Parkinson's disease in regional Australia.

INTRODUCTION: Parkinson's disease (PD) incidence and prevalence, particularly in Western countries, is greater in rural areas. Despite several epidemiological studies on PD in Australia, there are few publications addressing specific issues facing people with Parkinson's disease (PWP) in regional, rural and remote areas. This study looked at the dynamics of healthcare delivery to PWP and their carers in and around a regional New South Wales centre. METHODS: Qualitative analysis of rural and regional healthcare delivery to PWP involved five participant groups. Literature searches via electronic and medical databases were performed to provide a foundation for focus group questions, semi-structured interviews and questionnaires. Volunteers from five groups: PWP, carers, allied health professionals (AHP), GPs and neurologists participated after recruitment via pamphlets, newsletters, postal invitation, public advertisements and preliminary talks. RESULTS: Data analysis highlighted a lack of relevant facilities, funding, available health staff and awareness of information regarding beneficial services for PWP and their carers. With few available neurologists, the roles of GP and AHP were emphasized in consumer focus groups as being most significant in a regional and rural setting. Transport, and geographical and financial issues were also significant in these areas. Psychological issues, dementia and memory loss were considered to be as debilitating as the overt motor symptoms of PD. CONCLUSIONS: The study found that the management of PD in regional NSW was highly variable, depending on geographical location and liaison among GPs, neurologists, AHPs, carers and PWP. Enhanced communication is recommended among PD stakeholders in regional NSW. This study provided a microcosmic view of the issues revealed by the very limited literature available on Australia's rural and regional healthcare delivery to PWP and their carers. It highlighted the lack of health staff, funding and information for relevant stakeholders, as well as PWP's desire for increased input from medical practitioners and the ancillary sectors. While this study did not directly compare rural with metropolitan PD services, it was inferred from all participant groups that regional and rural areas are disadvantaged in terms of medical staff and facilities, hindering timely diagnosis, management and treatment. The findings have implications for all stakeholders in the care of rural patients with PD.

Issues for clinicians training international medical graduates: a systematic review.

OBJECTIVE: To ascertain the specialised communication issues clinicians need to understand when preparing international medical graduates (IMGs) for clinical practice in Australia. STUDY DESIGN: Systematic review. DATA SOURCES: A series of searches using MEDLINE (1990-2006) was conducted with relevant keywords. Literature from countries with experience in the integration of IMGs into their medical workforces was included. All except four articles were published between 1997 and 2006. STUDY SELECTION: The initial search identified 748 articles, which reduced to 234 evidence-based English language articles for review. Of these, only articles relating to postgraduate medical training and overseas trained doctors were selected for inclusion. DATA EXTRACTION: Titles and abstracts were independently reviewed by two reviewers, with a concordance rate of 0.9. Articles were included if they addressed communication needs of IMGs in training. Any disparities between reviewers about which articles to include were discussed and resolved by consensus. DATA SYNTHESIS: Key issues that emerged were the need for IMGs to adjust to a change in status; the need for clinicians to understand the high level of English language proficiency required by IMGs; the need for clinicians to develop IMGs' skills in communicating with patients; the need for clinicians to understand IMGs' expectations about teaching and learning; and the need for IMGs to be able to interact effectively with a range of people. CONCLUSION: Training organisations need to ensure that clinicians are aware of the communication issues facing IMGs and equip them with the skills and tools to deal with the problems that may arise.

Cultural and communication awareness for general practice registrars who are international medical graduates: a project of CoastCityCountry Training.

OBJECTIVE: (1) To generate discussion about Australian culture and language with GP registrars using the medium of poetry; and (2) to introduce discussion about language and communication skills in a role-play format that GP registrars would embrace as part of their clinical training. DESIGN: (1) A variety of Australian poems was selected to reflect six themes: men, women, the Bush, ANZACS, Aboriginal Australia and migrants, which would provide a basis for discussion on a range of cultural issues to aid a medical professional trained overseas in developing further understanding of aspects of Australian culture. (2) A series of role plays was developed to reflect the clinical themes of each Day Release education program. These were enacted in a small group setting by preselected GP registrars with feedback from a medical educator and an English as a Second Language teacher. SETTING: The Riverina/Murrumbidgee area of New South Wales, one of the three local training groups of CoastCityCountryTraining. PARTICIPANTS: GP registrars attached to the Riverina/Murrumbidgee Local Training Group. MAIN OUTCOME MEASURES: To show that discussion of poetry and participation in role plays are active language- and cultural-learning environments capable of enhancing understanding of a range of issues about Australia that are relevant to a GP registrar. RESULTS: There was increased participation by GP registrars in accessing the set material prior to each session. It was noted that there was also increased active involvement of all registrars in discussion within the group throughout the year. Discussion allowed clarification of aspects of Australian culture to participants with different international medical backgrounds, as well as providing an opportunity for GP registrars to share their own experiences.