Browsing by Author "Burch, Vanessa"

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    The effect of structured reflection on the diagnostic accuracy of postgraduate trainees during real patient encounters
    (2016) Rush, Colin James; Burch, Vanessa
    Structured reflection has been shown to improve the diagnostic competence of undergraduate and postgraduate trainees in a range of experimental settings using written case scenarios. Evidence supporting the use of this strategy during real patient encounters is lacking. This paper reports on a study conducted to determine the effects of structured reflection on the diagnostic accuracy of postgraduate medical trainees during bedside tutorials using real patient encounters. Method Fifty-five postgraduate trainees in Internal Medicine at the University of Cape Town, South Africa, were prospectively studied during 18 beside tutorials using real patient encounters. Each patient encounter was conducted as a 4-stage diagnostic process and a diagnostic accuracy score (DAS) was calculated for all participants at each stage: • DAS 1: immediately upon arrival at the patient's bedside (visual cues only); • DAS 2: after an oral presentation of the interview and physical examination findings (pre-reflection); • DAS 3: after review of the clinical data using a process of structured reflection (post-reflection); • DAS 4: after discussion of the patient facilitated by the attending physician (facilitated reflection). Memory structure and flexibility in thinking of participants were evaluated using the Diagnostic Thinking Inventory (DTI) and compared to their post-reflection diagnostic accuracy scores. Results A total of 212 diagnostic events were studied. Friedman's test demonstrated a significant difference when comparing the median diagnostic accuracy scores (DAS) of the respective stages of the diagnostic process (χ² (3) = 406.34, p value < 0.001). The Wilcoxon signed-rank test confirmed that there was a significant difference between the immediate DAS (DAS 1) and the pre-reflection DAS (DAS 2) (Z = 8.66, p value < 0.001), the pre-reflection DAS (DAS 2) and the post reflection DAS (DAS 3) (Z = 4.98, p value < 0.001). Linear regression identified a significant relationship between DTI scores and DAS 3 (p value = 0.035), however this explains only a small portion of the variation in the data (r² = 0.093). Conclusion Structured reflection improved the diagnostic accuracy of postgraduate trainees during real patient encounters at the bedside. These data provide support for the suggestion that clinical teachers should consider adding structured reflection to their toolbox of bedside teaching strategies. In addition, DTI scores may help clinical teachers identify trainees struggling with the development of diagnostic expertise.
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    Health sciences undergraduate education at University of Cape Town: a story of transformation
    (Health & Medical Publishing Group, 2012) Hartman, Nadia; Kathard, Harsha; Perez, Gonda; Reid, Steve; Irlam, James; Gunston, Geney D; Janse van Rensburg, Vicki; Burch, Vanessa; Duncan, Madeleine; Hellenberg, Derek; Van Rooyen, Ian; Smouse, Mantoa; Sikakane, Cynthia N; Badenhorst, Elmi; Ige, B
    Undergraduate education and training in the Faculty of Health Sciences at the University of Cape Town has become socially responsive. A story of transformation that is consonant with wider societal developments since the 1994 democratic elections, outlining the changes in undergraduate curricula across the faculty, is presented.
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    A prospective evaluation of the feasibility of using enrolled nursing auxiliaries to triage patients in the emergency unit of an urban public hospital in South Africa
    (2006) Bruins, Stevan Raynier; Burch, Vanessa
    Includes bibliographical references (leaves 73-80).
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    The role of a medical high care unit in service provision at an urban secondary level hospital in South Africa
    (2005) Van Zyl-Smit, Richard Nellis; Burch, Vanessa; Willcox, Paul
    Because of the large number of critically ill patients presenting to GF Jooste Hospital each month it is essential that adequate allocation of resources be done in order to address this need. Given this high demand for critical care service provision in a seceondary level hospital, a prospective audit of service provision by the HCU at the GF Jooste Hopital was undertaken.
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    The role of abdominal ultrasound in the investigation of suspected extrapulmonary and disseminated tuberculosis
    (2007) Patel, Maya Nathu; Beningfield, Stephen J; Burch, Vanessa
    The primary objective was to undertake a prospective study in order to determine whether abdominal lymphadenopathy detected at ultrasound examination could be used as an indicator of the presence of active extrapulmonary and/or disseminated TB.
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    The power of patient-side teaching - still of benefit to student and patient
    (2006) Seggie, Janet; Burch, Vanessa
    As Ramani points out, the patient-side, which may occur in in-patient or ambulatory settings, is the ‘perfect venue for triangular interactions between teacher, trainees and patient’. Linked as they typically are to busy public-sector hospitals, South African medical schools are still in the (some might say, dubiously) fortunate position of offering a wealth of clinical experience to their undergraduates and new graduates.