ABSTRACT
BACKGROUND: Heart failure (HF) has high mortality and healthcare utilisation. It has a complex and unpredictable trajectory, which is often interpreted as a barrier to guideline recommended early integration of palliative care (PC). In particular, lack of referral criteria and misconceptions around PC affect inpatient specialist PC referrals. AIMS: The main objective was to characterise the pattern and predictors of referral of HF patients to the specialist inpatient PC consultative service at our healthcare service. METHODS: A retrospective, single-centre cohort study was performed on consecutive patients admitted across the hospital with HF over a 12-month period (July 2019-June 2020). Mortality data were checked against state death registry data. RESULTS: The 502 patients admitted for HF were elderly (mean age 78±14 years), had high dependency (54% Australian-modified Karnofsky Performance Status (AKPS) 50-70, 29% AKPS 10-40), and high mortality (53% within median 32 months at death registry data linkage). Seven per cent (7%) were referred to inpatient specialist PC. AKPS 10-40 (62% of those referred vs 26% not referred, p<0.01), reliance on carers (65% vs 36%, p<0.01), and New York Heart Association (NYHA) class III-IV symptoms (86% vs 42%, p<0.01) were associated with referral, but two or more admissions in the last 12 months for HF were not (16% vs 10%, p=0.21). Many PC domains, such as symptom burden, distress, and preferred care, were not adequately assessed. CONCLUSIONS: Referral to inpatient specialist PC in hospitalised HF patients is low relative to the morbidity and mortality in these patients.
ABSTRACT
BACKGROUND: Pharmacology is a cornerstone of medical education as it underlies safe prescribing practices. However, medical students have reported unease regarding their perceived proficiency in medical pharmacology. Despite the significant impetus to improve student outcomes, there is little analysis available of the techniques used by medical students to learn, retain and apply medical pharmacology knowledge. METHODS: A mixed-methods, student-focused approach was conducted to design and evaluate specific resources developed to address gaps in pharmacology education. This methodology comprised an anonymised scoping survey, followed by semi-structured focus group interviews. We then developed a flashcard resource as an intervention to support long-term revision for academic and clinical success. This resource was released to a cohort of 100 graduate entry preclinical medical students who were invited at the end of year to evaluate the intervention via a subsequent anonymous survey. RESULTS: The scoping survey received 103 complete responses. Surveys and focus group interviews revealed that only 50% of students engage in ongoing revision. Amongst our cohort, we identified that the evidence-based technique of spaced-repetition was particularly well regarded. Hence, we developed and evaluated a bespoke resource utilising Anki™, an open-source, spaced-repetition flashcard program. A total of 1208 flashcards spanning 156 distinct classes of drugs with supplementary summary tables, diagrams and explanatory video and summary guides were created. Designed as a strategic revision tool to reinforce learning, evaluation showed students greatly appreciated the "comprehensive" and "well formatted" Anki™ resource that supported existing teaching modalities, with a global rating of 3.8 out of 5. CONCLUSIONS: Strategic and personalised resources for medical pharmacology education that assist with in-semester revision and long-term retention are highly valued amongst students for examination preparation and preparedness for practice. Collectively, these results reflect a novel approach to identifying and addressing weaknesses in existing learning resources in a manner that is inclusive of, and acceptable to, medical students.
