Professor Christine Jorm
School of Medicine and Public Health
Christine Jorm is the Director of NSW Regional Health Partners, an NHMRC accredited Centre for Innovation in Regional Health. The Centre’s role is to accelerate the translation of research into practice order to improve regional and rural health. The Centre receives support from its eight partners (HNELHD, CCLHD, MNCLHD, Calvary Mater, UON, UNE, HMRI), the NSW Ministry of Health and the Medical Research Future Fund.
Christine is a safety and quality expert, with experience as a clinician, policy maker, researcher and educator.
As well as specialty medical qualifications, Christine has doctorates in neuropharmacology and sociology: Her PhD thesis explored aspects of medical culture. From it she published a book: ‘Reconstructing Medical Practice - Engagement, Professionalism and Critical Relationships in Health Care’. Based on study of teaching hospital consultants, it examines why doctors are limited in their ability to lead change in the current system. Doctors' self-esteem was found to be delicate due to the uncertain nature of their work; colleagues provide necessary support but both factors limit their ability to admit to error or engage with ‘the system’. It argues that regulation is a clumsy approach to ensuring good care instead, detailed attention to organisational relationships is needed.
Christine worked as an anaesthetist for more than 15 years before her interest in quality assurance led to full-time cross-disciplinary work in patient safety and quality at hospital level and then later as the foundation Senior Medical Advisor for the Australian Commission on Safety and Quality in Healthcare. After leaving the Commission, Christine worked at Sydney Medical School as Associate Dean (Professionalism) before focusing on interprofessional health education. The interprofessional team she led won a Sydney University Vice Chancellor’s Award for Outstanding Educational Engagement and Innovation and an Australian Award for University Teaching in 2017.
Christine has been part of several successful research teams and supervised PhD students. She is currently a member of an ARC Discovery Grant team (Manias E lead) DP170100308 'Communicating about medications with older people across transition points of care' and co-supervising two PhD students:
- A/Prof Paul McGurgan UWA: What factors influence judgements about medical students' professional behavior? Commenced 2016
- Dr Nancy Sturman UQ: Peer assessment in the transition from medical student to junior doctor. Commenced 2016
Christine’s past consultancy work includes analyses for the Australian Institute of Health and Welfare, development of a number of online units of study and a major report on Clinician Engagement for the Victorian Department of Health and Human Services. She is a graduate of the Institute of Company Directors, has been a member of several Boards and is currently a member of the UNSW Centre for Big Data Research in Health Advisory Committee and is a long-term member of the Grattan Health Program Advisory Group. Christine co-authored with Stephen Duckett, the three recent Grattan safety and quality reports:
- Strengthening safety statistics: How to make hospital safety data more useful - takes stock of a diverse range of health data (from clinical registries to patient experience measures) using an original actionability frame I have developed.
- All complications should count: Using our data to make hospitals safer - - provides an analysis of national hospital complications and makes a call for more transparency for Australian health data, including that comprehensive comparative outcomes data should be published for both public and private hospitals.
- Safer care saves money: how to improve care and save money at the same time – analyses the costs of harm and proposes funding reforms and a new approach to hospital accreditation.
Christine has published more than 80 opinion pieces, peer reviewed articles, books and book chapters in a diverse range of fields and been cited by others more than 1400 times. Her google scholar profile is here.
- interprofessional education
- organisational change
- quality improvement
Fields of Research
|150310||Organisation and Management Theory||30|
|130209||Medicine, Nursing and Health Curriculum and Pedagogy||30|
|111799||Public Health and Health Services not elsewhere classified||40|
For publications that are currently unpublished or in-press, details are shown in italics.
Book (1 outputs)
Jorm C, Reconstructing medical practice: Engagement, professionalism and critical relationships in health care (2016)
© Christine Jorm 2012. All right reserved. Reconstructing Medical Practice examines how doctors see health care and their place in it, why they remain in medicine and why they are... [more]
© Christine Jorm 2012. All right reserved. Reconstructing Medical Practice examines how doctors see health care and their place in it, why they remain in medicine and why they are limited in their ability to lead change in the current system. Doctors are beset by doubts and feel rejected by systems where they should be leaders - some see their role as 'flog[ging] a derelict system to get the last breath of workability out for their patients'. Others simply turn away. Rigorous studies carried out at large public teaching hospitals in Australia found that doctors were reluctant to increase safety in the wider health system, despite making every effort for their 'own' patients. Doctors' self-esteem was found to be delicate due to the uncertain nature of their work; colleagues provide the support doctors need to deliver good care. However, these essential relationships and their cherished connections with patients have disadvantages: reducing doctors' ability to admit to error. On top of this, senior doctors predict a future bereft of professional values - one where medicine is 'just a job'. While the loss of professional identity introduces new risks for patients and doctors, the repercussions of the more self-serving attitudes of younger doctors are unknown. Reconstructing Medical Practice concludes that regulation, despite its recent proliferation, is a clumsy and limited approach to ensuring good care. It presents original and much-needed ideas for ways to rebuild the critical relationship between doctors and the system. By better valuing communicative interactions and workplace relationships, safe and satisfying medical practice can be reconstructed.
Chapter (8 outputs)
|2019||Jorm C, Duckett S, 'Transforming hospital accreditation: from assurance to improvement', Hospital Transformation: From Failure to Success and Beyond, Springer International, Switzerland (2019)|
Jorm C, Roper L, 'Errors related to personal mobile technology', Safety of Health IT: Clinical Case Studies 99-115 (2016)
© Springer International Publishing Switzerland 2016. Mobile devices, especially smartphones, are used by doctors on a daily basis to assist them do their job. This results in inf... [more]
© Springer International Publishing Switzerland 2016. Mobile devices, especially smartphones, are used by doctors on a daily basis to assist them do their job. This results in infection control and patient privacy risks and error due to interruption. In this chapter, case studies display the complexity of practice and a detailed analysis is provided. Societal expectations around availability make it hard to restrict ¿personal¿? calls and in the case of privacy unsafe practices may result from lack of appropriate systems to support the communication needs of dispersed clinical teams. The balance of risk and benefit associated with mobile device use is highly context dependent; thus rather than prohibitions being needed, clinicians need to become aware of their own cognitive limitations and ensure that use is thoughtful.
|2015||Jorm C, Lancman B, 'Taking the heat in critical situations: being aware, assertive and heard', Communicating Quality and Safety in Healthcare, Cambridge University Press, Melbourne (2015)|
|Show 5 more chapters|
Journal article (76 outputs)
Sturman N, Jorm C, Parker M, 'With a grain of salt? Supervisor credibility and other factors influencing trainee decisions to seek in-consultation assistance: A focus group study of Australian general practice trainees', BMC Family Practice, 21 (2020)
© 2020 The Author(s). Background: 'Ad hoc' help-seeking by trainees from their supervisors during trainee consultations is important for patient safety, and trainee prof... [more]
© 2020 The Author(s). Background: 'Ad hoc' help-seeking by trainees from their supervisors during trainee consultations is important for patient safety, and trainee professional development. We explored trainee objectives and activities in seeking supervisor assistance, and trainee perceptions of the outcomes of this help-seeking (including the utility of supervisor responses). Methods: Focus groups with Australian general practice trainees were undertaken. All data was audio-recorded and transcribed, coded using in-vivo and descriptive codes, and analysed by the constant comparison of provisional interpretations and themes with the data. Findings are reported under the over-arching categories of help-seeking objectives, activities and outcomes. Results: Early in their general practice placements trainees needed information about practice facilities, and the "complex maze" of local patient resources and referral preferences: some clinical presentations were also unfamiliar, and many trainees were unaccustomed to making patient management decisions. Subsequent help-seeking was often characterised informally as "having a chat" or "getting a second opinion" so as not to "miss anything" when trainees were "not 100% sure". Trainees emphasised the importance of being (and demonstrating that they were) clinically safe. Workflow constraints, and supervisory and doctor-patient relationships, had a powerful influence on trainee help-seeking activities. An etiquette for providing help in front of patients was described. Trainees assessed the credibility of supervisors based on their approach to risk and their clinical expertise in the relevant area. Several trainees reported reservations about their supervisor's advice on occasions. Conclusion: A trainee's subsequent help-seeking is strongly influenced by how their supervisor responds when their help is sought. Trainees prefer to seek help from credible supervisors who respond promptly and maintain trainee 'face' in front of patients. Trainees learn through help-seeking to make their own clinical decisions but may remain uncertain about professional and societal expectations, and curious about how other general practitioners practise. Trainees value opportunities throughout their training to observe expert general practice.
Attia JR, Jorm C, Kelly B, 'Medical assistance in dying: the downside', BMJ SUPPORTIVE & PALLIATIVE CARE, 10 259-261 (2020)
Ozavci G, Bucknall T, Woodward-Kron R, Hughes C, Jorm C, Joseph K, Manias E, 'A systematic review of older patients experiences and perceptions of communication about managing medication across transitions of care', Research in Social and Administrative Pharmacy, (2020)
© 2020 Elsevier Inc. Background: Communication about managing medications may be difficult when older people move across transitions of care. Communication breakdowns may result i... [more]
© 2020 Elsevier Inc. Background: Communication about managing medications may be difficult when older people move across transitions of care. Communication breakdowns may result in medication discrepancies or incidents. Objective: The aim of this systematic review was to explore older patients¿ experiences and perceptions of communication about managing medications across transitions of care. Design: A systematic review. Methods: A comprehensive review was conducted of qualitative, quantitative and mixed method studies using CINAHL Complete, MEDLINE, Embase and PsycINFO, Web of Science, INFORMIT and Scopus. These databases were searched from inception to 14.12.2018. Key article cross-checking and hand searching of reference lists of included papers were also undertaken. Inclusion criteria: studies of the medication management perspectives of people aged 65 or older who transferred between care settings. These settings comprised patients¿ homes, residential aged care and acute and subacute care. Only English language studies were included. Comments, case reports, systematic reviews, letters, editorials were excluded. Thematic analysis was undertaken by synthesising qualitative data, whereas quantitative data were summarised descriptively. Methodological quality was assessed with the Mixed Methods Appraisal Tool. Results: The final review comprised 33 studies: 12 qualitative, 17 quantitative and 4 mixed methods studies. Twenty studies addressed the link between communication and medication discrepancies; ten studies identified facilitators of self-care through older patient engagement; 18 studies included older patients¿ experiences with health professionals about their medication regimen; and, 13 studies included strategies for communication about medications with older patients. Poor communication between primary and secondary care settings was reported as a reason for medication discrepancy before discharge. Older patients expected ongoing and tailored communication with providers and timely, accurate and written information about their medications before discharge or available for the post-discharge period. Conclusions: Communication about medications was often found to be ineffective. Most emphasis was placed on older patients' perspectives at discharge and in the post-discharge period. There was little exploration of older patients¿ views of communication about medication management on admission, during hospitalisation, or transfer between settings.
McGurgan P, Calvert KL, Narula K, Celenza A, Nathan EA, Jorm C, 'Medical students opinions on professional behaviours: The Professionalism of Medical Students (PoMS) study', Medical Teacher, 42 340-350 (2020) [C1]
© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Introduction: The Professionalism of Medical Students (PoMS) study aimed to develop a comprehensive und... [more]
© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Introduction: The Professionalism of Medical Students (PoMS) study aimed to develop a comprehensive understanding of Australian and New Zealand (Aus/NZ) medical students¿ opinions and experience with professionalism dilemmas. Methods: A confidential, online survey for medical students was developed and distributed to all Aus/NZ medical schools. Students submitted de-identified demographic information, gave opinions on the acceptability of a range of student behaviours for professionally challenging situations, and whether they had encountered similar situations. Results: 3171 medical students participated from all 21 Aus/NZ medical schools (16% of the total student population). Medical students reported encountering many of the professionally challenging situations and had varying opinions on what was acceptable behaviour for the scenarios. In general, students¿ opinions were not influenced by the seniority, gender or the type of health professional involved in the scenario. Participant demographic factors appeared to have significant effects on professional opinions¿particularly male gender and being a student in the latter stages of the course. Discussion: Medical students¿ professional opinions are a complex area. The PoMS data provides a reference point for students, their educators and other health professionals in identifying current student professional behaviour norms, determining the effects of demographic factors on their decision making, and where important gaps exist in medical students¿ approaches to professionalism.
Hooker C, Hor S, Wyer M, Gilbert GL, Jorm C, Iedema R, 'Trajectories of hospital infection control: Using non-representational theory to understand and improve infection prevention and control.', Social science & medicine (1982), 256 113023 (2020) [C1]
Jorm C, Roberts C, Gordon C, Nisbet G, Roper L, 'Time for university educators to embrace student videography', Cambridge Journal of Education, 49 673-693 (2019) [C1]
© 2019, © 2019 University of Cambridge, Faculty of Education. The authors provide an interdisciplinary investigation of student videography for assessment in higher education. Vid... [more]
© 2019, © 2019 University of Cambridge, Faculty of Education. The authors provide an interdisciplinary investigation of student videography for assessment in higher education. Video is becoming a dominant communication modality in our world; school students are taught to create and critique it and educators employ it on-line. Yet the opportunity to include appropriate video-based assessments that capture integrated graduate attributes has been largely missed in higher education. The authors reflect on a health professional student case study which illustrates how video enables students to powerfully demonstrate achievement against learning outcomes: they used filmic techniques to display empathy, patient centred collaboration and interprofessional communication. They also reflect on the barriers to video-based assessment raised by academics. Finally, they call upon leaders in higher education to recognise the utility of multi-media approaches to assessment of complex but critical graduate skills such as communication, digital literacy and interdisciplinarity, in addition to demonstrating the application of disciplinary knowledge to relevant and authentic problems.
Jorm C, Hudson R, Wallace E, 'Turning attention to clinician engagement in Victoria', Australian Health Review, 43 123-125 (2019)
© 2019 Journal Compilation AHHA. The engagement of clinicians with employing organisations and with the broader health system results in better safer care for patients. Concerns a... [more]
© 2019 Journal Compilation AHHA. The engagement of clinicians with employing organisations and with the broader health system results in better safer care for patients. Concerns about the adequacy of clinician engagement in the state of Victoria led the Victorian Department of Health and Human Services to commission a scoping study. During this investigation more than 100 clinicians were spoken with and 1800 responded to surveys. The result was creation of a clear picture of what engagement and disengagement looked like at all levels-from the clinical microsystem to state health policy making. Multiple interventions are possible to enhance clinician engagement and thus the care of future patients. A framework was developed to guide future Victorian work with four elements: setting the agenda, informing, involving and empowering clinicians. Concepts of work or employee engagement that are used in other industries don't directly translate to healthcare and thus the definition of engagement chosen for use centred on involvement. This was designed to encourage system managers to ensure clinicians are full participants in design, planning and evaluation and in all decisions that affect them and their patients.
Iedema R, Jorm C, 'Nurturing anaesthetic expertise: On narrative, affect and professional inclusivity', Communication and Medicine, 15 53-64 (2018)
Copyright © 2019 Equinox Publishing Ltd This article seeks to establish the educational and social significance of narrative and affect in anaesthetic training. Data were obtained... [more]
Copyright © 2019 Equinox Publishing Ltd This article seeks to establish the educational and social significance of narrative and affect in anaesthetic training. Data were obtained from focus group discussions involving three groups of eight (total 24) young anaesthetists from around Australia held at an Australian and New Zealand College of Anaesthetists (ANZCA) residential conference. Analysis applied to transcripts of the discussions revealed the prominence of narratives used among trainees and supervisors as a medium for explaining and nurturing anaesthetic expertise. Nurturing expertise was accomplished by sharing narratives about extreme circumstances that highlighted a need for constant vigilance directed towards not just clinical circumstances but also colleagues. The article suggests that the narrative emphasis on remaining vigilant and maintaining personal resourcefulness may explain graduands¿ tendency towards social exclusivity (avoidance of non-colleague others), and contribute to a better understanding of medicine¿s professional inclusivity (strong in-group bonding).
Jorm C, Blease J, Haq I, 'Time to establish comprehensive long-term monitoring of Australian medical graduates?', Australian Health Review, 42 635-639 (2018)
© AHHA 2018. We believe that the well being of our medical students (and medical staff throughout the continuum of practice) matters too much not to ask, 'How do they feel?&a... [more]
© AHHA 2018. We believe that the well being of our medical students (and medical staff throughout the continuum of practice) matters too much not to ask, 'How do they feel?' Society, and students themselves, have invested too much in their education not to query 'How well are they performing in the workplace?'. Our accountability to the community demands we ask, 'How are their patients going?' This article presents a schema for building long-term monitoring in Australia, using linked and reliable data, that will enable these questions to be answered. Although the answers will be of interest to many, medical schools will then be well placed to alter their programs and processes based on these three domains of graduate well being, workplace performance and patient outcomes.
Jorm C, Bleasel J, Haq I, 'Is Time to Implement Comprehensive Graduate Monitoring Programs', ACADEMIC MEDICINE, 93 1423-1424 (2018)
Roper L, Jorm C, 'Preparing medical students for the e-patient: Is a theoretical grounding required?', Medical Teacher, 39 1101 (2017)
Roberts C, Jorm C, Gentilcore S, Crossley J, 'Peer assessment of professional behaviours in problem-based learning groups', Medical Education, 51 390-400 (2017)
© 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education Context: Peer assessment of professional behaviour within problem-based learning (PBL) gr... [more]
© 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education Context: Peer assessment of professional behaviour within problem-based learning (PBL) groups can support learning and provide opportunities to identify and remediate problem behaviours. Objectives: We investigated whether a peer assessment of learning behaviours in PBL is sufficiently valid to support decision making about student professional behaviours. Methods: Data were available for two cohorts of students, in which each student was rated by all of their PBL group peers using a modified version of a previously validated scale. Following the provision of feedback to the students, their behaviours were again peer-assessed. A generalisability study was undertaken to calculate the students¿ professional behaviour scores, sources of error that impacted the reliability of the assessment, changes in student rating behaviour, and changes in mean scores after the delivery of feedback. Results: Peer assessment of professional learning behaviour was highly reliable for within-group comparisons (G = 0.81¿0.87), but poor for across-group comparisons (G = 0.47¿0.53). Feedback increased the range of ratings given by assessors and brought their mean ratings into closer alignment. More of the increased variance was attributable to assessee performance than to assessor stringency and hence there was a slight improvement in reliability, especially for comparisons across groups. Mean professional behaviour scores were unchanged. Conclusions: Peer assessment of professional learning behaviours may be unreliable for decision making outside a PBL group. Faculty members should not draw conclusions from peer assessment about a student's behaviour compared with that of their peers in the cohort, and such a tool may not be appropriate for summative assessment. Health professional educators interested in assessing student professional behaviours in PBL groups might focus on opportunities for the provision of formative peer feedback and its impact on learning.
Walton MM, Harrison R, Kelly P, Smith-Merry J, Manias E, Jorm C, Iedema R, 'Patients' reports of adverse events: A data linkage study of Australian adults aged 45 years and over', BMJ Quality and Safety, 26 743-750 (2017)
© Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights... [more]
© Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/. Background Understanding a patient's hospital experience is fundamental to improving health services and policy, yet, little is known about their experiences of adverse events (AEs). This study redresses this deficit by investigating the experiences of patients in New South Wales hospitals who suffered an AE. Methods Data linkage was used to identify a random sample of 20000 participants in the 45 and Up Cohort Study, out of 267153 adults aged 45years and over, who had been hospitalised in the prior 6months. A cross-sectional survey was administered to these patients to capture their experiences, including whether they had an AE and received honest communication about it. Results Of the 18993 eligible participants, 7661 completed surveys were received (40% response rate) and 474 (7%) reported having an AE. Most AEs related to clinical processes and procedures (33%), or medications and intravenous fluids (21%). Country of birth and admission through emergency were significant predictors of the occurrence of an event. An earlier admission in the prior 6months or a transfer to another healthcare facility was also associated with more AEs. Of those who suffered an AE, 58% reported serious or moderate effects. Conclusions Given the exclusions in our sample population (under 45years), the AE rate reported by patients of 7% is similar to the approximately 10% rate reported in the general population by retrospective medical record reviews. AE data that include patient experience may provide contextual information currently missing. Capturing and using patient experience data more effectively is critical; there may be opportunities for applying co-design methodology to improve the management of AEs and be more responsive to patients' concerns.
Hor SY, Hooker C, Iedema R, Wyer M, Gilbert GL, Jorm C, O'Sullivan MVN, 'Beyond hand hygiene: A qualitative study of the everyday work of preventing cross-contamination on Hospital wards', BMJ Quality and Safety, 26 552-558 (2017)
© 2017 BMJ Publishing Group. All rights reserved. Background: Hospital-acquired infections are the most common adverse event for inpatients worldwide. Efforts to prevent microbial... [more]
© 2017 BMJ Publishing Group. All rights reserved. Background: Hospital-acquired infections are the most common adverse event for inpatients worldwide. Efforts to prevent microbial crosscontamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical practice. Methods: We report on an interventionist videoreflexive ethnography study that explored how healthcare workers performed IPC in three wards in two hospitals in New South Wales, Australia: an intensive care unit and two general surgical wards. We conducted 46 semistructured interviews, 24 weeks of fieldwork (observation and videoing) and 22 reflexive sessions with a total of 177 participants (medical, nursing, allied health, clerical and cleaning staff, and medical and nursing students). We performed a postintervention analysis, using a modified grounded theory approach, to account for the range of IPC practices identified by participants. Results: We found that healthcare workers' routine IPC work goes beyond hand hygiene and PPE. It also involves, for instance, the distribution of team members during rounds, the choreography of performing aseptic procedures and moving 'from clean to dirty' when examining patients. We account for these practices as the logistical work of moving bodies and objects across boundaries, especially from contaminated to clean/vulnerable spaces, while restricting the movement of micro-organisms through cleaning, applying barriers and buffers, and trajectory planning. Conclusions: Attention to the logistics of moving people and objects around healthcare spaces, especially into vulnerable areas, allows for a more comprehensive approach to IPC through better contextualisation of hand hygiene and PPE protocols, better identification of transmission risks, and the design and promotion of a wider range of preventive strategies and solutions.
Roper L, Jorm C, 'Please leave your phone outside: Policymakers and medical app providers are encouraging patient participation, but doctors in the consult room are not', BMJ Innovations, 3 65-70 (2017)
Nisbet G, Jorm C, Roberts C, Gordon CJ, Chen TF, 'Content validation of an interprofessional learning video peer assessment tool', BMC Medical Education, 17 (2017)
© 2017 The Author(s). Background: Large scale models of interprofessional learning (IPL) where outcomes are assessed are rare within health professional curricula. To date, there ... [more]
© 2017 The Author(s). Background: Large scale models of interprofessional learning (IPL) where outcomes are assessed are rare within health professional curricula. To date, there is sparse research describing robust assessment strategies to support such activities. We describe the development of an IPL assessment task based on peer rating of a student generated video evidencing collaborative interprofessional practice. We provide content validation evidence of an assessment rubric in the context of large scale IPL. Methods: Two established approaches to scale development in an educational setting were combined. A literature review was undertaken to develop a conceptual model of the relevant domains and issues pertaining to assessment of student generated videos within IPL. Starting with a prototype rubric developed from the literature, a series of staff and student workshops were undertaken to integrate expert opinion and user perspectives. Participants assessed five-minute videos produced in a prior pilot IPL activity. Outcomes from each workshop informed the next version of the rubric until agreement was reached on anchoring statements and criteria. At this point the rubric was declared fit to be used in the upcoming mandatory large scale IPL activity. Results: The assessment rubric consisted of four domains: patient issues, interprofessional negotiation; interprofessional management plan in action; and effective use of video medium to engage audience. The first three domains reflected topic content relevant to the underlying construct of interprofessional collaborative practice. The fourth domain was consistent with the broader video assessment literature calling for greater emphasis on creativity in education. Conclusions: We have provided evidence for the content validity of a video-based peer assessment task portraying interprofessional collaborative practice in the context of large-scale IPL activities for healthcare professional students. Further research is needed to establish the reliability of such a scale.
Wyer M, Iedema R, Hor SY, Jorm C, Hooker C, Gilbert GL, 'Patient involvement can affect clinicians perspectives and practices of infection prevention and control: A post-qualitative study using video-reflexive ethnography', International Journal of Qualitative Methods, 16 (2017)
© The Author(s) 2017. This study, set in a mixed, adult surgical ward of a metropolitan teaching hospital in Sydney, Australia, used a novel application of video-reflexive ethnogr... [more]
© The Author(s) 2017. This study, set in a mixed, adult surgical ward of a metropolitan teaching hospital in Sydney, Australia, used a novel application of video-reflexive ethnography (VRE) to engage patients and clinicians in an exploration of the practical and relational complexities of patient involvement in infection prevention and control (IPC). This study included individual reflexive sessions with eight patients and six group reflexive sessions with 35 nurses. VRE usually involves participants reflecting on video footage of their own (and colleagues¿) practices in group reflexive sessions. We extended the method here by presenting, to nurses, video clips of their clinical interactions with patients, in conjunction with footage of the patients themselves analyzing the videos of their own care, for infection risks.We found that this novel approach affected the nurses¿ capacities to recognize, support, and enable patient involvement in IPC and to reflect on their own, sometimes inconsistent, IPC practices from patients¿ perspectives. As a ¿post-qualitative¿ approach, VRE prioritizes participants¿ roles, contributions, and learning. Invoking affect as an explanatory lens, we theorize that a ¿safe space¿ was created for participants in our study to reflect on and reshape their assumptions, positionings, and practices.
Roper L, Foster K, Garlan K, Jorm C, 'The challenge of authenticity for medical students', Clinical Teacher, 13 130-133 (2016)
© 2016 John Wiley & Sons Ltd. Background: The development of a professional identity occurs during medical school. Formal study of students' reflections on this process... [more]
© 2016 John Wiley & Sons Ltd. Background: The development of a professional identity occurs during medical school. Formal study of students' reflections on this process may provide insight into how to better support them. Methods: A qualitative data analysis of 56 student essays was undertaken. Results: Students' early interactions with patients seem to be influential in their process of identity development. Students were preoccupied with creating or preserving a professional persona in front of patients. They responded to this perceived challenge in three ways: some were concerned with controlling the experience and expression of emotion, others felt that they failed to be authentic, and the third group focused on the patient's experience of the interaction and agonised over what the patients might want. Discussion: This article adds to the literature by highlighting the struggles medical students encounter trying to behave and feel the way they think they ought. Students may be less troubled and participate more naturally in empathic communication if they learn to access authentic emotions in their interactions with patients. This article discusses strategies for medical faculties and clinical tutors to support and encourage them to do so.
Jorm C, Roberts C, Lim R, Roper J, Skinner C, Robertson J, et al., 'A large-scale mass casualty simulation to develop the non-technical skills medical students require for collaborative teamwork', BMC Medical Education, 16 (2016)
© 2016 Jorm et al. Background: There is little research on large-scale complex health care simulations designed to facilitate student learning of non-technical skills in a team-wo... [more]
© 2016 Jorm et al. Background: There is little research on large-scale complex health care simulations designed to facilitate student learning of non-technical skills in a team-working environment. We evaluated the acceptability and effectiveness of a novel natural disaster simulation that enabled medical students to demonstrate their achievement of the non-technical skills of collaboration, negotiation and communication. Methods: In a mixed methods approach, survey data were available from 117 students and a thematic analysis undertaken of both student qualitative comments and tutor observer participation data. Results: Ninety three per cent of students found the activity engaging for their learning. Three themes emerged from the qualitative data: the impact of fidelity on student learning, reflexivity on the importance of non-technical skills in clinical care, and opportunities for collaborative teamwork. Physical fidelity was sufficient for good levels of student engagement, as was sociological fidelity. We demonstrated the effectiveness of the simulation in allowing students to reflect upon and evidence their acquisition of skills in collaboration, negotiation and communication, as well as situational awareness and attending to their emotions. Students readily identified emerging learning opportunities though critical reflection. The scenarios challenged students to work together collaboratively to solve clinical problems, using a range of resources including interacting with clinical experts. Conclusions: A large class teaching activity, framed as a simulation of a natural disaster is an acceptable and effective activity for medical students to develop the non-technical skills of collaboration, negotiation and communication, which are essential to team working. The design could be of value in medical schools in disaster prone areas, including within low resource countries, and as a feasible intervention for learning the non-technical skills that are needed for patient safety.
Gordon CJ, Jorm C, Shulruf B, Weller J, Currie J, Lim R, Osomanski A, 'Development of a self-assessment teamwork tool for use by medical and nursing students', BMC Medical Education, 16 (2016)
© 2016 The Author(s). Background: Teamwork training is an essential component of health professional student education. A valid and reliable teamwork self-assessment tool could as... [more]
© 2016 The Author(s). Background: Teamwork training is an essential component of health professional student education. A valid and reliable teamwork self-assessment tool could assist students to identify desirable teamwork behaviours with the potential to promote learning about effective teamwork. The aim of this study was to develop and evaluate a self-assessment teamwork tool for health professional students for use in the context of emergency response to a mass casualty. Methods: The authors modified a previously published teamwork instrument designed for experienced critical care teams for use with medical and nursing students involved in mass casualty simulations. The 17-item questionnaire was administered to students immediately following the simulations. These scores were used to explore the psychometric properties of the tool, using Exploratory and Confirmatory Factor Analysis. Results: 202 (128 medical and 74 nursing) students completed the self-assessment teamwork tool for students. Exploratory factor analysis revealed 2 factors (5 items - Teamwork coordination and communication; 4 items - Information sharing and support) and these were justified with confirmatory factor analysis. Internal consistency was 0.823 for Teamwork coordination and communication, and 0.812 for Information sharing and support. Conclusions: These data provide evidence to support the validity and reliability of the self-assessment teamwork tool for students This self-assessment tool could be of value to health professional students following team training activities to help them identify the attributes of effective teamwork.
Jorm C, Nisbet G, Roberts C, Gordon C, Gentilcore S, Chen TF, 'Using complexity theory to develop a student-directed interprofessional learning activity for 1220 healthcare students', BMC Medical Education, 16 (2016)
© 2016 The Author(s). Background: More and better interprofessional practice is predicated to be necessary to deliver good care to the patients of the future. However, universitie... [more]
© 2016 The Author(s). Background: More and better interprofessional practice is predicated to be necessary to deliver good care to the patients of the future. However, universities struggle to create authentic learning activities that enable students to experience the dynamic interprofessional interactions common in healthcare and that can accommodate large interprofessional student cohorts. We investigated a large-scale mandatory interprofessional learning (IPL) activity for health professional students designed to promote social learning. Methods: A mixed methods research approach determined feasibility, acceptability and the extent to which student IPL outcomes were met. We developed an IPL activity founded in complexity theory to prepare students for future practice by engaging them in a self-directed (self-organised) learning activity with a diverse team, whose assessable products would be emergent creations. Complicated but authentic clinical cases (n = 12) were developed to challenge student teams (n = 5 or 6). Assessment consisted of a written management plan (academically marked) and a five-minute video (peer marked) designed to assess creative collaboration as well as provide evidence of integrated collective knowledge; the cohesive patient-centred management plan. Results: All students (including the disciplines of diagnostic radiology, exercise physiology, medicine, nursing, occupational therapy, pharmacy, physiotherapy and speech pathology), completed all tasks successfully. Of the 26 % of students who completed the evaluation survey, 70 % agreed or strongly agreed that the IPL activity was worthwhile, and 87 % agreed or strongly agreed that their case study was relevant. Thematic analysis found overarching themes of engagement and collaboration-in-action suggesting that the IPL activity enabled students to achieve the intended learning objectives. Students recognised the contribution of others and described negotiation, collaboration and creation of new collective knowledge after working together on the complicated patient case studies. The novel video assessment was challenging to many students and contextual issues limited engagement for some disciplines. Conclusions: We demonstrated the feasibility and acceptability of a large scale IPL activity where design of cases, format and assessment tasks was founded in complexity theory. This theoretically based design enabled students to achieve complex IPL outcomes relevant to future practice. Future research could establish the psychometric properties of assessments of student performance in large-scale IPL events.
Jorm C, Parker M, 'Medical leadership is the New Black: Or is it?', Australian Health Review, 39 217-219 (2015)
© AHHA 2015. Considerable resources are being invested in healthcare leadership development programs and there is a new requirement for leadership teaching for Australian medical ... [more]
© AHHA 2015. Considerable resources are being invested in healthcare leadership development programs and there is a new requirement for leadership teaching for Australian medical students. The new attention to medical leadership may be a reaction to loss of medical status and power. There is little evidence for return on investment from such programs. It is simply not clear what kind of leadership training is needed for collaborative work to improve healthcare nor what kind of organisational structures enable productive exercise of medical leadership skills. Caution is recommended.
Wyer M, Jackson D, Iedema R, Hor SY, Gilbert GL, Jorm C, et al., 'Involving patients in understanding hospital infection control using visual methods', Journal of Clinical Nursing, 24 1718-1729 (2015)
© 2015 John Wiley & Sons Ltd. Aims and Objectives: This paper explores patients' perspectives on infection prevention and control. Background: Healthcare-associated inf... [more]
© 2015 John Wiley & Sons Ltd. Aims and Objectives: This paper explores patients' perspectives on infection prevention and control. Background: Healthcare-associated infections are the most frequent adverse event experienced by patients. Reduction strategies have predominantly addressed front-line clinicians' practices; patients' roles have been less explored. Design: Video-reflexive ethnography. Methods: Fieldwork undertaken at a large metropolitan hospital in Australia involved 300 hours of ethnographic observations, including 11 hours of video footage. This paper focuses on eight occasions, where video footage was shown back to patients in one-on-one reflexive sessions. Findings: Viewing and discussing video footage of clinical care enabled patients to become articulate about infection risks, and to identify their own roles in reducing transmission. Barriers to detailed understandings of preventative practices and their roles included lack of conversation between patients and clinicians about infection prevention and control, and being ignored or contradicted when challenging perceived suboptimal practice. It became evident that to compensate for clinicians' lack of engagement around infection control, participants had developed a range of strategies, of variable effectiveness, to protect themselves and others. Finally, the reflexive process engendered closer scrutiny and a more critical attitude to infection control that increased patients' sense of agency. Conclusion: This study found that patients actively contribute to their own safety. Their success, however, depends on the quality of patient-provider relationships and conversations. Rather than treating patients as passive recipients of infection control practices, clinicians can support and engage with patients' contributions towards achieving safer care. Relevance to clinical practice: This study suggests that if clinicians seek to reduce infection rates, they must start to consider patients as active contributors to infection control. Clinicians can engage patients in conversations about practices and pay attention to patient feedback about infection risk. This will broaden clinicians' understandings of infection control risks and behaviours, and assist them to support appropriate patient self-care behaviour.
Iedema R, Hor SY, Wyer M, Gilbert GL, Jorm C, Hooker C, O Sullivan MVN, 'An innovative approach to strengthening health professionals infection control and limiting hospital-acquired infection: Video-reflexive ethnography', BMJ Innovations, 1 157-162 (2015)
© 2015, BMJ Publishing Group. All rights reserved. Objective To strengthen clinicians¿ infection control awareness and risk realisation by engaging them in scrutinising footage of... [more]
© 2015, BMJ Publishing Group. All rights reserved. Objective To strengthen clinicians¿ infection control awareness and risk realisation by engaging them in scrutinising footage of their own infection control practices and enabling them to articulate challenges and design improvements. Design and participants Clinicians and patients from selected wards of 2 hospitals in western Sydney. Main outcome measures Evidence of risk realisation and new insights into infection control as articulated during video-reflexive feedback meetings. Results Frontline clinicians identified previously unrecognised infection risks in their own practices and in their team¿s practices. They also formulated safer ways of dealing with, for example, charts and patient transfers. Conclusions Video-reflexive ethnography enables frontline clinicians to identify infection risks and to design locally tailored solutions for existing risks and emerging ones.
Khoiriyah U, Roberts C, Jorm C, Van Der Vleuten CPM, 'Enhancing students' learning in problem based learning: Validation of a self-assessment scale for active learning and critical thinking', BMC Medical Education, 15 (2015)
© 2015 Khoiriyah et al. Background: Problem based learning (PBL) is a powerful learning activity but fidelity to intended models may slip and student engagement wane, negatively i... [more]
© 2015 Khoiriyah et al. Background: Problem based learning (PBL) is a powerful learning activity but fidelity to intended models may slip and student engagement wane, negatively impacting learning processes, and outcomes. One potential solution to solve this degradation is by encouraging self-assessment in the PBL tutorial. Self-assessment is a central component of the self-regulation of student learning behaviours. There are few measures to investigate self-assessment relevant to PBL processes. We developed a Self-assessment Scale on Active Learning and Critical Thinking (SSACT) to address this gap. We wished to demonstrated evidence of its validity in the context of PBL by exploring its internal structure. Methods: We used a mixed methods approach to scale development. We developed scale items from a qualitative investigation, literature review, and consideration of previous existing tools used for study of the PBL process. Expert review panels evaluated its content; a process of validation subsequently reduced the pool of items. We used structural equation modelling to undertake a confirmatory factor analysis (CFA) of the SSACT and coefficient alpha. Results: The 14 item SSACT consisted of two domains "active learning" and "critical thinking." The factorial validity of SSACT was evidenced by all items loading significantly on their expected factors, a good model fit for the data, and good stability across two independent samples. Each subscale had good internal reliability (>0.8) and strongly correlated with each other. Conclusions: The SSACT has sufficient evidence of its validity to support its use in the PBL process to encourage students to self-assess. The implementation of the SSACT may assist students to improve the quality of their learning in achieving PBL goals such as critical thinking and self-directed learning.
Westbrook MT, Braithwaite J, Travaglia JF, Long D, Jorm C, Iedema RA, 'Promoting safety: Longer-term responses of three health professional groups to a safety improvement programme', International Journal of Health Care Quality Assurance, 20 555-571 (2007)
Patient safety has been addressed since 2002 in the health system of New South Wales, Australia via a Safety Improvement Programme (SIP), which took a system-wide approach. The pr... [more]
Patient safety has been addressed since 2002 in the health system of New South Wales, Australia via a Safety Improvement Programme (SIP), which took a system-wide approach. The programme involved two-day courses to educate healthcare professionals to monitor and report incidents and analyse adverse events by conducting root cause analysis (RCA). This paper aims to predict that all professions would favour SIP but that their work and educational histories would result in doctors holding the least and nurses the most positive attitudes. Alternative hypotheses were that doctors' relative power and other professions' team-working skills would advantage the respective groups when conducting RCAs. Responses to a 2005 follow-up questionnaire survey of doctors (n=53), nurses (209) and allied health staff (59), who had participated in SIP courses, were analysed to compare: their attitudes toward the course; safety skills acquired and applied; perceived benefits of SIP and RCAs; and their experiences conducting RCAs. Significant differences existed between professions' responses with nurses being the most and doctors the least affirming. Allied health responses resembled those of nurses more than those of doctors. The professions' experiences conducting RCAs (number conducted, leadership, barriers encountered, findings implemented) were similar. Observational studies are needed to determine possible professional differences in the conduct of RCAs and any ensuing culture change that this may be eliciting. There is strong professional support for SIPs but less endorsement from doctors, who tend not to prefer the knowledge content and multidisciplinary teaching environment considered optimal for safety improvement education. This is a dilemma that needs to be addressed. Few longer-term SIPs' assessments have been realised and the differences between professional groups have not been well quantified. As a result of this paper, benefits of and barriers to conducting RCAs are now more clearly understood. © 2007, Emerald Group Publishing Limited
Braithwaite J, Westbrook MT, Travaglia JF, Iedema R, Mallock NA, Long D, et al., 'Are health systems changing in support of patient safety?: A multi-methods evaluation of education, attitudes and practice', International Journal of Health Care Quality Assurance, 20 585-601 (2007)
Purpose - The purpose of this study is to evaluate the effects of a health system-wide safety improvement program (SIP) three to four years after initial implementation. Design/me... [more]
Purpose - The purpose of this study is to evaluate the effects of a health system-wide safety improvement program (SIP) three to four years after initial implementation. Design/methodology/approach - The study employs multi-methods studies involving questionnaire surveys, focus groups, in-depth interviews, observational work, ethnographic studies, documentary analysis and literature reviews with regard to the state of New South Wales, Australia, where 90,000 health professionals, under the auspices of the Health Department, provide healthcare to a seven-million population. After enrolling many participants from various groups, the measurements included: numbers of staff trained and training quality; support for SIP; clinicians' reports of safety skills acquired, work practices changed and barriers to progress; RCAs undertaken; observation of functioning of teams; committees initiated and staff appointed to deal with adverse events; documentation and computer records of reports; and peak-level responses to adverse events. Findings - A cohort of 4 per cent of the state's health professionals has been trained and now applies safety skills and conducts RCAs. These and other senior professionals strongly support SIP, though many think further culture change is required if its benefits are to be more fully achieved and sustained. Improved information-handling systems have been adopted. Systems for reporting adverse incidents and conducting RCAs have been instituted, which are co-ordinated by NSW Health. When the appropriate structures, educational activities and systems are made available in the form of an SIP, measurable systems change might be introduced, as suggested by observations of the attitudes and behaviours of health practitioners and the increased reporting of, and action about, adverse events. Originality/value - Few studies into health systems change employ wide-ranging research methods and metrics. This study helps to fill this gap. © Emerald Group Publishing Limited.
Iedema RAM, Jorm C, Long D, Braithwaite J, Travaglia J, Westbrook M, 'Turning the medical gaze in upon itself: Root cause analysis and the investigation of clinical error', Social Science and Medicine, 62 1605-1615 (2006)
In this paper, we discuss how a technique borrowed from defense and manufacturing is being deployed in hospitals across the industrialized world to investigate clinical errors. We... [more]
In this paper, we discuss how a technique borrowed from defense and manufacturing is being deployed in hospitals across the industrialized world to investigate clinical errors. We open with a discussion of the levers used by policy makers to mandate that clinicians not just report errors, but also gather to investigate those errors using root cause analysis (RCA). We focus on the tensions created for clinicians as they are expected to formulate 'systems solutions' that go beyond blame. In addressing these matters, we present a discourse analysis of data derived during an evaluation of the NSW Health Safety Improvement Program. Data include transcripts of RCA meetings which were recorded in a local metropolitan teaching hospital. From this analysis we move back to the argument that RCA involves clinicians in 'immaterial labour', or the production of communication and information, and that this new labour realizes two important developments. First, because RCA is anchored in the principle of health care practitioners not just scrutinizing each other, but scrutinizing each others' errors, RCA is a challenging task. Second, thanks to turning the clinical gaze in on the clinical observer, RCA engenders a new level of reflexivity of clinical self and of clinical practice. We conclude with asking whether this reflexivity will lock the clinical gaze into a micro-sociology of error, or whether it will enable this gaze to influence matters superordinate to the specifics of practice and the design of clinical treatments; that is, the over-arching governance and structuring of hospital care. © 2005 Elsevier Ltd. All rights reserved.
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Conference (5 outputs)
STAMFORD JA, JORM CM, 'ISOFLURANE DECREASES NORADRENALINE RELEASE IN THE RAT LOCUS-COERULEUS BY A MECHANISM NOT INVOLVING AUTORECEPTORS', BRITISH JOURNAL OF ANAESTHESIA (1994)
JORM CM, STAMFORD JA, 'ACTIONS OF ALPHA2-ADRENOCEPTOR AGONISTS ON NORADRENALINE RELEASE IN THE RAT LOCUS-CERULEUS', BRITISH JOURNAL OF ANAESTHESIA (1993)
PALIJ P, JORM CM, STAMFORD JA, 'CHARACTERIZATION OF MONOAMINE EFFLUX IN RAT LOCUS-CERULEUS SLICES USING FAST CYCLIC VOLTAMMETRY', BRITISH JOURNAL OF PHARMACOLOGY (1993)
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Report (1 outputs)
Searles A, Gleeson M, Reeves P, Jorm C, Leeder S, Karnon J, et al., 'The Local Level Evaluation of Healthcare in Australia: Health Systems Improvement and Sustainability (HSIS) National Initiative', Australian Health Research Alliance (2019)
Grants and Funding
|Number of grants||2|
Click on a grant title below to expand the full details for that specific grant.
20201 grants / $1,028,236
Addressing the evidence gap on medical nutrition therapy for primary and secondary prevention of cardiovascular disease in regional and rural communities$1,028,236
Funding body: Department of Health
|Funding body||Department of Health|
|Project Team||Professor Clare Collins, Professor John Attia, Professor Jennifer May, Professor Andrew Boyle, Doctor Tracy Schumacher, Doctor Megan Rollo, Professor Christine Jorm, John Baillie, Doctor Shanthi Ramanathan|
|Scheme||MRFF - Primary Health Care|
|Type Of Funding||C1300 - Aust Competitive - Medical Research Future Fund|
20191 grants / $2,000,000
Rapid Applied Research Translation$2,000,000
Funding body: Department of Health
|Funding body||Department of Health|
|Project Team||Professor Christine Jorm, Conjoint Professor David Durrheim, Professor Nicholas Goodwin, Professor Erica James, Doctor Nicole Nathan, Professor Neil Spratt, Associate Professor Luke Wolfenden|
|Scheme||MRFF Rapid Applied Research Translation Grant|
|Type Of Funding||C1300 - Aust Competitive - Medical Research Future Fund|