An exploration into the awareness and perceptions of medical students of the psychosociocultural factors which influence the consultation: implications for teaching and learning of health professionals

Background. South African society is undergoing rapid changes; and includes people from different cultures; beliefs and social backgrounds. Research suggests that these contextual influences have an important bearing on how patients present and relate to healthcare providers. Medical students; too; have a life-world based on their own backgrounds and cultures; and may find relating to a patient with a different life-world challenging. Objectives. To explore students' awareness and perceptions of how psychosociocultural factors in a multicultural society influence the consultation; and to suggest adaptations for teaching. Methods. Focus group discussions were conducted with final-year medical students in the Family Medicine rotation. Some of the students had viewed a video of a consultation with an isiZulu-speaking patient; and completed a self-reflection learning task. Audio recordings were transcribed and analysed thematically. Results. Exposure to patients in the clinical years had made students aware of the challenges of cultural diversity; although they felt under-prepared to deal with this. Students alluded to the influences of their own cultures; of cultural similarities as well as differences; the roles and behaviours of doctors and patients in cross-cultural consultations; the potential knowledge and experience gap that exists across cultures; and an awareness of the need for patient-centredness. Conclusion. Students should be assisted to improve their cultural competence. Recommendations are made for using various methods; including critical incidents and visual learning to provide opportunities for reflexive practice and transformative learning. Educators must be equipped to address learning objectives relating to cultural competence

Re-transfusion of autologous blood from wound drains: the means for reducing transfusion requirements in total knee arthroplasty.

The requirements for homologous blood transfusion in patients undergoing total knee replacements under tourniquet, before and after the introduction of autologous transfusion of blood collected from wound drains, are compared. In a control population of 93 patients undergoing total knee replacement, 67 required homologous transfusions of two units or more. In 160 patients who were re-transfused with blood from wound drains, only 30 required additional homologous transfusions. Re-transfusion of filtered drained blood reduces the need for homologous bank blood. This avoids the risks associated with donated blood and affords significant cost savings.

Failure to culture bacteria in groin lymph nodes during arterial reconstruction.

A prospective trial was undertaken to establish if infection of groin lymph nodes was a significant risk factor in postoperative wound infection in patients undergoing groin dissection for arterial reconstruction surgery. In a series of 32 patients there was no growth on culture of any lymph nodes biopsied. None of the cases developed a post-operative infection discharging pus. In five cases minor superficial infections occurred from which bacteria were cultured. All resolved rapidly. All patients received prophylactic systemic antibiotics. We conclude that our present direct approach via a short vertical incision carries no increased risk of infection and has the advantage of speed and simplicity. It is unnecessary to make any special more complicated incision designed to avoid lymphatics.