© The Editor(s) and The Author(s) 2016. Expanding upon Leadership Development for Interprofessional Education and Collaborative Practice and Leadership and Collaboration, the third installment to this original and innovative collection of books considers a variety of research models and theories. Emphasizing research and evaluation in leadership aspects, Leading Research and Evaluation in Interprofessional Education and Collaborative Practice showcases examples from around the globe in various multicultural contexts. Crucial for academics and researchers in this field, the book includes studies on traditionally under-represented countries and aims to prompt new ideas for future research and policy structures in Interprofessional education and practice.
© Dawn Forman, Marion Jones, and Jill Thistlethwaite 2015, Respective authors 2015 and Barbara Brandt 2015. Leadership and Collaboration provides international examples of how leadership of interprofessional education and practice has developed in various countries and examines how interprofessional education and collaborative practice can make a difference to the care of the patient, client and community.
© Jill E. histlethwaite 2012. The provision of care within the context of the modern health service environment involves a wide range of professionals. The health care team might include general practitioners, nurses, midwives, hospital doctors, physiotherapists, other allied health professionals, as well as receptionists and practice managers. To optimise delivery of care at both individual and population levels, team members must work collaboratively with colleagues in their own profession and others. This book, in the Values-Based Practice series, adds the dimension of values to the more usual discussions of teamwork, considering interactions between health care professionals and how these might be affected by differences in professional and personal values. Examples of scenarios based on real-life experience promote learning and reflection. Anybody working or training in health care and who aspires to collaborate successfully with their colleagues in other specialties will find this book extremely valuable, as will educators who facilitate learners in teamwork.
Kitto, S, Chesters, J, Thistlethwaite, J & Reeves, S 2011, Sociology of interprofessional health care practice: Critical reflections and concrete solutions.
In recent years governments around the world have been bending their will toward increasing collaborative practice amongst health care professionals. Although interprofessional learning has been on the agenda since the 1950s, to date there has been mixed success in bringing the disparate range of health professionals in the health care system together in a coherent and systematic way. Surprisingly, there has been limited sociological analysis of this phenomenon with no identifiable seminal text that critical analyses the issues facing the development of successful inter-professional practice in health. This edited collection to redress this by providing the conditions for critical engagement with inter-professional issues through developing a critical sociology of interprofessional health care practice. The core strength of the book is the meditations, case studies, evaluations and theoretical reflections on the practice of inter-professional collaboration in health by preeminent scholars from Australia, Canada and the United Kingdom. The book provides a sophisticated critical inquiry that uses a wide array of multi-disciplinary conceptual tools to study the phenomenon of interprofessional practice in a way that is easily understood by both instructors and students in the fields of medicine, allied health and nursing. © 2011 by Nova Science Publishers, Inc. All rights reserved.
Interprofessionalism, an emerging model and philosophy of multi-disciplinary and multi-agency working, has in increasingly become an important means of cultivating joint endeavors across varied and diverse disciplinary and institutional settings. Interprofessional E-Learning and Collaborative Work: Practices and Technologies is therefore, an important source for understanding how interprofessionalism can be promoted and enhanced at various levels in learners' educational experiences, particularly with regard to e-learning and reusable learning objects, given the potential to cross boundaries of time, location and academic disciplines. This book provides relevant theoretical frameworks and the latest case driven research findings to improve understanding of interprofessional possibilities through e-learning at the level of universities, networks and organizations, teams and work groups, information systems and at the level of individuals as actors in the networked environments. © 2010 by IGI Global. All rights reserved.
Roberts, C, Khanna, P, Rigby, L, Bartle, E, Llewellyn, A, Gustavs, J, Newton, L, Newcombe, JP, Davies, M, Thistlethwaite, J & Lynam, J 2018, 'Utility of selection methods for specialist medical training: A BEME (best evidence medical education) systematic review: BEME guide no. 45', Medical Teacher, vol. 40, no. 1, pp. 3-19.View/Download from: UTS OPUS or Publisher's site
© 2017 AMEE. Background: Selection into specialty training is a high-stakes and resource-intensive process. While substantial literature exists on selection into medical schools, and there are individual studies in postgraduate settings, there seems to be paucity of evidence concerning selection systems and the utility of selection tools in postgraduate training environments. Aim: To explore, analyze and synthesize the evidence related to selection into postgraduate medical specialty training. Method: Core bibliographic databases including PubMed; Ovid Medline; Embase, CINAHL; ERIC and PsycINFO were searched, and a total of 2640 abstracts were retrieved. After removing duplicates and screening against the inclusion criteria, 202 full papers were coded, of which 116 were included. Results: Gaps in underlying selection frameworks were illuminated. Frameworks defined by locally derived selection criteria, and heavily weighed on academic parameters seem to be giving way to the evidencing of competency-based selection approaches in some settings. Regarding selection tools, we found favorable psychometric evidence for multiple mini-interviews, situational judgment tests and clinical problem-solving tests, although the bulk of evidence was mostly limited to the United Kingdom. The evidence around the robustness of curriculum vitae, letters of recommendation and personal statements was equivocal. The findings on the predictors of past performance were limited to academic criteria with paucity of long-term evaluations. The evidence around nonacademic criteria was inadequate to make an informed judgment. Conclusions: While much has been gained in understanding the utility of individual selection methods, though the evidence around many of them is equivocal, the underlying theoretical and conceptual frameworks for designing holistic and equitable selection systems are yet to be developed.
Dunston, R, Forman, D, Thistlethwaite, J, Steketee, C, Rogers, G & Moran, M 2018, 'Repositioning interprofessional education from the margins to the centre of Australian health professional education – what is required?', Australian Health Review, vol. Online.View/Download from: UTS OPUS or Publisher's site
Thistlethwaite, JE 2018, 'Questions and answers in health care and education.', Education for primary care : an official publication of the Association of Course Organisers, National Association of GP Tutors, World Organisation of Family Doctors, vol. 29, no. 1, pp. 3-4.View/Download from: UTS OPUS or Publisher's site
Questions and answers are integral to the practice of health professionals and their education. Health professionals are taught to ask questions and we expect that patients will answer them. We may also invite patients to ask questions without considering that this may be difficult due to many factors including professional hierarchies. Choosing Wisely is a global initiative that frames questions for patients to ask in relation to tests and treatments. The same concept has been applied to health professional education with students and trainees also being encouraged to question their seniors about their choice of investigations and management. Now is the time for learners to also question how they are educated for their health profession. Their education should be evidence-guided and not solely informed by tradition. Asking and answering questions with respect and honesty is likely to enhance partnerships across the continuum of health and education.
Thistlethwaite, J & Weeks, L 2018, 'Evaluating and prescribing new medicines in general practice', Australian Journal of General Practice, vol. 47, no. 6, pp. 327-331.View/Download from: Publisher's site
Sorinola, OO, Thistlethwaite, J, Davies, D & Peile, E 2017, 'Realist evaluation of faculty development for medical educators: What works for whom and why in the long-term.', Medical teacher, vol. 39, no. 4, pp. 422-429.View/Download from: UTS OPUS or Publisher's site
Realism is a perspective in which entities exist independently of being perceived or independently of our theories about them. The realist framework with its principle of explanatory causation was used for an in-depth exploration of faculty development (FD) since, despite the widespread investment in FD, the evidence that it enhances the effectiveness of teaching in the long-term is still limited. The study aimed to develop realist theories that explain the connections between contexts (C), mechanisms (M) and outcomes (O) to find out what works for whom and why in FD.Purposive sampling was used to select two medical schools from each of the four UK regions (total 8 of the 33 UK medical schools) for interview of a faculty development coordinator and a medical educator at each school. Sixteen interviews were carried out. Data were coded and summarized under contexts, mechanisms, and outcomes (CMO) to derive realist theories.We identified contexts that facilitated FD mechanisms of engagement, motivation, positive perception and professionalization, which led to educators' outcomes of improved confidence, competence, credibility and career progression.Four realist theories, which support the effectiveness of FD in the long-term, were derived, enabling recommendations for FD stakeholders.
Rogers, GD, Thistlethwaite, JE, Anderson, ES, Abrandt Dahlgren, M, Grymonpre, RE, Moran, M & Samarasekera, DD 2017, 'International consensus statement on the assessment of interprofessional learning outcomes.', Medical teacher, vol. 39, no. 4, pp. 347-359.View/Download from: UTS OPUS or Publisher's site
Regulatory frameworks around the world mandate that health and social care professional education programs graduate practitioners who have the competence and capability to practice effectively in interprofessional collaborative teams. Academic institutions are responding by offering interprofessional education (IPE); however, there is as yet no consensus regarding optimal strategies for the assessment of interprofessional learning (IPL). The Program Committee for the 17th Ottawa Conference in Perth, Australia in March, 2016, invited IPE champions to debate and discuss the current status of the assessment of IPL. A draft statement from this workshop was further discussed at the global All Together Better Health VIII conference in Oxford, UK in September, 2016. The outcomes of these deliberations and a final round of electronic consultation informed the work of a core group of international IPE leaders to develop this document. The consensus statement we present here is the result of the synthesized views of experts and global colleagues. It outlines the challenges and difficulties but endorses a set of desired learning outcome categories and methods of assessment that can be adapted to individual contexts and resources. The points of consensus focus on pre-qualification (pre-licensure) health professional students but may be transferable into post-qualification arenas.
Thistlethwaite, J.E. 2016, 'Collaboration, cooperation, communication, contact and competencies', GMS Journal for Medical Education, vol. 33, no. 2.
Thistlethwaite, JE 2016, 'Collaboration, cooperation, communication, contact and competencies.', GMS journal for medical education, vol. 33, no. 2, p. Doc37.View/Download from: UTS OPUS or Publisher's site
Thistlethwaite, JE 2016, 'The Roundhouse model.', The British journal of general practice : the journal of the Royal College of General Practitioners, vol. 66, no. 648, p. 351.View/Download from: UTS OPUS or Publisher's site
Towle, A, Farrell, C, Gaines, ME, Godolphin, W, John, G, Kline, C, Lown, B, Morris, P, Symons, J & Thistlethwaite, J 2016, 'The patient's voice in health and social care professional education: The vancouver statement', International Journal of Health Governance, vol. 21, no. 1, pp. 18-25.View/Download from: UTS OPUS or Publisher's site
© Emerald Group Publishing Limited. Purpose - The purpose of this paper is to present a statement about the involvement of patients in the education of health and social care professionals developed at an international conference in November 2015. It aims to describe the current state and identify action items for the next five years. Design/methodology/approach - The paper describes how patient involvement in education has developed as a logical consequence of patient and public participation in health care and health research. It summarizes the current state of patient involvement across the continuum of education and training, including the benefits and barriers. It describes how the conference statement was developed and the outcome. Findings - The conference statement identifies nine priorities for action in the areas of policy, recognition and support, innovation, research and evaluation, and dissemination and knowledge exchange. Originality/value - The conference statement represents the first time that an international and multidisciplinary group has worked together to assemble in a single document specific priorities for action to embed the patient's voice in health professional education.
Thistlethwaite, JE 2016, 'The medical home: A need for collaborative practice.', Australian family physician, vol. 45, no. 10, pp. 759-760.
Thistlethwaite, J, Dallest, K, Moran, M, Dunston, R, Roberts, C, Eley, D, Bogossian, F, Forman, D, Bainbridge, L, Dryan, D & Fyfe, S 2016, 'Introducing the individual Teamwork Observation and Feedback Tool (iTOFT): Development and description of a new interprofessional teamwork measure', Journal of Interprofessional Care, vol. 30, no. 4, pp. 526-528.View/Download from: Publisher's site
The individual Teamwork Observation and Feedback Tool (iTOFT) was devised by a consortium of seven universities in recognition of the need for a means of observing and giving feedback to individual learners undertaking an interprofessional teamwork task. It was developed through a literature review of the existing teamwork assessment tools, a discussion of accreditation standards for the health professions, Delphi consultation and field-testing with an emphasis on its feasibility and acceptability for formative assessment. There are two versions: the Basic tool is for use with students who have little clinical teamwork experience and lists 11 observable behaviours under two headings: 'shared decision making' and 'working in a team'. The Advanced version is for senior students and junior health professionals and has 10 observable behaviours under four headings: 'shared decision making', 'working in a team', 'leadership', and 'patient safety'. Both versions include a comprehensive scale and item descriptors. Further testing is required to focus on its validity and educational impact.
Sorinola, OO, Thistlethwaite, J, Davies, D & Peile, E 2015, 'Faculty development for educators: a realist evaluation', Advances in Health Sciences Education, vol. 20, pp. 385-401.View/Download from: UTS OPUS or Publisher's site
The effectiveness of faculty development (FD) activities for educators in UK medical schools remains underexplored. This study used a realist approach to evaluate FD and to test the hypothesis that motivation, engagement and perception are key mechanisms of effective FD activities. The authors observed and interviewed 33 course participants at one UK medical school in 2012. An observed engagement scale scored participants' engagement while interviews explored motivation for attendance, engagement during the course and perception of relevance/usefulness. Six months later, using the realist framework, 12 interviews explored impact on learning outcomes/behavioural changes, the mechanisms that led to the changes and the context that facilitated those mechanisms. The authors derived bi-axial constructs for motivation, engagement and perception from two data-sources. The predominant motivation was individualistic rather than altruistic with no difference between external and internal motives. Realist evaluation showed engagement to be the key mechanism influencing learning; the contextual factor was participatory learning during the course. Six months later, engagement remained the key mechanism influencing learning/behavioural changes; the context was reflective practice. The main outcome reported was increased confidence in teaching and empowerment to utilise previously unrecognised teaching opportunities. Individual motivation drives FD participation; however engagement is the key causal mechanism underpinning learning as it induces deeper learning with different facilitating contexts at various time points. The metrics of motivation, engagement and perception, combined with the realist framework offers FD developers the potential to understand 'what works for whom, in what context and why'. © 2014 Springer Science+Business Media Dordrecht.
Interprofessional education (IPE) aims to improve patient outcomes and the quality of care. Interprofessional learning outcomes and interprofessional competencies are now included in many countries' health and social care professions' accreditation standards. While IPE may take place at any time in health professions curricula it tends to focus on professionalism and clinical topics rather than basic science activities. However generic interprofessional competencies could be included in basic science courses that are offered to at least two different professional groups. In developing interprofessional activities at the preclinical level, it is important to define explicit interprofessional learning outcomes plus the content and process of the learning. Interprofessional education must involve interactive learning processes and integration of theory and practice. This paper provides examples of IPE in anatomy and makes recommendations for course development and evaluation.
© 2015. This paper considers the development, delivery and implications of interprofessional education (IPE) using a 4-dimensional curriculum development framework. This framework involves: considering curricula for the education of the workforce of the twenty-first century and the rationale for IPE; defining learning outcomes taking into account national and professional accreditation standards; learning activities and assessment; and institutional support.
Thistlethwaite, J 2015, 'Patient portals: furthering the reality of patient partnership.', Australian family physician, vol. 44, no. 7, pp. 524-525.
Thistlethwaite, J, Kumar, K, Moran, M, Saunders, R & Carr, S 2015, 'An exploratory review of pre-qualification interprofessional education evaluations.', Journal of interprofessional care, vol. 29, no. 4, pp. 292-297.View/Download from: Publisher's site
There are diverse perceptions about the primary purpose of evaluation. In interprofessional education (IPE), there has been a perceived focus on evaluating against the outcome of improved collaborative practice and quality of care. This paper presents an exploration of the nature and purpose of evaluation methods commonly utilized in the IPE literature with its focus on outcomes-based evaluation and particularly the Kirkpatrick framework. It categorises recent evaluations of pre-qualification (pre-certification) IPE interventions. Of the 90 studies included, most evaluated soon after the educational intervention, only five specifically referred to an evaluation framework and the most frequently used tool was the RIPLS. There was a noteworthy reliance on students' self-rated perceptions of their attitudes towards collaborative practice collected through surveys, focus groups and interviews. There appears to be a need to reconsider the type of evaluation required. In conclusion, this paper offers recommendations for evaluation practice that is moving towards realist approaches; describes the longer term effects of interventions on attitudes and behaviour; develops and validates data collection tools including direct observation of practice and more comprehensively engages with all stakeholders to ensure that evaluation activities are not only focused on improving IPE but also on enhancing our understanding of interprofessional practice.
Hu, WCY, Thistlethwaite, JE, Weller, J, Gallego, G, Monteith, J & McColl, GJ 2015, ''It was serendipity': a qualitative study of academic careers in medical education.', Medical education, vol. 49, no. 11, pp. 1124-1136.View/Download from: UTS OPUS or Publisher's site
Despite a demand for educational expertise in medical universities, little is known of the roles of medical educators and the sustainability of academic careers in medical education. We examined the experiences and career paths of medical educators from diverse professional backgrounds seeking to establish, maintain and strengthen their careers in medical schools.Semi-structured interviews were conducted with 44 lead and early-career medical educators from all 21 Australian and New Zealand medical schools. Questions explored career beginnings, rewards and challenges. Transcripts underwent systematic coding and independent thematic analysis. Final themes were confirmed by iterative review and member checking. Analysis was informed by Bourdieu's concepts of field (a social space for hierarchical interactions), habitus (individual dispositions which influence social interactions) and capital (economic, symbolic, social and cultural forms of power).Participants provided diverse accounts of what constitutes the practice of medical education. Serendipitous career entry and little commonality of professional backgrounds and responsibilities suggest an ambiguous habitus with ill-defined career pathways. Within the field of medicine as enacted in medical schools, educators have invisible yet essential roles, experiencing tension between service expectations, a lesser form of capital, and demands for more highly valued forms of scholarship. Participants reported increasing expectations to produce research and obtain postgraduate qualifications to enter and maintain their careers. Unable to draw upon cultural capital accrued from clinical work, non-clinician educators faced additional challenges. To strengthen their position, educators consciously built social capital through essential service relationships, capitalising on times when education takes precedence, such as curriculum renewal and accreditation.Bourdieu's theory provides insight into medical educator career path...
Brough, N, Lindenmeyer, A, Thistlethwaite, J, Lewith, G & Stewart-Brown, S 2015, 'Perspectives on the effects and mechanisms of craniosacral therapy: A qualitative study of users' views', European Journal of Integrative Medicine, vol. 7, no. 2, pp. 172-183.View/Download from: UTS OPUS or Publisher's site
© 2014 Elsevier GmbH. Introduction: Craniosacral Therapy (CST) is a 'body based' complementary or alternative medical practice which aims to support natural healing mechanisms. There is limited evidence regarding its effectiveness or mechanisms of action. Methods: Qualitative study based on constant comparative methods informed by grounded theory. Semi-structured interviews explored 29 participants' experiences with CST. Inductive thematic analysis resulted in themes, concepts and illustrative quotes. Results: Participants consulted for pain relief, emotional and psychological issues and help with rehabilitation. All but four participants reported improvement in at least two of the three dimensions of holistic wellbeing: body, mind and spirit, others in one. Experiences during CST included altered perceptual states and other specific sensations and emotions. The importance of the therapeutic relationship was emphasized. Theory emerging from this study regarding CST and the ways in which healing can be enabled holistically suggests that the establishment of a trusting therapeutic relationship enables CST to take clients into altered perceptual states; these in turn facilitate a new level of awareness regarding the interrelatedness of body, mind and spirit, together with an enhanced capacity to care for self and manage health problems. Conclusion: All participants in this study observed positive changes in their health status and most attributed these to CST; these changes were frequently accompanied by new levels of health awareness which enhanced participants' capacity to self-care. Interviewees were self-selected users of CST and the data are therefore subject to certain methodological biases.
Haider, SI, Johnson, N, Thistlethwaite, JE, Fagan, G & Bari, MF 2015, 'WATCH: Warwick Assessment insTrument for Clinical teacHing: Development and testing.', Medical teacher, vol. 37, no. 3, pp. 289-295.View/Download from: UTS OPUS or Publisher's site
Medical education and teaching skills are core competencies included in the generic curriculum for specialty training. To support the development of these skills, there is need for a validated instrument. This study aims to develop and test an instrument to measure the attributes of specialty trainees as effective teachers.The study was conducted in two phases. In first phase, the content of the instrument was generated from the literature and tested using the Delphi technique. In second phase, the instrument was field tested for validity and reliability using factor analysis and generalizability study. Feasibility was calculated by the time taken to complete the instrument. Acceptability and educational impact were determined by qualitative analysis of written feedback. Attributes of specialty trainees were assessed by clinical supervisors, peers, and students.The Delphi study produced consensus on 15 statements which formed the basis of the instrument. In field study, a total of 415 instruments were completed. Factor analysis demonstrated a three-factor solution ('learning-teaching milieu', 'teaching skills', and 'learner-orientated'). A generalizability coefficient was 0.92. Mean time to complete the instrument was five minutes. Feedback indicated that it was an acceptable and useful method of assessment.This new instrument provides valid, reliable, feasible, and acceptable assessment of clinical teaching.
Graham, S, Eley, D, Cameron, I & Thistlethwaite, J 2014, 'Inclusion of rehabilitation medicine concepts in school of medicine resources.', Disability and rehabilitation, vol. 36, no. 18, pp. 1555-1561.View/Download from: UTS OPUS or Publisher's site
PURPOSE: To perform a gap analysis of rehabilitation medicine learning objectives (RMLOs) coverage within school of medicine (SOM) curriculum and educational resources as a basis for development of educational resources to fill any identified gaps. METHOD: Following ethics approval, interviews were carried out with SOM academics and clinicians to assess the relevance of a set of RMLOs and the extent to which RMLOs were addressed in SOM resources. Interviewee opinion was quantified via Likert scales and additional free comments were subjected to thematic analysis. RESULTS: Most RMLOs were perceived as relevant by more than half of the 18 participants. There was evidence of relevant material relating to each RMLO in SOM resources. Thematic analysis suggested that rehabilitation medicine was addressed at the SOM in less detail than outlined in the RMLOs, and that additional rehabilitation content could be included in SOM resources across a number of courses and year levels. CONCLUSIONS: Rehabilitation medicine is considered relevant by clinicians and academics at the SOM. The most effective way of filling identified gaps in coverage of rehabilitation medicine at the SOM will be via engagement across a number of medical and surgical disciplines. Implications for Rehabilitation Rehabilitation-related knowledge and skills are relevant to medical education. Many of these issues are already partially addressed in existing educational resources. The design and delivery of medical school curricula should include a trans-disciplinary and inter-year approach to the inclusion of rehabilitation concepts and aptitudes. This could be done by introducing relevant concepts early, making resources available online, and embedding rehabilitation items across different disciplines, courses and assessments.
Thistlethwaite, JE, Forman, D, Matthews, LR, Rogers, GD, Steketee, C & Yassine, T 2014, 'Competencies and Frameworks in Interprofessional Education: A Comparative Analysis', ACADEMIC MEDICINE, vol. 89, no. 6, pp. 869-875.View/Download from: UTS OPUS or Publisher's site
Thistlethwaite, J & Dallest, K 2014, 'Interprofessional teamwork: still haven't decided what we are educating for?', Medical Education, vol. 48, no. 6, pp. 556-558.View/Download from: Publisher's site
Patel, S, Ngunjiri, A, Hee, SW, Yang, Y, Brown, S, Friede, T, Griffiths, F, Lord, J, Sandhu, H, Thistlethwaite, J, Tysall, C & Underwood, M 2014, 'Primum non nocere: shared informed decision making in low back pain--a pilot cluster randomised trial.', BMC Musculoskeletal Disorders, vol. 15, pp. 1-13.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Low back pain is a common and disabling condition leading to large health service and societal costs. Although there are several treatment options for back pain little is known about how to improve patient choice in treatment selection. The purpose of this study was to pilot a decision support package to help people choose between low back pain treatments. METHODS: This was a single-centred pilot cluster randomised controlled trial conducted in a community physiotherapy service. We included adults with non-specific low back pain referred for physiotherapy. Intervention participants were sent an information booklet prior to their first consultation. Intervention physiotherapists were trained to enhance their skills in shared informed decision making. Those in the control arm received care as usual. The primary outcome was satisfaction with the treatment received at four months using a five-point Likert Scale dichotomised into "satisfaction" (very satisfied or somewhat satisfied) and "non-satisfaction" (neither satisfied nor dissatisfied, somewhat dissatisfied or very dissatisfied). RESULTS: We recruited 148 participants. In the control arm 67% of participants were satisfied with their treatment and in the intervention arm 53%. The adjusted relative risk of being satisfied was 1.28 (95% confidence interval 0.79 to 2.09). For most secondary outcomes the trend was towards worse outcomes in the intervention group. For one measure; the Roland Morris Disability Questionnaire, this difference was clinically important (2.27, 95% confidence interval 0.08 to 4.47). Mean healthcare costs were slightly lower (£38 saving per patient) within the intervention arm but health outcomes were also less favourable (0.02 fewer QALYs); the estimated probability that the intervention would be cost-effective at an incremental threshold of £20,000 per QALY was 16%. CONCLUSION: We did not find that this decision support package improved satisfaction with treatment; it may have h...
BACKGROUND: Despite an increasing concern about a future shortage of medical educators, little published research exists on career choices in medical education nor the impact of specific training posts in medical education (e.g. academic registrar/resident positions). Medical educators at all levels, from both medical and non-medical backgrounds, are crucial for the training of medical students, junior doctors and in continuing professional development. We explored the motivations and experiences of junior doctors considering an education career and undertaking a medical education registrar (MER) post. METHODS: Data were collected through semi-structured interviews with junior doctors and clinicians across Queensland Health. Framework analysis was used to identify themes in the data, based on our defined research questions and the medical education workforce issues prompting the study. We applied socio-cognitive career theory to guide our analysis and to explore the experience of junior doctors in medical education registrar posts as they enter, navigate and fulfil the role. RESULTS: We identified six key themes in the data: motivation for career choice and wanting to provide better education; personal goals, expectations and the need for self-direction; the influence of role models; defining one's identity; support networks and the need for research as a potential barrier to pursuing a career in/with education. We also identified the similarities and differences between the MERs' experiences to develop a composite of an MER's journey through career choice, experience in role and outcomes. CONCLUSIONS: There is growing interest from junior doctors in pursuing education pathways in a clinical environment. They want to enhance clinical teaching in the hospitals and become specialists with an interest in education, and have no particular interest in research or academia. This has implications for the recruitment and training of the next generation of clinical educat...
Sorinola, OO, Thistlethwaite, J & Davies, D 2013, 'Motivation to engage in personal development of the educator.', Education for primary care : an official publication of the Association of Course Organisers, National Association of GP Tutors, World Organisation of Family Doctors, vol. 24, no. 4, pp. 226-229.View/Download from: UTS OPUS or Publisher's site
Thistlethwaite, JE, Bartle, E, Chong, AAL, Dick, M-L, King, D, Mahoney, S, Papinczak, T & Tucker, G 2013, 'A review of longitudinal community and hospital placements in medical education: BEME Guide No. 26.', Medical teacher, vol. 35, no. 8, pp. e1340-e1364.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Traditionally, clinical learning for medical students consists of short-term and opportunistic encounters with primarily acute-care patients, supervised by an array of clinician preceptors. In response to educational concerns, some medical schools have developed longitudinal placements rather than short-term rotations. Many of these longitudinal placements are also integrated across the core clinical disciplines, are commonly termed longitudinal integrated clerkships (LICs) and often situated in rural locations. This review aimed to explore, analyse and synthesise evidence relating to the effectiveness of longitudinal placements, for medical students in particular to determine which aspects are most critical to successful outcomes. METHOD: Extensive search of the literature resulted in 1679 papers and abstracts being considered, with 53 papers ultimately being included for review. The review group coded these 53 papers according to standard BEME review guidelines. Specific information extracted included: data relating to effectiveness, the location of the study, number of students involved, format, length and description of placement, the learning outcomes, research design, the impact level for evaluation and the main evaluation methods and findings. We applied a realist approach to consider what works well for whom and under what circumstances. FINDINGS: The early LICs were all community-based immersion programs, situated in general practice and predominantly in rural settings. More recent LIC innovations were situated in tertiary-level specialist ambulatory care in urban settings. Not all placements were integrated across medical disciplines but were longitudinal in relation to location, patient base and/or supervision. Twenty-four papers focussed on one of four programs from different viewpoints. Most evaluations were student opinion (survey, interview, focus group) and/or student assessment results. Placements varied from one half day per week for...
Sorinola, OO & Thistlethwaite, J 2013, 'A systematic review of faculty development activities in family medicine.', Medical teacher, vol. 35, no. 7, pp. e1309-e1318.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Faculty development (FD) has been defined as a planned programme to prepare institutions and faculty members for their roles in the areas of teaching, research, administration and career management. However, there are few generalisable evaluations of FD activities available to help family medicine FD planners to choose the most effective training strategies. AIM: To assess the evidence for the effectiveness of family medicine FD activities. METHOD: Six electronic databases were searched from 1980 to 2010 and included all articles on FD interventions in family medicine. Hand searching was also undertaken. RESULTS: A total of 4520 articles were identified, 46 fulfilled the search criteria and were reviewed across three domains: (a) Context, i.e. setting, participation and funding. (b)Content/Process, i.e. theoretical framework, focus of intervention/learning outcomes, types of FD intervention and instructional methods. (c) Evaluation using Freeth et al's adaptation of Kirkpatrick's outcome levels. CONCLUSION: FD activities appear highly valued by the participants, leading to changes in learning and behaviour. Changes in organisational practice and student learning were not frequently reported. The continued success of family medicine FD will depend on the contextual approach/collegial support, adaptability of the programmes, robust evaluation and adequate funding in terms of resources and time.
McColl, GJ, Thistlethwaite, JE, Wilkinson, T, Schuwirth, LWT & Hu, WCY 2013, 'Re: Where is the next generation of medical educators?', Medical Journal of Australia, vol. 198, no. 10, p. 535.View/Download from: Publisher's site
Patel, S, Brown, S, Friede, T, Griffiths, F, Lord, J, Ngunjiri, A, Thistlethwaite, J, Tysall, C, Woolvine, M & Underwood, M 2013, 'Erratum: Study protocol: Improving patient choice in treating Low back pain (IMPACT - LBP): A randomised controlled trial of a decision support package for use in physical therapy (BMC Musculoskeletal Disorders (2013) 14 (158))', BMC Musculoskeletal Disorders, vol. 14.View/Download from: UTS OPUS or Publisher's site
Gittell, JH, Godfrey, M & Thistlethwaite, J 2013, 'Interprofessional collaborative practice and relational coordination: improving healthcare through relationships.', Journal of interprofessional care, vol. 27, no. 3, pp. 210-213.View/Download from: UTS OPUS or Publisher's site
Thistlethwaite, J & Hammick, M 2013, 'Systematic reviews: stimulating the research agenda through appropriate questions.', Medical education, vol. 47, no. 4, p. 431.View/Download from: Publisher's site
Hu, WCY, McColl, GJ, Thistlethwaite, JE, Schuwirth, LWT & Wilkinson, T 2013, 'Where is the next generation of medical educators?', The Medical journal of Australia, vol. 198, no. 1, pp. 8-9.View/Download from: Publisher's site
Thistlethwaite, J & GRIN working group 2013, 'Introducing the Global Research Interprofessional Network (GRIN).', Journal of interprofessional care, vol. 27, no. 2, pp. 107-109.View/Download from: UTS OPUS or Publisher's site
Thistlethwaite, J, Jackson, A & Moran, M 2013, 'Interprofessional collaborative practice: a deconstruction.', Journal of interprofessional care, vol. 27, no. 1, pp. 50-56.View/Download from: UTS OPUS or Publisher's site
This paper uses (and perhaps abuses) deconstruction to revisit the meanings of collaboration and practice. We start with a description of deconstruction itself, as espoused by Jacques Derrida, and then move onto challenging the notion that words, such as collaboration, can have fixed meanings. And, in the spirit of Derrida, "I can foresee the impatience of the bad reader: this is the way I name or accuse the fearful reader, the reader in a hurry to be determined, decided upon deciding (in order to annul, in other words to bring back to oneself, one has to wish to know in advance what to expect...)" (Derrida, 1987, p. 4--original italics), we move straight into the text.
Brooks, V & Thistlethwaite, J 2012, 'Working and Learning Across Professional Boundaries', British Journal of Educational Studies, vol. 60, no. 4, pp. 403-420.View/Download from: UTS OPUS or Publisher's site
This paper focuses on a context where interdisciplinarity intersects with interprofessionality: the work of children's services professionals who address the needs of children identified as vulnerable. It draws on evidence and perspectives from two disciplines - educational studies and health care - to consider the issues and challenges posed by learning and/or working across disciplinary boundaries and why these have proved so obdurate. © 2012 Copyright 2012 Society for Educational Studies.
Zhang, JJ, Wilkinson, D, Parker, MH, Leggett, A & Thistlethwaite, J 2012, 'Evaluating workplace-based assessment of interns in a Queensland hospital: does the current instrument fit the purpose?', The Medical journal of Australia, vol. 196, no. 4, p. 243.View/Download from: Publisher's site
Coomber, J, Charlton, R, Thistlethwaite, JE & England, L 2012, 'Can GPs working in secure environments in England re-license using the Royal College of General Practitioners revalidation proposals?', BMC family practice, vol. 13, pp. 123-123.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Revalidation for UK doctors is expected to be introduced from late 2012. For general practitioners (GPs), this entails collecting supporting information to be submitted and assessed in a revalidation portfolio every five years. The aim of this study was to explore the feasibility of GPs working in secure environments to collect supporting information for the Royal College of General Practitioners' (RCGP) proposed revalidation portfolio. METHODS: We invited GPs working in secure environments in England to submit items of supporting information collected during the previous 12 months using criteria and standards required for the proposed RCGP revalidation portfolio and complete a GP issues log. Initial focus groups and initial and follow-up semi-structured face-to-face and telephone interviews were held to explore GPs' views of this process. Quantitative and qualitative data were analysed using descriptive statistics and identifying themes respectively. RESULTS: Of the 50 GPs who consented to participate in the study, 20 submitted a portfolio. Thirty-eight GPs participated in an initial interview, nine took part in a follow-up interview and 17 completed a GP issues log. GPs reported difficulty in collecting supporting information for valid patient feedback, full-cycle clinical audits and evidence for their extended practice role(s) as sessional practitioners in the high population turnover custodial environment. Peripatetic practitioners experienced more difficulty than their institution based counterparts collating this evidence. CONCLUSIONS: GPs working in secure environments may experience difficulties in collecting the newer types of supporting information for the proposed RCGP revalidation portfolio primarily due to their employment status within a non-medical environment and characteristics of the detainee population. Increased support from secure environment service commissioners and employers will be a prerequisite for these practitioners to ena...
Thistlethwaite, JE, Davies, D, Ekeocha, S, Kidd, JM, MacDougall, C, Matthews, P, Purkis, J & Clay, D 2012, 'The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23.', Medical teacher, vol. 34, no. 6, pp. e421-e444.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Case-based learning (CBL) is a long established pedagogical method, which is defined in a number of ways depending on the discipline and type of 'case' employed. In health professional education, learning activities are commonly based on patient cases. Basic, social and clinical sciences are studied in relation to the case, are integrated with clinical presentations and conditions (including health and ill-health) and student learning is, therefore, associated with real-life situations. Although many claims are made for CBL as an effective learning and teaching method, very little evidence is quoted or generated to support these claims. We frame this review from the perspective of CBL as a type of inquiry-based learning. AIM: To explore, analyse and synthesise the evidence relating to the effectiveness of CBL as a means of achieving defined learning outcomes in health professional prequalification training programmes. METHOD: SELECTION CRITERIA: We focused the review on CBL for prequalification health professional programmes including medicine, dentistry, veterinary science, nursing and midwifery, social care and the allied health professions (physiotherapy, occupational therapy, etc.). Papers were required to have outcome data on effectiveness. SEARCH STRATEGIES: The search covered the period from 1965 to week 4 September 2010 and the following databases: ASSIA, CINAHL, EMBASE, Education Research, Medline and Web of Knowledge (WoK). Two members of the topic review group (TRG) independently reviewed the 173 abstracts retrieved from Medline and compared findings. As there was good agreement on inclusion, one went onto review the WoK and ASSIA EndNote databases and the other the Embase, CINAHL and Education Research databases to decide on papers to submit for coding. Coding and data analysis: The TRG modified the standard best evidence medical education coding sheet to fit our research questions and assessed each paper for quality. After a preliminary ...
Thistlethwaite, J, Charlton, R & Coomber, J 2012, 'Revalidation for relicensing - reflections on the proposed British model.', Australian family physician, vol. 41, no. 1-2, pp. 70-72.View/Download from: UTS OPUS
In the United Kingdom, the General Medical Council aims to introduce revalidation for all medical doctors from 2012, in response to public and government pressure. Doctors will submit evidence to support their fitness to practise medicine every 5 years in relation to the four domains and 12 attributes of good medical practice.This article reviews the argument for revalidation, the proposed process and some of the findings of a pilot carried out with general practitioners.A revalidation process is being piloted in several parts of the United Kingdom with a view to implementation in 2012. However, there is a lack of evidence internationally that revalidation or relicensure identifies doctors who are performing poorly. The medical profession in Australia needs to reflect on whether this model is one it wishes to consider.
Thistlethwaite, J 2012, 'Interprofessional education: a review of context, learning and the research agenda.', Medical education, vol. 46, no. 1, pp. 58-70.View/Download from: UTS OPUS or Publisher's site
CONTEXT: Interprofessional education (IPE) is not a recent phenomenon and has been the subject of several World Health Organization reports. Its focus is on health professionals and students learning with, from and about one another to improve collaboration and the quality of patient care. The drivers for IPE include new models of health care delivery in the context of an ageing population and the increasing prevalence of long-term chronic disease, in addition to the patient safety agenda. The delivery of complex health care requires a team-based and collaborative approach, although teamwork and collaborative practice are not necessarily synonymous. The rationale for IPE is that learning together enhances future working together. DISCUSSION: Systematic reviews of IPE have shown some evidence that IPE fosters positive interaction among different professions and variable evidence that it improves attitudes towards other professionals. Generalisation across published papers is difficult because IPE initiatives are diverse and good evaluation methodology and data are lacking. In terms of constructive alignment from an education viewpoint, there is a need for educators to define learning outcomes and match these with learning activities to ensure that IPE demonstrates added value over uniprofessional learning. Assessment is difficult as pre-qualification professional education focuses on the individual and professional accreditation organisations mandate only for their own professions. CONCLUSIONS: Interprofessional education draws from a number of education, sociology and psychology theories, and these are briefly discussed. The most pressing research questions for the IPE community are defined and the challenges for IPE explored.
Charlton, R, Coomber, J & Thistlethwaite, JE 2011, 'Re-licensing of general practitioners using the current UK revalidation proposals: a cross sectional study.', Postgraduate medical journal, vol. 87, no. 1034, pp. 807-813.View/Download from: Publisher's site
Objective To explore the views of general practitioners (GPs) on the feasibility of collecting supporting information for the Royal College of General Practitioners (RCGP) revalidation portfolio and mapping of this evidence to the General Medical Practice framework for proposed UK medical re-licensing. Design Cross sectional study with a questionnaire. Setting One inner city and one mixed urban/rural primary care organisation in the West Midlands, England and one rural primary care organisation in Wales. Participants 51/69 GPs who submitted a revalidation portfolio from November 2009 to February 2010. Results The majority of GPs considered the majority of work based supporting information was feasible to collect within a 5 year revalidation cycle; most concerns were expressed about providing evidence for extended practice, learning credits, and patient satisfaction and colleague feedback surveys (59%, 63%, 72%, and 77%, respectively, of GPs considered it feasible to collect this evidence) due to workload time constraints and lack of automatic access to evidence from others, which differed by GP work role. Two-thirds of participants (65%) stated that the submission of a portfolio of evidence was a feasible component of GP revalidation, reporting reservations on the appropriateness of patient and colleague feedback surveys and extended practice (55%, 57%, and 59% respectively) to provide objective evidence. GPs requested further clarity on the evidence mapping process. Conclusion Overall, GPs reported a positive response to the RCGP revalidation proposals. Concerns were focused on collecting the newer types of supporting information and the ability of GPs non-principals to collect this evidence. GP revalidation training and preparation is required.
Matthews, L, Pockett, R, Nisbet, G, Thistlethwaite, J, Dunston, R, Lee, A & White, JF 2011, 'Building Capacity In Australian Interprofessional Health Education: Perspectives From Key Health And Higher Education Stakeholders', Australian Health Review, vol. 35, no. 2, pp. 136-140.View/Download from: UTS OPUS or Publisher's site
Abstract Objective. A substantial literature engaging with the directions and experiences of stakeholders involved in interprofessional health education exists at the international level, yet almost nothing has been published that documents and analyses the Australian experience. Accordingly, this study aimed to scope the experiences of key stakeholders in health and higher education in relation to the development of interprofessional practice capabilities in health graduates in Australia. Methods. Twenty-seven semi-structured interviews and two focus groups of key stakeholders involved in the development and delivery of interprofessional health education in Australian higher education were undertaken. Interview data were coded to identify categories that were organised into key themes, according to principles of thematic analysis. Results. Three themes were identified: the need for common ground between health and higher education, constraints and enablers in current practice, and the need for research to establish an evidence base. Five directions for national development were also identified. Conclusions. The study identified a range of interconnected changes that will be required to successfully mainstream interprofessional education within Australia, in particular, the importance of addressing issues of culture change and the need for a nationally coordinated and research informed approach. These findings reiterate those found in the international literature.
Kumar, K, Roberts, C & Thistlethwaite, J 2011, 'Entering and navigating academic medicine: academic clinician-educators' experiences.', Medical education, vol. 45, no. 5, pp. 497-503.View/Download from: UTS OPUS or Publisher's site
OBJECTIVES: Despite a recognised need for richer narratives about academic medicine, much of the literature is limited to an analysis of the enablers and barriers associated with recruitment and retention, and focuses on analysing the development of research career pathways. We explored academic clinician-educators' experiences of entering into and navigating academic medicine, with a particular focus on those who privilege teaching above research. METHODS: Data were collected through interviews and focus groups conducted across a medical school at one Australian university. We used socio-cognitive career theory to provide theoretical insight into the factors that influence academic clinician-educators' interests, choice and motivations regarding entering and pursuing a teaching pathway within academic medicine. Framework analysis was used to illustrate key themes in the data. RESULTS: We identified a number of themes related to academic clinician-educators' engagement and performance within an academic medicine career focused on teaching. These include contextual factors associated with how academic medicine is structured as a discipline, cultural perceptions regarding what constitutes legitimate practice in academia, experiential factors associated with the opportunity to develop a professional identity commensurate with being an educator, and socialisation practices. CONCLUSIONS: The emphasis on research in academia can engender feelings of marginalisation and lack of credibility for those clinicians who favour teaching over research. The prevailing focus on supporting and socialising clinicians in research will need to change substantially to facilitate the rise of the academic clinician-educator.
Patel, S, Brown, S, Friede, T, Griffiths, F, Lord, J, Ngunjiri, A, Thistlethwaite, J, Tysall, C, Woolvine, M & Underwood, M 2011, 'Study protocol: improving patient choice in treating low back pain (IMPACT-LBP): a randomised controlled trial of a decision support package for use in physical therapy.', BMC musculoskeletal disorders, vol. 12, p. 52.View/Download from: UTS OPUS or Publisher's site
Low back pain is a common and costly condition. There are several treatment options for people suffering from back pain, but there are few data on how to improve patients' treatment choices. This study will test the effects of a decision support package (DSP), designed to help patients seeking care for back pain to make better, more informed choices about their treatment within a physiotherapy department. The package will be designed to assist both therapist and patient.Firstly, in collaboration with physiotherapists, patients and experts in the field of decision support and decision aids, we will develop the DSP. The work will include: a literature and evidence review; secondary analysis of existing qualitative data; exploration of patients' perspectives through focus groups and exploration of experts' perspectives using a nominal group technique and a Delphi study.Secondly, we will carry out a pilot single centre randomised controlled trial within NHS Coventry Community Physiotherapy. We will randomise physiotherapists to receive either training for the DSP or not. We will randomly allocate patients seeking treatment for non specific low back pain to either a physiotherapist trained in decision support or to receive usual care. Our primary outcome measure will be patient satisfaction with treatment at three month follow-up. We will also estimate the cost-effectiveness of the intervention, and assess the value of conducting further research.Informed shared decision-making should be an important part of any clinical consultation, particularly when there are several treatments, which potentially have moderate effects. The results of this pilot will help us determine the benefits of improving the decision-making process in clinical practice on patient satisfaction.Current Controlled Trials ISRCTN46035546.
Chesters, J, Thistlethwaite Prof., J & Williams, B 2010, 'Interprofessional education and the health care team challenge: An interview with Monash University paramedic student, Tegwyn Bath', Journal of Emergency Primary Health Care, vol. 8, no. 1, p. 5.
BACKGROUND: This study explores the factors influencing students to seek medical help, and student perceptions in relation to student-doctor interactions with implications for health help-seeking behaviours. METHOD: Students were interviewed across year groups. The interviews were audiotaped, transcribed and qualitatively analysed. RESULTS: We interviewed 22 students and identified common themes. CONCLUSION: Medical students reflect on issues related to seeking medical help, their choice of GP and the decision whether to divulge they are medical students.
Thistlethwaite, J & Hammick, M 2010, 'The Best Evidence Medical Education (BEME) Collaboration: Into the next decade.', Medical teacher, vol. 32, no. 11, pp. 880-882.View/Download from: Publisher's site
Towle, A, Bainbridge, L, Godolphin, W, Katz, A, Kline, C, Lown, B, Madularu, I, Solomon, P & Thistlethwaite, J 2010, 'Active patient involvement in the education of health professionals.', Medical education, vol. 44, no. 1, pp. 64-74.View/Download from: Publisher's site
CONTEXT: Patients as educators (teaching intimate physical examination) first appeared in the 1960s. Since then, rationales for the active involvement of patients as educators have been well articulated. There is great potential to promote the learning of patient-centred practice, interprofessional collaboration, community involvement, shared decision making and how to support self-care. METHODS: We reviewed and summarised the literature on active patient involvement in health professional education. RESULTS: A synthesis of the literature reveals increasing diversity in the ways in which patients are involved in education, but also the movement's weaknesses. Most initiatives are 'one-off' events and are reported as basic descriptions. There is little rigorous research or theory of practice or investigation of behavioural outcomes. The literature is scattered and uses terms (such as 'patient'!) that are contentious and confusing. CONCLUSIONS: We propose future directions for research and development, including a taxonomy to facilitate dialogue, an outline of a research strategy and reference to a comprehensive bibliography covering all health and human services.
Thistlethwaite, J, Moran, M & World Health Organization Study Group on Interprofessional Education and Collaborative Practice 2010, 'Learning outcomes for interprofessional education (IPE): Literature review and synthesis.', Journal of interprofessional care, vol. 24, no. 5, pp. 503-513.View/Download from: Publisher's site
As part of a World Health Organization (WHO) initiative we searched the literature to explore defined learning outcomes for interprofessional education between 1988, when the last WHO technical report on interprofessional education was published, and 2009. We describe and synthesize findings from 88 citations over this 21 year period. There is a variety in the way learning outcomes are presented but there are many similarities between specific outcomes and/or objectives. Papers describing educational interventions do not always include specific outcomes or objectives. Our findings have been integrated into a list of learning outcomes with six categories for further debate and discussion. This project is part of a wider initiative initiated by the WHO in 2007 to review the current position of interprofessional education worldwide. It is also a sub-project of a learning and teaching grant funded by the Carrick Institute for Learning and Teaching within Australia. In this paper we use the CAIPE definition of interprofessional education: "Occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of care" (Barr, 2002 ).
Stewart, R & Thistlethwaite, J 2010, 'Pap tests--what do women expect?', Australian family physician, vol. 39, no. 10, pp. 775-778.
BACKGROUND: Women express various opinions regarding expectations and experiences of having Pap tests, particularly with regards to explanation of the procedure, its implications and results, and accompanied preventive health activities. AIM: To explore patient expectations and experiences regarding Pap tests and associated screening activities. METHODS: Semistructured interviews were conducted with volunteer female patients. RESULTS: Twenty-four women were interviewed. There was variation in expectations regarding consultations for a Pap test, and also of the information given as to what is meant by a 'normal' result. Many women expressed a preference for a female and regular health professional to undertake their smear. CONCLUSION: Recognition of general and individual barriers to cervical screening by health professionals will enhance patient access to, and acceptance of, screening activities. Understanding patient expectations regarding Pap tests ensures practitioners deliver health services with sufficient information and without false reassurance.
Ajjawi, R, Thistlethwaite, JE, Aslani, P & Cooling, NB 2010, 'What are the perceived learning needs of Australian general practice registrars for quality prescribing?', BMC medical education, vol. 10, p. 92.View/Download from: Publisher's site
BACKGROUND: Little is known about the perceived learning needs of Australian general practice (GP) registrars in relation to the quality use of medicines (QUM) or the difficulties experienced when learning to prescribe. This study aimed to address this gap. METHODS: GP registrars' perceived learning needs were investigated through an online national survey, interviews and focus groups. Medical educators' perceptions were canvassed in semi-structured interviews in order to gain a broader perspective of the registrars' needs. Qualitative data analysis was informed by a systematic framework method involving a number of stages. Survey data were analysed descriptively. RESULTS: The two most commonly attended QUM educational activities took place in the workplace and through regional training providers. Outside of these structured educational activities, registrars learned to prescribe mainly through social and situated means. Difficulties encountered by GP registrars included the transition from hospital prescribing to prescribing in the GP context, judging how well they were prescribing and identifying appropriate and efficient sources of information at the point of care. CONCLUSIONS: GP registrars learn to prescribe primarily and opportunistically in the workplace. Despite many resources being expended on the provision of guidelines, decision-support systems and training, GP registrars expressed difficulties related to QUM. Ways of easing the transition into GP and of managing the information 'overload' related to medicines (and prescribing) in an evidence-guided, efficient and timely manner are needed. GP registrars should be provided with explicit feedback about the process and outcomes of prescribing decisions, including the use of audits, in order to improve their ability to judge their own prescribing.
Ajjawi, R, Thistlethwaite, J, Williams, K, Ryan, G, Seale, PJ & Carroll, P 2010, 'Breaking down professional barriers: Medicine and pharmacy students learning together', FOCUS ON HEALTH PROFESSIONAL EDUCATION: A MULTI-DISCIPLINARY JOURNAL, vol. 12, no. 1, pp. 1-10.View/Download from: UTS OPUS
Background: This paper reports findings of a pilot interprofessional problem based learning (PBL) study in the faculties of Medicine and Pharmacy at the University of Sydney, New South Wales. The aim of the research was to investigate whether small group interprofessional learning activities with medical and pharmacy students can lead to: changes in attitude toward each other and toward interprofessional education (IPE); added value when learning together; and better understanding of each other's professional roles. Methods: Nineteen medical and 20 pharmacy students participated in two, 2-hour PBL tutorials focussed on conducting a Home Medicines Review. The Attitudes to Health Professionals Questionnaire (AHPQ) was used to measure attitude change pre- and postinterprofessional PBL. Paired t-tests were used to analyse pre- and post-IPE data. Focus groups were conducted with the students after the PBL sessions. These were audio-recorded, transcribed and analysed. Results: Students reported added value from the IPE experience. Pharmacy students reported a small but significant change in attitude toward the medical students on the AHPQ caring scale, rating them as more caring post-IPE (p=0.001). Although medical students rated the pharmacy students more caring after the intervention, this was not statistically significant (p=0.08). Medical students valued the pharmacy students' input and knowledge. Conclusion: There was evidence of a positive change in students' attitudes to the other profession after only two sessions. Aspects of IPE design such as explicit interprofessional learning outcomes, the use of PBL processes, and relevant learning activities were important to the success of this pilot study
Thistlethwaite, J & Topps, D 2009, 'Changes to general practice.', Australian family physician, vol. 38, no. 1-2, p. 7.
In September 2008, the Federal Minister for Health and Ageing, Nicola Roxon, announced plans to change delivery of primary health care in Australia. Ms Roxon suggested that general practitioners should 'relinquish some of the work that could be safely done by other health professionals'. The New South Wales Australian Medical Association President immediately responded by saying 'any fragmentation of primary health care to other allied health workers will mean diminution of care for patients'. Any suggestion of change to general practice service provision in Australia seems to be met with scepticism and negativity from the medical profession. Yet if we examine Ms Roxon's proposals in detail, we find they are neither revolutionary nor likely to compromise patient safety.
Thistlethwaite, J, Lee, A, Dunston, R, Nisbet, G, Matthews, L & Pockett, R 2009, 'Interprofessional developments in Australia - L-TIPP (Aus) and the Way Forward', JOURNAL OF INTERPROFESSIONAL CARE, vol. 23, no. 4, pp. 315-317.View/Download from: Publisher's site
Topps, D, Evans, RJ, Thistlethwaite, JE, Tie, RN & Ellaway, RH 2009, 'The one minute mentor: A pilot study assessing medical students' and residents' professional behaviours through recordings of clinical preceptors' immediate feedback', Education for Health: Change in Learning and Practice, vol. 22, no. 1.
Introduction: The assessment of professional development and behaviour is an important issue in the training of medical students and physicians. Several methods have been developed for doing so. What is still needed is a method that combines assessment of actual behaviour in the workplace with timely feedback to learners. Goal: We describe the development, piloting and evaluation of a method for assessing professional behaviour using digital audio recordings of clinical supervisors' brief feedback. We evaluate the inter-rater reliability, acceptability and feasibility of this approach. Methods: Six medical students in Year 5 and three GP registrars (residents) took part in this pilot project. Each had a personal digital assistant (PDA) and approached, their clinical supervisors to give proximately one minute of verbal feedback on professionalism-related behaviours they had observed in the registrar's clinical encounteis. The comments, both in transcribed text format and audio, were scored by five evaluators for competence (the learner's performance) and confidence (how confident the evaluator was that the comment clearly described an observed behaviour or attribute that was relevant). Students and evaluators were surveyed for feedback on the process. Results: Study evaluators rated 29 comments from supervisors in text and audio format. There was good inter-rater reliability (Cronbach around 0.8) on competence scores. There was good agreement (paired t-test) between scores across supervisors for assessments of comments in both written and audio formats. Students found the method helpful in providing feedback on professionalism. Evaluators liked having a relatively objective approach for judging behaviours and attributes but found scoring audio comments to be time-consuming. Discussion: This method of assessing learners' professional behaviour shows potential for providing both formative and summative assessment in a way that is feasible and acceptable to student...
Topps, D, Evans, RJ, Thistlethwaite, JE, Nan Tie, R & Ellaway, RH 2009, 'The one minute mentor: a pilot study assessing medical students' and residents' professional behaviours through recordings of clinical preceptors' immediate feedback.', Education for health (Abingdon, England), vol. 22, no. 1, p. 189.
INTRODUCTION: The assessment of professional development and behaviour is an important issue in the training of medical students and physicians. Several methods have been developed for doing so. What is still needed is a method that combines assessment of actual behaviour in the workplace with timely feedback to learners. GOAL: We describe the development, piloting and evaluation of a method for assessing professional behaviour using digital audio recordings of clinical supervisors' brief feedback. We evaluate the inter-rater reliability, acceptability and feasibility of this approach. METHODS: Six medical students in Year 5 and three GP registrars (residents) took part in this pilot project. Each had a personal digital assistant (PDA) and approached their clinical supervisors to give approximately one minute of verbal feedback on professionalism-related behaviours they had observed in the registrar's clinical encounters. The comments, both in transcribed text format and audio, were scored by five evaluators for competence (the learner's performance) and confidence (how confident the evaluator was that the comment clearly described an observed behaviour or attribute that was relevant). Students and evaluators were surveyed for feedback on the process. RESULTS: Study evaluators rated 29 comments from supervisors in text and audio format. There was good inter-rater reliability (Cronbach alpha around 0.8) on competence scores. There was good agreement (paired t-test) between scores across supervisors for assessments of comments in both written and audio formats. Students found the method helpful in providing feedback on professionalism. Evaluators liked having a relatively objective approach for judging behaviours and attributes but found scoring audio comments to be time-consuming. DISCUSSION: This method of assessing learners' professional behaviour shows potential for providing both formative and summative assessment in a way that is feasible and acceptable to st...
Christensen, S & Thistlethwaite, J 2009, 'Developing general practitioners' teaching skills: Student enhanced learning', Clinical Teacher, vol. 6, no. 4, pp. 225-228.View/Download from: Publisher's site
Thistlethwaite, J, Nehill, C & Wilcoxon, H 2009, 'Breaking bad news: An interactive workshop for general practitioners', Clinical Teacher, vol. 6, no. 4, pp. 277-282.View/Download from: Publisher's site
Knapp, P, Raynor, DK, Thistlethwaite, JE & Jones, MB 2009, 'A questionnaire to measure health practitioners' attitudes to partnership in medicine taking: LATCon II.', Health expectations : an international journal of public participation in health care and health policy, vol. 12, no. 2, pp. 175-186.View/Download from: Publisher's site
To revise and improve an existing scale to measure health practitioners' attitudes to partnership in medicine taking and to ascertain the views of medical students, nursing students and pre-registration pharmacists on concordance.The traditional model of the practitioner-patient interaction incorporates a practitioner-centred approach, focusing on the disease rather than the patient. The philosophy of 'concordance' (or 'partnership in medicine-taking') puts the patient at the centre of the interaction, with the patient interacting reciprocally with the practitioner. The Leeds Attitude to Concordance (LATCon) scale was developed in 2001 to assess practitioners' and patients' attitudes to concordance. However, thinking on concordance has developed since then and the present study aimed to revise the scale to ensure that it reflected current thinking and also to increase its reliability and validity.A pool of potential items was developed and sent to three subject experts for opinion. An attitudinal Likert scale of 31 items was developed. Its completion was followed by statistical item reduction to 20 items. The shorter scale was completed by the same participants 4-6 weeks later.The study was set in a university in the UK. Participants were 183 medical students, nursing students, and pre-registration pharmacists.The study derived a 20 item scale, including five negatively-worded items, with good levels of internal and test-retest reliability. Factor analysis suggested five main factors. A statistically significant difference in attitudes was found between student nurses and medical students, and student nurses and pre-registration pharmacists, with student nurses being more in agreement with the concordant approach. Overall, participants were in agreement with the concordant approach to medicine taking. The UK National Health Service advocates partnership in medical care and is encouraging both practitioners and patients to work to introduce this. There is increase...
Thistlethwaite, JE, Leeder, SR, Kidd, MR & Shaw, T 2008, 'Addressing general practice workforce shortages: policy options.', The Medical journal of Australia, vol. 189, no. 2, pp. 118-121.
There is an ongoing shortage of general practitioners in Australia, accompanied by a decline in the popularity of general practice as a career choice. Many factors influence the career choice of junior doctors and medical students, including role models, the quality of clinical attachments during training, remuneration, and flexibility of training and working hours. Evidence-based strategies that could increase the number of doctors choosing general practice as a career include longer and higher-quality general practice attachments during medical school and the early postgraduate years, and emphasising the positive aspects of general practice, such as flexibility. General practice would become a more attractive choice if remuneration was in line with hospital specialties.
Stewart, RA, Thistlethwaite, J & Evans, R 2008, 'Pelvic examination of asymptomatic women - attitudes and clinical practice.', Australian family physician, vol. 37, no. 6, pp. 493-496.
BACKGROUND: Many women see their general practitioner for 'well woman' checks, which often include Pap tests and a pelvic examination. A recent review of the evidence revealed pelvic examination in asymptomatic women is not a valid screening test, particularly with regard to ovarian cancer screening. METHOD: This project explored the attitudes of GPs regarding the performance of pelvic examinations in asymptomatic women. Twenty-seven GPs were interviewed about their current practice and opinions of the value, advantages and disadvantages of pelvic examinations in asymptomatic women. The interview data was analysed qualitatively. DISCUSSION: The majority of the GPs interviewed perform pelvic examinations as part of a well woman check. Despite broad consensus by the GPs that the value of a pelvic examination as a screening test was questionable, they were performed for a range of reasons including patient reassurance, documenting the norm, 'because I was taught to', for legal reasons, and for completeness. The disadvantages of performing pelvic examinations in asymptomatic women noted by the GPs were time constraints, chaperone issues, intimacy concerns, and false reassurance and unnecessary anxiety caused by unexpected findings. However, neither these disadvantages nor the presentation of evidence based guidelines dissuaded the doctors from performing the examinations. This highlights the ongoing discrepancy between the theoretical development of such recommendations and their practical implementation.
Thistlethwaite, J, Kidd, MR, Leeder, S, Shaw, T & Corcoran, K 2008, 'Enhancing the choice of general practice as a career.', Australian family physician, vol. 37, no. 11, pp. 964-968.
BACKGROUND: The shortage of general practitioners in Australia is likely to continue unless more doctors choose general practice as a career. The aim of this qualitative research was to explore the factors that influence students' and junior doctors' career choice, particularly in respect to choosing general practice. METHODS: Medical students, junior doctors, general practice registrars and GPs were recruited and interviewed. The interviews were semistructured, transcribed and analysed by theme. RESULTS: Themes from the 38 interviews included the experience of general practice during training, the impact of the postgraduate general practice placements program, and factors that make general practice attractive or unattractive as a career choice. DISCUSSION: There are a number of factors that contribute to medical students' and junior doctors' career choice. Attention needs to be paid to the quality of the general practice learning experience and general practice posts in the early postgraduate years, and the attractions of general practice should be promoted.
Thistlethwaite, J, Stewart, R & Evans, R 2008, 'Clinical breast examination of asymptomatic women - attitudes and clinical practice.', Australian family physician, vol. 37, no. 5, pp. 377-379.
BACKGROUND: Well woman health checks are offered in general practice and may include breast examination. METHODS: The authors explored the attitudes of general practitioners toward clinical breast examination as a screening test in asymptomatic women. Twenty-seven GPs were interviewed about their current practice and opinions of the value, advantages and disadvantages of breast examination. The interview data was analysed qualitatively. RESULTS: Most GPs performed clinical breast examinations and had no wish to change their practice. The GPs had different opinions about the value of breast examination, few of which were evidence based. DISCUSSION: It is difficult to change doctors' practice based on evidence alone when the practitioner has personal opinions concerning the value of a procedure. However, women need to be fully informed of the efficacy of clinical breast examination if such examinations are to be performed.
Page, SL, Birden, HH, Hudson, JN, Thistlethwaite, JE, Roberts, C, Wilson, I, Bushnell, J, Hogg, J, Freedman, SB & Yeomans, N 2008, 'Medical schools can cooperate: a new joint venture to provide medical education in the Northern Rivers region of New South Wales.', The Medical journal of Australia, vol. 188, no. 3, pp. 179-181.
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 committee has identified the availability and support requirements 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 of the program include preparing doctors who can perform effectively in rural settings and multidisciplinary health care teams, and to advance research in medical education.
Millard, FB, Thistlethwaite, J, Spagnolo, C, Kennedy, RL & Baune, BT 2008, 'Dementia diagnosis: A pilot randomised controlled trial of education and IT audit to assess change in GP dementia documentation', Australian Journal of Primary Health, vol. 14, no. 3, pp. 141-149.
This trial aimed to test whether education and audit can change documentation of dementia by general practitioners (GPs). We measured the number of new dementia diagnoses documented and Mini Mental State Examinations (MMSEs) performed following the interventions of education and audit, using electronic data for audit and outcomes. GPs in Mackay were randomly assigned to the interventions of either an educational workshop or education combined with audit of their documented dementia diagnoses and MMSE performed in electronic medical records. The results were compared with a control group of GPs in Townsville. Together with education, audit significantly improved documentation of dementia compared with education alone and a control group. We developed a data extraction tool for Medical Director (MD) software producing a report of dementia diagnoses, MSSE tests and practice population at risk of dementia. General practitioners participating in this project were likely to be motivated to learn about dementia. Education using Royal Australian College of General Practitioners' (RACGP) guidelines and audit using an IT extraction tool can improve computer documentation of dementia. Differences in practice software and past adverse experiences with new software were barriers to using our data extraction software for audit purposes.
Thistlethwaite, JE 2008, 'The future of health professional education: some reflections on possibilities and complexities.', Journal of interprofessional care, vol. 22, no. 2, pp. 129-132.View/Download from: Publisher's site
Playford, D, Towler, S, Blackwell, S, Lake, F, O'Neill, B, Nesbitt, G & Thistlethwaite, J 2008, 'Health professional education: perpetuating obsolescence?', Australian health review : a publication of the Australian Hospital Association, vol. 32, no. 1, p. 6.View/Download from: Publisher's site
Thistlethwaite, J, Heal, C, Tie, RN & Evans, R 2007, 'Shared decision making between registrars and patients--web based decision aids.', Australian family physician, vol. 36, no. 8, pp. 670-672.
BACKGROUND: Current evidence suggests that doctors do not always involve patients in decisions; this may be due to lack of training. This study explores the feasibility of using web based decision aids (DAs) to improve the skills of general practice registrars in sharing decisions with patients. METHOD: Interviews were conducted with registrars to explore their attitudes to shared decision making. Following an educational intervention, registrars were asked to adopt shared decision making within their consultations using DAs as appropriate. The registrars were interviewed again to explore their experiences and any barriers to the process. RESULTS: Registrars had positive views about the shared decision making process but required more training. They had mixed opinions about the use of DAs and identified several barriers to their use. They felt that they had learned from the project and process without necessarily wanting to pursue the use of DAs as interactive tools, preferring to use them as educational resources.
Brimstone, R, Thistlethwaite, JE & Quirk, F 2007, 'Behaviour of medical students in seeking mental and physical health care: exploration and comparison with psychology students.', Medical education, vol. 41, no. 1, pp. 74-83.View/Download from: Publisher's site
CONTEXT: Doctors are often reluctant to seek health care through the usual channels and tend to self-diagnose and prescribe. Medical students learn attitudes and values from clinician role models and may also adopt behaviour patterns that lead them to seek help for physical and mental health problems from informal sources. OBJECTIVES: This study aimed to explore the behaviour of students in seeking health care for physical and mental health problems, comparing medical with psychology students, and to understand what barriers to conventional routes of seeking health care may affect this. METHODS: We administered a questionnaire asking for demographic details and responses to 2 vignettes in which a student from the respondent's discipline was experiencing firstly symptoms of a mental health problem and secondly symptoms of a physical health problem. Data were analysed with spss and univariate anovas to examine differences between respondents. RESULTS: A total of 172 students at the psychology and medical schools at James Cook University in Australia participated. We identified a number of barriers affecting student behaviour in seeking help, which included worries about knowing the doctor they could consult at the university health centre or having future dealings with him or her, and cost of treatment. There were differences between the 2 groups of students. DISCUSSION: There are several barriers for both psychology and medical students to accessing appropriate professional mental health care. Medical students also experience barriers to attaining appropriate physical health care when needed. Psychology and medical students were more likely to seek advice informally from friends and/or family with regard to mental health care.
Thistlethwaite, J & Stewart, RA 2007, 'Clinical breast examination for asymptomatic women - exploring the evidence.', Australian family physician, vol. 36, no. 3, pp. 145-150.
BACKGROUND: Clinical breast examination (CBE) is often offered as a component of the well woman check or carried out at the request of an asymptomatic woman. In these cases the examination is a screening procedure, as opposed to a diagnostic CBE in a symptomatic woman. OBJECTIVE: This article examines the evidence for screening CBE. DISCUSSION: Screening CBE should involve informed consent. A negative examination does not exclude the presence of breast cancer and women should be aware of this. There have been no randomised controlled trials of CBE alone, only trials comparing CBE with mammography for the detection of breast cancer. While there is a low sensitivity (54%) for CBE, the specificity is high (94%). It is unlikely that these figures are discussed with patients. There are different methods of CBE, and these are described in the literature without a firm evidence base as to effectiveness. However, evidence does suggest that practice on models and retraining help improve clinicians' skills.
Thistlethwaite, JE, Kidd, MR & Hudson, JN 2007, 'General practice: a leading provider of medical student education in the 21st century?', The Medical journal of Australia, vol. 187, no. 2, pp. 124-128.
General practice is well placed to become a major setting for medical student education over the next decade. New models of clinical education are required, to take account of changes in the patient population, disease profile and management strategies. While there has been an increase in general practice-based and other community-based education, there is the potential for further expansion. Evidence for the positive role of general practitioners and general practice in medical education is growing, including the benefits of prevocational training in general practice. If GPs are to assume a major role in community-based education of medical students, there will need to be changes in funding structures and supporting resources, particularly at this time of increasing medical student numbers and workforce shortage and maldistribution.
Thistlethwaite, J, Evans, R, Tie, RN & Heal, C 2006, 'Shared decision making and decision aids - a literature review.', Australian family physician, vol. 35, no. 7, pp. 537-540.
Shared decision making (SDM) is a process within a patient centred consultation that involves both the patient and doctor discussing management options and agreeing on management decisions in partnership. Decision aids are designed to help patients understand the options relating to management for certain conditions and their possible benefits and potential adverse effects. We discuss the evolution and rationale behind SDM and the evidence relating to outcomes, the types of decision aids available, and research relating to their use.
Thistlethwaite, JE 2006, 'Altruism can no longer support community-based training.', The Medical journal of Australia, vol. 185, no. 1, pp. 53-54.
Stewart, RA & Thistlethwaite, J 2006, 'Routine pelvic examination for asymptomatic women--Exploring the evidence.', Australian family physician, vol. 35, no. 11, pp. 873-877.
BACKGROUND: A routine pelvic examination is often performed as part of a 'well woman' check, in combination with a Pap test, sexually transmitted infection screening, or before commencing the contraceptive pill or hormone therapy. This check is also done at the woman's request, on the understanding that it may screen for ovarian cancer and other pathology. OBJECTIVE: This article reviews the evidence regarding the use of routine pelvic examination in asymptomatic women as a screening test, and if the examination is performed, what information should be imparted to the patient to obtain informed consent. DISCUSSION: Review of the literature indicates that the use of routine pelvic examination as screening for ovarian malignancy (with or without serum CA-125 and ultrasound) cannot be justified due to the low prevalence of the disease and low sensitivity and specificity of the examination. Pelvic examinations may be performed at the time of routine Pap tests to aid in technical issues with the Pap test itself, but are not recommended for screening purposes. There is no evidence to support pelvic examination of asymptomatic women taking hormone therapy or attending for a sexual health check. The performance of pelvic examination at the woman's request must be preceded by thorough gynaecological, medical and family history and after obtaining informed consent from the patient.
Thistlethwaite, JE 2005, 'The act of communicating.', The British journal of general practice : the journal of the Royal College of General Practitioners, vol. 55, no. 511, pp. 147-148.
Thistlethwaite, JE, Cocksedge, S & Wass, V 2005, 'Breakdown in communication (multiple letters) ', British Journal of General Practice, vol. 55, no. 520, pp. 884-885.
Thistlethwaite, JE, Jacobs, H & Rudolphy, S 2005, 'Undergraduate general practice attachments--implications and challenges.', Australian family physician, vol. 34, no. 3, pp. 181-182.
Thistlethwaite, JE & Ridgeway, G 2005, 'Unannounced standardised patients.', Australian family physician, vol. 34, no. 12, pp. 998-999.
Thistlethwaite, JE 2005, 'Breakdown in communication.', The British journal of general practice : the journal of the Royal College of General Practitioners, vol. 55, no. 520, pp. 884-885.
Thistlethwaite, JE 2005, 'Professionalism and medical education.', Medical teacher, vol. 27, no. 7, p. 659.
Thistlethwaite, JE & Gupta, S 2005, 'Full engagement in health  (multiple letters)', British Medical Journal, vol. 330, no. 7485, p. 255.
Thistlethwaite, J 2004, 'Reflection on 'Reflections on the ethics of assessment'', Education for Primary Care, vol. 15, no. 1, p. 125.
Thistlethwaite, J & Storr, E 2004, 'The views of general practitioner tutors on developing medical students' communication and management skills', Education for Primary Care, vol. 15, no. 3, pp. 370-377.
Community-based education and communication skills training are key aspects of modern undergraduate medical curricula. In primary care settings medical students are able to learn and practise communication skills; however, the management of patients using a shared decision-making model is often neglected. The aim of this paper is to consider the views of GP undergraduate tutors on how medical students may learn about patient management and shared decision making, taking into account the GPs' experiences of teaching and whether they act as role models by using a shared decision-making model themselves. The GPs' views will inform the planning of future primary care attachments. This is a study using qualitative analysis of semi-structured interviews with the 11 GP undergraduate tutors who teach medical students in years 2, 3 and 4 of a five-year undergraduate curriculum. We identified three main themes with subsidiaries. GPs enjoy teaching and have useful ideas about how to involve students in patient management. On the whole they try and encourage patients to share decisions about management and have developed strategies to decide how much information to share with patients. The GPs feel that over the years, with changes in undergraduate curricula, the students' communication skills have improved. For students to become better skilled at shared decision making with patients, they need to have longer attachments in primary care with the ability to follow up patients. We concluded that while GPs are being asked to take on increasing amounts of undergraduate teaching, they are keen to help students learn consultation skills and are good role models for shared decision-making strategies. Longer attachments in primary care have implications for workload and curriculum planning but appear to be one method to help students manage patients.
Thistlethwaite, JE & Cockayne, EA 2004, 'Early student-patient interactions: the views of patients regarding their experiences.', Medical teacher, vol. 26, no. 5, pp. 420-422.View/Download from: Publisher's site
This study was designed to investigate the experience and attitudes of patients to being interviewed by first-year medical students. A questionnaire was sent to 120 patients who have been interviewed during the last four years. Patients were asked what they felt about the process, what they understood was the purpose of the interview and if they felt they had benefited in any way from the interview. There was a 76% response rate. The majority of respondents (82%) felt they had benefited from the process, describing the experience as useful and interesting. Benefits included the opportunity to talk to someone about their problems, a feeling of use and improving the skills of future generations of doctors. It is concluded that patients enjoy being involved in the early education of medical students. As patients prefer students to be well prepared it is important that the students are adequately briefed before the exercise.
Thistlethwaite, J & Van Der Vleuten, C 2004, 'Informed shared decision making: Views and competencies of pre-registration house officers in hospital and general practice', Education for Primary Care, vol. 15, no. 1, pp. 83-92.
The objectives of this qualitative study were to explore whether newly qualified doctors feel adequately trained to discuss management with patients, their attitudes to the concept of sharing decisions about treatment with patients and their strategies for coping with managing patients. Thirty-six pre-registration house officers (PRHOs) in general practice were interviewed over the course of three years. The doctors also carried out a consultation with a simulated patient in their practice to match their attitudes to their behaviour. Six themes arose from the interview data. Medical students infrequently formulate management plans and only one had discussed such a plan with a real patient before qualifying. Yet all the PRHOs had to manage patients once in post, although they felt ill prepared to do this. However, they had developed strategies to manage patients and believe that shared decision making is appropriate. The PRHOs feel that discussing options with patients is more likely in general practice than in hospital and they have more opportunity to practise sharing decisions in primary care. There was evidence that the PRHOs do involve patients in the decision-making process. However, medical students and PRHOs need further training and practice in sharing decisions with patients and in receiving feedback on their skills.
Thistlethwaite, JE & Ewart, BR 2003, 'Valuing diversity: helping medical students explore their attitudes and beliefs.', Medical teacher, vol. 25, no. 3, pp. 277-281.View/Download from: Publisher's site
The General Medical Council of the United Kingdom has defined a set of standards for doctors dealing with patients, including respecting the diversity of lifestyles and beliefs of patients. These have been incorporated into Personal and Professional Development (PPD) course unit of the undergraduate medical curriculum at Leeds University. The objectives of PPD include helping students understand how age, gender, culture, sexuality and disability affect how events are experienced or perceived. In 2002 seminars were run on valuing diversity to encourage students to develop insight into and reflect on their own attitudes to diversity. The sessions were evaluated and assessed by means of student feedback and as part of a written PPD exercise. Students rated the sessions highly and appeared to learn a great deal about diversity including approaches to communication and breaking down stereotypes. Their evaluation will help to improve the course.
Thistlethwaite, J 2003, 'Home visiting', British Journal of General Practice, vol. 53, no. 488, p. 264.
Kilminster, S, Hale, C, Lascelles, M, Morris, P, Roberts, T, Stark, P, Sowter, J & Thistlethwaite, J 2003, 'Can interprofessional education workshops affect interprofessional communications?', Journal of Interprofessional Care, vol. 17, no. 2, pp. 199-200.
Thistlethwaite, J 2003, 'The use of incognito simulated patients in general practice: A feasibility study', Education for Primary Care, vol. 14, no. 4, pp. 419-425.
The use of simulated patients in the training and assessment of medical students and doctors is now widespread. However, in the United Kingdom, simulated patients have not been used covertly in general practice, though this practice has been introduced elsewhere. The aim of this study was to investigate the feasibility of introducing incognito simulated patients into general practices and to explore the experiences of the doctors and simulated patients involved. Covert simulated patients attended five general practice surgeries in West Yorkshire for consultations with 11 pre-registration house officers, followed by semi-structured interviews of the doctors and reports from the patients. Six of the doctors deduced that the simulated patient was not a 'real' patient. There were various reasons for this. The doctors did not object to the experience, though some were worried about revealing a perceived lack of knowledge, and valued getting feedback on their consultations. This is a valuable method, amongst others, of looking at general practitioner consultations, but involves difficult logistics. A code of practice needs to be adhered to so that the doctors and simulated patients do not feel threatened by the experience. Special care needs to be taken with the patient scenario.
Thistlethwaite, JE, Raynor, DK & Knapp, P 2003, 'Medical students' attitudes towards concordance in medicine taking: exploring the impact of an educational intervention.', Education for health (Abingdon, England), vol. 16, no. 3, pp. 307-317.View/Download from: Publisher's site
BACKGROUND AND OBJECTIVES: Concordance has been suggested as a new way of describing the agreement about medicine taking during the consultation process. The aim is a decision on management agreed on by both doctor and patient. As such it has strong links with shared decision-making and patient partnership. In order to encourage doctors to adopt a concordant model, we need to foster a positive attitude towards the concept. We decided to investigate the attitudes of first and second year medical students towards concordance as a base for further educational interventions. SETTING: The School of Medicine, Leeds University. METHODS: We administered the Leeds Attitude toward Concordance scale (LATCon) to first and second year medical students at the beginning of the academic year, and to the same second year students after they had completed a written exercise relating to concordance. RESULTS: The response rate was over 80% for each group. There was no difference in the attitudes towards concordance of the first years and the second years prior to the intervention. After they had completed the exercise, the second years' attitudes towards concordance improved by a small but significant amount. CONCLUSIONS: A paper-based exercise with questions focusing on concordance and based around cases appears to improve medical students' attitudes towards the concept. This exercise needs to be followed up with skills training and observation of role models in order that the attitudes of the students translate into practice once they are qualified.
Thistlethwaite, JE 2002, 'Developing an OSCE station to assess the ability of medical students to share information and decisions with patients: Issues relating to interrater reliability and the use of simulated patients', Education for Health, vol. 15, no. 2, pp. 170-179.View/Download from: Publisher's site
Context: Patient partnership is being promoted as an aid to compliance with treatment and to improve outcomes for patients. An integral part of this partnership is information-sharing between doctor and patient and negotiation of management decisions, together with an ability by the doctor to analyse critically treatment options. These skills are being taught to some extent in communication skills for medical students and assessments are being devised to test them. Objectives: To develop an OSCE station to assess medical students' skills in the application of evidence and the negotiation of treatment options with a simulated patient. To evaluate the station by tests of reliability and comparison of the marking of observing examiners and simulated patients. Design: An OSCE station was devised using a case scenario in which there were varying opinions as to the treatment options. The marking schedule was designed to assess the students' ability to assess evidence and discuss this with patients. Setting: University of Leeds. Subjects: Undergraduate medical students. Results: A total of 194 students undertook the station. Inter-rater reliability amongst examiners was poor for individual student marks but there was better agreement as to whether a student passed or failed. There was poor agreement between the observing examiners and the simulated patients for individual marks. The examiners thought this was a useful attempt to assess students' ability to give information but agreed that further work was needed on the marking schedule. Conclusions: More work is needed to refine the station to increase its reliability. However, the station is useful in highlighting to students the importance of sharing information and decision-making on treatment options with patients.
Thistlethwaite, JE 2002, 'Making and sharing decisions about management with patients: the views and experiences of pre-registration house officers in general practice and hospital.', Medical education, vol. 36, no. 1, pp. 49-55.View/Download from: Publisher's site
OBJECTIVES: To explore the views and experiences of pre-registration house officers (PRHOs) in general practice and hospital settings regarding the concept of patient partnership and their experience of involving patients in management decisions. DESIGN: The 12 PRHOs who had graduated from British universities and who were working within the Yorkshire Deanery were interviewed towards the end of their four-month general practice attachments. The interviews were semi-structured and analysed qualitatively. RESULTS: Three major themes emerged. The PRHOs perceived differences in approach between consultations carried out in hospital and primary care settings, with general practitioners being more likely to share information and decisions with patients. As medical students, the PRHOs had little opportunity to practise sharing information and management decisions with patients, and variable experience of this after graduation. On the whole they were favourable to the concept of patient partnership. CONCLUSIONS: Medical students and PRHOs lack training and opportunities to decide on management and discuss this with patients and yet, particularly in general practice settings, they have to practise these skills. The PRHOs had begun to develop strategies to decide how much information to give to patients and to what extent to involve patients in management decisions. This is an area that needs further consideration when planning both undergraduate and postgraduate medical education.
Thistlethwaite, J 2001, 'Paternalism', British Journal of General Practice, vol. 51, no. 472, p. 960.
Thistlethwaite, JE & Ewart, BR 2001, 'The Leeds community newsletter.', Medical education, vol. 35, no. 11, pp. 1074-1075.
Raynor, DKT, Thistlethwaite, JE, Knapp, PR & Steven, K 2001, 'Concordance in medicine (multiple letters)', British Journal of General Practice, vol. 51, no. 462, pp. 63-64.
Brennan, C, Thistlethwaite, JE & Williams, CJ 2001, 'An assessment of medical students' experiences of learning about the psychosocial enquiry in their introductory clinical course', Medical Teacher, vol. 23, no. 1, pp. 65-70.View/Download from: Publisher's site
Medical students' ability to take a meaningful psychosocial history has been shown to decline during clinical training. We postulated that psychosocial histories are given a low priority in busy clinical attachments. The aim of this study was to identify factors that affect how medical students gain skills in psychosocial assessment. A random sample of 37 students filled in a questionnaire before and after their introductory course, and they were asked to keep a logbook of their experiences of teaching about psychosocial history taking. There were 504 teaching experiences recorded of which less than half were positive. Negative experiences often related to poor communication by clinicians. At the end of the course less than half the students felt confident in taking a psychosocial history. To improve doctors' skills in this important area we suggest that teaching in psychosocial history taking should be made explicit, as an integrated part of the overall assessment of a patient.
Raynor, DK, Thistlethwaite, JE, Hart, K & Knapp, P 2001, 'Are health professionals ready for the new philosophy of concordance in medicine taking?', International Journal of Pharmacy Practice, vol. 9, no. 2, pp. 81-84.View/Download from: Publisher's site
Objectives - To develop and administer a practical, valid and reliable tool to measure attitudes to concordance in medicine taking, a new concept where decisions depend on an equal partnership between patient and prescriber. Method - A postal questionnaire was devised comprising statements from the original concordance document, along with statements reflecting the orthodox model of medicine taking. There was a total of 22 statements. Respondents rated each statement on a four-point Likert agreement scale. The questionnaire also included three scenarios of consultations involving medicine prescribing and taking, with associated statements for rating as true or false. Setting - A random sample of 207 medical, nursing and pharmacy graduates in the North of England at the time of qualification. We received 81 completed questionnaires (39 per cent) Key findings - Item analysis reduced the 22-item scale to a 12-item scale with good reliability (Cronbach's alpha = 0.79) and construct validity was demonstrated through correlation with responses to the scenarios. Although the typical respondent had a positive attitude towards concordance (mean = 2.3), 25 per cent of respondents had negative attitudes. Pharmacists showed the least favourable attitudes (P<0.05). Conclusions - The 12-item Leeds Attitude Towards Concordance (LATCon) scale is a reliable and valid tool for assessing health care providers' attitudes to the new concept of concordance in medicine taking. Newly qualified doctors, nurses and pharmacists tended to hold favourable attitudes, although a significant minority - especially pharmacists - hold negative attitudes. These results have implications for undergraduate education and continuing professional education.
Raynor, DK, Thistlethwaite, JE & Knapp, PR 2001, 'Concordance in medicine.', The British journal of general practice : the journal of the Royal College of General Practitioners, vol. 51, no. 462, p. 63.
Thistlethwaite, JE & Jordan, J 2000, 'Antenatal screening in the community: The views and experience of women in one general practice', Primary Health Care Research and Development, vol. 1, no. 1, pp. 29-38.View/Download from: Publisher's site
The publication of the Department of Health's 1993 report Changing Childbirth has prompted major changes in the organization of maternity care, with an emphasis on returning antenatal care to the community. Serum screening for Down's syndrome (triple test) is usually carried out and followed up in secondary care, and work relating to the psychosocial effects of the test has been hospital-based. The aims of this study were to examine the views of women regarding the process and effects of delivering the test as part of routine general practice-based antenatal care, with a view to considering how this care might be most appropriately managed. We sent a questionnaire to all women registered with a fundholding practice who were offered the triple test between 1992 and 1997. The main outcome measures were satisfaction with the way in which the test was offered, what women understood by positive/negative results, why some women declined the test, and satisfaction with obtaining results/follow-up. The response rate was 60.7%. The majority of women were satisfied with the way in which the test was discussed, but there was ambivalence with regard to the procedure for receiving results, including the counselling offered. Confusion over the meaning of the results (particularly negative results) was apparent. The test caused anxiety in many women. The need for continuity of advice and support when women are subsequently referred to secondary care for further tests was highlighted. The majority of women wish the test to be available for all. The conclusion we draw is that no abnormalities have been detected during the study period, raising questions about cost-effectiveness. However, the majority of women view the test as a means of making informed decisions about their pregnancies. Although limited to one practice, the issues associated with a broad range of aspects of care identified through an analysis of the experience both of women declining the test and those accepting ...
Thistlethwaite, JE, Green, PD, Heywood, P & Storr, E 2000, 'First step: report on a pilot course for personal and professional development.', Medical education, vol. 34, no. 2, pp. 151-154.View/Download from: Publisher's site
OBJECTIVE: To describe a pilot course in personal and professional development, entitled 'Becoming a doctor: the first step' and our suggestions for what might be incorporated into future courses. SETTING AND CONTEXT: Leeds Medical School begins a new curriculum in September 1999 with a proportion of the first 3 years being devoted to a new module on personal and professional development. This module will include courses involving communication skills, ethics, working in groups and early patient contact through community visits. Some of these topics were piloted in a short course for first-year medical students in 1998. LEARNING METHODS: The course ran for 9 weeks and was largely experiential. The group facilitators came from diverse health and social care backgrounds. A variety of learning methods were used, concentrating on self-reflection, discussion, community visits and information gathering. EVIDENCE FOR EFFECTIVENESS: The views of both facilitators and students were analysed. Students particularly appreciated the community visits and group work. The facilitators were positive about the course overall while suggesting improvements, including their own involvement in future development of the course. CONCLUSIONS: The pilot course has helped us to focus on objectives for the new curriculum and to plan the new course. In particular there is a need for more attention to be given to the involvement of facilitators in course development.
Thistlethwaite, JE 2000, 'Introducing community-based teaching of third year medical students: Outcomes of a pilot project one year later and implications for managing change', Education for Health, vol. 13, no. 1, pp. 53-62.View/Download from: Publisher's site
Introduction: British undergraduate medical education is undergoing change, including a greater emphasis being placed on community-based teaching. These changes need to be evaluated for their educational outcomes, but there also needs to be a review of the process of introducing change and its subsequent management. The setting: During the academic year 1996/97 a new project was piloted at Leeds University. Fifty-three third year medical students were attached in groups of four to general practitioner tutors in a primary care setting for four days in order to improve consultation skills. There was an emphasis on adopting a patient-centered approach, particularly asking patients about their concerns. Method: These students were asked to fill in a questionnaire to determine whether the community-based teaching has made any lasting impression on their attitudes and performance. The response rate was 80%. The students commented that even only four days of community-based teaching had helped them realize the importance of asking about patients' concerns. They also reported beginning to concentrate on psychosocial issues while talking to patients, issues that are often ignored by medical students. The students' comments are contrasted with those of the hospital-based tutors, some of whom have looked less than favorably on the project. Discussion: The introduction of any new learning experience needs to be evaluated both in the short term and in the long term. This study begins to address long- term evaluation and suggests that a brief attachment can be memorable to students and beneficial one year later.
Thistlethwaite, JE 2000, 'School students and general practice.', The British journal of general practice : the journal of the Royal College of General Practitioners, vol. 50, no. 461, p. 1006.
Thistlethwaite, J 2000, 'Plus ca change - Or why reading about the history of medical education is good for you.', British Journal of General Practice, vol. 50, no. 454, p. 437.
Thistlethwaite, JE & Jordan, JJ 1999, 'Patient-centred consultations: a comparison of student experience and understanding in two clinical environments.', Medical education, vol. 33, no. 9, pp. 678-685.View/Download from: Publisher's site
OBJECTIVES: To explore students' perspectives on doctor-patient communication. DESIGN: We interviewed students in focus groups before and after their placements. In semistructured interviews they were asked about their experiences of learning through clinical contact, with particular emphasis on patient-centred consultations, on the wards and during their community attachment. Students whose clinical skills training remained hospital-based were also interviewed to compare the range of experiences. SETTING: Leeds University. SUBJECTS: Third-year medical students. RESULTS: During hospital training students are rarely introduced, either through teaching or observation, to the idea of patient-centred consultations. In contrast both the principles underpinning and/or the practice of such consultations were routinely encountered during the general practice placement. Students considered the community attachment to have helped them appreciate the value of exploring patients' concerns both in terms of enhancing the patients' overall healthcare experience and promoting effective clinical management. While they considered the nature and purpose of hospital care to be qualitatively different from that conducted in the community, the relevance of adopting a patient-centred approach on the wards was confirmed. CONCLUSIONS: Recommendations for clinical training are made. The relevance and best use of community and hospital-based attachments need to be evaluated further.
In 1996 a community-based attachment was introduced in Leeds for third year medical students, to help improve their interaction with patients in the patients' own environment. The introductory session aims to help students integrate the communication skills they learnt in second year with the 'history-taking' skills they use in third year to improve their consultation skills. With the help of simulated patients, students begin to understand the importance of eliciting the patient's story, as well as medical symptoms. In this session the students realise that it is important to discuss personal and emotional topics with patients in order to understand the medical problem and that negotiation with the patient helps to improve the outcome of the consultation. The structure of the session is outlined, and the students' evaluation discussed.
Thistlethwaite, JE 1999, 'Medical students in GP consultations.', The British journal of general practice : the journal of the Royal College of General Practitioners, vol. 49, no. 441, p. 317.
Thistlethwaite, JE 1999, 'Introducing medical students to the concept of patient-centred consultations during a community-based teaching attachment', Medical Teacher, vol. 21, no. 5, pp. 523-526.View/Download from: Publisher's site
Launer, J, Holden, J, Westcott, R, Thistlethwaite, J, Pierce, B & Martin, A 1998, 'Teaching exchange', Education for General Practice, vol. 9, no. 4, pp. 441-457.
Forman, D & Thistlethwaite, J 2016, 'Best practice in leading research and evaluation for interprofessional education and collaborative practice' in Leading Research and Evaluation in Interprofessional Education and Collaborative Practice, Springer, Germany, pp. 3-21.View/Download from: UTS OPUS or Publisher's site
The decade since the mid-2000s has reignited an interest in interprofessional education (IPE) and collaborative practice (CP) globally. The editors of this book believe this was due at least in part to the publication of the World Health Organization (2010) Framework for Action on Interprofessional Education and Collaborative Practice, which not only reviewed examples of interprofessional education internationally but also provided a framework that linked interprofessional education (IPE) to collaborative practice (CP) and improved health care provision. Our two books (Forman, Jones, & Thistlethwaite, 2014, 2015) took into account further work by the World Health Organization (WHO) (2013) and policies which were being implemented in diverse countries, such as by Health Education England (2014). We also included reports on research studies such as Interprofessional Curriculum Renewal and Australia (2014) in Australia, to provide global examples of how IPE and CP were being taken forward in higher education institutions and communities.
Brandt, B & Thistlethwaite, J 2016, 'The formation and development of the national center for interprofessional practice and education' in Leading Research and Evaluation in Interprofessional Education and Collaborative Practice, Springer, Germany, pp. 23-39.View/Download from: UTS OPUS or Publisher's site
This chapter is written by two people who have different relationships with and observations about the National Center for Interprofessional Practice and Education (referred to below as the National Center), based at the University of Minnesota, Minneapolis, USA. The first author (Barbara Brandt) is the director of the National Center and created the original vision for its formation. The second author (Jill Thistlethwaite) was an Australian-American Fulbright senior scholar at the centre for 4 months in late 2014. We are presenting the chapter in a mix of first and third person voices to capture our personal reflections as well as more objective details on the progress of the centre. We begin with a history of the National Center, its vision and aims, its evaluation framework and the leadership model.
Thistlethwaite, J 2016, 'Research and evaluation: The present and the future' in Leading Research and Evaluation in Interprofessional Education and Collaborative Practice, Springer, Germany, pp. 355-368.View/Download from: UTS OPUS or Publisher's site
In the field of interprofessional education (IPE) as academics we are continuously asked: 'What is the evidence for IPE?' The question is really about effectiveness and outcomes, and has the sub-text of 'Why should we change what we do?' So, does IPE work? In our experience there are fewer questions posed about the effectiveness of team-based practice yet 'learning together to work together' (WHO, 1988) seems inherently logical, in the same way that clinically-based education is necessary for clinical practice. Those health systems, which have the luxury of employing a diverse range of health and social care professionals, work on the premise that no one practitioner knows everything or has all the skills required for health care delivery in an increasingly complex environment. However, there are still many areas relating to interprofessional collaborative practice (IPECP) that need exploring and greater understanding through well-designed research projects. These include uncertainties about leadership and 'followership', hierarchies and power relationships, the nature of interprofessional identity and that of collaborative practice (CP) itself.
Thistlethwaite, J. 2015, 'Assessment of Interprofessional Teamwork - An International Perspective' in Leadership and Collaboration: Further Developments for Interprofessional Education, Palgrave Macmillan, pp. 135-152.View/Download from: Publisher's site
Dunston, R., Forman, D., Matthews, L., Nicol, P., Pockett, R., Rogers, G., Steketee, C. & Thistlethwaite, J. 2015, 'Utilizing Curriculum Renewal as a Way of Leading Cultural Change in Australian Health Professional Education' in Leadership and Collaboration: Further Developments for Interprofessional Education, Palgrave MacMillan, UK, pp. 121-134.View/Download from: Publisher's site
Health systems globally are engaged with major reforms focused on the need to deliver more responsive, effective and sustainable health services. Interprofessional practice (IPP), and the development of interprofessional educational (IPE) targeted at enabling IPP, sit at the heart of many of these reforms. IPP enabled by IPE could be argued as the practice foundation for achieving new and more effective forms of health service provision and health professional practice (World Health Organization, 2010; Gittell et al., 2013).
Thistlethwaite, J & Jones, M 2015, 'Leadership into the future' in Leadership and Collaboration: Further Developments for Interprofessional Education, Palgrave Macmillan, pp. 229-236.View/Download from: Publisher's site
Thistlethwaite, JE & Ridgway, GG 2015, 'The content and process of simulated patient-based learning activities' in Nestel, D & Bearman, M (eds), Simulated Patient Methodology: Theory, Evidence and Practice, John Wiley & Sons, UK, pp. 16-22.View/Download from: UTS OPUS or Publisher's site
This chapter looks at the content and process of simulation activities and how these need to be informed by learners' previous knowledge and experience. It highlights the importance of defining learning outcomes and their alignment with learning activities. The chapter considers generic design principles rather than specific scenarios. Simulated Patient (SP) roles should be as authentic as possible and based on the defined learning outcomes and learners' prior knowledge and experience. Evaluation may take the form of a group discussion at the end of the session or may be more formal with written evaluation questionnaires. A common model of outcomes evaluation is that of Kirkpatrick and Kirkpatrick, which provides four types of outcome data. For a successful learning experience, all learners need to engage positively with the experience and demonstrate acquisition or change of skills and knowledge. Evaluation is important in quality assurance of learning activities.
Dunston, R, Forman, D, Matthews, L, Nicol, P, Pockett, R, Rogers, G, Steketee, C & Thistlethwaite, J 2015, 'Utilizing Curriculum Renewal as a Way of Leading Cultural Change in Australian Health Professional Education' in Forman, D, Jones, M & Thistlethwaite, J (eds), Leadership and Collaboration: Further Developments for Interprofessional Education, Palgrave MacMillan, UK, pp. 121-134.View/Download from: Publisher's site
Health systems globally are engaged with major reforms focused on the need to deliver more responsive, effective and sustainable health services. Interprofessional practice (IPP), and the development of interprofessional educational (IPE) targeted at enabling IPP, sit at the heart of many of these reforms. IPP enabled by IPE could be argued as the practice foundation for achieving new and more effective forms of health service provision and health professional practice (World Health Organization, 2010; Gittell et al., 2013).
Thistlethwaite, J 2015, 'Hidden amongst us: The language of inter- and outer-professional identity and collaboration' in Hafferty, FW & O'Donnell, JF (eds), The Hidden Curriculum in Health Professional Education, Dartmouth College Library Press, UK, pp. 158-168.
Thistlethwaite, J 2015, 'Assessment of Interprofessional Teamwork - An International Perspective' in Forman, D, Jones, M & Thistlethwaite, J (eds), Leadership and Collaboration: Further Developments for Interprofessional Education, Palgrave Macmillan, USA, pp. 135-152.View/Download from: Publisher's site
This chapter is written on the understanding that there is a need for health professions students and qualified health professionals to be able to practise collaboratively and to deliver team-based health care in the 21st century. In a 2013 set of guidelines for the transformation of health professions education the World Health Organization suggests that 'building on an approach of global collaborative leadership, efforts that are adaptive and flexible in various cultural and socioeconomic settings will be key to the successful implementation of these evidenceinformed guideline recommendations' (WHO, 2013, p. 11). Moreover, leadership and good governance are crucial for education reform (WHO, 2013). While interprofessional education (IPE) may facilitate the process of becoming interprofessional, educators are continually challenged by the need to observe and assess teamwork, and learners to provide evidence that they are capable of working in teams. Teamwork is listed as a graduate attribute by many higher education institutions (HEIs), while the accreditation bodies of increasing numbers of the health professions globally are including teamwork and collaborative practice as core standards. Moreover, 'leadership' is also frequently included in the list of attributes required of health professionals, while some educators have suggested that 'followership' is also an important skill. However, there is a lack of valid and feasible assessment methods for use at the prequalification level.
Thistlethwaite, J & Jones, M 2015, 'Leadership into the future' in Forman, D, Jones, M & Thistlethwaite, J (eds), Leadership and Collaboration Further Developments for Interprofessional Education, Springer, Germany, pp. 229-237.
Leadership and Collaboration provides international examples of how leadership of interprofessional education and practice has developed in various countries and examines how interprofessional education and collaborative practice can make a ...
Sorinola, O, Gerzina, T & Thistlethwaite, J 2013, 'Health professional education programs: How the teacher develops' in Educating Health Professionals: Becoming a University Teacher, Sense Publishers, The Netherlands, pp. 49-60.View/Download from: UTS OPUS or Publisher's site
Health professionals who teach may be salaried health sector employees who are
directly engaged by a higher education institution in adjunct or conjoint academic
appointments. Many teaching health professionals also provide learning activities
through good will and altruism. Another group consists of academics with health
professional degrees for whom academia is the primary employment; these
professionals may engage in professional clinical practice in only a limited capacity.
Many assume that practising health professionals will be adequate educators: that
as clinical (content or discipline) experts, they should naturally also be competent
teachers. We know, however, that there may be little correlation between clinical
proficiency, seniority and teaching excellence. Thus there is a need for health
professional educators to be provided with the opportunities to develop skills in
educating. The provision of teaching development in this area has expanded over the
last few decades. Many universities now offer degree programs such as certificates
and masters level degrees so that health professionals can gain formal education
qualifications, thus legitimising their teaching in a professional context.
Chesters, J, Thistlethwaite, J, Reeves, S & Kitto, S 2011, 'Introduction: A sociology of interprofessional healthcare' in Sociology of Interprofessional Health Care Practice: Critical Reflections and Concrete Solutions, Nova, pp. 1-8.
Kitto, S, Reeves, S, Chesters, J & Thistlethwaite, J 2011, 'Re-imagining interprofessionalism: Where to from here?' in Sociology of Interprofessional Health Care Practice: Critical Reflections and Concrete Solutions, pp. 207-211.View/Download from: UTS OPUS
Thistlethwaite, J & Nisbet, G 2011, 'Preparing educators for interprofessional learning: Rationale, educational theory and delivery' in Sociology of Interprofessional Health Care Practice: Critical Reflections and Concrete Solutions, Nova Science Publishers, USA, pp. 169-184.View/Download from: UTS OPUS
The growing literature on interprofessional education (IPE), learning and practice mainly focuses on evidence for the effectiveness of education and practice, while describing educational activities taking place around the world. There has been less emphasis on the need for the development of educators and facilitators of IPE, the specific challenges of 'training the trainers' for interprofessional activities and models of professional development. In this chapter we discuss the attributes required of effective interprofessional facilitators and consider whether they should still be clinical practitioners. Facilitators have to ease learners through the process of professional socialisation and acculturation while ensuring that they develop skills and behaviours for working and collaborating with other professionals and within interprofessional teams. Faculty development is vital to prepare and hone the skills of facilitators who may have a wide experience of working uniprofessionally and therefore find interprofessional activities challenging. Both sociological and learning theories are important to provide a firm base for educational delivery. We describe a module we have developed for health professionals wishing to become involved in IPE and explore the difficulties associated with the evaluation of educational developments and delivery. © 2011 by Nova Science Publishers, Inc. All rights reserved.
Irvine, D, Johnson, N, Thistlethwaite, J & Hundt, GL 2010, 'Professionalism: The UK perspective' in Professionalism in Mental Healthcare: Experts, Expertise and Expectations, pp. 48-61.View/Download from: Publisher's site
© Cambridge University Press 2011. Editors' introduction In the past two decades, a run of highly publicized medical scandals in the UK have affected the reputation of the medical profession. Beginning with Bristol, it was the cumulative effect of several such scandals, coming in quick succession, which fired up the public. Together they had a huge impact on the public mind, with the result that public opinion demanded that doctors be regulated more stringently. Consequently, the regulatory body, the General Medical Council (GMC), found its role came under increased scrutiny. The medical royal colleges decided to look at the role of doctors in various settings. Irvine et al. address the need for redefining professionalism, particularly in the context of regulation and continuing professional development. Using Good Medical Practice as described by the GMC as the basis of their discussion of professionalism, the authors suggest that the fundamental principle for an individual doctor is about their conscience and knowing what is right. Individually and collectively, team members have to ensure that patients and their carers get the right information, have autonomy and are respected. Thus, there is a collective professional conscience as well. Regulatory and professional bodies have a duty to ensure that these standards are disseminated, acknowledged, reached and maintained. Taking a historical perspective, Irvine et al. point out that changes in knowledge lead to changes in skills and required competencies which contribute to the redefinition of professionalism.
Thistlethwaite, J, Davies, H, Dornan, T, Greenhalgh, T, Hammick, M & Scalese, R 2012, 'What is evidence? Reflections on the AMEE symposium, Vienna, August 2011.', Medical teacher, pp. 454-457.View/Download from: UTS OPUS or Publisher's site
In this article, we present a summary of the discussion from the symposium on 'what is evidence', which took place at the AMEE conference in 2011. A panel of five academics and clinicians, plus the chair, considered the nature of evidence, in particular in relation to the 'evidence' in the best evidence medical education reviews. Evidence has multiple meanings depending on context and use, and this reflects the complex and often chaotic world in which we work and research.
Pizzica, J, Heard, R, Mahony, M & Thistlethwaite, J 2010, 'Perspectives on the organisational impact of university teacher preparation programs', Proceedings of the Annual HERDSA Conference 2010: Reshaping Higher Education, Higher Education Research and Development Society of Australasia Annual Conference, Higher Education Research and Development Society of Australasia, Inc. (HERDSA), Melbourne, NSW, Australia.
Kilminster, S, Hale, C, Lascelles, M, Morris, P, Roberts, T, Stark, P, Sowter, J & Thistlethwaite, J 2004, 'Learning for real life: patient-focused interprofessional workshops offer added value.', Medical education, pp. 717-726.View/Download from: Publisher's site
OBJECTIVES: This paper reports relevant findings of a pilot interprofessional education (IPE) project in the Schools of Medicine and Healthcare Studies at the University of Leeds. The purpose of the paper is to make a contribution towards answering 2 questions of fundamental importance to the development of IPE. Is there a demonstrable value to learning together? What types of IPE, under what circumstances, produce what type of outcomes? DESIGN: Pre-registration house officers (PRHOs), student nurses and pre-registration pharmacists attended a series of 3 workshops intended to develop participants' understanding about each other's professional roles, to enhance teamworking and to develop communication skills. Evaluation covered the process of development of the workshops, the delivery of the workshops and their effects on both facilitators and participants. RESULTS: The course was well received by the participants. The learning reported by the participants reflected 2 project objectives. Participants emphasised communication skills--both with other professionals and patients--and the development of increased awareness of others' roles. These 2 aspects were interlinked. CONCLUSIONS: The project aims and 2 of the learning outcomes were achieved. There was a demonstrable value to learning together, particularly with regard to interprofessional communications. This project was effective and can make a contribution towards answering the question 'What types of IPE, under what circumstances, produce what type of outcomes?'
Dunston, R, Forman, D, Moran, M, Rogers, G, Thistlethwaite, J & Steketee, C Commonwealth of Australia 2015, Curriculum Renewal in Interprofessional Education in Health: Establishing Leadership and Capacity, Report to the Office of Learning and Teaching, Office for Learning and Teaching, Sydney.View/Download from: UTS OPUS
Dunston, R, Forman, D, Hager, J, Manidis, M, Rogers, G, Rossiter, C, Thistlethwaite, J & Yassine, T Commonwealth of Australia 2014, Curriculum Renewal for Interprofessional Education in Health, Final Report for Office for Learning and Teaching, Sydney.
Dunston, R, Forman, D, Manidis, M, Rogers, G, Rossiter, C, Thistlethwaite, J & Yassine, T Centre for Research in Learning and Change, University of Technology Sydney 2013, Interprofessional Education: a National Audit. Report to Health Workforce Australia, Sydney.