Dissertations / Theses on the topic 'Physicians (General practice) Training of Australia'

Bibliography: leaves 554-636. Examines aspects of teaching medical students communication skills at a time when they are entering their clinical years. Integrates reports of 12 data-gathering exercises centred on medical student communication skills with the international literature, and with the author's reflections as an experienced educator and G.P. Recommends that communication skills training in a general practice setting should be a crucial factor in all future training of medical students.

To train to be a general practitioner in the U.K. a doctor must spend two years in hospital training posts and one year in general practice as a general practice registrar (GPR). Concern has been expressed in the literature about both the duration and adequacy of general practice training. A literature review identified that there was limited knowledge of and understanding about the learning experiences of GPRs. The aim of the study was to describe and interpret the learning experiences of GPRs in the South East of Scotland during their year in general practice. The methodology was derived from Denzin's concept of Interpretivism and involved in depth interviews over time with GPRs and thick description to capture and interpret the GPRs learning experiences. Two cohorts of 24 GPRs were recruited, cohort one ran from September 2002 to July 2003 and cohort two from September 2003 to August 2004. The GPRs were interviewed on three occasions during their year. In addition to the interviews six GPR focus groups and six GP trainer focus groups were held over the period December 2002 to September 2003. 21 GPRs in cohort one completed all three interviews and 20 GPRs in cohort two. All the participating GPRs completed at least two interviews. The results were interpreted within the educational concept of the curriculum. Four main curricula were identified during the GPR year: these were the formal, assessment, individual and hidden. Each independently contributed to the GPRs learning and also interacted synergistically at various times during the year. In the last quarter of the year there was a tension between the requirements of the assessment and individual curricula. The individual curriculum which was composed of the GPRs clinical experiences and in particular epiphanies was the main driver of GPR learning. Epiphanies were identified by GPRs as having the most significant impact on their learning. Central to this learning was the contribution of their general practice trainer who supported their learning both through the development of the practice learning environment and the promotion of reflection and self directed learning. GPR learning during the year was an iterative process, which involved a reflective and supported interaction between the GPR, their clinical experiences, epiphanies and their trainer. Through this process the GPRs became self directed and reflective learners and developed individual learning networks which led to changes in the way they practiced medicine. This process also led to the socialisation of their learning and promoted their integration into the culture of working general practice, through which they were exposed to the working realities of life as a general practitioner and these experiences had a critical effect on their future career choice. A number of important policy implications were identified which have implications for the present and future direction of training for general practice. The process of thick description and the longitudinal nature of the study allowed for a new interpretation of the learning experiences of GPRs and added to the knowledge and understanding of how GPRs learn during their training.

Background: Dissemination of evidence-based mental health clinical practice guidelines had not been studied in Australia prior to the National General Practice Guideline Implementation Program. This naturalistic research reports ten national interventions designed to disseminate the NHMRC 1997 Clinical Practice Guideline Depression in Young People for GPs (GDIYP-GP) through 123 Divisions of General Practice. The guideline covered depression and suicide in young people aged 13 to 20 years. Aim: To evaluate a 'coordinated link agent' and 'enhanced packaged approach' for disseminating a national guideline by engaging 20 Divisions in using 5 dissemination models and to measure Divisions' capacities in performing unfunded local dissemination to GPs. Method: An Implementation Kit was the main national intervention, housing the guidelines and 5 models: Education by the Division; Education by an external provider; 3) Clinical Audit; 4) Segmented Formats and 5) Appraisal. Five studies are reported: 1) an organisational census on guideline-related practices in all topics; 2) a Case Study Database of 3 consecutive interviews of 51 participating Divisions; 3) a Guideline Appraisal study of 9 cohorts of doctors; 4) a Clinical Audit study of 54 doctors involving 1200 patients; and 5) a 'Segmented Formats' documentary analysis of Division communications on GDIYP-GP. Results: Prior dissemination by most Divisions was administrative mail outs rather than planned programs. In all, 70 instead of the pilot 20 organisations participated (57% of the sector) using 10,000 guidelines: 45 participated by 7 weeks and 71 by 35 weeks and the majority used multiple active strategies showing fidelity to the Kit. Education by the Division, Segmented Formats and Appraisal were the most adopted models. GDIYP-GP was acceptable and relevant to the majority of Divisions and to 9 samples of doctors. Conclusion: Divisions are one appropriate system through which evidence-based mental health guidelines can be disseminated to general practitioners. Uptake can be rapid using a flexible enhanced package approach with link-agent support. 3-6 months is needed for organisations to begin effective interventions. Divisions reorient their approach with guidance toward evidence-based dissemination but Division and practice barriers

As the Australian population is expanding and ageing, there is an associated need for a focus to be placed on the Individual rights of elderly people, and for the general populus to be made more aware of areas related to our older generation. Elder abuse, as an area of concern, developed as an offshoot of investigations into child abuse and general domestic violence, and initially surfaced in the 1970s and 80s. Some sections of the medical profession were made specifically aware of the problem initially in 1975, through a letter that was sent to the British Medical Journal. However, throughout some of the literature, GPs have been criticised about their level of awareness of the issue of elder abuse, and for their lack of involvement in this area. The purpose of this study was to explore how General Practitioners and Aged Care workers perceive incidences of elder abuse. Due to the limited amount of research which has been undertaken on elder abuse within Australia, the study looked at exploring the issue rather than trying to measure its cause, or trying to identify the extent of the problem. The study investigated the perceptions of general practitioners (GPs) toward the area of elder abuse, and looked further to explore how general practitioners were perceived by aged care workers. The approach used for data collection consisted of circulating 100 mailed out questionnaires to general practitioners within metropolitan Perth, and follow up face-to-face interviews with some of the respondents to this questionnaire. Additionally, face-to-face interviews were also held with key informants who worked in the aged care industry, to ascertain their perceptions of elder abuse. The mailed questionnaires were analysed by adding the frequencies of responses given to each question. The data from the face-to-face doctor interviews and the key informant interviews were transcribed verbatim from the tape recordings and then assessed by looking for consistent regularities from each response made, therefore using a cross-case analysis. From this analysis, patterns emerged in the data, from which themes were developed. The recommendations from the data suggest that a clear and concise definition of elder abuse needs to be developed, to assist in clearly Identifying the prevalence of the problem. The data further recommended the need for an awareness campaign on the area of elder abuse to be undertaken. This should focus on raising the awareness of the possible characteristics of individuals who are vulnerable to being abused, as well as the characteristics of likely perpetrators of abuse. This study also recommended that a coordinated approach to dealing with the area of elder abuse should be developed, which should include the development of specific roles that should be undertaken by professional and non-professionals. Training of people across the Human Services field in the area of elder abuse, and in particular, GPs, social workers and paraprofessionals who work with elderly people, was identified as a recommendation of the study. Areas of training should include: awareness of the problem's existence; providing people with the required skills to detect cases of abuse; providing insight to referral agencies who may be able to assist; having a clear and exhaustive list of interventions to use to assist with addressing the problem; and having knowledge of the characteristics that abused individuals, and perpetrators are likely to have. This study also Identified that more research is required to ascertain if the amount of time which GPs spend with elderly people, is sufficient for them to identify cases of elder abuse, and if the allocated time from Medicare is adequate for GPs to Identify elder abuse.

Thesis (MFamMed)--Stellenbosch University, 2014.
BACKGROUND:Family physicians are trained to enable them to staff community health centres and primary care hospitals. Part of this training is teaching them procedural skills for anaesthetics and surgery. Knysna hospital is a training facility for family medicine registrars and this article aims to evaluate if sufficient learning opportunities exist in Knysna hospital’s theatre to teach family medicine registrars procedural skills. METHODS:A descriptive study was undertaken of the number and type of procedures performed in Knysna hospital theatre for a one year period, and compared with the required skills,as stipulated in the national training outcomes, for the discipline. RESULTS:Three thousand seven hundred and forty one procedures were performed during the study period. Anaesthesia was the most common procedure, followed by caesarean section. There were adequate opportunities for teaching most core skills. CONCLUSIONS: There were sufficient opportunities for a registrar to be taught all the core skills that are exclusive to theatre. Further research is needed to evaluate Knysna hospital as a training facility for all procedural skills.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.

Thesis (M.D.)--University of Adelaide, Dept. of General Practice, 2005.
Includes publications published as a result of ideas developed in this thesis, inserted at end. "April 2005" Includes bibliographical references (leaves 210-242).

Thesis (PhD)--University of Stellenbosch, 2004.
ENGLISH ABSTRACT: District hospitals play a pivotal role in the district health system of the Western Cape and other provinces of South Africa. It is a dual role, supporting both primary health care services and serving as a gateway to higher levels of care. Most district hospitals are in rural areas, staffed by generalist medical practitioners who provide health services often supplied by specialists in urban areas. There is a paucity of research and published material on the scope of practice of district hospital practitioners in South Africa, as well as the factors influencing the performance of their duties. There were two main objectives for this study. Firstly, to identify the professional knowledge and skills of medical practitioners delivering district hospital services in the Western Cape and to compare these with service platform needs. Secondly, to use the information gathered to make recommendations regarding human resource development and appropriate education and training and continuing professional development of these doctors. The study was conducted in three phases to ensure coherent evolution of investigation, co-ordination and response. Phase One was a comprehensive survey, utilising district hospital data, medical officer questionnaires and in-depth interviews to determine the professional knowledge and skills of medical practitioners working in district hospitals in the Western Cape. This information gathering endeavour resulted in a skills and knowledge compendium being formulated. It established that the spectrum of functions required of these doctors was extremely wide - ranging from the management of undifferentiated problems to performing complex surgical procedures, as well as providing a vital public health function. Two main factors influenced their performance, namely their working conditions and the education and training which they received.In common with rural practice in other countries, it was apparent that the working environment had a major impact on attitudes and functioning. These findings were developed into a conceptual framework depicting the negative influences that can build up and result in these doctors opting out of rural practice. In addition, other influences were established having a profound effect on doctors’ satisfaction, mainly in the realm of education and training. This gave rise to a second more comprehensive framework being evolved, encapsulating the positive and negative factors enhancing or retarding efficiency and satisfaction in the workplace. Phase Two of the study consisted of the validation of the findings of the basic research data. In keeping with the second aim of the study, the education and training perspectives of rural and district hospital practice were explored. The deficiencies exposed have implications for undergraduate and postgraduate education and training, as well as for continuing professional development programmes. Phase Three concentrated on the exploration of ways and means of defining and maintaining ongoing professional competence for district hospital practice. This was approached by using the data captured in Phase One and refined in Phase Two to pose a series of educational problems to a group of experts. Using the Delphi Technique, a series of electronic exchanges achieved consensus on a range of topics varying from educational content to learning modalities and modern adult teaching techniques applicable to district hospital practice. This research presents information defining the circumstances, experiences and needs of medical practitioners working in district hospitals in the Western Cape province of South Africa. It reveals clear challenges to the capacity, attitudes, costs, isolation, political will, monitoring and organisation which will be crucial in the development of future human resource strategies.It, furthermore, defines the educational objectives, content and methods required to establish and maintain the ongoing professional competence of medical practitioners delivering district hospital services in the Western Cape.
AFRIKAANSE OPSOMMING: Distrikshospitale speel ‘n sentrale rol in die distriksgesondheidstelsel van die Wes- Kaap en ander provinsies in Suid-Afrika. Dit is ‘n dubbele rol wat beide primêre gesondheidsorgdienste ondersteun en optree as ‘n deurgang vir verwysing na hoër vlakke van sorg. Die meeste distrikshospitale is te vinde in plattelandse gebiede. Dit is hier waar die algemene geneeskundige praktisyn dienste lewer wat gewoonlik deur spesialiste in stedelike gebiede verrig word. Daar is ‘n gebrek aan bestaande navorsing en publikasies oor die omvang van praktyk van geneeshere in distrikshospitale in Suid- Afrika, sowel as onvoldoende inligting in verband met faktore wat die funksionering van hierdie praktisyns beïnvloed. Hierdie studie het twee hoofdoelwitte vervat. Die eerste doelwit was die bepaling van die professionele kennis en vaardighede van geneeshere werksaam in distrikshospitale in die Wes-Kaap, en die vergelyking daarvan met die behoetes van die diensplatform. Die tweede doelwit was om hierdie inligting te gebruik om aanbevelings te doen aangaande menslike hulpbronontwikkeling en toepaslike onderrig, opleiding en voortgesette professionele ontwikkeling vir hierdie geneeshere. Die studie is in drie fases uitgevoer om samehangende ontwikkeling van ondersoek, koördinasie en respons te verseker. Fase Een het bestaan uit ‘n omvattende opname van die professionele kennis en vaardighede van geneeshere werksaam in distrikshospitale in die Wes-Kaap deur die gebruik van distrikshospitaaldata, vraelyste vir geneeshere, en in-diepte onderhoude. Die resultate is gebruik om ‘n omvattende stel kennis en vaardigheidsareas te identifiseer. Fase Een het bewyse gelewer dat die rol en funksie van dokters in distrikshospitale uitsonderlik wyd is en wissel tussen die hantering van ongedifferensieërde probleme en die uitvoer van komplekse chirurgiese prosedures, sowel as ‘n belangrike rol in openbare gesondheid. Werksomstandighede en onderrigen opleiding is geïdentifiseer as die twee belangrikste invloede wat die uitvoer van hierdie praktisyns se pligte beïnvloed. Soortgelyk aan plattelandse praktyke in ander lande, het dit duidelik geword dat werksomstandighede ‘n groot invloed op houdings en funksionering het. Hierdie bevindings is saamgevoeg in ‘n konseptuele raamwerk om die negatiewe invloede toe te lig wat veroorsaak dat hierdie geneeshere die plattelandse diens verlaat. Ander faktore wat ‘n beduidende uitwerking op praktisyns se werksbevrediging gehad het, veral wat onderrig en opleiding betref, is saamgevat in ‘n tweede en omvattende raamwerk wat die positiewe en negatiewe invloede op effektiwiteit van dienslewering en werksverrigting uitspel. Fase Twee van die studie het bestaan uit die bevestiging van die bevindings van die basiese navorsingsinligting. Perspektiewe in die onderrig en opleiding vir plattelandse praktyk is ondersoek in oorleg met die tweede doelwit van die studie. Verskeie implikasies vir voorgraadse en nagraadse onderrig en opleiding en voortgesette professionele ontwikkelingsprogramme is uit ontblote tekortkomings geïdentifiseer. Die omskrywing en die behoud van professionele bevoegdheid is in Fase Drie ondersoek. Data verkry in Fase Een, en verfyn in Fase Twee, is gebruik in die ontwikkeling van ‘n reeks opvoedkundige vraagstukke. ‘n Groep deskundiges is daarna die taak gestel om konsensus te bereik oor ‘n spektrum van onderwerpe, insluitend toepaslike inhoud, metodes van leer en moderne volwasse onderrigtegnieke vir distrikshospitaal praktykvoering. Die Delphi tegniek met herhalende elektroniese rondtes is hiervoor gebruik. Hierdie navorsing lewer inligting wat die omstandighede, ondervindings en behoeftes van geneeshere werksaam in distrikshospitale in die Wes-Kaap provinsie van Suid- Afrika beskryf.Die navorsing onthul duidelike uitdagings vir die kapasiteit, houdings, koste, isolasie, politieke wilskrag, monitering en organisasie van strategieë vir die ontwikkeling van menslike hulpbronne. Dié navorsing definieër hierbenewens die opvoedkundige doelwitte, inhoude en metodes wat nodig is vir die vestiging en instandhouding van die professionele bevoegdheid van distrikshospitaalpraktisyns in die Wes-Kaap.

Bibliography: leaves 554-636.
637 leaves
Examines aspects of teaching medical students communication skills at a time when they are entering their clinical years. Integrates reports of 12 data-gathering exercises centred on medical student communication skills with the international literature, and with the author's reflections as an experienced educator and G.P. Recommends that communication skills training in a general practice setting should be a crucial factor in all future training of medical students.
Thesis (M.D.) -- University of Adelaide, Dept. of Psychiatry, 2000

Over the last seven years the recruitment of overseas trained doctors (OTDs) has formed a significant part of Australia’s policy to address the medical workforce issue of geographic maldistribution to ensure that communities in rural and remote Australia have access to adequate general practice (GP) services. This policy has not been without problems, particularly in the areas of assessment of skills and qualifications, appropriate orientation and integration into Australian communities, and retention of these doctors within rural and remote communities. To date there has been little evidence-based research on the role of OTDs in the medical workforce in Australia. This study explores the service provision and quality of care provided by OTDs using the 5 Year OTD Scheme as the case study. In doing so, it assesses the adequacy of this strategy and discusses the implications for future workforce policies and programs. A mixed method design was used in the study. The quantitative component involved secondary analysis of Medicare Australia data for all OTDs participating in the 5 Year OTD Scheme in 2002 and all Australian trained doctors (ATDs) practising in rural and remote Australia in the same year. A log Poisson regression model was used to assess the interactive effect of the various GP characteristics, such as age, sex, experience and practice location with OTD/ATD status on the rate of a particular service item per patient, adjusted for patient age and sex. The qualitative component involved two focus groups with OTDs which were used to help explain the relationships between variables found in the quantitative component of the study. Template analysis was used to identify themes from the focus group. Significantly different rates per patient between OTDs and ATDS were found across most service items and GP characteristics examined. The greatest variation was found among items relating to in-surgery consultations and non-surgery consultations such as nursing home visits. Fewer differences were found between groups relating to pathology, imaging or procedural services. Analysis of surrogate quality items identified few differences between OTDs and ATDs. The focus group identified a number of other factors that influenced their patterns of service and accounted for some of the differences identified in the quantitative analysis. These factors included knowledge of the health care system in Australia, cultural and communication influences, health conditions of patients, patient and community attitudes, remuneration influences and training influences. These had varying degrees of influence on their patterns of service. The reasons for the differences found between OTDs and ATDs are partially explained by the characteristics of the GPs examined and partially explained by other external influences that relate to the particular circumstances of the OTDs, such as knowledge of the Australian health care system and cultural and communication issues. Understanding the nature of practice is central to ensuring appropriate professional support measures. The study findings highlight the need for a targeted training program for OTDs that address the areas that have the greatest influence on patterns of service to ensure that rural and remote communities receive the same quality of service from OTDs as provided by ATDs.
http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1320385
Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008

Over the last seven years the recruitment of overseas trained doctors (OTDs) has formed a significant part of Australia’s policy to address the medical workforce issue of geographic maldistribution to ensure that communities in rural and remote Australia have access to adequate general practice (GP) services. This policy has not been without problems, particularly in the areas of assessment of skills and qualifications, appropriate orientation and integration into Australian communities, and retention of these doctors within rural and remote communities. To date there has been little evidence-based research on the role of OTDs in the medical workforce in Australia. This study explores the service provision and quality of care provided by OTDs using the 5 Year OTD Scheme as the case study. In doing so, it assesses the adequacy of this strategy and discusses the implications for future workforce policies and programs. A mixed method design was used in the study. The quantitative component involved secondary analysis of Medicare Australia data for all OTDs participating in the 5 Year OTD Scheme in 2002 and all Australian trained doctors (ATDs) practising in rural and remote Australia in the same year. A log Poisson regression model was used to assess the interactive effect of the various GP characteristics, such as age, sex, experience and practice location with OTD/ATD status on the rate of a particular service item per patient, adjusted for patient age and sex. The qualitative component involved two focus groups with OTDs which were used to help explain the relationships between variables found in the quantitative component of the study. Template analysis was used to identify themes from the focus group. Significantly different rates per patient between OTDs and ATDS were found across most service items and GP characteristics examined. The greatest variation was found among items relating to in-surgery consultations and non-surgery consultations such as nursing home visits. Fewer differences were found between groups relating to pathology, imaging or procedural services. Analysis of surrogate quality items identified few differences between OTDs and ATDs. The focus group identified a number of other factors that influenced their patterns of service and accounted for some of the differences identified in the quantitative analysis. These factors included knowledge of the health care system in Australia, cultural and communication influences, health conditions of patients, patient and community attitudes, remuneration influences and training influences. These had varying degrees of influence on their patterns of service. The reasons for the differences found between OTDs and ATDs are partially explained by the characteristics of the GPs examined and partially explained by other external influences that relate to the particular circumstances of the OTDs, such as knowledge of the Australian health care system and cultural and communication issues. Understanding the nature of practice is central to ensuring appropriate professional support measures. The study findings highlight the need for a targeted training program for OTDs that address the areas that have the greatest influence on patterns of service to ensure that rural and remote communities receive the same quality of service from OTDs as provided by ATDs.
Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008

"June 2002"
Bibliography: p. 347-360.
xiii, 360, [200] p. : ill. ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Thesis (M.Med.Sc.)--University of Adelaide, Dept. of Public Health, 2002

Bibliography: p. 379-394.
xi, 394 p. ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 1988

This thesis empirically examines the impact of economic changes on: i. the health of the general Australian population, and ii. the claim incidence experience of the Australian Disability Income Insurance (DII) business. Changes in economic conditions have been captured via movements in the unemployment rate. Changes in health by the following two indicators: a. mortality rate, and b. per capita general physician (GP) visits. In many countries it has been established that short-run cyclical patterns in mortality are associated with economic fluctuations. In Chapter 2, an aggregate state level panel data analysis is used to investigate the general pattern of cyclical mortality in Australia for the period 1985-2008. Employing a fixed effects regression methodology, we show that there is a significant counter-cyclical pattern of mortality (mortality increases during economic contractions) in the general Australian population. Evidence in the literature suggests that the pattern of cyclical mortality experienced in other countries is varied. Drawing from this literature, it is argued that one reason for the observed counter-cyclical mortality in Australia is the relatively high level of social security expenditure. In Chapter 3, a poisson fixed effects analysis shows that, in Australia, over the period 1994-2010, per capita GP visits increase with economic expansions. This may indicate that self-perceived morbidity in Australia is pro-cyclical in nature. At first glance, while this result appears to be in contradiction with counter-cyclical mortality (established in Chapter 2), it is argued that the various financial and psychological factors that cause a reduction in GP visits during economic downturns may be a factor in explaining the increase in mortality observed in Chapter 2. Practitioners of DII commonly believe that DII claims experience is highly correlated with economic movements. In Chapter 4, using claims incidence data from Australian DII business for the period 1986-2001, and a conditional model, it is found that the incidence of claims significantly increases with increasing unemployment, illustrating a counter-cyclical pattern of claims incidence. Moreover, a multinomial logit analysis on cause of claim shows that the probability of a new claim arising from accidents significantly increases with increasing unemployment. The results suggest that the counter-cyclical pattern of claim incidence may stem from increasing claims for minor causes amongst the insured population. Our results are important from the perspective of policy makers and insurance companies. For example, to a policy maker, evidence of counter-cyclical mortality and pro-cyclical GP visits provides insights on the impact of economic changes on health. This may lead to further research in order to isolate the causes of these relationships and quantify the social costs associated with tackling the issues. From the perspective of an insurer, the counter-cyclical patterns of mortality and DII claims may help them to incorporate appropriate premium loadings and capital reserves in anticipation of economic downturns.

Patient-doctor relationships between same-sex attracted women and general practitioners (GPs) have been presented as problematic in the literature. The problems arise from women’s concerns about the potential for negative attitudes amongst GPs. They also relate to GPs’ concerns about offending patients if they ask about sexual orientation due to the stigmatised nature of minority sexual orientation. As a result, disclosure of sexual orientation can be difficult and the patient-doctor relationship can be compromised. The aim of this study was to explore the nature of patient-doctor relationships in this context and how optimal relationships can be achieved.
Using a critical hermeneutic approach, I conducted in-depth interviews with 33 same-sex attracted women and 28 doctors. This included 24 pairs of people in a current patient-doctor relationship. I found that women commonly experienced silencing of their minority sexual orientation within general practice settings, but that this was occasionally desired and not problematic for some women and most GPs. For other women and for many GPs, the silence resulting from a lack of disclosure was a response to perceived risks to women’s personal identity and GPs’ professional identity. Few GPs asked directly about sexual orientation, placing the burden of responsibility for disclosure on same-sex attracted women. Building reciprocal trust could overcome the perceived risks inherent in revealing minority sexual orientation. I initially defined optimal patient-doctor relationships in terms of existing models of cultural competence and patient-centredness; however I found that such relationships were built on cultural sensitivity rather than cultural competence, and relationship-centredness rather than patient-centredness.
I developed a new model of sexual identity disclosure that demonstrated the key influences on disclosure of sexual orientation to GPs for same-sex attracted women. These influences were women’s sexual identity experience, risk perceptions, and the level of knowing within the patient-doctor relationship. The model depicts women’s range and fluidity of sexual identity experiences and challenges current assumptions that disclosure is essential for effective health care. The model has transformative potential for general practice education and research. It could assist GPs to understand that not all women desire disclosure, but that the majority of women are happy to disclose if asked. GPs would be encouraged to take note of the socio-political environment in which women live and its influence on women’s fears and actual experiences of discrimination. Finally, understanding the role of trust and reciprocal knowing in mitigating perceived risks would encourage GPs to focus more on relationship building. This could also assist GPs to overcome their own perceptions of risk and encourage them to broach the subject of sexual orientation, ultimately enhancing the patient-doctor relationship.

Includes publications published as a result of ideas developed in this thesis, inserted at end.
"April 2005"
Includes bibliographical references (leaves 210-242)
242 leaves :
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Examines goal setting in people with diabetes as part of chronic disease management in a rural setting. The studies were performed in Eyre Peninsula with a significant (10-20%) Aboriginal population.
Thesis (M.D.)--University of Adelaide, Dept. of General Practice, 2005

Includes publications published as a result of ideas developed in this thesis, inserted at end.
Includes bibliographical references (leaves 210-242)
242 leaves
Examines goal setting in people with diabetes as part of chronic disease management in a rural setting. The studies were performed in Eyre Peninsula with a significant (10-20%) Aboriginal population.
Thesis (M.D.) -- University of Adelaide, Dept. of General Practice, 2005