RESEARCH ROUNDUP – August 2017

This month’s Research Roundup features our GPSA Chair, Steve Holmes and the MJA musing on pathology test ordering rates;  the highs and lows of antibiotic prescribing and all you ever wanted to know about competency-based medical education. And old William Horman of Eton may well have nailed it when he said that “manners maketh the man (or woman)”…..

Read on!

Changes in pathology test ordering by early career GPs

This paper appears in July’s MJA and concludes that test ordering by GP registrars increased by 11% per training term over the course of vocational training.

The only problem is that the actual data presented doesn’t support this conclusion. In fact quite the opposite.

Based on the data presented GP registrars actually order less tests over time – an average of 26% less over the course of training rather than the 11% per term more that the study suggests.

The drop off in protected teaching time as registrars progress from term 2 to term 3 might be reflected in the increase in test ordering that happens at this point

In any event, the paper does support a number of points that GPSA has been calling out over the years, including

• At some points in registrar training, registrars need more supervision, not less, as they move toward independent practice.
• the necessity of learning to manage uncertainty.

Read the paper here:

https://www.mja.com.au/journal/2017/207/2/changes-pathology-test-ordering-early-career-general-practitioners-longitudinal

And Steve Holmes’ response here:

https://www.medicalobserver.com.au/professional-news/after-20-years-of-stagnation-its-time-to-give-gp-supervisors-proper-support

Antibiotic prescribing

MJA feature a paper by McCulloch et al that examines antibiotic prescribing rates for acute respiratory infections and finds………(drumroll)…….that the rates are way above guideline recommendations. In fact, anywhere between 4 and 9 times the recommended rate. Ouch!!

So of course, there’s an editorial (Gulliford and Ashworth) that asks the question: can it be reduced?

The answer? Yes! Results from the UK (this is an international problem of course) indicate that a deferred prescribing strategy can work but a no-prescribing strategy is preferable and still acceptable to patients.

The NHS has introduced a contractual financial incentive for meeting targets. Hmm. Another SIP perhaps?

Best of all, something as simple as a personalized letter from the Chief Medical Officer resulted in a 3% reduction in antibiotic dispensing!!!

So expect your personalised letter from John Horvath soon!

Read the paper here:

https://www.mja.com.au/journal/2017/207/2/antibiotics-acute-respiratory-infections-general-practice-comparison-prescribing

And the editorial here:

https://www.mja.com.au/journal/2017/207/2/can-antibiotic-prescribing-respiratory-infections-be-reduced

Everything you ever wanted to know about competency-based medical education but were afraid to ask

A whole journal edition devoted purely to CBME! Wow!

If you want to know anything about this topic, look no further and read the whole June edition of Medical Teacher cover to cover.

But for a surprisingly balanced read, look no further than Holmboe et al’s call to action on the topic in the first few pages.

The authors cite the continued global growth in CBME as being indicative of the effectiveness of an outcomes-based approach to the primary mission of medical education i.e. to meet the needs of those they serve.

http://www.tandfonline.com/doi/abs/10.1080/0142159X.2017.1315067

And well-known ME radical, Jason Frank (aka father of CanMEDS), reckons the end of time-based training is nigh!

http://www.tandfonline.com/doi/abs/10.1080/0142159X.2017.1315069

Do yourself a favour, keep yourself up to date and grab a copy of this one.

Miss Manners says….

Ever thought there’s a problem with your millennial registrars and their manners? Well, they might think the same about you!

This report looks at social etiquette in Australia and modern manners – I kid you not!

But the results are fascinating and instructive!

If you think everyone is more rude and impatient these days compared to 20 years ago, you’re right!! (at least seniors think so).

And the worst public faux pas?

Both groups agreed that remembering your “please”, “thank you” and “excuse me” was important but interestingly, millenials thought that avoiding making racist or classist comments was even more important. Food for thought.

Everyone agreed that burping, farting and swearing in public were right out!

Want to really make a millennial uncomfortable? Get into their personal space. Bothers ‘em twice as much as seniors.

But which is the best city in the social etiquette stakes?

Melbourne!

And the worst?

You guessed it, Sydney!

Here’s an important point of difference on social media.

• Seniors know the old rule about never posting on social media when you’re tired, angry or intoxicated and the virtues of always checking the content before sending.
• Milllienials know the importance of not sending a personal message through a public post and not oversharing or doing an emotional dump on social media.

So there you have it! But lots of little gems in this report.

Put on your hard hat and go mining here:

https://www.seniors.com.au/seniors/media/documents/media%20releases/2017-modern-manners-report.pdf