RACE AND COMMUNITY PRACTICE: REFLECTIONS FROM THE SUPERVISION OF PROFESSIONAL TRAINING

Given South Africa's unique history of colonization and racial segregation, understanding and working with issues of race and racialization have been of paramount importance in South African critical community psychology. This article considers how race has emerged in the supervision of community work with master's students in a community psychology practicum. Using an autoethnographic approach, we document our reflections as two community psychology supervisors to discuss the dilemmas experienced in dealing with race in community psychology supervision. We engage with notions of Whiteness and Blackness, intersections of race and language, and race and crime, and document specific issues that emerge in the supervision for Black and White supervisors. In conclusion, we highlight the importance for supervisors to adopt a critical stance that utilizes reflexivity as a tool for the supervision of community work to help students to reflect on issues of race and racism as part of their community engagement.     

Perceptions of newly admitted undergraduate medical students on experiential training on community placements and working in rural areas of Uganda

Background  

Uganda has an acute problem of inadequate human resources partly due to health professionals' unwillingness to work in a rural environment. One strategy to address this problem is to arrange health professional training in rural environments through community placements. Makerere University College of Health Sciences changed training of medical students from the traditional curriculum to a problem-based learning (PBL) curriculum in 2003. This curriculum is based on the SPICES model (student-centered, problem-based, integrated, community-based and services oriented). During their first academic year, students undergo orientation on key areas of community-based education, after which they are sent in interdisciplinary teams for community placements. The objective was to assess first year students' perceptions on experiential training through community placements and factors that might influence their willingness to work in rural health facilities after completion of their training.     

Psychotherapy training in an isolated setting

This paper describes the setting up of a training programme in psychodynamic psychotherapy in Perth, 'the most isolated city in the world'. Previous attempts to do so have petered out after a short period of time. It had certainly never been possible to develop a training programme. Initially a study group of interested health professionals was formed in 1984 which met to study certain texts at fortnightly meetings and participated in workshops conducted by the supervisors who visited from Sydney, 3,400 km away. At the end of that year the study group was changed into the Association for Psychodynamic Psychotherapy of Western Australia. The foundation members were also the first training group. The training programme consisted of fortnightly meetings concerned with intragroup issues, administrative matters and with the didactic programme: this consisted of seminars being conducted as part of a training programme in Sydney which were recorded on videotape and flown to Perth. As the 3-year training progressed we also added additional topics of our own. On the alternative fortnight the members split into small groups for peer supervision of audiotape recordings of sessions with the patient being supervised. In addition there were supervision workshops conducted by the visiting supervisors from Sydney. The paper also discusses the logistical problems of conducting such a training as well as transference and countertransference issues that arose within the group of trainees as well as with the supervisors who were so far away.     

Assessing the capacity of the health services research community in Australia and New Zealand

BACKGROUND: In order to profile the health services research community in Australia and New Zealand and describe its capacity, a web-based survey was administered to members of the Health Services Research Association of Australia and New Zealand (HSRAANZ) and delegates of the HSRAANZ's Third Health Services Research and Policy Conference. RESULTS: Responses were received from 191 individuals (68%). The responses of the 165 (86%) who conducted or managed health services research indicated that the health services research community in Australia and New Zealand is characterised by highly qualified professionals who have come to health services research via a range of academic and professional routes (including clinical backgrounds), the majority of whom are women aged between 35 and 54 who have mid- to senior- level appointments. They are primarily employed in universities and, to a lesser extent, government departments and health services. Although most are employed in full time positions, many are only able to devote part of their time to health services research, often juggling this with other professional roles. They rely heavily on external funding, as only half have core funding from their employing institution and around one third have employment contracts of one year or less. Many view issues around building the capacity of the health services research community and addressing funding deficits as crucial if health services research is to be translated into policy and practice. Despite the difficulties they face, most are positive about the support and advice available from peers in their work settings, and many are actively contributing to knowledge through academic and other written outputs. CONCLUSION: If health services research is to achieve its potential in Australia and New Zealand, policy-makers and funders must take the concerns of the health services research community seriously, foster its development, and contribute to maximising its capacity through a sustainable approach to funding. There is a clear need for a strategic approach, where the health services research community collaborates with competitive granting bodies and government departments to define and fund a research agenda that balances priority-driven and investigator-driven research and which provides support for training and career development.     

Interpretive Community,Intersubjective Experiences,and Supervisees’ Paradoxes

Contemporary theorists believe that each expert's discourse has meaning only in the context of an interpretive community. For therapists, the analytic community serves this purpose, helping them to construct their patients’ experiences and to hold inherent intersubjective paradoxes; the community provides them with a vantage point from which they learn to acknowledge, tolerate, and accept these paradoxes. I will examine the role of this vantage point in holding one of the central paradoxes for therapists: the uniqueness of each therapeutic relationship which urges them to ‘reinvent psychoanalysis’ with each patient, and its similarity to other therapeutic relationships which urges them to draw on the analytic community's theoretical schemas. I will suggest that supervisors help their supervisees in this internal struggle by representing the analytic community's vantage point and by holding a parallel paradox: the uniqueness of each supervisory relationship, which urges them to ‘reinvent’ the theory of supervision for each supervisee, and its similarity to other supervisory relationships, which urges them to draw on the analytic community's theoretical supervisory schemas. Reasonably, the supervisors’ capacity to hold these paradoxes is gradually internalized by their supervisees, facilitating their growth as therapists.     

French training program for medical students in transfusion medicine. Transfusion Medicine Teachers' College]

In France, transfusion medicine training program has been updated. A national committee of professors in transfusion medicine propose a series of 13 items which represent the minimum knowledge that general practitioners should possess. This overview of transfusion medicine is far below the level that specialists should reach and they will need an additional specialized training. Several French universities have set up their own training program which is quite similar to the work of the committee of professors. The following recommendations are not strict guidelines but is a common basis which will be improved in 2005 according to new evidence based transfusion medicine.     

Finding an ideal site for intraosseous infusion of the tibia: an anatomical study

Intraosseous infusion is a technique used for the administration of fluids to a hemodynamically shocked child in whom attempts to access the vascular system have been unsuccessful. Although few complications are seen, injury to the epiphyseal growth plate during the performance of this technique remains a serious problem. This study investigates the relationship between the site of insertion of the intraosseous needle and the epiphyseal growth plate, and the ease of needle insertion into various locations of the tibia in newborn infants. Fourteen newborn infant cadavers (28 tibias in total) were dissected after placement of four needles: 1). through the tibial tuberosity (Site A); 2). 10 mm distal to the tibial tuberosity (Site B); 3). 20 mm distal to the tibial tuberosity (Site C) and; 4). 10 mm proximal to the tibial tuberosity (Site D). Distances from the distal end of the epiphyseal growth plate were measured. A high number of needle placements at Site A were inserted into the epiphyseal growth plate. Most placements at Site B were between 10 and 16 mm from the epiphyseal growth plate on the right side and between 10 and 15 mm on the left side, and all were inserted without difficulty. Although far from the epiphyseal growth plate, most placements at Site C were very difficult to insert because of the thick cortical bone. All placements at Site D entered the epiphysis or the epiphysis and joint space of the knee. An insertion site of at least 10 mm distal to the tibial tuberosity is therefore recommended to avoid epiphyseal growth plate injury and ensure ease of insertion.     

Primary immunodeficiency diseases: an update

Although relatively rare, primary immune deficiency diseases (PIDs) provide an excellent window into the functioning of the immune system. In the late 1960s, observations on these diseases, with their associated infections and genetics, bisected the immune system into humoral immunity and cell-mediated immunity. These diseases also represent a challenge in their diagnosis and treatment. Beginning in 1970, a unified nomenclature for the then-known primary immunodeficiency diseases was created by a committee convened by the World Health Organization. Since then, and later under the aegis of the International Union of Immunological Societies, an international committee of experts has met every 2 to 3 years to update the classification of PIDs. During the past 15 years, the molecular basis of more than 100 PIDs has been elucidated. This update results from the latest meeting of this committee in Sintra, Portugal, June 2003, which followed 2(1/2) days of scientific discussions.     

Primary and community health services in Newcastle upon Tyne--a joint statement of intent.

In the absence of a single primary health care authority (except in Scotland) district health authorities and family practitioner committees must cooperate in planning health services for the community. Equally, in the field, the potential for teamwork between salaried district health authority nursing staff and the independent general practitioners remains largely unrealized. Yet the government has restated its commitment to the development of primary health care teams as the best means of delivering health care in the community. In Newcastle upon Tyne the local medical committee and the community health services management team have set out their shared aspirations for future development in a joint 'Statement of intent'. This statement, since endorsed by the district health authority and family practitioner committee, includes a number of key principles as a basis for future joint working. These principles emanate from an understanding of the complementary nature of general practice and district health authority community services, and firmly support the primary health care team approach. This statement of intent could serve as a useful model for collaboration and planning of services elsewhere in the country.     

Effectiveness of day treatment with proctor care for young children: A four‐year follow‐up

This study evaluated the immediate and long‐term outcomes of a day treatment and proctor care model for preschool‐aged children. Seventy‐seven boys and 52 girls completed the program which combined day treatment, case management, individual and family therapy. Also, 60% of these clients were placed in proctor care homes which are short‐term family placements providing in‐home treatment. Results showed there was increased stabilization in family placements, with 67% of participants still living in a permanent family placement at the 4‐year follow‐up. Also, 69% of participants transitioned to a less‐restrictive academic placement and remained in regular classroom placements at follow‐up. Participants showed significant behavioral improvement at discharge and follow‐up on the Child Behavior Checklist. Participants also showed significant developmental improvement on the Battelle Developmental Inventory and the Expressive One Word Vocabulary Test. The results suggest that this treatment modality is effective in maintaining these children in the community and in producing positive long‐term outcomes. © 2003 Wiley Periodicals, Inc. J Comm Psychol 31: 459–468, 2003.     

A suggested schema for utilization review for a Community Mental Health Center

Three record-keeping models were examined by an interdisciplinary committee at the Rochester Mental Health Center to see which would best meet the needs for a standardized record format that could be used by an outpatient comprehensive community mental health center. The systems examined were: (1) Model Criteria Set, (2) Problem Oriented Record, and (3) a Combination Diagnosis and Standardized Problem List. A modification of the Combination System used at the Cleveland Metropolitan General Hospital was developed. Using this tool, an audit committee began the process of Utilization Review. It is a suggested schema to other outpatient mental health centers who are in the process of developing a utilization review process.     

The development of national injury prevention policy in the Australian health sector: and the unmet challenges of participation and implementation

For the last 20 years injury prevention policy in Australia has been hampered by poor consultation practices, limited stakeholder involvement, inadequate allocation of resources, poor implementation, and an absence of performance measures. This paper describes the development of injury prevention policy in Australia from its beginnings in 1981 to the current day and considers what measures should be undertaken to create an effective platform for the reduction of the burden of injury in Australia.The National Injury Prevention and Safety Promotion Plan 2004–2014, released in 2005, needs to be supported by a whole of government commitment to the reduction of injury. The Council of Australian Governments would be an ideal forum to monitor progress, supported by a cross-government Ministerial Council.     

COMMUNITY ACTIVISTS’ COMPETENCE: THE CONTRIBUTING FACTORS

This study examined the contribution of the personal and social resources to community activists' competence. The research population included 163 activists who engage in volunteer activity in traditional communities. The findings revealed that the activists' gender, supervision by community‐organizers, sense of mastery, sense of belonging to the community, citizen participation, representation, and perceptions of leadership all contributed significantly to the activists' competence. A comprehensive analysis of the findings is presented, as well as practical recommendations for community organization. The recommendations highlight the importance of professional supervision for community activists, which aims to develop perceptions of community leadership, community belonging, citizen participation, and representation in order to enhance the success of community activity. Finally, the examination of personal and social resources that contribute to activists' competence can facilitate identification of potential community activists, in addition to shedding light on the content that professional supervisors should incorporate in their work with activists.     

Epidemiological, clinical and laboratory aids for the diagnosis of neonatal herpes -- an Australian perspective

Neonatal herpes is rare in Australia, possibly because of the older average age at pregnancy compared with other developed countries, low herpes simplex virus (HSV)-2 seroprevalence in the general community, low risk of HSV-2 acquisition during pregnancy and relatively high HSV-1 seroprevalence in adults. Guidelines on herpes management in pregnancy have been produced by the Australian Society for Infectious Diseases and endorsed by the Australian College of Obstetricians and Gynaecologists. However, diagnosing and managing neonatal infection remains difficult. Until an effective strategy to prevent neonatal herpes is developed, our efforts should focus on improving early diagnosis of HSV disease in the neonate and developing more effective strategies to reduce early reactivation and long-term morbidity.     

Seeking ethical approval for an international study in primary care patient safety

Seeking ethics committee approval for research can be challenging even for relatively simple studies occurring in single settings. Complicating factors such as multicentre studies and/or contentious research issues can challenge review processes, and conducting such studies internationally adds a further layer of complexity. This paper draws on the experiences of the LINNAEUS Collaboration, an international group of primary care researchers, in obtaining ethics approval to conduct an international study investigating medical error in general practice in six countries. It describes the ethics review processes applied to exactly the same research protocol for a study run in Australia, Canada, England, the Netherlands, New Zealand, and the US. Wide variation in ethics review responses to the research proposal occurred, from no approval being deemed necessary to the study plan narrowly avoiding rejection. The authors'' experiences demonstrated that ethics committees operate in their own historical and cultural context, which can lead to radically different subjective interpretations of commonly-held ethical principles, and raised further issues such as ‘what is research?’. This first LINNAEUS study started when patient safety was a particularly sensitive subject. Although it is now a respectable area of inquiry, patient safety is still a topic that can excite emotions and prejudices. The LINNAEUS Collaboration now extends to more countries and continues to pursue an international research agenda, so reflection on the influences of history, social context, and structure of each country''s ethical review processes is timely.     

Credentialing for radiology

Patients expect to receive safe, predictable and high-quality care delivered by competent professionals. Thus, it has become important to provide specific training in existing and new modalities and prove on-going clinical expertise. Hospital credentialing is the process by which the competence of a doctor is determined by the hospital management. In Australia, radiologists participate in a mandatory program of continuing professional development and are also required to maintain a logbook of procedures. The Conjoint Committee for the Recognition of Training in Peripheral Endovascular Therapy has been established to advise the respective subspecialty groups on the requirements for accreditation. This article examines some of the issues the committee has considered in preparing the criteria to assist institutions for the purposes of credentialing and gives an Australian perspective on future trends.     

Trust,sense of community,and civic engagement: Lessons from Australia

This article examines the association between trust, sense of community, and civic engagement, with a particular focus on the socioeconomic characteristics of individuals, using data from the Household, Income, and Labor Dynamics in Australia Survey. Through the use of panel logit and binary panel data models, we draw three core observations. First, there is evidence that trust is associated with civic engagement in Australia, particularly in the case of volunteering. Trust is a prerequisite for women to participate in volunteering but not for men, where a sense of community matters more. Second, a high sense of community matters for both types of participation, political and volunteering. Third, the relationships between trust, sense of community, and civic engagement are present among the Baby Boomer and Generation X generations but not the Generation Y generation, which participates differently. The study makes an important contribution to the literature by unmasking the gender and generation stories and debunking popular myths about the unwillingness of new Australians to engage in associative behavior.     

HIV, ethnicity and travel: HIV infection in Vietnamese Australians associated with injecting drug use.

BACKGROUND: The movement of people with their constructed identities including ethnicity has always been one of the determinants of the human immunodeficiency virus (HIV) pandemic. An example of the contributions of travel and ethnicity to experiences of HIV can be seen in the Vietnamese community in Australia. OBJECTIVES: This paper seeks to describe the contributions of ethnicity and travel to the Australian HIV epidemic with particular reference to the evolving epidemic within the Vietnamese Australian community. STUDY DESIGN: We reviewed the available data on the HIV epidemic in Australia with reference to overseas acquisition, ethnicity, the epidemic in the Vietnamese community and the determinants of the current patterns of transmission within this community. RESULTS: Available data suggests that 20-25% of HIV infections notified in Australia are acquired overseas. This proportion is higher in some specific categories such as heterosexually acquired infections. Notification rates are no higher in Vietnamese Australians than in the general Australian population apart from infections associated with injecting drug use (IDU) notified in the state of Victoria. The reasons for this increased rate of notification include increased vulnerability to blood borne virus infection in Australia and the additional, unique risk of frequent travel to Vietnam, a country where IDU carries a high risk of HIV infection. CONCLUSIONS: Australia has succeeded in stabilising the HIV epidemic partly through successful interventions to limit the spread of infection among IDUs. There is now early evidence that HIV transmission may be increasing amongst Vietnamese Australian IDUs. Timely responses that help Vietnamese Australian IDUs reduce their accumulation of risk are likely to be important in determining the level of harm associated with IDU throughout Australia.     

Initiating undergraduate medical students into communities of research practise: what do supervisors recommend?

Background  

Much has been written in the educational literature on the value of communities of practise in enhancing student learning. Here, we take the experience of senior undergraduate medical students involved in short-term research as a member of a team as a paradigm for learning in a community of practise. Based on feedback from experienced supervisors, we offer recommendations for initiating students into the research culture of their team. In so doing, we endeavour to create a bridge between theory and practise through disseminating advice on good supervisory practise, where the supervisor is perceived as an educator responsible for designing the research process to optimize student learning.     

Evaluating the clinical teaching of medical imaging students at Curtin University of Technology, Australia

Purpose:

To ascertain the effectiveness of the clinical, tutorial-based component of teaching and the clinical assessment method in the Bachelor of Medical Imaging Science at Curtin University of Technology (CUT), Perth, Western Australia.

Materials and Methods:

In mid-2006, second- and third-year students enrolled in CUT’s Medical Imaging Science degree were asked to complete a questionnaire assessing the Objective Structured Clinical Examination (OSCE) evaluation program and clinical teaching. Thirty-three of 57 students answered questions about demographics and their opinions of the laboratory sessions, clinical placements and the OSCEs.

Results:

Seventy-six per cent of students were satisfied with their laboratory sessions and clinical placements. Sixty-four percent of respondents indicated that the OSCE was not an objective evaluation, but 82% of students felt the OSCE was an effective test of their radiography skills and knowledge, and believed that they were able to evaluate and care for a patient during the OSCE.

Conclusion:

Overall, the surveyed students believed that the practical skills explored in laboratory sessions helped improve clinical training outcomes; however, only 33% of the students were satisfied that the OSCE was an appropriate assessment of their clinical training in hospitals.