ABSTRACT
In our hospital we receive about 200 skin 2-week wait (2WW) referrals weekly. This is a huge burden on local services. Many of these patients are discharged at the first appointment, and, for a significant proportion of referrals, the 'level of cancer concern' on the general practitioner (GP)-provided 'suspected skin cancer referral form' is rated: 'I'm unsure, it might well be cancer but there are other equally plausible explanations'. In collaboration with secondary care and community stakeholders, an innovative pilot using an optional teledermatology advice and guidance process (A&G) was implemented as a complementary pathway for patients in two large GP practice networks. Conventional 2WW faceto- face referrals could be initiated as normal;however, at the GP's discretion an alternative teledermatology e-triage A&G pathway was introduced for lesions equivocal for malignancy. A model where healthcare assistants (HCAs) maintained a weekly clinic in each of the practices was designed and implemented. The HCA received training and undertook a lesion history via proforma and macroscopic and dermatoscopic photographs, which were subsequently uploaded to the National Health Service e-referral service. A consultant dermatologist reviewed the A&G e-triage request within 72 h and either provided advice or recommended 2WW referral, which was then actioned via the outpatient appointment centre, without further need for GP action. The pilot commenced in November 2021. Over 2 months (November-December 2021 inclusive) 101 e-triage A&G requests were made and 212 conventional 2WW face-to-face referrals. Of the A&G e-triage requests 70 (69.3%) were returned with advice and the patient did not require onward referral. In total 70/313 (22.4%) of the skin lesion episodes were retained in primary care with advice. Since the initiation of the pilot, there are signs that A&G requests and 2WW referrals are changing, with increased uptake in A&G e-triage. Comparing the referral behaviours of the two practice networks before and after the pilot is a challenge given the short period of the pilot and the event of COVID-19 on referral patterns. However, in November- December 2019 (pre-community COVID-19 in the UK), the two practices sent 201 2WW referrals juxtaposed with 212 intrapilot (November-December 2021). This demonstrates a more sustainable number of 2WW referrals and in keeping with previous levels at a period when locally skin 2WW referrals are increasing. Fiscally, given that many of the A&G e-triage requests would have resulted in a face-to-face 2WW referral a cost saving has been made. Our interim data demonstrate the development and implementation of an optional A&G e-triage pathway as an alternative approach for equivocal lesions and it has resulted in retention of 22.4% of would-be 2WW referrals in primary care. Community stakeholders and engagement has been crucial for the project. Our 6-month pilot data will be presented.
ABSTRACT
It has been argued that self-directed professional development is a necessary component of continuous, lifelong teacher learning. Research has predominantly focused on top-down, institution-mandated professional development, however, a paucity of data exists concerning self-directed teacher professional development. Therefore, the aim of this project was to explore the self-directed professional development that native English-speaking teachers (NESTs) in South Korea engaged in, as well as assess if these behaviors matched their stated beliefs about self-directed professional development. Employing a mixed-methods approach, data was collected from 56 teachers who completed online questionnaires, and 11 teachers who participated in follow-up interviews. Analysis revealed that in the 12 months prior to the study, only 35 teachers engaged in self-directed professional development. Findings indicated that the teachers who held education degrees and were interested in an EFL/ESL career were the most likely to engage in self-directed professional development. Of the participants that did not engage in self-directed professional development, the preeminent factors hindering involvement were a lack of ambition and/or ambivalence, lack of necessity, a shortage of career advancement prospects, and the COVID-19 pandemic. It could be concluded that most NESTs in the study did not engage in enough professional development to increase student learning outcomes. © 2022 AsiaTEFL All rights reserved.