Advance care directives in residential aged care.

BACKGROUND: Although most people have clear preferences with regard to end-of-life care, there is a disconnect between these preferences and what happens in practice. Advance care directives (ACDs) are a way of allowing people to plan ahead for any future loss in decision-making capacity, by allowing a systematic approach to decision making that respects the person's previously ex-pressed wishes. OBJECTIVE: This article reviews ACDs, considering, in particular, aspects of their use for patients in residential aged care. DISCUSSION: All people should be offered the opportunity to make an ACD as part of their routine care prior to any need for residential care. Once there is a need for residential care, advance care directives become even more important. Systems to ensure routine re-view of advance care directives and appropriate transfer of information between healthcare providers should be implemented by clinicians and residential aged care facilities.

Learning trajectories in longitudinal rural medical school placements.

BACKGROUND: Rural longitudinal placements are now a key part of clinical medical education, and are part of workforce strategies to enhance the rural medical workforce. Learning trajectories (a map to guide student learning) have been recommended as a means of maximising student learning on placements, and have the potential to assist long-term rural students and supervisors in adapting to a longitudinal clerkship. CONTEXT: This study focuses on year-3 medical students in rural longitudinal clinical placements at an Australian graduate-entry medical school. INNOVATION: This article reports the outcomes of working with current rural supervisors and students to develop a learning trajectory across the rural stream year, for implementation in future years. IMPLICATIONS: Students and supervisors identified incremental learning goals in keeping with Dreyfus's model of progressive skill development. Students offered tips to future students to adjust to variations in learning experiences across rural sites. Some supervisors were reluctant to have a learning trajectory, fearing it would be seen as proscriptive and reduce student ambition for varied rich experiences. Future research will focus on the impact of the rural learning trajectory.