Research Doctorate - Doctor of Philosophy / This thesis explores the barriers that are preventing large numbers of permanent resident overseas-trained doctors (PROTDs) from working as general practitioners (GPs) in rural New South Wales (NSW). It focuses specifically on doctors from non-English speaking backgrounds who are permanent residents of Australia or Australian citizens, and who migrated to Australia for reasons other than employment. This thesis explores the views and perceptions of PROTDs and does not specifically consider the views of other stakeholders. Archival, qualitative and quantitative research techniques have been used to determine the suitability of the policies and practices governing the appointment and registration of PROTDs in NSW, and to identify any policy changes required. This research demonstrates that the policies governing medical registration in NSW have frequently been driven by political factors, and have, at times, been used to control the size of the medical workforce. As a consequence of these policies, many PROTDs have been prevented from working as a doctor in NSW. Of particular concern is the lack of training or clinical experience available to PROTDs and their difficulties preparing for, and passing, the Australian Medical Council (AMC) examinations. The lack of accurate information regarding the requirements and opportunities for medical practice in NSW is also a major problem. PROTDs in NSW are unable to get the training and support they need to meet the requirements for medical registration in NSW and are rapidly losing their confidence, and their clinical skills. Not all PROTDs are going to have, or be able to acquire, the skills and knowledge required for general practice in rural NSW. However the need for additional doctors is sufficiently great to warrant a proactive approach from governments and relevant agencies. In the seven years it has taken to complete this research, most of the discriminatory aspects of the assessment and registration of PROTDs in NSW have been removed. However the legacy of previous policies and practices remains and a large number of PROTDs remain out of the medical workforce.

Masters Research - Master of Philosopy (MPhil) / For almost 20 years it has been known that the most common cause of preventable adverse events in hospital is communication problems between clinicians (1, 2). Within maternity services, ineffective communication has a strong relationship with adverse events for women and babies (3). Despite this knowledge, the ‘turf wars’ between some midwives and some doctors are a continuing concern. Although the link between poor communications and adverse events has been well known for a long time, no real change in how professions relate to each other has occurred. This dissertation describes a project that was designed to answer the research question: What factors affect interprofessional interaction in birthing units and how do these interactions impact on birthing outcomes? Midwives and doctors from 10 geographically diverse maternity units contributed to this qualitative research project. In-depth interviews were conducted. Analysis and theorizing was guided by feminist Interpretive Interactionism. New findings, about how health services can strengthen interprofessional collaboration in maternity services, are presented and explained. I argue that organisational factors are more important than the personalities of the individuals involved in the interactions because organisational factors frame, direct and limit what discourses and therefore behaviours, are possible. The dissertation ends with some procedural guidelines that show how administrators and clinical leaders can create and maintain collaborative work settings for public sector midwives and doctors.

<p>During the Fall of 2001 a survey created by Kathleen Cannings and sponsored by the Swedish Medical Association was sent out to a random sample of 1 out of every 12 medical doctors in Sweden. Using this data, linear regressions have been estimates to study the effects of variables such as age, gender, and unionization on the wages of Swedish doctors. The results indicate that variables such as age, tenure, and union bargaining all have a positive impact on wages. The relative wage advantage was around 7 percent for both age and union bargaining, while the effect of tenure was lower by about 5 percent. These three variables have more positive effects for male doctors, which suggest that gender discrimination is still a reality in the medical field. During 2001, male physicians could expect an almost 6 percent higher average wage than their female colleges.</p>

During the Fall of 2001 a survey created by Kathleen Cannings and sponsored by the Swedish Medical Association was sent out to a random sample of 1 out of every 12 medical doctors in Sweden. Using this data, linear regressions have been estimates to study the effects of variables such as age, gender, and unionization on the wages of Swedish doctors. The results indicate that variables such as age, tenure, and union bargaining all have a positive impact on wages. The relative wage advantage was around 7 percent for both age and union bargaining, while the effect of tenure was lower by about 5 percent. These three variables have more positive effects for male doctors, which suggest that gender discrimination is still a reality in the medical field. During 2001, male physicians could expect an almost 6 percent higher average wage than their female colleges.

Background: Evidence-based medicine (EBM) receives significant attention worldwide. Many studies have used questionnaires to discuss the factors obstructing the practice of EBM. There has however been no large-scale data analysis on who and when to practice EBM. This study aims to fill this gap in research by applying nationally representative data to analyze EBM practice after the provision of new evidence regarding rosiglitazone prescription. Methods: We used the National Health Insurance Database in Taiwan to analyze the changes in the prescription of rosiglitazone after meta-analysis found the drug to increase the risk of myocardial infarction. The study period was 18 months from the second quarter of 2007 to the fourth quarter in 2008. Two models of doctors¡¦ prescription behaviors were analyzed in the study. We conducted univariate analyses to distinguish significant differences in the variable and applied multivariate logistic analyses to predict the probability of physicians ceasing to prescribe rosiglitazone. Results: We found a significant improvement in EBM practice from specialists and experienced physicians. When compared to other specialists, endocrinologists were four times more likely to change rosiglitazone prescription (OR: 4.129, 95% CI: 2.484-6.863). Doctors with more than 10 years of specialist experience performed better in EBM practice than younger doctors. The hospital level that a physician worked at was not a significant factor. Local urbanization and economic status did not affect the practice of EBM by physicians in clinics either. Conclusions: Our study found that the EBM was still not well practiced among doctors in Taiwan. The practice of new evidence depended on the specialty or professional experience. Younger doctors and doctors working in medical centers seemed not to practice EBM well. In clinics, patients did not have enough influence to modify the doctor¡¦s prescription behavior. There was a significant time lag between the EBM emergence and EBM practice. This suggests that setting up an authoritative organization to provide timely EBM recommendations is very important. Further improvements to the practice of EBM are still urgently needed within the medical community.

Title from PDF of title page. / Document formatted into pages; contains 78 pages. / Thesis (M.A.)--University of South Florida, 2003. / Includes bibliographical references. / Text (Electronic thesis) in PDF format. / ABSTRACT: This research explored the topic of professional caregivers who commit serial murder in institutional settings. In-depth case studies were created for individuals convicted of serial murder in institutional settings in the United States. The purpose of this research was to identify the characteristics of this group of institutional serialists and compare the current data to existing data on serial killers. A technique of secondary data analysis was utilized to gather information on the sample of 17 individuals. Only public information was reviewed. Results of the data comparison between the current sample and existing information on serial killers indicated that institutional serialists share many similarities with previously identified serialists, but differences between the groups were identified as well. / ABSTRACT: The characteristics of this current sample that were similar to those identified in previous research include sex of offender, race of offender, the offender's age at first murder, marital status of offender, number of victims, and victim characteristics. The characteristics that differed from those identified in previous research include sex of offender, the offender's childhood family situation, the offender's birth order, method of murder, number of victims, and victim characteristics. / System requirements: World Wide Web browser and PDF reader. / Mode of access: World Wide Web.

This report explores the role medical professionals played in state-sponsored torture during the Brazilian military rule. Between 1964 and 1985, counterinsurgency agencies imprisoned an estimated 50,000 people, many of them without a trial, and tortured at least 20,000 suspected of ‘subversive conduct’. Scholars often describe the implementation of torture as the exclusive work of ‘infamous interrogators’ belonging to repressive agencies of the security forces. They were not, however, the sole perpetrators of human rights violations. A large body of medical experts played a significant role in administering and justifying the regime’s mechanism of oppression. While the evidence pointing to these collaborations exists in diverse sources, scholarship dealing with this aspect of regime’s repression is scarce. The report unveils the particular roles of doctors in the torture mechanism, and places their history within two larger historiographical frameworks. Engaging with literature on Latin America’s Cold War, the study traces the history of the National Security Doctrine and examines the final form it took in Brazil in the 1960s and 1970s. It then utilizes the scholarship on torture to contextualize and illuminate the regime’s practice of inflicting pain. Finally, the report turns to studies from other disciplines to offer theoretical and conceptual frameworks elucidating professionals’ complicity in torture. / text

Darbo tikslas: Įvertinti pacientų pasitenkinimą VŠĮ Kauno Centro poliklinikos bendrosios praktikos gydytojų ir terapeutų paslaugomis. Tyrimo metodika. Pacientų apklausai sudaryta 31 klausimo anoniminė anketa. Klausimai vertinami dviem būdais: 5 balų Likerto skale, kur 1 reiškia visiškai nesutinku/nepasitikiu, o 5 – visiškai sutinku/pasitikiu ir klausimų pateiktais keliais atsakymo variantais. Pacientų, prisirašiusių prie bendrosios praktikos gydytojų, atsako dažnis 97,8% (N= 230),pacientų, prisirašiusių prie terapeutų – 61,3% (N= 230). Tyrimo duomenų analizė atlikta naudojant statistinį duomenų analizės paketą SPSS 9.0. Rezultatai. VšĮ Kauno Centro poliklinikos pacientų, prisirašiusių prie BPG ir prie apylinkės terapeutų, pasitenkinimo lygis šeimos gydytojo paslaugomis yra aukštas ( 4,51). Pacientai labiausiai patenkinti gydytojo rodoma pagarba jų asmeniui, aukšta kvalifikacija, įdėmiu nusiskundimų išklausymu bei išsamiu ir suprantamu paaiškinimu apie ligą ir jos gydymą. Mažiausiai pacientai patenkinti šeimos gydytojo pagalba, sprendžiant socialines ir psichologines problemas. Pacientų pasitenkinimas šeimos gydytojo paslaugomis (Spirmeno koreliacija) yra labiausiai susijęs su aukšta gydytojo kvalifikacija ( 0,827), išsamiu ir suprantamu paaiškinimu apie ligą ir gydymą ( 0,723), pakankamu laiko skyrimu aptariant sveikatos problemas (0,684), įdėmiu nusiskundimų išklausymu (0,635), atsižvelgimu į paciento nuomonę, skiriant gydymą (0,623) bei paaiškinimu apie atliekamų tyrimų... [toliau žr. visą tekstą] / The aim of the theses: To estimate satisfaction of patients with services of Kaunas Center general practitioners and therapists. The methodology of the research: anonymous questionnaire containing 31 questions was prepared to question the patients. The answers were evaluated in two ways: 5 points to Lickert Scale Questions, when 1 meant “totally disagree/ do not trust” and 5 – “totally agree/ trust”, there also were included questions with several possible answers. Patients, who registered at general practitioners responded 97,8% (N= 230), patients, who registered at therapists responded 61,3% (N= 230). The analysis of the research data was accomplished using statistic data analysis SPSS 9.0. The results. Satisfaction level of the patients, who registered at GP, local therapists and family doctors in Kaunas Center outpatient clinic was almost equal and was rather high (4,51). The patients mostly were satisfied with doctor’s respect, his/her high qualification, attentive listening to them and clear and detailed information about their disease and its treatment. The patients least were satisfied with family doctor’s help solving social and psychological problems. Patient satisfaction with family doctor’s services (Spirmen’s correlation) was mostly related to high qualification of the doctor ( 0,827), detailed and clear information about their disease and its treatment ( 0,723), enough time devoted to solve health problems (0,684), attentive listening (0,635), paying attention... [to full text]

Research Doctorate - Doctor of Philosophy / This thesis explores the barriers that are preventing large numbers of permanent resident overseas-trained doctors (PROTDs) from working as general practitioners (GPs) in rural New South Wales (NSW). It focuses specifically on doctors from non-English speaking backgrounds who are permanent residents of Australia or Australian citizens, and who migrated to Australia for reasons other than employment. This thesis explores the views and perceptions of PROTDs and does not specifically consider the views of other stakeholders. Archival, qualitative and quantitative research techniques have been used to determine the suitability of the policies and practices governing the appointment and registration of PROTDs in NSW, and to identify any policy changes required. This research demonstrates that the policies governing medical registration in NSW have frequently been driven by political factors, and have, at times, been used to control the size of the medical workforce. As a consequence of these policies, many PROTDs have been prevented from working as a doctor in NSW. Of particular concern is the lack of training or clinical experience available to PROTDs and their difficulties preparing for, and passing, the Australian Medical Council (AMC) examinations. The lack of accurate information regarding the requirements and opportunities for medical practice in NSW is also a major problem. PROTDs in NSW are unable to get the training and support they need to meet the requirements for medical registration in NSW and are rapidly losing their confidence, and their clinical skills. Not all PROTDs are going to have, or be able to acquire, the skills and knowledge required for general practice in rural NSW. However the need for additional doctors is sufficiently great to warrant a proactive approach from governments and relevant agencies. In the seven years it has taken to complete this research, most of the discriminatory aspects of the assessment and registration of PROTDs in NSW have been removed. However the legacy of previous policies and practices remains and a large number of PROTDs remain out of the medical workforce.

Introduction: Dyslexia is the most common specific learning difficulty, affecting of about 6% of the population. In medicine, the numbers of learners disclosing a diagnosis of dyslexia is rising. Small-scale studies have begun to venture into the effects of dyslexia on the education of medical students, and doctors in foundation year training and beyond. There is a call for research to develop a more nuanced understanding of how dyslexia affects doctors during their training and practice. Methodology: Using interpretative phenomenological analysis, this project aimed to develop a greater understanding of the ways in which dyslexia affects the training and practice of doctors. The data collection followed a three-phase approach, employing semi-structured interviews, a Self-Characterisation Sketch exercise, and Critical Incident Reflection audio-diaries. Analysis: In-depth, idiographic analysis of anonymised case studies for 10 doctors in training across a variety of specialties, from England and Wales was undertaken. The detail of the analysis cannot be adequately captured in a short summary but the overarching themes identified in the data included: Self; Belonging; and Coping. Each theme is supported by subthemes: good enough, chaos and power of the label; black sheep, conformity, and community; and difficulties and capabilities, agency and attribution, and strategies and risk, respectively. Notable ‘pearls’ within the data included the notion of partitioning, and that of brute failure. Discussion: The in-depth analysis of these doctors’ experience of their dyslexia, with reference to their education, training and practice, provides a unique insight into an unstudied aspect of lived experience of doctors. The analysis of the data from these doctors offers a unique understanding of self-concept, attribution and learned helplessness. These findings bear significance for engaging with, and seeking help from the team and wider structures in medical education. Synthesis of this analysis with wider literature would suggest a role for self-compassion and individual counselling approaches in medical education.