Virtual conference: School of Population Health and School of Medicine

Jordan VMB, Greenwood G, Glen J, Farquhar C and Showell M

Background:

In order to fulfill the implied contract between researchers and the participants of research, trial results need to be disseminated. Patients and careers have identified publication and dissemination as one of the key areas of research wastage that they are concerned about.

Australian research has reported the time lag between when funding was allocated by the National Health and Medical Research Council (NHMRC) and when results were published. Of trials that were funded between 2008 and 2011 only 50% had been published. The median time was 7.1 years after funding had been received. This research wastage was estimated to be Aus$30 million over a 3 year period.

The Health Research Council (HRC) in New Zealand is the “crown agency which is responsible managing the Government’s investment in health research”. The HRC funds research Programmes (up to $5 million of funding over five years) and Projects (up to $1.2 million over three years). These Programmes and Projects have been selected through a rigorous peer review system.

Objectives:

To determine the length of time to publication for publicly funded research in New Zealand.

Methods:

We investigated projects and programs funded by the HRC from 2006-2014. The HRC supplied us with the collated Programme and Project information publicly available on their website.

In order to determine if researchers had disseminated their research findings we undertook a search of the literature databases using investigators names and subject area. To find clinical trial registrations we searched WHO ICTRP & Clinical trials.gov and for conference publications and journal articles we searched MEDLINE, Embase and Google Scholar. Searches were conducted from December 2019- February 2020.

Results:

There were a total of 374 Programmes and Projects funded over this time.

We were able to identify published findings for 191 of these (51%) which means 183 (49%) of the Programmes and Projects that were publicly funded, had not published results that were able to be found in peer-reviewed journals. This unpublished research had received in total $258,988,275 NZD. Data will also be presented on time to publication for those published Programmes and Projects and a more in depth look by discipline and funding level will be discussed.

Conclusions:

There is serious concern about the level of dissemination of publicly funded research. Funding research granting bodies need additional resources in order to actively monitor funded projects. This could ensure that dissemination of results are achieved. Research funding organisations should consider levers to encourage publication of complete and usable research results such as making public the outputs of their own monitoring processes (as per the WHO joint statement on public disclosure of results from clinical trials).  

Showell MS, Stedman K, Farquhar C, Jordan V

Background:

Cochrane aims to produce ‘gold standard of evidence”. The Cochrane Gynaecology and Fertility Group (CGF) produce systematic reviews (SRs), within this subject area, using trials from a database of over 19,500 randomised control trials (RCTs). We believe many of these RCTs are not currently adding to the evidence base as there are gaps in the topics covered by the existing SRs.

Objectives:

The main aim of this project is to identify gaps in evidence by identifying the RCTs, published in the area of gynaecology that have not been used in Cochrane SRs.

Methods:

We conducted an audit of all fertility trials in the CGF specialised register, published 2010-2011. The search function in CRS web could quickly identify which trials had been ‘included’, ‘excluded’ or simply ‘not used’ in SRs across the Collaboration. We then classified the ‘not used trials’ into their population/condition and intervention. From this point we looked at the existing SRs in CGF to assess whether they in fact could be incorporated. The remaining ‘not used trials’ were grouped into potential review topics.

Results:

564 trials from 2010-2011 were found from our database search. From these 59 have been excluded as did not meet inclusion criteria, 318 were already used in Cochrane SRs reviews, of the unused trials, 108 could fit into a review if the review was updated (19%), and 79 trials (14%) had no existing SR topic and were classified as ‘unused’. The population groups were categorised as ‘women’, ‘men’, ‘oocytes’ and ‘sperm’, the intervention categories varied in accordance to the different treatments for each population. The largest population group with unused trials was ‘Women’ (52%) and within this group, the most common unused intervention was ‘Chinese herbal medicines’ (17%). In second largest population group “Oocytes’ (23%), ‘Preservation’ was the largest intervention group (28%). In order to develop new review titles, we looked at those topics that had at least three unused trials and developed eight proposed titles. The new title with the most unused trials was ‘Chinese medicine for women undergoing assisted reproductive technologies’ for which we found six unused trials.

Conclusions:

We were satisfied that Cochrane SRs were covering most topics in fertility, however there are improvements to be made, both in developing new titles and in updating existing reviews. By identifying the populations and interventions not currently systematically reviewed by Cochrane, we can now develop priority topics and thus provide better healthcare evidence and reduce research waste.

Patient or healthcare consumer involvement:

Subfertile couples will be asked to prioritise the proposed new review titles in terms of perceived importance and we will only progress those titles of importance into Cochrane fertility SRs.

Principal Author: Setayesh Rahmanipour, BHSc (Hons), Phd Candidate,

Co-authors: Associate Professor Janet Fanslow, Dr. Ladan Hashemi, Associate Professor Janine Wiles

Thematic Area: Positive Psychology

Objective:

The Mental Health Continuum-Short Form (MHC-SF) is a brief measure that assess three components of well-being (Emotional Wellbeing (EW), Psychological Wellbeing (PW), and Social Wellbeing (SW)). Despite previous studies assessing the use of the Mental Health Continuum-Short Form (MHC-SF) scale in a New Zealand (NZ) context, further investigation was required across larger and more gender-balanced sample. The present research aimed at studying the psychometric properties of the Mental Health Continuum–Short Form in a sample of 2051 New Zealand adults (50% males; 50% females).

Methods:

Construct validity was studied by conducting confirmatory factor analysis. Factor loadings, correlations between the factors and fit indices were examined to determine the model fit. The estimation method was robust Maximum Likelihood without missing values. Cronbach’s alphas were used to assess the internal consistency of three sub-scales (i.e. EW, PW, and SW).

Results:

Findings indicated an adequate fit of a three-dimensional model (CFI = 0.95, GFI=0.968, RMR= 0.035 and RMSEA = 0.053) confirming the structural validity of the model. Factor loadings showed high correlations between the latent variables (EW-PW=.88, PW-SW=.87, and EW-SW=.65), indicating that the variables are highly inter-related. The factor loadings ranged from 40 to 78. Cronbach’s alphas were .77, .72, and .71 for EW, PW, and SW respectively confirming adequate internal consistency of the three sub-scales. Gender and age factorial invariance will be discussed.

Conclusions:

The current psychometric evaluation indicates the MHC-SF is a reliable and valid instrument to assess overall well-being and its components among New Zealand adults. A strength of this study being that the sample size is larger compared to previous studies using this scale in NZ. Results are useful for further explorations of how to enhance positive mental health outcomes for this population.

Key-words: Mental health, MHC-SF, New Zealand, CFA, internal consistency, construct validity

Authors: Dr Shomel Gauznabi, Dr Sanjeev Krishna, Assoc Prof Andy Wearn

Background:

It is getting increasingly difficult to provide real patients for medical students’ clinical examination skills assessment. With tightening budgets, increasing student numbers and inconsistency in patients, alternative methods need to be employed to provide reliable and valid assessment of medical students’ clinical skills. Simulated patients (SPs) have been increasingly used given their consistency, reliability and practical advantages. However, SPs also raise concerns regarding their validity for assessing students’ abilities in recognising abnormal clinical signs.

Aims:

To explore the evidence supporting the use of SPs in the assessment of medical students’ clinical skills and how simulation technologies could be integrated into such assessment to allow for the assessment of identifying abnormal clinical signs.

Methods:

A literature review was conducted after a search through 3 databases – Medline, Embase and ERIC – looking for papers published between 2005 – 2020 using SPs in the context of medical student assessments.

Results:

137 articles were returned from the 3 databases with 13 papers subsequently being suitable for review following abstract and full text review. The studies were heterogeneous in their study methodologies with several integrating simulation technologies and others exploring the use of SPs in non-conventional contexts.

Discussion:

The heterogeneity of the studies presented challenges in directly comparing them. One of the questions elucidated during this review is that medical educators need to be clear what skill a clinical assessment is designed to test. One of the areas where SPs might be deficient is in replicating authentic clinical signs, which is where simulation technologies may have an increasingly significant role to play.

Conclusion:

Simulated patients can be augmented with simulation technologies in clinical skills assessments of medical students. Such solutions provide considerable practical advantages and retain assessment validity, without significantly sacrificing the authentic clinical signs real patients usually provide in these assessments.  

Yasmine Abid, Charlotte J. W. Connell, Branko Sijnja, Antonia Verstappen, Phillippa Poole

Introduction/background:

New Zealand (NZ) faces a shortage of rural medical professionals. In an effort to increase interest in rural practice, both medical schools offer rural immersion programmes.

Aim:

To compare the effect of Long (>27 week), Short (5-week), or no rural immersion on career location intentions of NZ medical students.

Methods:

Linked data from the Commencing Medical Students Questionnaire (CMSQ) and Exit Questionnaire (EQ), collected by the Medical Schools Outcomes Database between 2011 – 2017 was used. The main outcome measure was EQ career location intention (Rural, Regional, Urban). Explanatory variables included Rural immersion (Long, Short, None), age, ethnicity, background, CMSQ career location intention, gender, specialisation preferences, and interest in rural medicine.

Results:

Full data were available from 1367 medical students. Rural exposure was a significant predictor of EQ career location intention in the final multivariate model. Long rural immersion students were 6.4 and 4.4 times more likely to select a Rural or Regional intention, respectively, than those with no rural immersion. CMSQ career location intention, background, ethnicity, interest in rural medicine and specialisation preference were also significant predictors.

Discussion:

Long rural immersion is highly beneficial for increasing interest in rural work. Additionally, a three-category classification for geographical background and career location intention permitted a more holistic analysis of the interplay between explanatory variables and rural immersion in influencing career intentions.

Conclusions:

Long rural immersion increases the likelihood that medical students’ will intend to work outside an urban setting. Postgraduate follow-up is required to ascertain if career location intentions materialize.

Phillippa Poole, Dylan Van Lier, Antonia Verstappen, Warwick Bagg, Charlotte J. W. Connell, Garry Nixon, Tim J. Wilkinson

Introduction/background:

Rural background is associated with greater student interest in rural practice. New Zealand (NZ) medical schools have rural origin entry schemes in an effort to address the ongoing shortage of rural doctors. However, a major challenge in regards to medical education and healthcare delivery is the lack of a universally-agreed definition of ‘rural’.

Aim/objectives:

Explore the consequences of applying differing rural definitions in workforce terms.

Methods:

The study included University of Auckland students who completed a survey at medical school entry between 2009 and 2017. Responses were used to classify students according to seven rural definitions. Associations were made between student background and the population size of the geographic region that students intended to practice.

Results:

1592 (2096 total respondents; 92% response rate) students remained after applying exclusion criteria. 27.4% had a rural background according to at least one definition, and 3% met all definitions. Rural background was associated with a higher likelihood of intending to work outside urban areas compared to a non-rural background for all definitions. A restricted definition of ‘rural’ (home-town population <25,000) was associated with a higher relative risk of rural practice intention (7.7) versus a broad definition of rural (home-town population < 100,000; relative risk 4.5).

Conclusions:

Those involved in rural health workforce development should consider rural definitions given the degree of association between rural background and rural practice differs depending on the definition applied. For the NZ context we propose a three-category classification (metropolitan | regional | rural) based on population size.