Junior doctor perceptions of education and feedback on ward rounds.

AIM: The literature suggests that feedback is wanted and needed in clinical medicine and specifically on ward rounds, yet it is often lacking. This study aimed to examine junior doctor perceptions of education and feedback on ward rounds in one clinical department at a tertiary paediatric hospital and the key influences on these perceptions. METHODS: Six semi-structured focus groups were conducted over a period of 9 months comprising of 20 participants (post-graduate year 1-5) in a general medical department of a tertiary paediatric hospital. Qualitative analysis was performed on focus group transcripts using an inductive approach and codes and themes were generated in an iterative fashion with checking of themes between two researchers. RESULTS: Feedback experiences were largely positive compared to previous rotations. Three overarching themes were identified which influenced trainee perceptions of education and feedback on ward rounds. These were: consultant influences (e.g. educational engagement), trainee influences (e.g. active seeking of feedback), and structural factors (e.g. organisational constraints). CONCLUSIONS: Despite positive feedback experiences, the need to improve feedback for our junior doctors is clear, but how to do this remains challenging when navigating work-learning tensions. The notion of the educational alliance between the consultant and trainee is a potential useful solution, but it requires deliberate effort and dedicated time to establish given our increasingly complex and busy clinical environments.

A population-based study and systematic review of hearing loss in children with cerebral palsy.

AIM: The aims of this study were to estimate the frequency of hearing loss in children with cerebral palsy (CP), to examine factors associated with hearing loss, and to describe aspects of hearing in a population sample of children with CP and hearing loss. METHOD: A systematic review of the international literature was undertaken, and data on the frequency of hearing loss or severe hearing loss were extracted from 14 data sets based on previously devised criteria. Six hundred and eight-five children with CP (406 males, 279 females) born in Victoria, Australia, between 1999 and 2004 were identified from the Victorian Cerebral Palsy Register. Children were included if they had an established post neonatal cause for their CP before the age of 2 years. Additional information was collected on 48 children with documented hearing loss based on a four-tone pure tone average in the better ear. RESULTS: There was considerable variation in the definitions and proportions of hearing loss (range 4-13%) and severe hearing loss (range 2-12%) reported by CP registries in developed countries. In Victoria, 7% of individuals with CP had bilateral hearing loss of a moderate to profound degree, whereas the subgroup with a severe-profound degree of loss constituted 3% to 4% of the CP population. INTERPRETATION: These population-based data are likely to more accurately reflect the true frequency of defined hearing loss in children with CP than previous reviews.