ORCID Profile
0000-0002-1647-1099
Current Organisation
Royal Australasian College of Physicians
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Publisher: Springer Science and Business Media LLC
Date: 25-04-2019
Publisher: Informa UK Limited
Date: 12-08-2013
Publisher: Informa UK Limited
Date: 30-10-2017
Publisher: AMPCo
Date: 11-2010
DOI: 10.5694/J.1326-5377.2010.TB04066.X
Abstract: To explore the perceived impact of medicolegal concerns on how Australian doctors practise medicine and to compare doctors who have experienced a medicolegal matter with those who have not. Cross-sectional survey (posted in September 2007, with reminder 4 weeks later) of Australian doctors from all major specialty groups, trainees and a s le of general practitioners who were insured with a medical insurance company. 2999 respondents of 8360 who were sent the survey. Perceived practice changes due to concerns about medicolegal issues, beliefs about medicolegal issues, and the influence of medicolegal issues on both career choices and how doctors relate to their patients. Respondents reported changes in practice behaviour due to medicolegal concerns, with 43% of doctors stating that they referred patients more than usual, 55% stating that they ordered tests more than usual, and 11% stating that they prescribed medications more than usual. Respondents also reported improved communication of risk (66%), increased disclosure of uncertainty (44%), developed better systems for tracking results (48%) and better methods for identifying non-attenders (39%) and for auditing clinical practice (35%). Concerns about medicolegal issues led to 33% considering giving up medicine, 32% considering reducing their working hours and 40% considering retiring early. These proportions were all significantly greater for doctors who had previously experienced a medicolegal matter compared with those who had not. This Australian study, like international studies, confirms that doctors' concerns about medicolegal issues impact on their practice in a variety of ways. There is a greater perceived impact on those doctors who have previously experienced a medicolegal matter.
Publisher: Informa UK Limited
Date: 18-04-2022
Publisher: SAGE Publications
Date: 11-2007
DOI: 10.1080/00048670701634960
Abstract: Objective: To describe the differences in psychological morbidity between Australian general practitioners (GPs) who have experienced a medico-legal matter and those who have not. Methods: A total of 1499 GPs were initially invited to participate in the study. Two hundred and sixty requested not to participate, with 1239 subsequently being sent a survey. There were 566 respondents (45.7% response rate to survey). There were two sources of data. First, a cross-sectional survey sought demographic information, personality traits via the Eysenck Personality Questionnaire (EPQ), history of a medico-legal matter with any medical defence organization, and measures of psychological morbidity, including the General Health Questionnaire (GHQ), Sheehan Disability Scale (SDS), and Alcohol Use Disorders Identification Test. Second, information was extracted from the United Medical Protection database on medico-legal matters. Results: Fifty-nine per cent of respondents to the survey reported ever having a medico-legal matter, with 13% having a current medico-legal matter. Those with a current matter reported increased levels of disability (in work, social or family life) and higher prevalence of psychiatric morbidity (45% vs 27% GHQ ‘case identification’ rates), compared to those with no current matter. Those respondents with a history of past medico-legal matters reported increased levels of disability (SDS) and depression subscores (GHQ). Male respondents drank significantly more alcohol than female respondents, and male respondents with current or past medico-legal matters had significantly higher levels of alcohol use than male respondents with no experience of medico-legal matters. Conclusions: Doctors who have current and past medico-legal matters have a higher level of psychological morbidity. The study design was unable to distinguish cause or effect. A longitudinal study is planned to investigate this. The findings have significant implications for medical training, doctor support systems and medical insurance groups.
Publisher: Springer Science and Business Media LLC
Date: 03-12-2016
DOI: 10.1007/S10459-016-9740-3
Abstract: Recent research has demonstrated that longitudinal integrated placements (LICs) are an alternative mode of clinical education to traditional placements. Extended student engagement in community settings provide the advantages of educational continuity as well as increased service provision in underserved areas. Developing and maintaining LICs require a differing approach to student learning than that for traditional placements. There has been little theoretically informed empirical research that has offered explanations of which are the important factors that promote student learning in LICs and the relationships between those factors. We explored the relationship between student learning, student perceptions of preparedness for practice and student engagement, in the context of a rural LIC. We used a sequential qualitative design employing thematic, comparative and relational analysis of data from student interviews (n = 18) to understand possible processes and mechanisms of student learning in the LIC. Through the theoretical lens of social learning systems, we identified two major themes connectivity and preparedness for practice. Connectivity described engagement and relationship building by students, across formal and informal learning experiences, interprofessional interactions, social interactions with colleagues, interaction with patients outside of the clinical setting, and the extent of integration in the wider community. Preparedness for practice, reflected students' perceptions of having sufficient depth in clinical skills, personal and professional development, cultural awareness and understanding of the health system, to work in that system. A comparative analysis compared the nature and variation of learning across students. In a relational analysis, there was a positive association between connectivity and preparedness for practice. Connectivity is a powerful enabler of students' agentic engagement, collaboration, and learning within an LIC. It is related to student perceptions of preparedness for practice. These findings provide insight for institutions wishing to develop similar programmes, by encouraging health professional educators to consider all of the potential elements of the placements, which most promote connectivity.
Publisher: Wiley
Date: 08-03-2012
Publisher: Wiley
Date: 12-01-2012
DOI: 10.1111/J.1365-2923.2011.04102.X
Abstract: Integrated longitudinal rural placements are designed to promote favourable student attitudes towards and facilitate return to rural practice upon graduation. We explored the impact of an integrated placement on medical students' attitudes towards rural practice. Data were available from interviews with 10 medical students, 15 clinical supervisors and teachers, three community health staff, and focus groups made up of medical students. Socio-cognitive career theory gave insight into the personal, contextual and experiential factors, as well as the career barriers, that influence students' rural practice intentions. Framework analysis was used to develop a thematic framework illustrating the key findings. The longitudinal placement enabled students to achieve personal goals, and enhanced self-efficacy beliefs and orientation towards the complex personal and professional demands of rural practice. The informal curriculum, including multifaceted interactions with patients and their families, clinical teachers and other health care staff, was a vital experiential component. Students assimilated these rich experiences into their practice and evolving notions of professional identity as rural practitioners. Some students had little intention of practising rurally, partly as a result of contextual barriers such as geographic isolation, family and relationship needs, restricted postgraduate training opportunities and limited opportunities for specialist practice. The richness of the informal curriculum in a longitudinal rural placement powerfully influenced students' intentions to practise rurally. It provided an important context for learning and evolving notions of professionalism and rural professional identity. This richness could be reinforced by developing formal curricula using educational activities based around service-led and interprofessional learning. To overcome the contextual barriers, the rural workforce development model needs to focus on socialising medical students into rural and remote medicine. More generic issues include student selection, further expansion of structured vocational training pathways that vertically integrate with longitudinal rural placements and the maintenance of rurally focused support throughout postgraduate training.
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1111/IDJ.12260
Publisher: AMPCo
Date: 08-2010
DOI: 10.5694/J.1326-5377.2010.TB03837.X
Abstract: To identify factors associated with psychiatric morbidity and hazardous alcohol use in Australian doctors. Cross-sectional postal survey of 2999 doctors (including all major specialty groups, trainees and general practitioners) insured with an Australian medical insurance company. The potential for psychiatric morbidity was measured by the General Health Questionnaire (GHQ), and the potential for hazardous alcohol use by the Alcohol Use Disorders Identification Test (AUDIT). The survey was conducted in 2007. Demographic, work-related and personality factors associated with a GHQ score > 4 and an AUDIT score > or = 8. Factors significantly associated with psychiatric morbidity in doctors were: having a current medicolegal matter, not taking a holiday in the previous year, working long hours, type of specialty, and having personality traits of neuroticism and introversion. Factors significantly associated with potentially hazardous alcohol use were being male, being Australian-trained, being between 40 and 49 years of age, having personality traits of neuroticism and extroversion, failing to meet Continuing Medical Education requirements, and being a solo practitioner. The mental health of medical practitioners is crucial to the quality of care their patients receive. Doctors should reflect on their hours of work and need for holidays. Involvement with medicolegal processes, such as lawsuits, complaints and inquiries, is a stressful part of medical practice today. Doctors need to be educated about these processes and understand how the experience may affect their health, work and loved ones.
Publisher: Wiley
Date: 09-09-2013
DOI: 10.1111/MEDU.12271
Publisher: AMPCo
Date: 08-2010
Publisher: Oxford University Press
Date: 16-09-2013
Publisher: SAGE Publications
Date: 29-04-2016
Abstract: Younger onset dementia (YOD) not only affects the person with the diagnosis but the whole family, which often includes young people. A limited body of research on this group of young people indicates that they experience varying degrees of emotional trauma. We explored the lived experiences of young people having a parent with YOD from the perspective of the social model of disability. Data were available from semi-structured interviews with 12 young people who had a parent with YOD looking at their lived experiences between 8 and 24 years. Thematic analysis identified four main themes: the emotional toll of caring, keeping the family together, grief and loss and psychological distress. The social model of disability theory provides a helpful framework for these families who experience significant emotional distress, demonstrating that the disability is often socially constructed by a society, which marginalizes and excludes them. A ‘whole family’ approach is proposed, where the needs of young people and their parents are respected and responded to age appropriately.
Publisher: Informa UK Limited
Date: 20-03-2014
Publisher: Cambridge University Press (CUP)
Date: 13-11-2016
DOI: 10.1017/S1041610215001714
Abstract: Socially constructed disablement has marginalized young people in families where a parent has younger onset dementia (YOD). This has contributed to inadequate societal support for their complex situation. Impacts on such young people include significant involvement with mental health services for themselves. In this paper, we explored the young people's lived experiences in these families and the influencing factors to enable these young people to be included and supported within their community. In this qualitative research study, the social model of disability was used as the theoretical framework in conducting a thematic analysis of interviews with 12 participants. Three themes emerged invisibility highlighting the issues of marginalization connectivity foregrounding the engagement of young people with family, friends and their social networks, and being empowered through claiming their basic human right to receive the age appropriate support they needed. The current plight of young people living with a parent with YOD demands a fundamental shift by society in developing inclusive cross-sectorial cooperation linking service providers across youth and dementia sectors. This requires working in partnership with the service users responding to the identified needs of in idual family members.
Publisher: Wiley
Date: 22-08-2015
DOI: 10.1111/MEDU.12790
Publisher: Wiley
Date: 12-03-2013
DOI: 10.1111/MEDU.12097
Abstract: There is currently little theoretically informed exploration of how non-traditional clinical placement programmes that are longitudinal, immersive, based on community-engaged education principles and located in rural and remote settings may contribute to medical student learning. This paper aims to theoretically illustrate the pedagogical and socio-cultural underpinnings of student learning within a longitudinal, integrated, community-engaged rural placement. Data collected using semi-structured interviews with medical students, their supervisors and other health clinicians participating in a longitudinal rural placement programme were analysed using framework analysis. Data interpretation was informed by the theory of social learning systems (SLSs). In a longitudinal, rural clinical placement students participate in an SLS with distinct yet interrelated learning spaces that contain embedded communities of practice (CoPs). These spaces are characterised by varying degrees of formality, membership and interaction, and different learning opportunities and experiences. They are situated within and shaped by a unique geography of place comprising the physical and social features of the placement setting. Within these learning spaces, students acquire clinical knowledge, skills and competencies, professional attitudes, behaviours and professional values. The process of connectivity helps explain how students access and cross the boundaries between these learning spaces and develop a more complex sense of professional identity. Longitudinal, integrated clinical placement models can be understood as SLSs comprising synergistic and complementary learning spaces, in which students engage and participate in multiple CoPs. This occurs in a context shaped by unique influences of the geography of place. This engagement provides for a range of student learning experiences, which contribute to clinical learning and the development of a more sophisticated professional identity. A range of pedagogical and practical strategies can be embedded within this SLS to enhance student learning.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2019
DOI: 10.1097/CEH.0000000000000267
Abstract: Medical regulatory bodies in Australasia are encouraging greater use of continuing professional development activities, such as multisource feedback (MSF), which are practice-based, include facilitated feedback, and improve performance. The aim of this study was to explore the feasibility, effectiveness, and sustainability of an MSF process that includes a telephone/videoconference debrief, to better design future MSF implementation. Thirty-seven Australasian physician participants sought feedback from patients and colleagues and debriefed their feedback report with a trained facilitator. The impact was evaluated using quantitative and qualitative measures including surveys and semistructured interviews. The feasibility of the MSF process was impacted by the level of support for the participant to complete the MSF, the nature and location of participants' work, and the use of telephone/videoconference to deliver the debrief. Regarding effectiveness, the MSF stimulated reflection on practice and action on areas identified for improvement. In addition, the quality of rater feedback and the inclusion of a debrief impacted participant and facilitator reports of effectiveness. The absence of a culture of feedback, the formative nature of the MSF, and the confidentiality of the results were factors impacting sustainability. Optimizing MSF is important to encourage broad uptake in the wider medical community in Australasia. Although several factors were identified as having an impact, it is clear that inclusion of a quality debrief will increase the perceived value and the effectiveness of MSF. Delivering that debrief through telephone/videoconference can be effective and will increase the overall feasibility and sustainability.
Publisher: SAGE Publications
Date: 2009
DOI: 10.1080/10398560802085359
Abstract: Objectives: The aim of this paper was to explore the relationship between the personality traits of Australian General Practitioners (GPs) and their gender, work practice arrangements, and history of medico-legal matters. Methods: A cross-sectional self report survey was mailed to 1239 GPs. There were 566 respondents (45.7% response rate to survey). The survey assessed personality traits (using the Eysenck Personality Questionnaire), demographic and practice information, and history of medico-legal matters with any medical defence organization. The number and type of medico-legal matters was also extracted from the UNITED Medical Protection database. Results: Male respondents had significantly higher psychoticism scores than females (p .001), and females had significantly higher neuroticism scores than males (p .01), as in community s les. However, for GPs who worked more than 48 hours per week, there were no gender differences in personality trait scores. Solo practitioners and non-solo practitioners did not differ on personality scores. Proceduralists and non-proceduralists did not differ on personality scores. However, a higher proportion of proceduralists experienced a medico-legal matter than non-proceduralists (p .001). There was a positive correlation between extraversion scores and doctors who attended peer review (p .001). There was no difference in the numbers of medico-legal matters for doctors who attended peer review. Males who self reported a medico-legal matter had higher neuroticism scores than the males who did not report medico-legal matters. This was not the case for females. For males, this pattern was not replicated when considering data from UNITED. Conclusions: The known demographic and practice factors that differ for doctors having a medico-legal matter are replicated here – being male, a proceduralist and working longer hours. There is not a consistent pattern regarding personality traits and medico-legal matters.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Michele Daly.