students must develop not only their professional identity but also inclusive social attitudes for effective medical practice in the future. This study explores the elements that contribute to medical students’ sense of professional identity and investigates the concept of social exclusivity and how this might relate to students’ development of their identity as medical professionals. METHODS The study is based on qualitative data gathered in telephone interviews with 13 medical students enrolled in Years 1 or 3 at an undergraduate medical school at a university in Australia. The questions were open-ended and asked students about their experiences in …

Consultation-Liaison To General Practitioners Coming Of Age: The South Australian Psychiatrists' Experience, Anne Williams, Jane Dodding, Ian Wilson, Jeffrey Fuller, Victoria Wade

Ian G Wilson

Objective: To evaluate outcomes and satisfaction with a consultationliaison service to general practitioners (GPs), provided by a cohort of private and public psychiatrists. Methods: All SA psychiatrists were invited to participate in a project, funded by the Australian Government Department of Health and Ageing, which was operational for 9 months. Participating psychiatrists provided telephone advice in urgent cases to GPs, and where agreed by GP, patient and psychiatrist, a one-off assessment with rapid feedback to the GP. Evaluation was carried out by external evaluators on satisfaction rates of psychiatrists, and barriers to the use of such a service, and the …