Exploring patient ideas, concerns, and expectations in surgeon-patient consultations.

OBJECTIVES: This study explores patient perspectives (ideas, concerns, and expectations) in surgeon-patient consultations. METHODS: We examined 54 video-recorded consultations using applied conversation analysis. Consultations took place from 2012 to 2017 in an Australian metropolitan hospital clinic centre and involved seven surgeons across six specialties. RESULTS: Patient perspectives emerged in less than one third of consultations. We describe the initiation of and response to potential perspectives sequences, demonstrating how patients and surgeons co-construct these sequences when they do occur. CONCLUSIONS: Findings suggest a need for greater attention to supporting patient agency through explicit pursuit of patient perspectives. The implications extend to the Calgary-Cambridge Guide, suggesting that it may benefit from a focus on active pursuit and appropriate responsiveness to patient perspectives. PRACTICE IMPLICATIONS: This study highlights the need for surgeons to actively engage with the patient perspective offered in consultations, emphasising the importance of respect for the patient's knowledge and expectations to improve patient satisfaction and healthcare outcomes.

Maternal Judgments of Child Numeracy and Reading Ability Predict Gains in Academic Achievement and Interest.

In a representative longitudinal sample of 2,602 Australian children (52% boys; 2% Indigenous; 13% language other than English background; 22% of Mothers born overseas; and 65% Urban) and their mothers (first surveyed in 2003), this article examined if maternal judgments of numeracy and reading ability varied by child demographics and influenced achievement and interest gains. We linked survey data to administrative data of national standardized tests in Year 3, 5, and 7 and found that maternal judgments followed gender stereotype patterns, favoring girls in reading and boys in numeracy. Maternal judgments were more positive for children from non-English speaking backgrounds. Maternal judgments predicted gains in children's achievement (consistently) and academic interest (generally) including during the transition to high school.

Responses to a cancer diagnosis: a qualitative patient-centred interview study.

PURPOSE: A cancer diagnosis is an emotive and challenging time for patients. This study aimed to systematically explore patients' accounts of experiencing their cancer diagnosis. The purpose of this article is to offer a typology of patient responses to receiving a cancer diagnosis as a means through which to affirm the range of patients' experiences and to guide clinicians' practice. METHODS: Qualitative semi-structured interviews were conducted between 2015 and 2017 with 80 patients living with cancer: 34 females and 46 males, aged between 31 and 85, diagnosed with a range of cancer types, stages and treatment trajectories, from two metropolitan hospitals on the east coast of Australia. Interview data were analysed thematically, using the framework approach. RESULTS: A typology of responses to the cancer diagnosis was derived from the analysis and included (1) the incongruent diagnosis, unexpected because it did not 'fit' with the patient's 'healthy' identity; (2) the incidental diagnosis, arising from seemingly unrelated or minor medical investigations; (3) the validating diagnosis, as explanation and confirmation of previously unexplained symptoms, pain or feelings; (4) the life context diagnosis, where the cancer diagnosis was positioned relative to other challenging life events, or as relatively inconsequential compared with the hardship of others. CONCLUSIONS: A diagnosis of cancer is not always (or only) experienced by patients with shock and despair. Diagnosis is perceived and experienced in diverse ways, shaped by broader social or life contexts, and with important implications for the clinical encounter and communication from an oncology perspective.

Authenticity, ambivalence and recognition in caring at the end of life and beyond.

Informal caring at the end of life is often a fraught experience that extends well beyond the death of the person receiving care. However, analyses of informal carers' experiences are frequently demarcated relative to death, for example in relation to anticipatory grief (pre-death) or grief in bereavement (post-death). In contrast to this tendency to epistemologically split pre- and post-death experiences, we analyse informal caring across two separate qualitative interviews with 15 informal carers in one metropolitan city in Australia-one before and one after the death of the person for whom they cared. In doing so, we focus on accounts of care across dying and bereavement including: the evolving ambivalence of carers' social relations at the end of life and beyond; dying and death as a challenge to the ideal of authenticity; and, the potential for misrecognition and social estrangement in caring relations at the end of life. We draw on social theory addressing the themes of ambivalence, authenticity and recognition to enhance our understanding of caring as a social practice that occurs across dying and bereavement, rather than as structured primarily by the context of one or the other.

A psychometric evaluation of the Gender Bias in Medical Education Scale.

BACKGROUND: Gender bias within medical education is gaining increasing attention. However, valid and reliable measures are needed to adequately address and monitor this issue. This research conducts a psychometric evaluation of a short multidimensional scale that assesses medical students' awareness of gender bias, beliefs that gender bias should be addressed, and experience of gender bias during medical education. METHODS: Using students from the University of Wollongong, one pilot study and two empirical studies were conducted. The pilot study was used to scope the domain space (n = 28). This initial measure was extended to develop the Gender Bias in Medical Education Scale (GBMES). For Study 1 (n = 172), confirmatory factor analysis assessed the construct validity of the three-factor structure (awareness, beliefs, experience) and enabled deletion of redundant items. Study 2 (n = 457) tested the generalizability of the refined scale to a new sample. Combining Study 1 and 2, invariance testing for program of study and gender was explored. The relationship of the GBMES to demographic and gender politics variables was tested. The results were analyzed in R using confirmatory factor analysis and Multiple-Indicator-Multiple-Indicator-Cause models. RESULTS: After analysis of the responses from the original 16-item GBMES (Study 1), a shortened measure of ten items fitted the data well (RMSEA = .063; CFI = .965; TLI = .951; Mean R-square of items = 58.6 %; reliability: .720-.910) and was found to generalize to a new sample in Study 2 (RMSEA = .068; CFI = .952; TLI = .933; Mean R-square of items = 55.9 %; reliability: .711-.892). The GBMES was found to be invariant across studies, gender, and program of study. Female students and those who supported gender equality had greater agreement for each of the factors. Likewise, postgraduate students reported higher scores on experience of gender bias than undergraduate students. CONCLUSION: The GBMES provides a validated short multidimensional measure for use in research and policy. Given its good reliability across different target populations and its concise length, the GBMES has much potential for application in research and education to assess students' attitudes towards gender bias.