New Blog: ABC for AMC

Tips - Breaking Bad News

GREGG K. VANDEKIEFT,M.D.,Michigan State University College of Human Medicine, East Lansing,Michigan
 

A–ADVANCE PREPARATION

• Familiarize yourself with the relevant clinical infor-
mation. Ideally, have the patient’s chart or pertinent labo-
ratory data on hand during the conversation. Be prepared
to provide at least basic information about prognosis and
treatment options.

• Arrange for adequate time in a private, comfortable
location. Instruct office or hospital staff that there should
be no interruptions. Turn your pager to silent mode or
leave it with a colleague.

•Mentally rehearse how you will deliver the news. You
may wish to practice out loud, as you would prepare for
public speaking. Script specific words and phrases to use
or avoid. If you have limited experience delivering bad
news, consider observing a more experienced colleague or
role play a variety of scenarios with colleagues before actu-
ally being faced with the situation.

• Prepare emotionally.

B–BUILD A THERAPEUTIC ENVIRONMENT/RELATIONSHIP

•Determine the patient’s preferences for what and how
much they want to know.

•When possible, have family members or other sup-
portive persons present. This should be at the patient’s dis-
cretion. If bad news is anticipated, ask in advance who they...

Review: I didn't do any critical error, why did I fail? - Part II

Recently, as more and more candidates have become pretty conscious of the critical errors, it is good in a sense that they are aware of what the Australian Health Care system wants them to know the potential pitfalls. However, as the examiners are more aware of the trick of critical errors is good but it is not good enough to give everyone a "fair go", what Australian typically are used to say.

Obviously the so called would dramatically shift the assessment towards "qualitative" assessment of the "overall sense" back up by the specific details rather than "quantitative", single or several important clinical pitfalls - the critical errors.

When it comes to a dramatic change that is ongoing, the shift in the clinical  assessment is much more pronounced than the rules. The assessment details also vary from case to case from clinical aspect - significant omission from the relevant history taken (which can lead to difficulty in defining the correct diagnosis/ inappropriate management and harm to the patient as a consequent) to communication skill - failure to address the patient's questions or concerns/ poor patient counselling -...

Review: I didn't do any critical error, why did I fail? - Part I

Following the recent news of the feedback for the clinical exam, it is obvious that the AMC has changed or modified (if it is more appropriate) the way they assess the candidates.

As some of the candidates still believe "If I did nothing wrong as a critical error, I would pass the exam.", which may no longer hold true generally. To put it in other words "It's not that simple."

As the exam itself has gone through the dynamic process by providing better insight into what the health care system would like to have as a junior doctor by releasing a new Handbook for the clinical exam in early 2007.

The book itself does it's role by giving insight into the critical areas - how the failure of health care provider can lead to grave consequences. The message from the book to the candidates is overwhelming in a sense that they will never know unless they read through it.

However, many candidates especially the newcomers might take it wrong, wrong with a narrow-minded opinion that if they know the critical errors well and they do not...

Overseas graduates make up majority of new NSW doctors

Posted Sat Dec 20, 2008 9:41am AEDT
 

The New South Wales Medical Board says about two thirds of doctors to receive new registration in the past year were trained overseas.

The board's chief executive, Andrew Dix, says figures from its latest annual report show a continuation of the trend towards increasing the number of international graduates.

He says it is only likely to start being reversed when graduates from several new medical schools in Australia start entering the workforce.

"There's a new school coming online at Wollongong, Western Sydney, Notre Dame," he said.

"And then there are also clinical schools at the Australian National University in Canberra which will effectively feed into the New South Wales system, and also Newcastle is opening a new clinical school up at Armidale too."

He says the health system's heavy reliance on overseas-trained doctors is likely to continue for several years.

"International medical graduates working in hospital positions has gone up by about 30 per cent in the last two years," he said.

Mr Dix says the trend is likely to continue until there is an expected boost in the number of local graduates...

Skilled migrants to be given priority under new laws

The Federal Government says visa applications for certain foreign workers will be given priority to help industries struggling to find skilled labour.

Overseas workers sponsored by employers for permanent jobs that cannot be filled locally will be put ahead of other workers applying to get into Australia.

Immigration Minister Chris Evans says business groups believe the skilled migration program is not delivering the right skilled workers to the right areas.

Senator Evans says the changes, which start from January 1, will not result in an increase in the total number of visas issued.

"At the moment people are, if you like, self-nominating. They come in, in order of application across a broad range of skills, and what I think we should be doing is recruiting people in priority order for those skills that are in critical need in the medical areas and the engineering areas etcetera," he said.

"I think the changes we've announced will allow us to do that and to make sure that in changing economic circumstances we're getting the people we need in a highly targeted way that's responsive to businesses' needs.

"This would also help us with...

A new fast-track visa for Australia

PM - Wednesday, 17 December , 2008 18:34:00

Reporter: Alexandra Kirk

MARK COLVIN: The Federal Government has announced changes to the program that brings skilled migrants to Australia.

The Immigration minister Chris Evans says that fast-tracking professionals on the critical skills list will ensure the economy gets the skills it needs now, not just those people who applied first.

The changes will start from the 1st of January.

Senator Evans says the Government will fast track the processing of permanent migration visas where the skilled migrants are sponsored by an employer.

People applying to come to Australia without a sponsor will be given priority if they have an occupation on the government's list of skills in critical shortage.

The minister spoke to Alexandra Kirk a short time ago.

CHRIS EVANS: Well since the Budget a bit earlier in the year clearly the economic forecasts have been revised downwards and it's reasonable to see that the demands for skills in the economy will decline and I've been reviewing employer's needs. Talking to them about their expectations but their very strong message is to continue to run a strong migration program. That there are still skills...

Tags: news

Survival Tips for JMOs

(Adapted from “ A Handbook for Medical Residents”, Queensland Medical Education Centre 1997
and “An Information Package for Junior Medical Officers”, Council for Early Postgraduate Training
in South Australia, 2001).

FEAR IS NORMAL. There are probably a few of you who won't admit it, but everyone's scared on their first day. Internship is about transition, taking that first step onto the hierarchical ladder of the medical professions. By virtue of the arduous years at medical school, you are now equipped with sound medical knowledge and skills that should stand you in good stead during your intern year.

IF IN DOUBT, CALL. Registrars and Consultants can seem pretty distant and uninterested at times, but I can guarantee any abruptness or condescension you may experience in response to a question will in no way compare to the disaster of not seeking help in time. If you are faced with a medical problem you cannot deal with, remember that those on the rungs of the ladder above you are there to lend a hand, even though at times they may appear a little intimidating. There to offer assistance and guidance is a host of other staff members within the...

Tags: tips

Differences in medical consultations between country of origin & Australia as noted by IMGs 

IMGs need to adapt to a variety of differences in the style, setting or infrastructure of consultations in Australia. This can initially reduce the confidence of IMGs. By working on strategies to become aware of
these differences and adapt their consultation style can improve effectiveness of consultations and improve IMG confidence.

1. Communication

Difference in Australia

• Less paternalism
• More dialogue and negotiation.
• Less doctor driven
• Less respect (eg for elderly- use more slang)
• More patient awareness (?) , patients have more idea what they think is wrong with them and treatment….greater access to medical information
• More emphasis on emotion

Adapting the consultation 

• Shared roles in agenda & decision making
• Listen to the story, negotiate the agenda, agree on the diagnosis and plan 
• Adapt consultation style to age groups 
• Be open to patients opinion 
• Patient Centred Medicine 
  
• Use the metaphor of the tree, detect the emotion, express empathy 
  
  

2. Knowledge & Skills

Difference in Australia 

• Different pattern of disease, hence differential diagnosis different 
• Australians present to doctor earlier with less differentiated problems, less serious...harder to diagnose 
• Older population- more chronic disease management, more geriatrics,...

Tags: img

New Clinical Bridging Course - Bargain Fees ($ 50/section)

EVERGO Education now offers AMC examination both MCQ and clinical tutorial in Eastwood on base of face to face every Tuesday evening , Wednesday envening and online mock exam every Thursday evening. You pay as little as A$60 per week for all tutorials and we know we will help you pass the exam. Simply email us at info@evergo.com.au

Tags: clinical

Tags: clinical