Aust Fam Physician
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The process of clinical reasoning is undertaken by all clinicians, often automatically, and is the cognitive process that underlies diagnosis and management of a patient's presenting problem. The teaching of clinical reasoning can pose a challenge to the clinical teacher. ⋯ By considering clinical reasoning as a skill to be learnt rather than a concept to be understood, a framework for teaching this skill can be developed. The learner initially observes a consultation by the teaching clinician, followed by the teacher explaining the reasoning processes used including hypothesising, hypothesis testing, re-analysis and differential diagnosis. The student then comments on the reasoning of the teacher in a subsequent consultation, followed by feedback from the teacher on the student's reasoning in a third consultation.
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The impact of type 2 diabetes is severe in Aboriginal and Torres Strait Islander people. The Fitzroy Valley, a remote region of the Kimberley in Western Australia, has a high population of Indigenous Australians. An effective community partnership has been formed between the local hospital, the population health service and local health services. ⋯ A dedicated chronic disease team and a clinical information system to coordinate culturally appropriate, multidisciplinary chronic disease care enables effective management of chronic diseases such as type 2 diabetes.
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Acute rheumatic fever is a rare multisystem disease caused by an immunological response to Group A streptococcus infection. Acute rheumatic fever usually has onset in childhood and is most prevalent in Aboriginal and Maori populations and other disadvantaged groups. ⋯ Recurrent episodes of acute rheumatic fever may lead to rheumatic heart disease. Early detection of acute rheumatic fever and provision of secondary prophylaxis with antibiotics is paramount to the prevention of rheumatic heart disease. Primary healthcare providers can play an important role in identifying acute rheumatic fever and ensuring adherence to treatment within the context of a complex interplay of cultural and socioeconomic factors. The recent establishment of RHD Australia will support the development of appropriate educational resources and their dissemination among health professionals and vulnerable communities.
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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. ⋯ 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.
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Due to the projected increase of medical graduates and general practice registrars, a rapid increase in new trainers and practices is required. The resulting mix of relatively inexperienced trainers and trainees makes the examination of the important question of patient safety even more pertinent. ⋯ Trainees can both be conscious of their incompetence and ask for help, or unconscious of their incompetence. Many articles have been written on teaching trainees who ask for help, but it is the trainee who does not ask for help who may be at most risk of serious problems, and therefore compromise patient safety. Formative assessment and feedback should be used to empower trainees as self-regulated learners. There are seven principles of good feedback practice that help develop self-regulation. This article provides practical teaching tips for supervisors in general practice.