Associate Professor Conor Gilligan

Phenomenon: Communication is a complex and essential element of clinical practice. It is widely accepted that communication skills can be taught and learned, but challenges remain for clinicians in achieving effective communication with patients. This study explored the patient-communication challenges faced by both medical students and experienced clinicians. Approach: Semi-structured interviews were conducted with twenty medical students and nineteen experienced clinicians from a range of medical disciplines. Interviews were recorded and transcribed, and transcriptions subjected to thematic analysis and coding to quantify the challenges discussed. Findings: There was remarkable consistency in the challenges described by both groups of participants, with eight predominant challenges identified: time constraints and chaotic environments, rapport building, patient characteristics, reluctance, omissions, assumptions, decision-making, and keeping conversations focused. Insights: Medical curricula often focus on communication challenges associated with complex or sensitive clinical situations, but many of the challenges identified occur in routine consultations. Both pre-service and post-graduate medical training should adopt strategies to help build students¿ and clinicians¿ skills in managing these challenges from the outset of training.

Information gleaned from a patients¿ medical history is a core determinant of a medical diagnosis. Accurate and effective history-taking is, therefore, a foundational skill for medical practitioners and is introduced early in medical training. Recognizing and developing the skills of effective medical interviewing is an ongoing challenge for medical students and experienced clinicians alike. Important parallels exist between the information gathering skills required in medicine and health, and those required in investigative interviewing. Qualitative interviews were conducted with 19 experienced medical professionals from a range of specialty areas. They were asked about the role of the medical interview in their discipline, and about challenges they experience when gathering information from patients. Both theory-driven and grounded-theory approaches were used in combination to identify common themes. The interviews were rich with themes including approaches to introductory phases of the interview, eliciting a narrative account, and several topics that specifically paralleled issues in interviewing of vulnerable witnesses. We explore these themes through a lens of investigative interviewing by applying the knowledge of effective interviewing skills and structures to the data gained from the medical context. In general, themes indicated that there are numerous parallels to information gathering approaches in both contexts. As such, there may be scope for medical education to adopt some of the training techniques employed in the investigative interviewing field. Further, it is hoped that the present findings be used to spark an interdisciplinary conversation about communication from which both sides can learn.

Issue Addressed: ¿Schoolies¿ or ¿Leavers¿ is a mass celebration of the end of compulsory schooling where excessive drinking is considered integral to the experience. Leavers are at risk of alcohol-related harms. This paper reports the concerns of parents for their Year 12 students (age 17¿years) when attending Leavers celebrations. Methods: Parents of Year 12 students (n¿=¿87) were asked to complete a survey in relation to their eldest school-aged child. Six items relating to parents¿ level of ¿concern¿ about Leavers celebrations were measured on a 5-point scale. Results: Parents were concerned about their child experiencing peer pressure to consume alcohol (60%), 30% were neutral or unconcerned about peer pressure. Almost two thirds of parents were concerned about their child being injured as a result of their own alcohol use (66.7%). Parental concern relating to their child being injured because of others¿ alcohol use rated most highly (88.5%). Conclusions: Findings suggested that parents were more concerned with harm caused to their child by others than the use of alcohol by their own child. Parents were somewhat less concerned with peer pressure to drink, though given peer influence is a major factor in young people's decisions regarding alcohol, parents' apparent confidence in their children's capacity to resist peer pressure may be inflated. So What?: Future interventions reinforcing the important role that parents play in the decisions that young people make while at Leavers have the potential to reduce their alcohol intake and subsequent alcohol-related harm.

Objective: Communication in healthcare has influenced and been influenced by the COVID-19 pandemic. In this position paper, we share observations based on the latest available evidence and experiential knowledge that have emerged during the pandemic, with a specific focus on policy and practice. Methods: This is a position paper that presents observations relating to policy and practice in communication in healthcare related to COVID-19. Results: Through our critical observations as experts in the field of healthcare communication, we share our stance how healthcare communication has occured during the pandemic and suggest possible ways of improving policy and professional practice. We make recommendations for policy makers, healthcare providers, and communication experts while also highlighting areas that merit further investigation regarding healthcare communication in times of healthcare crises. Conclusion: We have witnessed an upheaval of healthcare practice and the development of policy on-the-run. To ensure that policy and practice are evidence-based, person-centred, more inclusive and equitable, we advocate for critical reflection on this symbiotic relationship between COVID-19 and the central role of communication in healthcare. Practice implications: This paper provides a summary of the key areas for development in communication in healthcare during COVID-19. It offers recommendations for improvement and a call to review policies and practice to build resilience and inclusive and equitable responsiveness in communication in healthcare.

Purpose: Alcohol use by adults at school events and alcohol promotion through school fundraising activities is common, but little is known about secondary school parents' attitudes towards these practices. Parental attitudes may influence principals' decision-making on this topic, particularly in jurisdictions where education department guidance is limited. This study explored parents' attitudes towards the consumption or promotion of alcohol in schools or at school events. Design/methodology/approach: Parents (n¿=¿298) from five non-government secondary schools in Western Australia completed an online survey and provided responses relating to the promotion and availability of alcohol through their child's school. Findings: This sample of parents were evenly divided in support of alcohol consumption or support of schools as alcohol-free zones. Parents reporting higher alcohol consumption were more supportive of alcohol promotion and use through schools, and those with higher education supported use of alcohol for school fundraising. Almost 20% of parents were neutral on several measures indicating they could be swayed by social pressure. Engaging parents is an ongoing challenge for school principals and alcohol may play a part in engagement activities. The results from this small, exploratory study suggest even engaged parents may have very differing views on alcohol use in schools. Practical implications: Education departments are encouraged to explore these issues carefully and introduce changes incrementally to assist decision-making and minimise potential parent disengagement. Originality/value: This paper addresses a knowledge gap about parents' attitudes towards alcohol in secondary schools. These findings can support those involved in the development of school alcohol policies.

Background and purpose: Effective, safe, and patient-centred dispensing is a core task of community pharmacists. Entrustable professional activities (EPAs) offer a way of defining and assessing these daily practice activities. Although EPAs have become popular within competency-based medical education programs, their use is new to pharmacy education and assessment. Educational activity and setting: A simulation-based assessment framework containing a scale of entrustment was developed to evaluate the readiness of Year 4 undergraduate pharmacy students to safely manage the supply of prescribed medicine(s) in a community pharmacy. The assessment framework was piloted in a fourth year ¿Transition to Practice¿ course with 28 simulation-based assessments conducted. Findings: An entrustment framework was developed and implemented successfully with Year 4 undergraduate pharmacy students. The EPA for medicine dispensing integrates competency domains that include information gathering, providing patient-centred care, clinical reasoning, medicine dispensing, and professional communications. On a scale ranging from level 1 to level 5, the majority (73%) of entrustment ratings were level 2 or level 3; and of the students who achieved different ratings between clinical scenarios, 75% of students improved on their second simulation attempt. There was a strong correlation between the global EPA ratings with the total score achieved across the domains. Using simulation-based assessment, entrustment decision making can be incorporated in ¿entry to profession¿ undergraduate and postgraduate pharmacy courses to assess students' readiness to transition between learning and professional practice.

Issue addressed: Excessive alcohol consumption places adolescents at increased risk of preventable, acute alcohol-related injury. Parental attitudes and behaviours influence adolescents¿ alcohol use. This study examined alignment in parent and child reports of alcohol-related parenting and whether misalignment related to the child ever having drunk alcohol. Methods: A cross-sectional online survey was conducted in five secondary schools in [information removed for blinding in Perth, Western Australia] in 2015. All students in Years 7, 10 and 12 and their parents were eligible, and data were matched for 124 child-parent dyads. Alignment of parent-child reports was assessed using kappa statistics. In dyads where the parent reported protective attitudes and behaviours, the association between misalignment and alcohol use was tested in logistic regressions. Results: Overall, child-parent reports were aligned on parents¿ expectations, knowledge and actions (65% and higher agreed). While alignment on parental expectations seemed to decrease with age, alignment on parental communication and rule-setting increased. Misalignment on reports of parents¿ expectations was associated with increased odds of the child reporting having ever had alcohol (OR¿=¿5.5; 95% CI¿=¿2.7-47.7), as was parental supply (OR¿=¿20.2; 95% CI¿=¿3.3-121.5), but misalignment on parental communication, rule-setting and knowledge were not. Conclusions: Parent nonsupply of alcohol and disapproval of use were most important in terms of associations with ever drinking. So what?: These findings call for interventions that support parents to expect no alcohol use and enable parents to communicate their expectation in a manner that resonates with their child. Effective parenting will contribute to reducing alcohol-related harm in adolescents.

Issue addressed The aim of this study was to investigate predictors of adults' perceived acceptability of introducing alcohol to children less than 18 years of age. Methods An online survey. Logistic regression analyses were used to examine the association between demographic characteristics, alcohol consumption, and social norms and adults' own age of initiation. Results Alcohol consumption, age of initiation and perception of the acceptability of drunkenness were all correlated with the acceptability of introducing children to alcohol. The strongest predictor was adults' own age of initiation. Conclusions Adults who began drinking before the age of 18, and those who drink more heavily, are more likely to perceive the provision of alcohol to children as acceptable. So what? Policy and research should continue to focus on and monitor efforts to delay adolescent alcohol initiation and reduce consumption levels among adults. A shift in awareness and perceptions about alcohol use among adults has the potential to influence initiation and heavy drinking among adolescents.

Medication errors are the second most prevalent cause of adverse patient incidents in Australian hospital settings. Although numerous strategies to address this patient safety issue have been implemented, the impact of interprofessional collaborative practice (IPCP) on medication safety has received limited attention. The aim of this article is to report the perspectives and experiences of recently graduated, currently practicing Australian nurses, pharmacists, and doctors in relation to IPCP and medication safety. Sixty-eight graduates from three Australian states participated in focus groups. Thematic analysis of transcripts was conducted using an iterative process. The findings from this study illustrate how knowing about and valuing the skills and responsibilities of other team members and respecting each person¿s unique contribution to the work of the team can lead to more effective communication and collaboration in the context of medication safety. Although collaborative practice is critical to safe medication prescribing, dispensing, and administration, there are recurring and pervasive challenges to its achievement. This study indicated the need for improved preparation of graduates to equip them with the knowledge and skills needed to participate in an interprofessional team; and we advocate that deliberate, structured, and meaningful interprofessional clinical education initiatives are required.

Decreasing the numbers of adverse health events experienced by people from culturally diverse backgrounds rests, in part, on the ability of education providers to provide quality learning experiences that support nursing students in developing cultural competence, an essential professional attribute. This paper reports on the implementation and evaluation of an immersive 3D cultural empathy simulation. The Satisfaction with Cultural Simulation Experience Scale used in this study was adapted and validated as the first stage of this study. Exploratory factor analysis and confirmatory factor analysis were undertaken to investigate the psychometric properties of the scale using two randomly-split sub-samples. Cronbach's Alpha was used to examine internal consistency reliability. Descriptive statistics were used for analysis of mean satisfaction scores and qualitative comments to open-ended questions were analysed and coded. A purposive sample (n = 497) of second of nursing students participated in the study. The overall Cronbach's alpha for the scale was 0.95 and each subscale demonstrated high internal consistency: 0.92; 0.92; 0.72 respectively. The mean satisfaction score was 4.64 (SD 0.51) out of a maximum of 5 indicating a high level of participant satisfaction with the simulation. Three factors emerged from qualitative analysis: "Becoming culturally competent", "Learning from the debrief" and "Reflecting on practice". The cultural simulation was highly regarded by students. Psychometric testing of the Satisfaction with Cultural Simulation Experience Scale demonstrated that it is a reliable instrument. However, there is room for improvement and further testing in other contexts is therefore recommended.

Environmental and societal factors are significant determinants of children's initiation to and use of alcohol. Schools are important settings for promoting well-being and substantial resources have been devoted to curriculum-based alcohol programs, but the effects of these in reducing the misuse of alcohol have been modest. Adults can and do consume alcohol at school events when students are present, but there is a dearth of evidence about parents' level of support for the practice. The aim of this study was to examine parents' level of support for the purchase and consumption of alcohol at primary school fundraising events when children are present. Methods: Four hundred seventy-nine Australian parents of children aged 0-12 years participated in an online survey. Logistic regression was used to assess the impact of parent characteristics on the level of agreement with parental purchase and consumption of alcohol at school fundraising events when children are present. Results: The majority of parents (60%) disagreed/strongly disagreed with the practice of adults being able to purchase and consume alcohol at school fundraising events when children were present. The 21% of parents who supported the practice were more likely to be daily smokers and/or have higher (>6) Alcohol Use Disorders Identification Test-alcohol consumption scores. Conclusions: Despite the fact that the majority of parents disagree with this practice, published reports suggest that adults' use of alcohol at primary school events is an emerging issue. It is important that school decision-makers are mindful of the financial and educational value of fundraising activities.

Aims and objectives: To determine the effect of immersive 3D cultural simulation on nursing students' empathy towards culturally and linguistically diverse patients. Background: Accelerated globalisation has seen a significant increase in cultural diversity in most regions of the world over the past forty years. Clinical encounters that do not acknowledge cultural factors contribute to adverse patient outcomes and health care inequities for culturally and linguistically diverse people. Cultural empathy is an antecedent to cultural competence. Thus, appropriate educational strategies are needed to enhance nursing students' cultural empathy and the capacity to deliver culturally competent care. Design: A one-group pretest, post-test design was used for this study. The simulation exposed students to an unfolding scene in a hospital ward of a developing county. Methods: A convenience sample of second-year undergraduate nursing students (n = 460) from a semi-metropolitan university in Australia were recruited for the study. Characteristics of the sample were summarised using descriptive statistics. T-tests were performed to analyse the differences between pre- and post simulation empathy scores using an eight item modified version of the Kiersma-Chen Empathy Scale. Results: Students' empathy towards culturally and linguistically diverse patients significantly improved after exposure to the 3D simulation experience. The mean scores for the Perspective Taking and Valuing Affective Empathy subscales also increased significantly postsimulation. Conclusions: The immersive 3D simulation had a positive impact on nursing students' empathy levels in regards to culturally and linguistically diverse groups. Research with other cohorts and in other contexts is required to further explore the impact of this educational approach. Relevance to clinical practice: Immersive cultural simulation experiences offer opportunities to enhance the cultural empathy of nursing students. This may in turn have a positive impact on their cultural competence and consequently the quality of care they provide to culturally and linguistically diverse patients.

Background: Safe medication practices depend upon, not only on individual responsibilities, but also effective communication and collaboration between members of the medication team. However, measurement of these skills is fraught with conceptual and practical difficulties. Aims: The aims of this study were to explore the utility of a Theory of Planned Behaviour-based questionnaire to predict health professional students' behavioural intentions in relation to medication safety and collaborative practice; and to determine the contribution of attitudes, subjective norms, and perceived control to behavioural intentions. Design: A descriptive cross-sectional survey based upon the Theory of Planned Behaviour was designed and tested. Participants: A convenience sample of 65 undergraduate pharmacy, nursing and medicine students from one semi-metropolitan Australian university were recruited for the study. Methods: Participants' behavioural intentions, attitudes, subjective norms, and perceived control to behavioural intentions in relation to medication safety were measured using an online version of the Theory of Planned Behaviour Medication Safety Questionnaire. Results: The Questionnaire had good internal consistency with a Cronbach's alpha of 0.844. The three predictor variables of attitudes, subjective norms, and perceived control accounted for between 30 and 46% of the variance in behavioural intention; this is a strong prediction in comparison to previous studies using the Theory of Planned Behaviour. Data analysis also indicated that attitude was the most significant predictor of participants' intention to collaborate with other team members to improve medication safety. Conclusion: The results from this study provide preliminary support for the Theory of Planned Behaviour-Medication Safety Questionnaire as a valid instrument for examining health professional students' behavioural intentions in relation to medication safety and collaborative practice.

Globally it has been suggested that interprofessional education can lead to improvements in patient safety as well as increased job satisfaction and understanding of professional roles and responsibilities. In many health care facilities staff report being committed to working collaboratively, however their practice does not always reflect their voiced ideologies. The inability to work effectively together can, in some measure, be attributed to a lack of knowledge and respect for others' professional roles, status and boundaries. In this paper, we will report on the findings of an interpretative study undertaken in Australia, focussing specifically on the experiences of new graduate nurses, doctors and pharmacists in relation to 'knowing about' and 'working with' other health care professionals. Findings indicated there was little understanding of the roles of other health professionals and this impacted negatively on communication and collaboration between and within disciplines. Furthermore, most new graduates recall interprofessional education as intermittent, largely optional, non-assessable, and of little value in relation to their roles, responsibilities and practice as graduate health professionals. Interprofessional education needs to be integrated into undergraduate health programs with an underlying philosophy of reciprocity, respect and role valuing, in order to achieve the proposed benefits for staff and patients.

Brief interventions are effective for problem drinking and reductions are known to occur in association with screening and assessment. The present study sought to assess, among participants (N= 202) in a clinical trial, how much change occurred between baseline assessment and a one-session brief intervention (S1), and the predictors of early change. The primary focus was on changes in the Beck Depression Inventory Fast Screen scores and alcohol consumption (standard drinks per week) prior to random allocation to nine further sessions addressing either depression, alcohol, or both problems. There were large and clinically significant reductions between baseline and S1, with the strongest predictors being baseline scores in the relevant domain and change in the other domain. Client engagement was also predictive of early depression changes. Monitoring progress in both domains from first contact, and provision of empathic care, followed by brief intervention appear to be useful for this high prevalence comorbidity. © 2013 Elsevier Inc.

Introduction: Cultural diversity among students in tertiary institutions in Australia and globally has increased rapidly in the last decade, and is continuing to do so. Methods: Focus groups were held at the University of Newcastle, NSW to: (1) examine the specifi c needs of international students in the Master of Pharmacy, Bachelor of Medicine and Bachelor of Nursing programs in relation to language and cultural considerations and (2) to understand the attitudes of domestic students to the cultural issues faced among their peers. Th e project explored these issues with the intention to inform curricula changes to accommodate the needs of culturally and linguistically diverse students. Results: Th e key themes emerging from international students were: diffi culties in spoken language, diff erences in professional roles and expectations, diff erences in methods of learning, inadequate social interaction outside the classroom and acceptance of diff erences in cultural and religious practices. Th e domestic student views reinforced the comments from international students both in regard to social interaction and in regard to participation in class discussions. Although local students were interested in learning from international students about their culture and religious beliefs, there were limited initiatives from both sides. Discussion: Th ere is a need for tertiary institutions that benefi t economically from increasing the numbers of international students to help them to study and live in a new environment. Assistance needs to go beyond learning the English language to helping students understand its use in a professional context (health terminology and slang used by patients), the nuances of the health professional disciplines in a western society, the approach to study and problem-based learning styles and skills to assist with social interaction. Th e results of the present exploration have led to a series of proposed actions for the University of Newcastle. Th ese recommendations are applicable to any 'Western' teaching institution with a large number of international students from developing countries enrolled in their health programs.