The extent of polypharmacy and use of 'fall risk increasing drugs' in the oldest old admitted to a regional New South Wales hospital.

Objective(s): Polypharmacy is associated with significant morbidity including cognitive decline and falls. We sought to quantify the extent of polypharmacy and use of medications associated with fall risk in the very old admitted to a regional NSW hospital.

Methods: Cross-sectional study of patients aged over 80 years admitted to a regional NSW hospital from September to October 2019.

Relevance of anatomy to medical education and clinical practice: perspectives of medical students, clinicians, and educators.

Introduction: Against a backdrop of ever-changing diagnostic and treatment modalities, stakeholder perceptions (medical students, clinicians, anatomy educators) are crucial for the design of an anatomy curriculum which fulfils the criteria required for safe medical practice. This study compared perceptions of students, practising clinicians, and anatomy educators with respect to the relevance of anatomy education to medicine.

Methods: A quantitative survey was administered to undergraduate entry (n = 352) and graduate entry students (n = 219) at two Irish medical schools, recently graduated Irish clinicians (n = 146), and anatomy educators based in Irish and British medical schools (n = 30).

Global sharing, local innovation: Four schools, four countries, one curriculum.

Background: Many internal and external obstacles, must be overcome when establishing a new medical school, or when radically revising an existing medical curriculum.

Aims: Twenty-five years after the Flinders University curriculum was introduced as the first graduate-entry medical programme (GEMP) in Australia, we aim at describing how it has been adopted and adapted by several other schools, in Australia and in Europe (UK, Ireland, and Portugal).

Method/results: This paper reports on the experience of four schools establishing a new medical school or new curriculum at different times and in different settings.

Studying medicine - a cross-sectional questionnaire-based analysis of the motivational factors which influence graduate and undergraduate entrants in Ireland.

Objectives: The number of places available in Ireland for graduate entry to medical school has steadily increased since 2006. Few studies have, however, characterized the motivational factors underlying decision to study medicine via this route. We compared the factors motivating graduate entrants versus undergraduate entry (UGE) students to choose medicine as a course of study.

The first survey of attitudes of medical students in Ireland towards termination of pregnancy.

Background: Since the UK Abortion Act (1967), women have travelled from Ireland to the UK for legal abortion. In 2011 >4000 women did so. Knowledge and attitudes of medical students towards abortion have been published, however, this is the first such report from Ireland.

Demographic attributes and knowledge acquisition among graduate-entry medical students.

Background: Recent changes to undergraduate (basic) medical education in Ireland have linked an expansion of student numbers with wide-ranging reforms. Medical schools have broadened access by admitting more mature students from diverse backgrounds and have increased their international student numbers. This has resulted in major changes to the demographic profile of students at Irish medical schools.

Assessment of waist-worn tri-axial accelerometer based fall-detection algorithms using continuous unsupervised activities.

This study aims to evaluate a variety of existing and novel fall detection algorithms, for a waist mounted accelerometer based system. Algorithms were tested against a comprehensive data-set recorded from 10 young healthy subjects performing 240 falls and 120 activities of daily living and 10 elderly healthy subjects performing 240 scripted and 52.4 hours of continuous unscripted normal activities.

Cross-institutional progress testing: feasibility and value to a new medical school.

Objectives: This study aimed to examine the feasibility of using a progress test to compare the rate of knowledge acquisition among students at a new medical school with that of students at a comparable but long-established school.

Methods: As part of an ongoing strategy, we administered the McMaster Personal Progress Index (PPI) on four occasions to the first two cohorts of students enrolled in the graduate-entry medical programme at the University of Limerick. We compared mean PPI scores for students at comparable stages in their courses at both schools.

The financial costs of delivering problem-based learning in a new, graduate-entry medical programme.

Context: In discussions of the merits and limitations of problem-based learning (PBL) as an educational methodology, the cost of its delivery is often cited as a significant issue. Although there appears to be no shortage of opinion as to the perceived cost of PBL, we know of no institution that has accurately measured its cost, even in financial terms. Where factual information is lacking, opinion and misconception tend to proliferate.

A new direction for medical education in Ireland?

In recent years, new concepts of educational theory and practice have stimulated new approaches to medical education in many countries. For various reasons, medical education in Ireland has been slow to change such that there are now increasing concerns about educational standards. In addition, Ireland currently produces too few doctors and is therefore highly dependent on overseas doctors to maintain its health service.

Working and training as an intern: a national survey of Irish interns.

The Medical Council of Ireland recently introduced some initiatives to enhance the education and training of interns. These include the development of a generic job description, a logbook to monitor training outcomes and a national network of supervisors to plan and oversee intern training. To get feedback on the impact of these reforms, the Medical Council surveyed all interns with Irish addresses in March 2003.

Evidence-based clinical practice in falls prevention: a randomised controlled trial of a falls prevention service.

Aims: Evidence-based guidelines recommend a range of treatments for falls and injury prevention. We undertook a randomised trial of a falls prevention service to screen for falls risk factors and recommend to GPs an evidenced base prescription for falls prevention.

Methods: All patients who presented with a fall to the Emergency Department at Flinders Medical Centre over a 22-week period were considered for the study.

An outreach intervention to implement evidence based practice in residential care: a randomized controlled trial [ISRCTN67855475].

Background: The aim of this project was to assess whether outreach visits would improve the implementation of evidence based clinical practice in the area of falls reduction and stroke prevention in a residential care setting.

Methods: Twenty facilities took part in a randomized controlled trial with a seven month follow-up period. Two outreach visits were delivered by a pharmacist.

Reforming medical education to enhance the management of chronic disease.

Medical education must adapt to change if it is to remain relevant to the needs of doctors, patients and society. Ideally, it should anticipate and lead change. Undergraduate education remains rooted in urban medical schools where the focus is on acute disease, while most graduates spend their working lives in the community, dealing mainly with chronic health problems.

A comparison of performance assessment programs for medical practitioners in Canada, Australia, New Zealand, and the United kingdom.

Purpose: To compare programs designed to assess the performance of practicing doctors in Canada, Australia, New Zealand, and the United Kingdom.

Methods: Senior representatives of 11 organizations undertaking performance assessments were invited to provide a description of their programs, using a standardized written questionnaire.

Results: Collectively, the 11 organizations provide 16 performance assessment programs that operate on three levels: those that screen populations of doctors (Level 1), those that target "at risk" groups (Level 2), and those that assess individuals who may be performing poorly (Level 3).

Clinical problem solving (CPS) as a teaching strategy: a 'dual teacher' approach.

A desire to take a 'problem-solving' approach to clinical teaching, combined with a lack of resources for a 'standard' problem-based learning (PBL) approach prompted the authors to develop a new teaching strategy that builds on the ideas of others and which they call clinical-problem solving (CPS). In this paper, they describe the CPS approach, its perceived strengths and weaknesses, and their experience with it to date. They believe that CPS provides a dynamic learning environment and one that can be adapted to a variety of settings.

Early discharge and home rehabilitation after hip fracture achieves functional improvements: a randomized controlled trial.

Objective: To compare hospital and home settings for the rehabilitation of patients following hip fracture.

Design: Randomized controlled trial comparing accelerated discharge and home-based rehabilitation (n = 34) with conventional hospital care (n = 32) for patients admitted to hospital with hip fracture.

Setting: Three metropolitan hospitals in Adelaide, Australia.

Is there a problem with the problems in problem-based learning?

Objective: To determine the balance between acute and chronic medical problems in the PBL cases at 2 Australian medical schools.

Methods: Analysis of 162 PBL cases.

Results: Cases concentrate on acute problems in young people and neglect chronic disease in the old.

The new medical curriculum at Flinders University, South Australia: from concept to reality.

After much discussion and planning, Flinders University in Adelaide, South Australia recently introduced a new Graduate-Entry Medical Program (GEMP) which centres on problem-based learning (PBL). We describe the factors that stimulated the development of this new course, discuss its aims and philosophies and provide a brief outline of its structure. Advice and practical help was freely provided by several institutions who had undertaken similarly radical curricular reform and without this, a difficult task would have been much harder.

Factors affecting physicians' decisions on caring for an incompetent elderly patient: an international study.

Objectives: To determine what treatment decisions physicians will make when faced with a hypothetical incompetent elderly patient with life-threatening gastrointestinal bleeding and to examine the relative importance of physician characteristics and factors (legal and ethical concerns, hospital costs, level of dementia, patient's age, physician's religion, patient's wishes and family's wishes) in making those decisions.

Design: Survey.

Setting: Family practice, medical and geriatrics rounds in academic medical centres and community hospitals in seven countries.