Understandings and practices: Towards socially responsive curricula for the health professions

Radiation therapist education and the changing landscape in Africa

In the changing global landscape, education programs for radiation therapists (RTTs), also known as therapeutic radiographers or radiation therapy technologists, at higher education institutions (HEIs) are non-existent in many African countries. In countries with local RTT education programs, there is evidence of a wide variety of qualification types, including in-house training, diploma and degree offerings. However, what is consistent is the integrated curriculum approach to classroom theory and clinical work-based learning that across the continent follows the general structure of a work-integrated learning (WIL) approach, to enhance clinical competence and meet the needs of the health sector. This study used a qualitative approach with thematic analysis of publicly available documents and reflective writings followed by further analysis through application of the Cultural Historical Activity Theory (CHAT) to explore the changing landscape of oncology in Africa and the impact of this on the education of RTTs. The study was guided by the reflective research question: How can the systemic understanding of RTT training in a changing landscape enable competent and caring practice? The study extends prior research on RTT education in Africa and contributes to debates on the changing role of RTTs in a rapidly changing environment.

Pregnancy experiences of transgender and gender-expansive individuals: A systematic scoping review from a critical midwifery perspective

BACKGROUND

Evidence suggests that transgender and gender-expansive people are more likely to have suboptimal pregnancy outcomes compared with cisgender people. The aim of this study was to gain a deeper understanding of the role of midwifery in these inequities by analyzing the pregnancy experiences of transgender and gender-expansive people from a critical midwifery perspective.

METHODS

We conducted a systematic scoping review. We included 15 papers published since 2010 that reported on pregnancy experiences of people who had experienced gestational pregnancy at least once, and were transgender, nonbinary, or had other gender-expansive identities.

RESULTS

Three themes emerged from our analysis: "Navigating identity during pregnancy," "Experiences with mental health and wellbeing," and "Encounters in the maternal and newborn care system." Although across studies respondents reported positive experiences, both within healthcare and social settings, access to gender-affirmative (midwifery) care and daily social realities were often shaped by trans-negativity and transphobia.

DISCUSSION

To improve care outcomes of transgender and gender-expansive people, it is necessary to counter anti-trans ideologies by "fixing the knowledge" of midwifery curricula. This requires challenging dominant cultural norms and images around pregnancy, reconsidering the way in which the relationship among "sex," "gender," and "pregnancy" is understood and given meaning to in midwifery, and applying an intersectional lens to investigate the relationship between gender inequality and reproductive inequity of people with multiple, intersecting marginalized identities who may experience the accumulated impacts of racism, ageism, and classism. Future research should identify pedagogical frameworks that are suitable for guiding implementation efforts.

Inclusivity in health professional education: how can virtual simulation foster attitudes of inclusion?

Disparities in accessing quality healthcare persist among diverse populations. Health professional education should therefore promote more diversity in the health workforce, by fostering attitudes of inclusion. This paper outlines the potential of virtual simulation (VS), as one method in a system of health professional education, to promote inclusion and diversity. We conceptualise how VS can allow learners to experience an alternative to what HPE currently is by drawing on two social justice theorists, Paulo Freire, and Nancy Fraser and their ideas about 'voice' and 'representation'. We present two principles for VS design and implementation: (1) giving voice to learners has the power to transform; and (2) representation in VS builds inclusion. We provide practical means of building voice and representation into VS learning activities, followed by an example. Purposeful and thoughtful integration of these principles paves the way for a more diverse and inclusive healthcare workforce.

Medical teachers' identity learning during major curriculum renewal: A landscapes of practice perspective

PURPOSE

To explore how medical teachers navigate their professional identities when required to implement critical pedagogy during an undergraduate curriculum renewal initiative.

METHODS

A qualitative exploratory study was conducted, using focus groups and individual interviews with twenty-six purposively selected undergraduate medical teachers at a South African university. Data were transcribed, coded, and thematically analysed. Concepts of Landscapes of Practice Theory and Teacher Identity Learning provided an interpretive framework.

RESULTS

Findings show that medical teachers' perceived capacity to implement critical pedagogy was influenced by identities that were constructed within the boundaries of a traditional biomedical curriculum. Three themes were identified, highlighting the inherent liminality of traversing a changing educational landscape: engaging in new practices: moving into the boundary space; attempting alignment: navigating identity in the boundary space; imagining the future: embracing identity in the boundary space.

CONCLUSION

Globally directed curriculum renewal imperatives may challenge the established pedagogical practices and professional identities of medical teachers. There is a need for institutional spaces that foster collaboration, dialogue, and reflection with a view to supporting the ongoing identity learning and development of knowledgeability of medical teachers responsible for curriculum transformation.

My paper has been rejected without review. What do I do now?

This column is intended to address the kinds of knotty problems and dilemmas with which many scholars grapple in studying health professions education. In this article, the authors address the question of why papers may be desk rejected (rejected without going out for formal peer review) and describe simple steps for authors to optimize their work so it gets past the desk reject stage.