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Papers by josephine thomas

PLOS ONE, Aug 26, 2021

Interprofessional Education (IPE) is one approach to improving communication and collaborative pr... more Interprofessional Education (IPE) is one approach to improving communication and collaborative practice between professions, which are essential for the optimal delivery of healthcare. Common barriers include negative attitudes, professional stereotypes, professional cultures and power differentials between professional groups. The aim of this qualitative study was to explore how professional hierarchies and power differentials shape interprofessional interactions between preregistration pharmacy and medicine students. Data were gathered via semi-structured interviews and subject to thematic analysis. Four main themes were identified: Reproducing traditional hierarchies; Social norms around respect; Hierarchies in care values and goals; and Challenging the narrative is possible. Students' interactions with and views of the other profession largely reflected traditional stereotypes and power differentials. Hierarchy was evident in how respect was accorded and in how care values and goals were managed. Despite this, students overwhelmingly perceived and reported a sense of agency in changing the status quo. Emerging professional identity and conceptualisation of future roles is heavily influenced by the hierarchical relationship between the professions and can pose a significant barrier to collaborative practice. Greater support for collaborative interprofessional practice is needed at the level of policy and accreditation in health education and healthcare to ensure greater commitment to change.

Purpose: Investigate the suitability of mobile devices to deliver drug information content to 4th... more Purpose: Investigate the suitability of mobile devices to deliver drug information content to 4th, 5th and 6th year medical students, searching for opportunities to improve drug information access or content to best support medication-related decision-making. Method: Participants undertook a baseline online survey prior to gaining access to the mobile drug information resource, and a second survey towards the end of the project. A small group of students were interviewed mid-way through the project. Question themes covered technology, smartphone and information use, and user experiences. Results: 94 students completed survey one between February and May 2011 and 83 students completed survey two between October 2011 and January 2012. Ten students were interviewed. General use of information and communications technology and smartphones was high. Smartphone-delivered mobile drug information … electronic Journal of Health Informatics <br>

Rheumatology, 2019

Cardiac troponin testing in idiopathic inflammatory myopathies and systemic sclerosis-spectrum di... more Cardiac troponin testing in idiopathic inflammatory myopathies and systemic sclerosis-spectrum disorders: biomarkers to distinguish between primary cardiac involvement and lowgrade skeletal muscle disease activity. Ann Rheum Dis 2015;74:795. 5 Lilleker JB, Diederichsen ACP, Jacobsen S et al. Using serum troponins to screen for cardiac involvement and assess disease activity in the idiopathic inflammatory myopathies.

Archives of Medicine and Health Sciences, 2018

Current evidence supports early discussions about end-of-life (EOL) care in patients with chronic... more Current evidence supports early discussions about end-of-life (EOL) care in patients with chronic, life-limiting illness. [1-4] Despite major advances in medical technology and treatment over recent years, rates of cardiopulmonary resuscitation survival (even in the intensive care setting) are low, with only one in six surviving to discharge from hospital. [5,6] Community expectations are often not well matched with the reality of what can be achieved at EOL, and the greater availability of options in management may result in inappropriate burden for patients. Effective planning for patients at EOL is essential to ensure that care is appropriate and well targeted. This planning necessitates frank and open discussion with patients, their carers, and families about what to expect at EOL. Patients need to be informed about prognosis, options for management, and likely outcomes. Health professionals need to explore patients' wishes, concerns, and understanding of EOL, to facilitate their understanding and assist them in navigating the complex web of decision-making. Despite the clear need, rates of EOL conversations in patients admitted to hospital are low, ranging from 10% to 30%. [7-13] Thus, the need for change still exists. One aspect highlighted in literature is the need for more education in this domain. Junior doctors represent an obvious target for our efforts in this endeavor, as they are most often present at pivotal times of patient admission and deterioration. Furthermore, they represent the future workforce and training them will pay future dividends in caring for our aging population. Recent changes to legislation in some states of Australia around Advance Care Planning have increased the educational focus on this topic. In South Australia, the implementation of new legislation in 2014-2016 was accompanied by the development of accessible online educational resources and opportunities to attend formal education sessions on this topic. [14] Anecdotally, this appears to have been beneficial and many junior doctors feel better prepared for these conversations. Nevertheless, this area is still perceived as a difficult one with good reason. "Obviously the consultants have best experience at sort of judging that, but they are often not the ones who have the discussion or make the decision" The lead author was involved developing material and content for the South Australian Health Department in the implementation of new legislation around Advance

PLOS ONE, 2019

Introduction Resuscitation clinical care plans (resuscitation plans) are gradually replacing 'Not... more Introduction Resuscitation clinical care plans (resuscitation plans) are gradually replacing 'Not for Cardiopulmonary Resuscitation' orders in the hospital setting. The 7-Step Pathway Resuscitation Plan and Alert form (7-Step form) is one example of a resuscitation plan. Treatment recommendations in resuscitation plans currently lack standardised language, creating potential for misinterpretation and patient harm. Aims To explore how terminology used in resuscitation plans is interpreted and applied by clinicians. Method A mixed methods study surveyed 50 general medical doctors, who were required to interpret and apply a 7-Step form in three case vignettes and define seven key terms. Statistical analysis on multiple choice and thematic analysis on free-text responses was performed. Results Terminology was inconsistently interpreted and inconsistently applied, resulting in clinically significant differences in treatment choices. Three key themes influenced the application of a resuscitation plan: in-depth discussion, precise documentation and personal experience of the bedside deciding doctor.

Medical Journal of Australia, 2010

The Medical Journal of Australia ISSN: 0025729X 21 June 2010 192 12 676-677 ©The Medical Journal ... more The Medical Journal of Australia ISSN: 0025729X 21 June 2010 192 12 676-677 ©The Medical Journal of Australia 2010 www.mja.com.au Editorials ing a complete history of a patient’s acute illness an ing comorbidities, as well as his or her social and issues, represents the ideal standard of care. Obviou there are tensions between providing holistic care a of care to the patient and achieving the rapid turn in such units. Genetic markers and tests are increasingly ava 4 Family history has a role, but who should be responsible for exploring and recording it?

Future Hospital Journal, 2017

Medical education fails to prepare young doctors for the nature of the work they will encounter. ... more Medical education fails to prepare young doctors for the nature of the work they will encounter. Doctors face a rapidly changing medical landscape, which relies more and more upon interprofessional collaboration to optimise patient outcomes and upon non-clinical skills to provide care efficiently and cost effectively. The current response to change is a reactive and resource-intensive effort, where established doctors are directed towards new ways of working. A better response would be interprofessional clinical and non-clinical training, incorporating a philosophy and style that accommodate innovation, communication and change. This preparative training should be overseen by a single educational enterprise that links undergraduate and postgraduate instruction. Improved training might enable better design of the healthcare system from within.

PLOS ONE, 2016

Objective To evaluate a holistic multidisciplinary outpatient model of care on hospital readmissi... more Objective To evaluate a holistic multidisciplinary outpatient model of care on hospital readmission, length of stay and mortality in older patients with multimorbidity following discharge from hospital. Design and Participants A pilot case-control study between March 2006 and June 2009 of patients referred on discharge to a multidisciplinary, integrated outpatient model of care that includes outpatient follow-up, timely GP communication and dial-in service compared with usual care following discharge, within a metropolitan, tertiary referral, public teaching hospital. Controls were matched in a 4:1 ratio with cases for age, gender, index admission diagnosis and length of stay.

QJM, 2014

Background: Prescribing is a complex task with potential for many types of error to occur. Despit... more Background: Prescribing is a complex task with potential for many types of error to occur. Despite the introduction of a standard national medication chart for Australian hospital inpatients in 2006, simple prescribing errors are common. Aim: To compare the effect of quality improvement initiatives on the rate of simple prescribing errors. Design: A prospective, multisite comparison of prescribing education interventions. Methods: Using three hospital sites, we compared site-specific changes in prescribing error rates following use of an online education module alone (low intensity) with prescribing error rates following a high-intensity intervention (comprising the same online education module plus nurse education and academic detailing of junior prescribers). The study period was 4 months between May and August 2011. Results: Full completion of the adverse drug reactions field did not improve after either intervention; however, there was better documentation of some elements following high-intensity intervention. Prescriber performance improved significantly for more elements in the regular prescription category than any other category of prescription. Legibility of medication name improved across all categories following interventions. Clarity of frequency, prescriber name and documentation of indication improved following both high-and low-intensity intervention. Conclusions: Improvements were seen in several prescription elements after the intervention but the majority of elements that improved were affected by both low-and high-intensity interventions. Despite targeted intervention, significant rates of prescribing breaches persisted. The prevalence of prescription breaches partially responds to an online education module. The nature of any additional intervention that would be effective is unclear.

The Medical Journal of Australia, 2012

TO THE EDITOR: I refer to Geelhoed and de Klerk's article 1 and related correspondence. 2,3 While... more TO THE EDITOR: I refer to Geelhoed and de Klerk's article 1 and related correspondence. 2,3 While concerned with the rise in the overall rate of emergency department (ED) presentations, I am alarmed by the disproportionate increase in the ED admission rate (24% increase, from 3960 admissions per 10 000 ED presentations in July 2007 to June 2008, to 4910 admissions per 10 000 ED presentations in July 2010 to June 2011) since the introduction of the 4-hour rule in Western Australia. The authors have failed to comment on this worrying trend. Incidentally, the staff at all three tertiary WA hospitals in Geelhoed and de Klerk's study should be commended on accommodating up to 28 767 extra ED admissions annually, without an increase in mortality. 1 The often misquoted study by Sprivulis and colleagues 4 did not manage to uncouple the effects of ED access block from hospital overcrowding (> 90% bed occupancy) when analysing mortality rates. The authors stated that there were an estimated "120 deaths per annum associated with

Internal Medicine Journal, 2014

Attendance at face-to-face sessions and completion of online components of the National Prescribi... more Attendance at face-to-face sessions and completion of online components of the National Prescribing Curriculum was made compulsory for final year medical students at the University of Adelaide in 2010. To determine the impact of a compulsory prescribing curriculum for final year medical students on their prescribing competencies at the start of clinical practice. Graduates&amp;amp;amp;#39; attitudes to their medical school training in prescribing were also surveyed. Two cohorts of medical graduates from the University of Adelaide who commenced medical practice in 2010 and 2011 were required to complete a prescribing task using the National Inpatient Medication Chart (NIMC) at orientation and after 6 months of clinical practice. The main outcome measure was a performance in a scenario-based prescribing test, as determined by test scores and overall safety of prescriptions at orientation and 6 months of clinical practice. There was a small difference in the average total score for the prescribing task between the 2010 and 2011 cohorts at orientation (P = 0.0007). The 2011 cohort had a higher number of safer charts at commencement of practice. We found no difference between the 2010 and 2011 cohorts in attitudes towards their undergraduate pharmacology education, and new graduates feel poorly prepared. Medical graduates who are required to complete a practically oriented prescribing curriculum in final year perform slightly better on a prescribing assessment at commencement of practice. More work on preparing graduates for this complex task before graduation is needed.

Clinical Medicine, 2012

This study aimed to quantify and compare the prevalence of simple prescribing errors made by clin... more This study aimed to quantify and compare the prevalence of simple prescribing errors made by clinicians in the first 24 hours of a general medical patient's hospital admission. Four public or private acute care hospitals across Australia and New Zealand each audited 200 patients' drug charts. Patient demographics, pharmacist review and pre-defined prescribing errors were recorded. At least one simple error was present on the medication charts of 672/715 patients, with a linear relationship between the number of medications prescribed and the number of errors (rϭ ϭ0.571, pϽ Ͻ0.001). The four sites differed significantly in the prevalence of different types of simple prescribing errors. Pharmacists were more likely to review patients aged у у75 years (39.9% vs 26.0%; pϽ Ͻ0.001) and those with more than 10 drug prescriptions (39.4% vs 25.7%; pϽ Ͻ0.001). Patients reviewed by a pharmacist were less likely to have inadequate documentation of allergies (13.5% vs 29.4%, pϽ Ͻ0.001). Simple prescribing errors are common, although their nature differs from site to site. Clinical pharmacists target patients with the most complex health situations, and their involvement leads to improved documentation.

PLOS ONE, 2021

MedEdPublish, 2018

Healthcare students from different professional backgrounds are often brought together under the ... more Healthcare students from different professional backgrounds are often brought together under the banner of Interprofessional Education (IPE) in an effort to improve collaborative practice. Despite the demonstrated positive impact of IPE on students' knowledge, skills and attitudes, it is not clear what students think about learning with students from another health profession. The aim of this study was to explore pharmacy and medicine students' views and experiences of learning together. Participants were Year 3 Pharmacy and Year 4 Medicine students, with qualitative data gathered via a written reflection. Three main themes were identified. Students were accepting of learning with the other professional group. Learning about was evident, particularly in relation to each other's roles and contributions to patient care. Learning from another professional group was the most problematic as students tended to view and treat knowledge as a commodity to be acquired from another rather than something that could be jointly developed. While medicine and pharmacy students' valued learning with and about each other, they were less likely to engage in co-constructing and sharing new meanings and thus learn from one another. To provide a basis for meaningful collaborative practice, IPE needs to challenge students' fundamental assumptions, beliefs and values about learning with, from and about other professions.

Focus on Health Professional Education: A Multi-Professional Journal, 2019

Health professional education (HPE) has grown as a field of research, with an increasing number o... more Health professional education (HPE) has grown as a field of research, with an increasing number of publications since the 1990s. Interprofessional education is a specific area of growth with ongoing debate in the literature, at least in part due to the challenges that exist in implementation, and further research is needed to inform ongoing practice. Participant recruitment is a major challenge, and poor participation rates lead to bias and a failure to demonstrate outcomes. There is a lack of information about why students decline to participate in research to inform and improve education. Motivation for volunteerism in other contexts and recruitment of human participants in other types of research are examined as a way to understand the likely motivations of student participants. Disincentives to participate include time commitment, survey fatigue and a poor understanding of the value of HPE research and the processes involved. The ethical considerations for teacher-researchers add another layer of complexity to recruitment. A multifaceted approach, involving all stakeholders and targeting known influences, is needed to improve recruitment in health professional education research, and clear communication of the research rationale and its potential impact on curriculum design is essential. Explicit communication and adequate information to allow informed student choice are also required, while improved literacy in HPE research may provide students with a better basis for decision making when considering participation. In addition, partnership and student co-design could be a mechanism for more meaningful engagement.

Introduction : Simulation is commonly used by health and education institutions to facilitate int... more Introduction : Simulation is commonly used by health and education institutions to facilitate interprofessional learning (IPL). The use of simulation in IPL is resource intensive. Evidence of what works, and with whom, is important to inform practice, policymaking and further research. The aim of this scoping review was to summarise the existing literature on IPL involving medical students, where simulation was the teaching modality. This review examined a variety of simulation-based interventions used to teach IPL to medical students and identified key features and outcomes. Methods : The databases Pubmed, Medline, EMBASE and PsychINFO were searched using the terms related to medical student and simulation combined with interprofessional. Included articles involved medical students alongside a student or practitioner from at least one other health profession taking part in at least one simulation session. Data extraction was performed by two authors using a standardised form. Res...

Heart, Lung and Circulation, 2008