BackgroundMedical student clinical confidence and positive attitudes to patient centredness are important outcomes of medical education. The clinical placement setting is regarded as a critical support to these outcomes, so understanding how the setting is influential is important. The aim of this study was to compare students’ attitudes towards patient-centredness and clinical confidence as they progressed through their medical course, and understand the influence of diverse clinical placement zones.MethodsStudents at one Australian medical school completed a questionnaire at the beginning of second year and at the end of their third year of medical training. The questionnaire measured attitudes to patient centred care, clinical confidence, role modelling experiences and clinical learning experiences. Descriptive analyses investigated change in these attitudes over time. Repeated measures analysis of variance was used to assess the influence of placement location on each variable of interest. Responses to two open-ended questions were also coded by two researchers and themes were identified.ResultsStudent confidence increased over the course of two years of clinical training (p < 0.001), but attitudes to patient centredness (p = 0.933) did not change. The location of clinical placements (urban, outer urban and rural) was unrelated to levels of confidence or patient centredness. Students had positive attitudes towards patient-centredness throughout, and noted its importance in contributing to quality care. Patient-centred care was encouraged within the clinical placements, and was influenced by positive and negative role modelling, direct teaching, and opportunities to practise patient-centred care.ConclusionsA new generation of doctors with a strong patient-centred focus is emerging. Medical schools have a responsibility to facilitate clinical placements that will support the acquisition and maintenance of skills in patient centred care through positive role modelling.

1976). Aust. paediat. J., 12, 296-304. Growth and development of fat in adolescent school children in Victoria. Part I. Normal growth values and prevalence of obesity.A cross-sectional study of 5347 Victorian secondary school children aged 11-18 years is reported. Measurements of height, weight and skinfold thickness over triceps and suhscapular regions have been used to construct centile charts for these parameters.Centile values for Victorian children indicate that they are somewhat shorter than British children and have somewhat greater triceps skinfold thickness measurements.Obesity has been defined as a weight 20% in excess of the expected weight for height and age. On this basis, and comparing each child to the normal data, the prevalence of obesity was approximately S% for girls and from 3.5 to 6.3% with increasing age for boys. From 17-2070 of girls and 9-15% of boys were overweight by 10% or more of their expected weight for height.

Griffiths, Leonie (1976). Aust. paediut. J.. 12, 305-312. Growth and development of fat in adolescent school children in Victoria. Part IT. Influence of ethnic, geographic and socio-economic factors.Data from the survey of prowth attainment of 5347 Virtorian school rhildren aped 11 to 18 vears has been analysed to determine the influence of ethnic, ceozraphic and socio-economic factors on measurements of heiyht, weight and skinfold thickness.Children living in the country tended to be taller than thoce living in the metropolitan area of Melbourne, and were slimmer as measured hy skinfold thickness.Second Feneration Australian boys were taller than boys from families in which one or both parents had migrated to Australia. The same was true for girls until the ape of 15 years. Skinfold thickness measurements from children with Ttalian or Greek horn parents were greater than second zeneration Australian children. most of whose families came originally from the U.K.The effect of socio-economic factors on growth could not bc ascessed from this study because of overlap of the variablcs studied. Tt w w conrll~ded however that bnth ethnir and geographic factors were independently related to prowth in height and body fat.

Background: Health professions education teaches students to notice particular things, but has given little attention to teaching 'noticing' as a form of personal inquiry. The former is self-evidently important, as it develops a way of seeing and behaving that is uniquely relevant to each health profession. Despite this emphasis, health professionals may fail to notice 'warning signs' in patients, be unaware of their own biases or develop unrecognised habits that have moved away from accepted standards. It has been suggested that such 'not noticing' is currently endemic.Approach: We situate our exploration of noticing in the mathematics and science education literature and John Mason's treatise on 'The discipline of noticing', differentiating between the observations that people make as they go about their lives ('ordinary' noticing), the specialised noticing that underpins professional expertise (Professional Noticing) and practices that can enhance the capacity to notice and to learn from experience (Intentional Noticing). We make the case for teaching health professions students about these conceptualisations of noticing, being able to notice with all our senses, and learning about the practices of Intentional Noticing in particular, which we suggest will have utility across health professional careers and personal lives.Implications: We acknowledge the difficulties in transferring heterogenous finding from one field to another but suggest that there are gains to be made in applying these noticing concepts to health professions education. We tentatively propose some strategies and activities for developing Professional Noticing and the practices of Intentional Noticing and link them to a new module that we are piloting with health professions students. As well as aiding health professionals sharpen their noticing abilities, reinvigorate their practice and interrogate assumptions that underpin health care, we suggest that ideas about 'noticing' may also help educators and researchers in the health professions reimagine their work.