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Melo VD, Saifuddin H, Peng LT, Wolanskyj-Spinner AP, Marshall AL, Leep Hunderfund AN. Signs, Sources, Coping Strategies, and Suggested Interventions for Burnout Among Preclerkship Students at a U.S. Medical School: A Qualitative Focus Group Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:987-996. [PMID: 38648293 DOI: 10.1097/acm.0000000000005744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE Research suggests that burnout can begin early in medical school, yet burnout among preclerkship students remains underexplored. This study aimed to characterize burnout signs, sources, coping strategies, and potential interventions among preclerkship students at one U.S. medical school. METHOD The authors conducted a qualitative study of preclerkship students at Mayo Clinic Alix School of Medicine (MCASOM) in June 2019. Participants completed 2 Maslach Burnout Inventory (MBI) items (measuring frequency of emotional exhaustion and depersonalization) and 2 free-text questions on burnout before participating in 1 of 3 semistructured focus groups. Focus group questions were derived from a literature review on medical student burnout with input from the MCASOM Student Life and Wellness Committee. Group discussions were recorded, transcribed, coded inductively, and analyzed iteratively (along with free-text comments) using a general inductive approach from a constructivist perspective. RESULTS Eighteen of 111 eligible students (16%) participated, with 5/18 (28%) reporting weekly emotional exhaustion and/or depersonalization on MBI items. Analysis of focus group transcripts showed that most students had experienced burnout symptoms during their first or second year, corresponding with school-related stressors and manifesting in cognitive-emotional, physical, and verbal-behavioral ways. Students identified systemic, institutional, and individual burnout drivers and discussed how these drivers interacted (e.g., high standards of excellence at the system level interacted with anxiety and maladaptive thinking at the individual level, creating pressure to always do more). Students used various coping strategies (e.g., self-care, peer support, reframing, and compartmentalization) but emphasized limitations of these strategies and recommended interventions directed toward systemic and institutional burnout drivers. CONCLUSIONS This study offers insights into burnout signs and sources among preclerkship medical students that can inform future large-scale studies. Results suggest that burnout emerges from dynamic interactions among systemic, institutional, and individual factors and may benefit from multipronged interventions.
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Alsbury-Nealy K, Scodras S, Colquhoun H, Jaglal SB, Munce S, Salbach NM. Exploring the role of healthcare partners in referrals to a community-based exercise program with a healthcare-community partnership designed for people with balance and mobility limitations. Disabil Rehabil 2024:1-9. [PMID: 39154242 DOI: 10.1080/09638288.2024.2390045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 06/24/2024] [Accepted: 08/04/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE To explore how healthcare partners in community-based exercise programs for people with balance and mobility limitations perceive and enact referral in the context of their role. MATERIALS AND METHODS We conducted a descriptive, qualitative study involving semi-structured interviews and reflexive thematic analysis. RESULTS Twelve healthcare partners from the Together In Movement and Exercise (TIMETM) program completed interviews. Seven (58%) participants were clinicians and 5 (42%) held non-clinical roles. The most common professional background of participants was physical therapy (n = 9, 75%). Clinicians made direct referrals while non-clinical participants facilitated referral by promoting the program. The main theme was healthcare partners perceive their role in referrals as secondary to their role as educators and trainers. Subthemes were: (1) healthcare partners fulfill educator and trainer roles when conducting formal training of instructors, educating instructors during program visits, and fielding questions; (2) almost all healthcare partners facilitate referral by sharing program information formally and informally; and (3) healthcare partners in clinical practice make direct referrals depending on the clientele. CONCLUSIONS Healthcare partners perceive their roles as educators and trainers as taking precedence over their role in referrals. Findings can be used to guide selection and training of healthcare partners, design of clinical education programs, and research on competencies.
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Affiliation(s)
- K Alsbury-Nealy
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - S Scodras
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - H Colquhoun
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - S B Jaglal
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- The KITE Research Institute, University Health Network, Toronto, Canada
| | - S Munce
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- The KITE Research Institute, University Health Network, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - N M Salbach
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- The KITE Research Institute, University Health Network, Toronto, Canada
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Hoang K, Grow HM, Rooholamini SN, McPhillips H, Selling SK, Rassbach CE, Blankenburg R. Impact of Longitudinal Coaching on Pediatric Residents' Professional Identity Formation: A Multi-Institution Qualitative Study. Acad Pediatr 2024; 24:866-874. [PMID: 38729301 DOI: 10.1016/j.acap.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 03/27/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Coaching has emerged in medical education as a strategy for trainees' development and has been endorsed by the Coalition for Physician Accountability and the American Medical Association. However, there is a lack of literature on how coaching impacts residents' professional identity formation (PIF). The purpose of this study was to explore how longitudinal clinical coaching impacted the professional identity of residency graduates. METHODS In July to November 2020, we conducted an Institutional Review Board-approved qualitative study with semistructured interviews of residency graduates from 2 pediatric programs who participated in a longitudinal coaching program. We inductively analyzed the transcripts using thematic analysis, guided by the sensitizing principles of PIF. We did a member check to enhance trustworthiness. RESULTS We interviewed 34 residency graduates from 2 institutions and identified 4 themes on how coaches influenced residency graduates' PIF by 1) the presence of a trusting relationship; 2) creating trust and sense of belonging through longitudinal encounters, supportive reflection, and formative feedback; 3) integrating clinical skill, career interests, and work-life integration; and 4) reflecting on their own personal and professional identities. Residency graduates highlighted coaching strategies that coaches, coaching programs, and residents themselves can take to promote resident PIF during residency. CONCLUSIONS Residency coaches have the potential to influence residents' PIF through their longitudinal relationship grounded in trust. Coaching strategies can be used to enhance resident clinical and professional development during residency training.
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Affiliation(s)
- Kim Hoang
- Department of Pediatrics (K Hoang, CE Rassbach, and R Blankenburg), Stanford University School of Medicine, Calif.
| | - Helene Mollie Grow
- Department of Pediatrics (HM Grow, SN Rooholamini, and H McPhillips), University of Washington School of Medicine, Seattle
| | - Sahar N Rooholamini
- Department of Pediatrics (HM Grow, SN Rooholamini, and H McPhillips), University of Washington School of Medicine, Seattle
| | - Heather McPhillips
- Department of Pediatrics (HM Grow, SN Rooholamini, and H McPhillips), University of Washington School of Medicine, Seattle
| | - Sarah Kate Selling
- Department of Pediatrics, Stanford University School of Medicine (SK Selling), Calif
| | - Caroline E Rassbach
- Department of Pediatrics (K Hoang, CE Rassbach, and R Blankenburg), Stanford University School of Medicine, Calif
| | - Rebecca Blankenburg
- Department of Pediatrics (K Hoang, CE Rassbach, and R Blankenburg), Stanford University School of Medicine, Calif
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Kiourtidis K, Nikolaidou S, Rouka E, Lange J, Griva K, Liakopoulos V, Zarogiannis SG. Assessment of the perceptions of health-related quality of life in Greek patients undergoing automated peritoneal dialysis with remote monitoring: A qualitative study. Ther Apher Dial 2024. [PMID: 38923684 DOI: 10.1111/1744-9987.14180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/27/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND This study aimed to explore in depth the lived experience and quality of life outcomes in patients receiving automated peritoneal dialysis (APD) treatment. METHODS The study adhered to the standards of the Consolidated Criteria for Reporting Qualitative Research. A total of 19 APD patients were recruited and assessed using in-depth semi-structured interviews on various aspects of life with respect to APD modality. The interviews were transcribed verbatim and analyzed using Interpretive Phenomenological Analysis. RESULTS Study findings generated five superordinate themes: (a) treatment-free daily routine, (b) sleep disturbances, (c) remote care, (d) limitations of peritoneal dialysis, and (e) the dimension of chronic disease. Further analysis of the material revealed the relationship of these themes with individual patient characteristics. CONCLUSIONS Overall, our findings suggest that APD characteristics contribute to the perceptions of quality of life in patients under dialysis considerably.
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Affiliation(s)
- Kyriakos Kiourtidis
- Primary Health Care Postgraduate Program, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, Larissa, Greece
| | - Sofia Nikolaidou
- Primary Health Care Postgraduate Program, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, Larissa, Greece
| | - Erasmia Rouka
- Department of Nursing, School of Health Sciences, University of Thessaly, GAIOPOLIS, Larissa, Greece
| | | | - Konstantina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sotirios G Zarogiannis
- Primary Health Care Postgraduate Program, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, Larissa, Greece
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, Larissa, Greece
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Alrø AB, Svenningsen H, Nedergaard HK, Jensen HI, Dreyer P. Patients' and relatives' experiences of cognitive impairment following an intensive care unit admission. A qualitative study. Aust Crit Care 2024:S1036-7314(24)00091-2. [PMID: 38839438 DOI: 10.1016/j.aucc.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/02/2024] [Accepted: 05/02/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Cognitive impairment poses a significant challenge following critical illness in the intensive care unit. A knowledge gap exists concerning how patients experience cognitive impairments. OBJECTIVES The aim was to explore patients' and relatives' experiences of patients' cognitive impairment due to critical illness following an intensive care unit admission. METHODS A qualitative multicentre study was conducted in Denmark with 3- and 6-month follow-ups using single and dyadic interviews. A phenomenological hermeneutic approach was adopted using a Ricoeur-inspired textual in-depth analysis method. The Consolidated Criteria for Reporting Qualitative Research checklist was used. RESULTS Three themes emerged from interviews with 18 patients and 14 relatives: 'It feels like living in a parallel world', 'Getting back to a normal everyday life with a vulnerable self', and 'Managing everyday life using self-invented strategies'. Patients used self-invented strategies to manage their vulnerability and newly acquired cognitive impairments when no help or support was provided specifically targeting their cognitive impairments. Not being as cognitively capable as they previously had been turned their lives upside down. Losing control and not being themselves made them vulnerable. Patients did not want to burden others. However, support from relatives was invaluable in their recovery and rehabilitation. CONCLUSIONS Patients experienced multiple cognitive impairments affecting their adaption to everyday life. They strove to overcome their vulnerability using a variety of self-invented strategies and activities.
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Affiliation(s)
- Anette Bjerregaard Alrø
- Department of Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Aarhus University, Institute of Public Health, Section of Nursing, Bartholins Alle' 2, 3. sal, Building 1260, 8000 Aarhus C, Denmark.
| | - Helle Svenningsen
- Research Centre for Health and Welfare Technology, VIA University College, Campus Aarhus N, Hedeager 2, Aarhus N, Denmark.
| | - Helene Korvenius Nedergaard
- Department of Anaesthesiology and Intensive Care, University Hospital of Southern Denmark, Kolding, Sygehusvej 24, 6000 Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Winsløvsparken 19,3., 5000 Odense C, Denmark.
| | - Hanne Irene Jensen
- Departments of Anaesthesiology and Intensive Care, Kolding Hospital, University Hospital of Southern Denmark, Denmark; Departments of Anaesthesiology and Intensive Care, Vejle Hospital, University Hospital of Southern Denmark, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Pia Dreyer
- Department of Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Aarhus University, Institute of Public Health, Section of Nursing, Bartholins Alle' 2, 3. sal, Building 1260, 8000 Aarhus C, Denmark.
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Merenda T, Denis J, Patris S. Pharmaceutical care for visually impaired patients: a qualitative study of community pharmacists' needs and professional experience. Int J Clin Pharm 2024; 46:665-674. [PMID: 38407693 DOI: 10.1007/s11096-023-01684-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/30/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND Visual impairment is a disability that can have a significant impact on the ability to take medication safely. As a result, pharmacists must adjust their practice to provide targeted and adapted support for this type of patient. AIM The aims of the present study were (1) to illustrate the usual clinical practice of community pharmacists to support the optimisation of medication use in visually impaired patients, and (2) to identify solutions to improve pharmaceutical care for visually impaired patients. METHOD Semi-structured interviews with 18 French-speaking community pharmacists were conducted via videoconference in Belgium. Participants were recruited on a voluntary basis and through a snowball method. An interview guide was developed based on literature review. Interviews were carried out until theoretical saturation of the data, recorded, transcribed verbatim and analysed using thematic analysis. Data were organised by NVivo Software. RESULTS Four themes were identified: community pharmacists' training, identification of visually impaired patients by the pharmacist, communication with visually impaired patients and their proxies, and provision of appropriate pharmaceutical care. Participants stated that they had not received any training regarding visual impairment. They described that they did not always know how to recognise visually impaired patients and that communication was often difficult. CONCLUSION This qualitative study has highlighted a lack of knowledge and skills among community pharmacists regarding visual impairment. One possible solution could be to develop recommendations and tools to improve the care of these patients.
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Affiliation(s)
- Théodora Merenda
- Unit of Clinical Pharmacy, Faculty of Medicine and Pharmacy, University of Mons, Avenue du Champ de Mars 25, Building 6, 7000, Mons, Belgium.
| | - Jennifer Denis
- Unit of Clinical Psychology, Faculty of Psychology and Education, University of Mons, Place du Parc 14, 7000, Mons, Belgium
| | - Stéphanie Patris
- Unit of Clinical Pharmacy, Faculty of Medicine and Pharmacy, University of Mons, Avenue du Champ de Mars 25, Building 6, 7000, Mons, Belgium
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Pless A, Hari R, Harris M. Why are medical students so motivated to learn ultrasound skills? A qualitative study. BMC MEDICAL EDUCATION 2024; 24:458. [PMID: 38671409 PMCID: PMC11046757 DOI: 10.1186/s12909-024-05420-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND The introduction of ultrasound (US) courses into medical undergraduate courses is usually met with a particularly high level of student motivation. The reasons for this are unclear. The aim of this study was to investigate the factors that contribute to undergraduate medical students' motivation to learn US skills. Understanding what motivates students to learn US will inform the efforts of faculty to foster students' motivation to learn. METHODS We carried out in-depth semi-structured one-to-one interviews with medical students participating in an optional US course at two Swiss universities. The interview guide consisted of 10 main questions. The content was informed by experts in the field of medical education and US, as well as by a literature review of motivation theories for learning, in particular by self-determination theory (SDT). SDT was used to guide the development of the interview guide and to reflect on the resulting themes in the discussion section. The interview guide was piloted with two medical students. The interviews lasted an average of 45 min and were audio recorded and transcribed. Thematic analysis was used to analyse the data. RESULTS Fourteen undergraduate medical students in their preclinical (year 3) and clinical studies (years 4 and 5) elaborated on a wide range of reasons for their high motivation to learn US. They were motivated for US training because of the positive nimbus of the US modality, emphasising the advantages of visualisation. Students acknowledged the potential professional benefits of learning US and described it as a fun, exciting group activity. CONCLUSIONS The four themes we found in our analysis can all be related to the three universal needs described in SDT. The strong focus on the visual aspect and the positive nimbus of the modality goes beyond that and reflects the visuo-centric Zeitgeist, which claims the superiority of visual information over other data. Educators should be aware that motivation to learn is affected by the Zeitgeist and ensuing preconceptions, such as the perception of the positive nimbus surrounding a topic. Other key elements that can be implemented to motivate students are just-in-time feedback, enabling group experiences and creating awareness of the clinical relevance of learning content.
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Affiliation(s)
- Anina Pless
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
| | - Roman Hari
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Michael Harris
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- College of Medicine & Health, University of Exeter Medical School, Exeter, UK
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Han ER, Chung EK. A qualitative study on the adoption of the new duty hour regulations among medical residents and faculty in Korea. PLoS One 2024; 19:e0301502. [PMID: 38603669 PMCID: PMC11008864 DOI: 10.1371/journal.pone.0301502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Abstract
Duty hour regulations (DHRs) were enforced in 2017 in Korea to prevent the detrimental effects of excessively prolonged working hours among medical residents. We investigated the adoption of and implications of the new DHRs among medical residents and faculty members. Semi-structured interviews were conducted with 15 medical residents and 9 faculty members across general surgery, internal medicine, obstetrics-gynecology, and pediatrics departments at Chonnam National University Hospital. Based on the constructivist grounded theory, we developed themes from the data by concurrent coding and analysis with theoretical sampling until data saturation. In addition, respondent validation was used to ensure accuracy, and all authors remained reflexive throughout the study to improve validity. The methods of DHRs adoption among residents and faculty members included the following 4 themes: DHRs improved work schedule, residents have more time to learn on their own, clinical departments have come to distribute work, organization members have strived to improve patient safety. Residents have undertaken initial steps towards creating a balance between personal life and work. Teamwork and shift within the same team are the transitions that minimize discontinuity of patient care considering patient safety. Teaching hospitals, including faculty members, should ensure that residents' work and education are balanced with appropriate clinical experience and competency-based training.
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Affiliation(s)
- Eui-Ryoung Han
- Department of Medical Education, Chonnam National University Medical School, Gwangju, South Korea
| | - Eun-Kyung Chung
- Department of Medical Education, Chonnam National University Medical School, Gwangju, South Korea
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Lee DWC, Tan CKN, Tan K, Yee XJ, Jion Y, Roebertsen H, Dong C. How community and organizational culture interact and affect senior clinical educator identity. MEDICAL TEACHER 2024; 46:564-572. [PMID: 37813120 DOI: 10.1080/0142159x.2023.2262103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
PURPOSE The development of Educator Identity has a significant impact on well-being, motivation, productivity, and the quality of teaching. Previous research has shown that conflicting responsibilities and a challenging work environment could negatively affect the development of Clinical Educator Identity within an organization. However, there is a lack of research that identifies the factors affecting Clinical Educator Identity Formation and provides guidance on how organizations can support its development, maintenance, and advancement. METHODS To examine the phenomenology of Professional Identity Development in experienced Senior Clinical Educators in Singaporean hospitals, the study utilized an exploratory qualitative approach. The data was collected from September 2021 to May 2022 through one-to-one interviews. Four investigators analyzed the data using constant comparative analysis to identify relevant themes. RESULTS Eleven senior educators revealed that personal, relational, and organizational factors influenced the development of Clinical Educator Identity. The relational aspect was a vital enabler, while organizational culture was a strong barrier. The study also identified several ways in which organizations can support Educator Identity development. CONCLUSION The study findings provide insight into how organizations can support the development of Clinical Educator Identity. The results could aid organizations in understanding the areas where they can channel resources to support Clinical Educator Identity development.
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Affiliation(s)
- Deanna Wai-Ching Lee
- DUKE-NUS School of Medicine Singapore, Singapore, Singapore
- Department of General Medicine, Sengkang General Hospital, Singapore, Singapore
| | | | - Kevin Tan
- Changi General Hospital, Singapore, Singapore
| | | | - Yasmin Jion
- Changi General Hospital, Singapore, Singapore
| | - Herma Roebertsen
- School of Health Professions Education (SHE), Maastricht University, Maastricht, Netherlands
| | - Chaoyan Dong
- Education Office, Sengkang General Hospital, Singapore, Singapore
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Carbonell-Soliva Á, Nouni-García R, López-Pineda A, Cordero-Fort A, Pérez-Jover V, Quesada JA, Orozco-Beltrán D, Nolasco A, Castellano-Vázquez JM, Mira-Solves JJ, Gil-Guillen VF, Carratala-Munuera C. Opinions and perceptions of patients with cardiovascular disease on adherence: a qualitative study of focus groups. BMC PRIMARY CARE 2024; 25:59. [PMID: 38365594 PMCID: PMC10870481 DOI: 10.1186/s12875-024-02286-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Cardiovascular diseases are becoming more frequent throughout the world. Adherence to both pharmacological and non-pharmacological treatment, as well as lifestyles, is important for good management and control of the disease. This study aims to explore the opinions and perceptions of patients with ischemic heart disease on the difficulties associated with therapeutic adherence. METHODS An interpretive phenomenological study was carried out using focus groups and one semi-structured interview. The MAXQDA qualitative data analysis program was used for inductive interpretation of the group discourses and interview. Data were coded, and these were grouped by categories and then consolidated under the main themes identified. RESULTS Two in-person focus groups and one remote semi-structured interview were performed. Twelve participants (6 men and 6 women) from the Hospital de San Juan de Alicante participated, two of them being family companions . The main themes identified were aspects related to the individual, heart disease, drug treatment, and the perception of the health care system. CONCLUSIONS Adhering to recommendations on healthy behaviors and taking prescribed medications for cardiovascular disease was important for most participants. However, they sometimes found polypharmacy difficult to manage, especially when they did not perceive the symptoms of their disease. Participants related the concept of fear to therapeutic adherence, believing that the latter increased with the former. The relationship with health professionals was described as optimal, but, nevertheless, the coordination of the health care system was seen as limited.
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Affiliation(s)
- Álvaro Carbonell-Soliva
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain
| | - Rauf Nouni-García
- Network for Research on Chronicity, Primary Care. and Health Promotion (RICAPPS), Barcelona, 08007, Spain
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain
- Institute of Health and Biomedical research of Alicante, Alicante Spain General University Hospital of Alicante, Diagnostic center, Fifth floor. Pintor Baeza street, 12, Alicante, 03110, Spain
| | - Adriana López-Pineda
- Network for Research on Chronicity, Primary Care. and Health Promotion (RICAPPS), Barcelona, 08007, Spain.
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain.
- Foundation for the Promotion of Health and Biomedical Research of the Valencian, Community. N-332, 03550 San Juan de Alicante, Alicante, Spain.
| | - Alberto Cordero-Fort
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain
- Biomedical Network Research Center for Cardiovascular Diseases (CIBERCV), Madrid, 28029, Spain
| | - Virtudes Pérez-Jover
- Health Psychology Department, Miguel Hernandez University of Elche, Elche, Spain
| | - Jose A Quesada
- Network for Research on Chronicity, Primary Care. and Health Promotion (RICAPPS), Barcelona, 08007, Spain
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain
| | - Domingo Orozco-Beltrán
- Network for Research on Chronicity, Primary Care. and Health Promotion (RICAPPS), Barcelona, 08007, Spain
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain
- University Hospital of San Juan de Alicante, San Juan de Alicante, Alicante, 03550, Spain
| | - Andreu Nolasco
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, San Vicente del Raspeig, Alicante, Spain
| | - Jose Maria Castellano-Vázquez
- Comprehensive Center for Cardiovascular Diseases, Montepríncipe University Hospital, HM Hospitales Group, Madrid, Spain
| | | | - Vicente F Gil-Guillen
- Network for Research on Chronicity, Primary Care. and Health Promotion (RICAPPS), Barcelona, 08007, Spain
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain
- Institute of Health and Biomedical research of Alicante, Alicante Spain General University Hospital of Alicante, Diagnostic center, Fifth floor. Pintor Baeza street, 12, Alicante, 03110, Spain
- General University Hospital of Elda, Alicante, 03600, Spain
| | - Concepción Carratala-Munuera
- Network for Research on Chronicity, Primary Care. and Health Promotion (RICAPPS), Barcelona, 08007, Spain
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain
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Scholte JBJ, Strehler JC, Dill T, van Mook WNKA. Trainee-supervisor collaboration, progress-visualisation, and coaching: a survey on challenges in assessment of ICU trainees. BMC MEDICAL EDUCATION 2024; 24:120. [PMID: 38321516 PMCID: PMC10848472 DOI: 10.1186/s12909-023-04980-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/14/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Assessing trainees is crucial for development of their competence, yet it remains a challenging endeavour. Identifying contributing and influencing factors affecting this process is imperative for improvement. METHODS We surveyed residents, fellows, and intensivists working in an intensive care unit (ICU) at a large non-university hospital in Switzerland to investigate the challenges in assessing ICU trainees. Thematic analysis revealed three major themes. RESULTS Among 45 physicians, 37(82%) responded. The first theme identified is trainee-intensivist collaboration discontinuity. The limited duration of trainees' ICU rotations, large team size operating in a discordant three-shift system, and busy and unpredictable day-planning hinder sustained collaboration. Potential solutions include a concise pre-collaboration briefing, shared bedside care, and post-collaboration debriefing involving formative assessment and reflection on collaboration. The second theme is the lack of trainees' progress visualisation, which is caused by unsatisfactory familiarisation with the trainees' development. The lack of an overview of a trainee's previous achievements, activities, strengths, weaknesses, and goals may result in inappropriate assessments. Participants suggested implementing digital assessment tools, a competence committee, and dashboards to facilitate progress visualisation. The third theme we identified is insufficient coaching and feedback. Factors like personality traits, hierarchy, and competing interests can impede coaching, while high-quality feedback is essential for correct assessment. Skilled coaches can define short-term goals and may optimise trainee assessment by seeking feedback from multiple supervisors and assisting in both formative and summative assessment. Based on these three themes and the suggested solutions, we developed the acronym "ICU-STAR" representing a potentially powerful framework to enhance short-term trainee-supervisor collaboration in the workplace and to co-scaffold the principles of adequate assessment. CONCLUSIONS According to ICU physicians, trainee-supervisor collaboration discontinuity, the lack of visualisation of trainee's development, and insufficient coaching and feedback skills of supervisors are the major factors hampering trainees' assessment in the workplace. Based on suggestions by the survey participants, we propose the acronym "ICU-STAR" as a framework including briefing, shared bedside care, and debriefing of the trainee-supervisor collaboration at the workplace as its core components. With the attending intensivists acting as coaches, progress visualisation can be enhanced by actively collecting more data points. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Johannes B J Scholte
- Department of Intensive Care Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland.
- Master of Medical Education Student, University of Bern, Bern, Switzerland.
| | - Johannes C Strehler
- Department of Intensive Care Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Tatjana Dill
- Master of Medical Education Student, University of Bern, Bern, Switzerland
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
- Swiss Air-Ambulance Ltd, Rega, Zurich, Switzerland
| | - Walther N K A van Mook
- Department of Intensive Care Medicine and Academy for Postgraduate Medical Training, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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Toussaint V, Paal P, Simader R, Elsner F. The state of undergraduate palliative care education at Austrian medical schools - a mixed methods study. BMC Palliat Care 2023; 22:151. [PMID: 37814283 PMCID: PMC10563205 DOI: 10.1186/s12904-023-01255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/01/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND There is an increasing demand for universal, high-quality access to palliative care in Austria. To ensure this, the implementation of palliative care in the medical studies curriculum is essential. This is the first study to investigate the state of undergraduate palliative care education at Austrian medical schools. METHODS For this mixed-methods study with concurrent embedded design, expert interviews and online surveys were conducted between March and August 2022. The interviews were subjected to a thematic analysis according to Braun and Clarke, while the questionnaires were analysed descriptively-statistically. For the final integration, the results of both methods for each topic are presented and discussed complementarily. Both the primary qualitative and supportive quantitative data were collected to combine the advantages of the in-depth nature of the qualitative data and the consistent structure of the quantitative data to provide a more precise representation of the state of teaching. RESULTS Twenty-two persons participated in the study, of whom twenty-one participated in the interview and eight in the questionnaire. The participants were experts in palliative care teaching at Austrian medical schools. Currently, palliative care is taught at seven out of the eight universities. Large differences were found in the number of hours, organisation, teaching formats, and interprofessional education. At present, three universities have a chair for palliative care and at least five universities have access to a palliative care unit. CONCLUSION Undergraduate palliative care education in Austria is very heterogeneous and does not meet the minimum standards suggested by the European Association for Palliative Care (EAPC) curriculum recommendations. However, several universities are planning measures to expand palliative care teaching, such as the introduction of mandatory teaching or the establishment of new teaching formats. Better coordination and networking within and between universities would be beneficial for the expansion and quality of teaching.
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Affiliation(s)
- Véronique Toussaint
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany.
| | - Piret Paal
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Rainer Simader
- Hospiz Österreich / Österreichische Palliativgesellschaft, Vienna, Österreich
| | - Frank Elsner
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
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Disha SR, Merin Eldhose K, Shetty Y. Exploring the trend of use of qualitative methods in randomized controlled trials. Perspect Clin Res 2023; 14:207-208. [PMID: 38025293 PMCID: PMC10679569 DOI: 10.4103/picr.picr_131_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- S. R. Disha
- Department of Pharmacology and Therapeutics, Main College Building, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - K Merin Eldhose
- Department of Pharmacology and Therapeutics, Main College Building, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Yashashri Shetty
- Department of Pharmacology and Therapeutics, Main College Building, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Maruszczyk K, McMullan C, Aiyegbusi OL, Keeley T, Wilson R, Collis P, Bottomley C, Calvert MJ. Paving the way for patient centricity in real-world evidence (RWE): Qualitative interviews to identify considerations for wider implementation of patient-reported outcomes in RWE generation. Heliyon 2023; 9:e20157. [PMID: 37809473 PMCID: PMC10559915 DOI: 10.1016/j.heliyon.2023.e20157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives Real-world evidence (RWE) generation can be enhanced by including patient-reported outcomes (PROs). Methods for collecting and using PRO data in the real-world setting are currently underdeveloped and there is no international guidance specific to its use in this context. This study explored stakeholders' perspectives and needs for using PROs in RWE generation. Barriers, facilitators, and opportunities for wider use of PROs in real-world studies were also investigated. Methods Online semi-structured interviews were conducted with international stakeholders: patients, patient advocates, regulators, payers, clinicians, academic researchers, and industry experts. Interviews were recorded, transcribed verbatim and analysed using NVivo 20. Thematic analysis was conducted based on the updated Consolidated Framework for Implementation Research (CFIR). Results Twenty-three interviews were conducted. Participants confirmed that the use of PROs in RWE generation is not yet well established. Participants expressed a mixed level of confidence in the value of PROs collected in a real-world setting. Operational challenges associated with collecting routine PRO data to inform care delivery at the individual level (e.g., setting up infrastructure) need to be addressed. Methodological and other challenges (e.g., financing research) associated with collecting prospective de novo data in a real-world setting should be considered to facilitate PRO utilisation in real-world studies. Conclusions Several opportunities and challenges were identified regarding the broader use of PROs in RWE research. Joint efforts from different stakeholders are needed to maximise PRO implementation, with consideration given to each stakeholders' specific needs (e.g., by developing good practices).
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Affiliation(s)
- Konrad Maruszczyk
- Centre for Patient Reported Outcome Research and Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Christel McMullan
- Centre for Patient Reported Outcome Research and Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcome Research and Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
| | - Thomas Keeley
- Centre for Patient Reported Outcome Research and Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- GlaxoSmithKline (GSK), Patient Centered Outcomes, Value Evidence and Outcomes, Brentford, UK
| | - Roger Wilson
- Centre for Patient Reported Outcome Research and Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- Patient partner, UK
| | - Philip Collis
- Centre for Patient Reported Outcome Research and Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- Patient partner, UK
| | | | - Melanie J. Calvert
- Centre for Patient Reported Outcome Research and Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
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Kollie KK, Jenkins J, Theobald S, Nallo G, Kpadeh O, Jones L, Borbor D, Phillip M, Wickenden A, Kollie JT, Rogers E, Zaizay Z, Stewart M, Dean L. Unpacking the impact of integrating the neglected tropical disease supply chain into the national supply chain system: illustrative evidence from Liberia. Parasitology 2023; 150:1052-1062. [PMID: 37927101 PMCID: PMC10801370 DOI: 10.1017/s0031182023000896] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 11/07/2023]
Abstract
Effective supply chain management is a critical pillar of well-functioning health systems ensuring that medical commodities reach those in need. In Liberia, the national neglected tropical disease (NTD) programme supports health systems strengthening for case management of NTDs. Integration of NTD commodities into the national health system supply chain is central to the integrated approach; however, there is minimal evidence on enablers and barriers. Drawing on qualitative evaluation data, we illustrate that perceived benefits and strengths to integrating NTD commodities into the supply chain include leveraged storage and management capacities capitalized at lower system levels; the political will to integrate based on cost-saving and capacity strengthening potential and positive progress integrating paper-based reporting tools. Challenges remain, specifically the risk of reliance on donor funding; difficulty in accessing commodities due to bureaucratic bottlenecks; lack of inclusion of NTD commodities within electronic data tools and poor coordination leading to an inability to meet demand. Collectively, the negative consequences of ineffective integration of NTD commodities into the supply chain has a detrimental impact on health workers (including community health workers) unable to deliver the quality of care to patients. Trust between affected populations and the health system is compromised when treatments are unavailable.
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Affiliation(s)
- Karsor K. Kollie
- Department of Health Services, Ministry of Health-Liberia, Congo Town Back Road, Monrovia, Liberia
| | - Jack Jenkins
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Sally Theobald
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Gartee Nallo
- University of Liberia Pacific-Institute for Research Evaluation, Monrovia, Liberia
| | - Otis Kpadeh
- University of Liberia Pacific-Institute for Research Evaluation, Monrovia, Liberia
| | - Lent Jones
- University of Liberia Pacific-Institute for Research Evaluation, Monrovia, Liberia
| | - Darwosu Borbor
- Cuttington University Graduate School, Monrovia, Liberia
| | - Maneesh Phillip
- Effect Hope, 200-90 Allstate Pkwy, Markham, ON L3R 6H3, Canada
| | - Anna Wickenden
- Effect Hope, 200-90 Allstate Pkwy, Markham, ON L3R 6H3, Canada
| | - Jewel Tarpeh Kollie
- A. M. Dogliotti School of Medicine, University of Liberia, Monrovia, Liberia
| | - Emerson Rogers
- Department of Health Services, Ministry of Health-Liberia, Congo Town Back Road, Monrovia, Liberia
| | - Zeela Zaizay
- Action Transforming Lives, Congo Town Backroad, Monrovia, Liberia
| | - Martyn Stewart
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Laura Dean
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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Ye WQW, Griffin C, Sverdlichenko I, Vegas DB. The impact of patient death experiences early in training on resident physicians: a qualitative study. CMAJ Open 2023; 11:E1006-E1011. [PMID: 37907213 PMCID: PMC10620010 DOI: 10.9778/cmajo.20230011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Patient death is an inevitability during medical training, with subsequent psychologic distress, decreased empathy and worse learning outcomes. We aimed to explore resident experiences with patient death early in training, including the immediate and delayed impacts of these experiences, preparedness of trainees for these events and coping strategies used, potentially identifying gaps and opportunities to further support trainees during difficult or traumatic events. METHODS We performed a qualitative study using phenomenology methodology to understand trainees' personal experiences with patient death. Resident physicians who had completed an internal medicine rotation at McMaster University, Hamilton, Ontario, were invited to participate from December 2020 to April 2021. Semistructured interviews were conducted to understand circumstances, emotional responses, support, coping mechanisms and preparedness regarding the patient death experience. Interviews were transcribed and coded to identify emerging themes with the use of thematic and interpretive analysis. RESULTS Eighteen participants were interviewed. On average, the interviews were 40 minutes in length. The participants' mean age was 27 years. The majority of trainees (10 [56%]) were in their first year of residency, with 5 (28%) from family medicine and 4 (22%) from internal medicine. Most participants (13 [72%]) had experienced their first patient death during medical school. Three themes were identified: patient death circumstances, immediate and delayed emotional impact, and preparedness and coping mechanisms. Unexpected death, pronouncing death, cardiopulmonary resuscitation and communicating with families were common challenges. Feelings of guilt, helplessness and grief followed the events. Feeling underprepared contributed to emotional consequences, including difficulties sleeping, intrusive thoughts and emotional distancing; however, these experiences were consistently normalized by participants. INTERPRETATION Patient death during medical training can be traumatic for trainees and may perpetuate loss of empathy, changes to practice and residual emotional effects. Educational initiatives to prepare trainees for patient death and teach adaptive coping strategies may help mitigate psychologic trauma and loss of empathy; further research is required to explore these strategies.
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Affiliation(s)
- Wen Qing Wendy Ye
- McMaster University (Ye, Griffin, Brandt Vegas), Hamilton, Ont.; University of Toronto (Ye, Griffin, Sverdlichenko), Toronto, Ont.; Department of Internal Medicine (Brandt Vegas), St. Joseph's Hospital, Hamilton, Ont
| | - Candice Griffin
- McMaster University (Ye, Griffin, Brandt Vegas), Hamilton, Ont.; University of Toronto (Ye, Griffin, Sverdlichenko), Toronto, Ont.; Department of Internal Medicine (Brandt Vegas), St. Joseph's Hospital, Hamilton, Ont
| | - Irina Sverdlichenko
- McMaster University (Ye, Griffin, Brandt Vegas), Hamilton, Ont.; University of Toronto (Ye, Griffin, Sverdlichenko), Toronto, Ont.; Department of Internal Medicine (Brandt Vegas), St. Joseph's Hospital, Hamilton, Ont
| | - Daniel Brandt Vegas
- McMaster University (Ye, Griffin, Brandt Vegas), Hamilton, Ont.; University of Toronto (Ye, Griffin, Sverdlichenko), Toronto, Ont.; Department of Internal Medicine (Brandt Vegas), St. Joseph's Hospital, Hamilton, Ont.
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Sofro ZM, Wibowo RA, Wasityastuti W, Kusumadewi AF, Utomo PS, Ekawati FM, Putri RE, Aldrin E, Fatmawati JS, Chang TC, Pratista MI, Agustiningsih D. Physical activity virtual intervention for improving mental health among university students during the COVID-19 pandemic: A Co-creation process and evaluation using the Behavior Change Wheel. Heliyon 2023; 9:e18915. [PMID: 37588605 PMCID: PMC10425908 DOI: 10.1016/j.heliyon.2023.e18915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 07/22/2023] [Accepted: 08/02/2023] [Indexed: 08/18/2023] Open
Abstract
Background During the COVID-19 pandemic, there were reductions in university students' physical activity, which further increased their mental distress, calling for technology-based physical activity interventions to address the challenges in delivering in-person interventions. This study aimed to develop a technology-based physical activity intervention and pilot test it. Methods We developed a virtually-delivered team-based physical activity challenge using the Behavior Change Wheel and Co-creation Framework based on Self-determination Theory. A pilot study was conducted in the evaluation phase to measure the recruitment rate, dropout rate, change in physical activity, and mental distress while identifying problems and collecting participants' opinions regarding the challenge. Wilcoxon signed-rank tests were conducted to assess the change in physical activity and mental distress. Qualitative data were analyzed using thematic analysis. Results A three-week physical activity challenge comprising five identified intervention functions was held with 480 participants. The recruitment rate was 84.8% resulting from 407 virtual challenge participants who were conveniently joined as research participants. The dropout rate for the pilot study was 10.96% resulting from the incompatibility problems with the application. Among sample participants who lacked physical activity, participation in this challenge improved their physical activity by 52.5 min of moderate-intensity physical activity per week and reduced their mental distress by three points of self-reporting questionnaire-20 score. Issues regarding the virtual application and the influence of participation in the challenge on basic psychological needs emerged. Participants' opinions identified lack of time as the main barrier to physical activity. Conclusion A co-created physical activity intervention developed using the Behavioral Change Wheel Framework inspired high interest from university students and may increase their physical activity and improve their mental health. Several suggestions were discussed to address the identified problems and improve the internal and external validity of the evaluation phase. Trial registration TCTR20220720004 (retrospectively registered on July 19, 2022).
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Affiliation(s)
- Zaenal Muttaqien Sofro
- Department of Physiology, Faculty of Medicine, Public Health, And Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Rakhmat Ari Wibowo
- Department of Physiology, Faculty of Medicine, Public Health, And Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, United Kingdom
| | - Widya Wasityastuti
- Department of Physiology, Faculty of Medicine, Public Health, And Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Andrian Fajar Kusumadewi
- Department of Psychiatry, Faculty of Medicine, Public Health, And Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Prattama Santoso Utomo
- Department of Medical Education and Bioethics, Faculty of Medicine, Public Health, And Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Fitriana Murriya Ekawati
- Department of Family and Community Medicine, Faculty of Medicine, Public Health, And Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Rayhani Erika Putri
- Medical School, Faculty of Medicine, Public Health, And Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Enrique Aldrin
- Medical School, Faculty of Medicine, Public Health, And Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jihan Santika Fatmawati
- Medical School, Faculty of Medicine, Public Health, And Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Trisha Cheeren Chang
- Medical School, Faculty of Medicine, Public Health, And Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Muhammad Ivan Pratista
- Medical School, Faculty of Medicine, Public Health, And Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Denny Agustiningsih
- Department of Physiology, Faculty of Medicine, Public Health, And Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Devillers L, Subts A, De Bandt D, Druais PL, Gilles de la Londe J. Patients' experiences of being touched by their general practitioner: a qualitative study. BMJ Open 2023; 13:e071701. [PMID: 37524558 PMCID: PMC10391798 DOI: 10.1136/bmjopen-2023-071701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE This study aimed to explore patients' experiences and perceptions of touch, as practised by their general practitioner during their medical appointment. DESIGN Qualitative study using grounded theory method, based on individual interviews. Data collection and analysis occurred iteratively; themes were identified using constant comparison. SETTING Recruitment among general practitioners' private practices and health centres in Ile-de-France. PARTICIPANTS Twenty-one patients aged 19-88 years old, interviewed between June 2018 and May 2019. RESULTS Physical examination was described as a ritual enabling the establishment of patients' and doctors' roles, the verification of the doctor's skills and the construction of a caring experience. Touch was also a media for the doctor to exercise power that the patient authorised. Finally, it had relational and emotional value. DISCUSSION AND CONCLUSION Physical examination is so internalised by the patients that it becomes unquestionable. It may be inappropriate when this touch does not belong to physical examination or on the contrary represents a proof of the doctor's humanity. The patient is not necessarily aware of the relational dimension that underpins touching and, in particular, clinical examination. This raises the question of why should doctor use it and how they can communicate about it, so that it may become an active tool in favour of trust and the construction of the relationship.
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Affiliation(s)
- Louise Devillers
- Department of General Medicine, Versailles Saint-Quentin-en-Yvelines University, Montigny-Le-Bretonneux, France
- CESP, UVSQ, INSERM U1018, Primary Care and Prevention Team, University Paris-Saclay, Villejuif, France
| | - Amélie Subts
- Department of General Medicine, Versailles Saint-Quentin-en-Yvelines University, Montigny-Le-Bretonneux, France
| | - David De Bandt
- Department of General Medicine, Versailles Saint-Quentin-en-Yvelines University, Montigny-Le-Bretonneux, France
| | - Pierre-Louis Druais
- Department of General Medicine, Versailles Saint-Quentin-en-Yvelines University, Montigny-Le-Bretonneux, France
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Sasson DC, Hsia HC. Coronavirus Disease 2019 and the Yale Response: A Semistructured Interview Study on Plastic Surgery Resident Education and Departmental Adaptation to the Lockdown. J Craniofac Surg 2023; 34:1238-1241. [PMID: 36935390 PMCID: PMC10205062 DOI: 10.1097/scs.0000000000009295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/27/2022] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Sooner-than-expected progression to statewide lockdown at the height of the coronavirus disease 2019 pandemic left minimal time for medical specialty boards, including The American Board of Plastic Surgery, to issue guidance for their respective programs. As a result, programs were tasked with developing creative alternatives to their standard resident curricula and department schedules. OBJECTIVE To capture attending and resident experience of the coronavirus disease 2019 lockdown in narrative form and to understand what specific changes enacted to maintain adequate education should be considered for continuation after the pandemic's conclusion. METHODS Qualitative, semistructured interviews of residents, fellows, and faculty of the Section of Plastic and Reconstructive Surgery during 2019 to 2020 academic year were conducted on the following topics: (1) general reflection on lockdown, (2) resident maintenance of daily logs, (3) multi-institutional collaborative lectures, (4) modified didactic curriculum, (5) virtual 3-dimensional craniofacial planning sessions, (6) maintenance of department camaraderie, and (7) effect on preparation to become a surgeon. RESULTS Twenty interviews (response rate 77%) were conducted between October 2020 and February 2021. Of residents, 100% felt observing the craniofacial planning sessions was beneficial, with many explicitly noting it provided a unique perspective into the surgeon's thought process behind planned manipulations, to which they usually are not privy. Of residents, 100% felt confident at the time of the interview that the lockdown would have no lasting effects on their preparation to become a surgeon. CONCLUSIONS Rapid changes enacted at Yale enabled resident training to advance, and documentation of the success of these changes can inform future curriculum design.
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Lin S, Zimmerman E, Datta S, Selby M, Chan T, Fant A. Curated collections for educators: Nine key articles and article series for teaching qualitative research methods. AEM EDUCATION AND TRAINING 2023; 7:e10862. [PMID: 37013134 PMCID: PMC10066497 DOI: 10.1002/aet2.10862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/13/2023] [Accepted: 02/23/2023] [Indexed: 06/19/2023]
Abstract
Background Qualitative research explains observations, focusing on how and why phenomena and experiences occur. Qualitative methods go beyond quantitative data and provide critical information inaccessible through quantitative methods. However, at all levels of medical education, there is insufficient exposure to qualitative research. As a result, residents and fellows complete training ill-equipped to appraise and conduct qualitative studies. As a first step to increasing education in qualitative methods, we sought to create a curated collection of papers for faculty to use in teaching qualitative research at the graduate medical education (GME) level. Methods We conducted literature searches on the topic of teaching qualitative research to residents and fellows and queried virtual medical education and qualitative research communities for relevant articles. We searched the reference lists of all articles found through the literature searches and online queries for additional articles. We then conducted a three-round modified Delphi process to select papers most relevant to faculty teaching qualitative research. Results We found no articles describing qualitative research curricula at the GME level. We identified 74 articles on the topic of qualitative research methods. The modified Delphi process identified the top nine articles or article series most relevant for faculty teaching qualitative research. Several articles explain qualitative methods in the context of medical education, clinical care, or emergency care research. Two articles describe standards of high-quality qualitative studies, and one article discusses how to conduct the individual qualitative interview to collect data for a qualitative study. Conclusions While we identified no articles reporting already existing qualitative research curricula for residents and fellows, we were able to create a collection of papers on qualitative research relevant to faculty seeking to teach qualitative methods. These papers describe key qualitative research concepts important in instructing trainees as they appraise and begin to develop their own qualitative studies.
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Affiliation(s)
- Sophia Lin
- Department of Emergency MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Elise Zimmerman
- Division of Emergency Medicine, Department of PediatricsUniversity of California at San DiegoSan DiegoCaliforniaUSA
| | - Suchismita Datta
- Department of Emergency MedicineNew York University Long Island School of MedicineMineolaNew YorkUSA
| | - Maurice Selby
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Teresa Chan
- Division of Emergency Medicine, Division of Education and Innovation, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Abra Fant
- Department of Emergency MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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Kellar J, Martimianakis MA, van der Vleuten CPM, Oude Egbrink MGA, Austin Z. Factors Influencing Professional Identity Construction in Fourth-Year Pharmacy Students. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:ajpe9110. [PMID: 36270661 PMCID: PMC10159543 DOI: 10.5688/ajpe9110] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/08/2022] [Indexed: 05/06/2023]
Abstract
Objectives. To explore the key factors that influence professional identity construction in fourth-year pharmacy students enrolled in a Doctor of Pharmacy program.Methods. A single-site instrumental case study of current fourth-year pharmacy students from the Leslie Dan Faculty of Pharmacy, University of Toronto, was used. Thirteen students participated in semistructured interviews. Poststructural social identity theories were used to analyze the data and identify themes that influence identity construction in pharmacy students.Results. Data analysis identified five overarching themes that influence pharmacy student professional identity construction: path to pharmacy, curriculum, environment, preceptors, and patient interactions. The Leslie Dan Faculty of Pharmacy curriculum prioritized the health care provider identity, which influenced the students desire to "become" clinicians. Based on their internalized health care provider identity, they rejected preceptors and practice environments that negatively impacted their ability to embody this identity.Conclusion. The findings of this study suggest that pharmacy students align themselves strongly with health care provider identities at the cost of other potentially relevant identities. Pharmacy education programs may benefit from curricular reforms that incorporate and legitimize multiple pharmacist identities to ensure a strong pharmacy workforce for the future.
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Affiliation(s)
- Jamie Kellar
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | | | | | | | - Zubin Austin
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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Wibowo RA, Hartarto RB, Bhattacharjee A, Wardani DTK, Sambodo NP, Santoso Utomo P, Annisa L, Hakim MS, Sofyana M, Dewi FST. Facilitators and barriers of preventive behaviors against COVID-19 during Ramadan: A phenomenology of Indonesian adults. Front Public Health 2023; 11:960500. [PMID: 37033074 PMCID: PMC10073479 DOI: 10.3389/fpubh.2023.960500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 02/24/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Intercity mobility restriction, physical distancing, and mask-wearing are preventive behaviors to reduce the transmission of COVID-19. However, strong cultural and religious traditions become particular challenges in Indonesia. This study uses the Behavior Change Wheel to explore barriers and facilitators for intercity mobility restriction, physical distancing, and mask-wearing during Ramadan. Methods Semi-structured in-depth interviews with 50 Indonesian adults were conducted between 10 April and 4 June 2020. Having mapped codes into the Capacity, Opportunity, Motivation - Behavior (COM-B), and Theoretical Domain Framework (TDF) model, we conducted summative content analysis to analyze the most identified factors to preventive behaviors and proposed interventions to address those factors. Results Belief about the consequence of preventive behaviors was the most mentioned facilitator to all preventive behaviors among compliers. However, optimism as a TDF factor was commonly mentioned as a barrier to preventive behaviors among non-compliers, while environmental context and resources were the most commonly mentioned factors for intercity mobility restriction. Conclusions Public health intervention should be implemented considering the persuasion and involvement of religious and local leaders. Concerning job and economic context, policy related to the intercity mobility restriction should be reconsidered to prevent a counterproductive effect.
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Affiliation(s)
- Rakhmat Ari Wibowo
- Department of Physiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Romi Bhakti Hartarto
- Department of Economics, Faculty of Economics and Business, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Arnab Bhattacharjee
- Edinburgh Business School, Heriot-Watt University, Edinburgh, United Kingdom
- The National Institute of Economic and Social Research, London, United Kingdom
| | - Dyah Titis Kusuma Wardani
- Department of Economics, Faculty of Economics and Business, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Novat Pugo Sambodo
- Center for Health Financing Policy and Health Insurance Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Economics, Faculty of Economics and Business, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Prattama Santoso Utomo
- Department of Medical Education and Bioethics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Luthvia Annisa
- Department of Microbiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mohamad Saifudin Hakim
- Department of Microbiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Meida Sofyana
- Department of Physiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Fatwa Sari Tetra Dewi
- Department of Health Behavior, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Ringborg CH, Wengström Y, Schandl A, Lagergren P. The long-term experience of being a family caregiver of patients surgically treated for oesophageal cancer. J Adv Nurs 2023; 79:2259-2268. [PMID: 36779443 DOI: 10.1111/jan.15580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 01/10/2023] [Accepted: 01/22/2023] [Indexed: 02/14/2023]
Abstract
AIM This qualitative study aimed to explore the experience of being family caregivers of patients treated for oesophageal cancer 2 years after treatment. To better understand the family caregiver's situation, a conceptual model was used in the analysis. The results of the study can guide future interventions to support family caregivers of patients treated for oesophageal cancer. DESIGN A qualitative descriptive study using semi-structured telephone interviews. An abductive approach was used in the analysis to reach deeper knowledge about the family caregivers' experiences and to better understand deeper patterns. METHODS A qualitative study was conducted and included 13 family caregivers of patients surgically treated for oesophageal cancer in Sweden in 2018 who participated in a population-based nationwide cohort study. Individual telephone interviews were held in 2020, 2 years after the patients' surgery. The analysis of the interviews started with an inductive approach using thematic analysis. Thereafter, a deductive approach was used to interpret the findings in relation to the conceptual model, The Cancer Family Caregiving Experience. RESULTS The most essential/evident stress factors for the family caregivers were distress regarding the patients' nutrition, fear of tumour recurrence and worry about the future. In addition, a transition was experienced, going from a family member to a caregiver, and the many psychosocial aspects of this transition were highlighted during the disease trajectory. CONCLUSION Despite, the long-term survival of the patient, family caregivers were still struggling with psychosocial consequences because of the patient's cancer diagnosis and treatment. Furthermore, there is a need to improve supportive interventions for family caregivers during the whole disease trajectory. IMPACT The current study includes comprehensive information about the family caregivers' experiences when caring for a patient treated for oesophageal cancer. Family caregivers struggle with the psychosocial consequences of the patient's cancer and worry about tumour recurrence even 2 years after surgery. These findings can be useful in the development of supportive interventions, which may facilitate life for family caregivers. PATIENT OR PUBLIC CONTRIBUTION The study was discussed and planned together with our research partnership group including patients and family caregivers. In addition, the manuscript was reviewed by some of the members to cross-check the results and discussed them to avoid misinterpretation.
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Affiliation(s)
- Cecilia H Ringborg
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Yvonne Wengström
- Karolinska Comprehensive Cancer Centre, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Anna Schandl
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Pernilla Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Department of Surgery and Cancer, Imperial College London, London, UK
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Greenwald L, Blanchard O, Hayden C, Sheffield P. Climate and health education: A critical review at one medical school. Front Public Health 2023; 10:1092359. [PMID: 36711353 PMCID: PMC9878448 DOI: 10.3389/fpubh.2022.1092359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/23/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction As medical schools continue to improve and refine their undergraduate curricula, they are also redefining the roadmap for preparing future generations of physicians. Climate change is a critical topic to integrate into medical education. This period of change for undergraduate medical education coincides with a surge in interest and design efforts for climate and health curricula in health professional education, but this nascent field has yet to be solidly institutionalized. To continue to grow the number of medical students who achieve competency in the effects of climate change on individual health and the health of the planet during their training, we must examine what has worked to date and continue to shift our approach as curricular changes are implemented for feasibility and relevancy. Objective and methods In the present study, we assessed the "climate and health" content at one northeastern U.S. medical school that is undergoing an overhaul of their entire curriculum to explore strategies to deliver more robust climate health education in the context of the educational redesign. We conducted 1) a retrospective review of the now four-year-old initiative to investigate the sustainability of the original content, and 2) semi-structured interviews with lecturers, course directors, and medical education coordinators involved in implementation, and with faculty tasked with developing the upcoming curricular redesign. Results and discussion Of the original implementation plan, the content was still present in nine of the 14 lectures. Themes determined from our conversations with involved faculty included the need for 1) a shared vision throughout the content arc, 2) further professional development for faculty, and 3) involvement of summative assessment for students and the content itself to ensure longevity. The interviews also highlighted the importance of developing climate-specific resources that fit within the school's new curricular priorities. This critical review can serve as a case study in curriculum to inform other schools undergoing similar changes.
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Affiliation(s)
- Lucy Greenwald
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Olivia Blanchard
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Colleen Hayden
- The Leni and Peter W. May Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Perry Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States,Departments of Environmental Medicine, Public Health, and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States,*Correspondence: Perry Sheffield ✉
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Gamborg ML, Mehlsen M, Paltved C, Vetter SS, Musaeus P. Clinical decision-making and adaptive expertise in residency: a think-aloud study. BMC MEDICAL EDUCATION 2023; 23:22. [PMID: 36635669 PMCID: PMC9835279 DOI: 10.1186/s12909-022-03990-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Clinical decision-making (CDM) is the ability to make clinical choices based on the knowledge and information available to the physician. It often refers to individual cognitive processes that becomes more dependent with the acquisition of experience and knowledge. Previous research has used dual-process theory to explain the cognitive processes involved in how physicians acquire experiences that help them develop CDM. However, less is known about how CDM is shaped by the physicians' situated cognition in the clinical environment. This is especially challenging for novice physicians, as they need to be adaptive to compensate for the lack of experience. The adaptive expert framework has been used to explain how novice physicians learn, but it has not yet been explored, how adaptive expertise is linked to clinical decision-making amongst novice physicians.This study aimed to analyse how residents utilize and develop adaptive expert cognition in a natural setting. By describing cognitive processes through verbalization of thought processes, we sought to explore their CDM strategies considering the adaptive expert framework.We used concurrent and retrospective think-aloud interviews in a natural setting of an emergency department (ED) at a university hospital, to query residents about their reasoning during a patient encounter. We analysed data using protocol analysis to map cognitive strategies from these verbalizations. Subsequently in a narrative analysis, we compared these strategies with the literature on adaptive expertise.Fourteen interviews were audio recorded over the course for 17 h of observation. We coded 78 informational concepts and 46 cognitive processes. The narrative analysis demonstrated how epistemic distance was prevalent in the initial CDM process and self-regulating processes occurred during hypothesis testing. However, residents who too quickly moved on to hypothesis testing tended to have to redirect their hypothesis more often, and thus be more laborious in their CDM. Uncertainty affected physicians' CDM when they did not reconcile their professional role with being allowed to be uncertain. This allowance is an important feature of orientation to new knowledge as it facilitates the evaluation of what the physician does not know.For the resident to learn to act as an adaptive decision-maker, she relied on contextual support. The professional role was crucial in decisional competency. This supports current literature, which argues that role clarification helps decisional competency. This study adds that promoting professional development by tolerating uncertainty may improve adaptive decisional competency.
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Affiliation(s)
- Maria Louise Gamborg
- Centre for Educational Development, Aarhus University, Aarhus C, Denmark.
- Coporate HR MidtSim & Department of Clinical Medicine, Faculty of Health, Aarhus University, Central Denmark Region, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus N, Denmark.
| | - Mimi Mehlsen
- Department of Psychology, Faculty of Business and Social Sciences, Aarhus University, Bartholins Allé 11, 8000, Aarhus C, Denmark
| | - Charlotte Paltved
- Coporate HR MidtSim & Department of Clinical Medicine, Faculty of Health, Aarhus University, Central Denmark Region, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus N, Denmark
| | - Sigrid Strunge Vetter
- Department of Psychology, Faculty of Business and Social Sciences, Aarhus University, Bartholins Allé 11, 8000, Aarhus C, Denmark
| | - Peter Musaeus
- Centre for Educational Development, Aarhus University, Aarhus C, Denmark
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Gisby A, Ross C, Francis-Smythe J, Anderson K. The ‘Rich Pictures’ Method: Its Use and Value, and the Implications for HRD Research and Practice. HUMAN RESOURCE DEVELOPMENT REVIEW 2023. [DOI: 10.1177/15344843221148044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Embracing new and innovative qualitative methods has helped researchers in a number of fields to access aspects of the lived experience that traditional methods cannot easily reach. This paper explores the use and value of one such method – ‘rich pictures’: a technique whose origins lie in ‘soft systems’ engineering but which has been successfully applied in a broader range of contexts in recent years including health, medicine and education. Despite its use in these disciplines, however, recent studies suggest that HRD research continues to rely on established methods and that uptake of visual methods – and ‘rich pictures’ in particular – is virtually non-existent. The aim of this paper therefore is to shed light on this underused method and encourage HRD researchers to recognize its potential for studying human development.
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Affiliation(s)
- Alison Gisby
- School of Psychology & Counselling, The Open University, Milton Keynes, UK
| | - Catharine Ross
- Worcester Business School, University of Worcester, Worcester, UK
| | | | - Kazia Anderson
- School of Psychology, University of Leicester, Leicester, UK
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Grant J, Grant L. Quality and constructed knowledge: Truth, paradigms, and the state of the science. MEDICAL EDUCATION 2023; 57:23-30. [PMID: 35803477 DOI: 10.1111/medu.14871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
CONTEXT AND TRUTH Education is a social science. Social science knowledge is related to its context of origin. The concept of global 'truth' in education is therefore of limited use when truth is tempered by context. The wider applicability of our knowledge can only be judged if we look at the context in which that knowledge was produced and the assumptions that underpin it. This calls into question the idea that educational research is a quest for global 'truth', although in relation to programme evaluation, truth tied to context is an aim. An analysis is presented of the effects of social construction on research and evaluation processes, on the selection of paradigms, reporting and interpreting findings, and on the ethics of all this. QUALITY AND IMPROVEMENT Quality improvement is based on information selected, constructed and interpreted by those who gather, analyse or use it. The strength, and not the weakness, of our knowledge is that it is socially constructed, contextual and of its time. Increasingly looking for our own truth about educational quality, and not importing the truth of others, is crucial to the state of the science. In terms of quality development, using others' findings must be based on informed local judgement. In social science, those judgements are linked to social context and their associated ideologies. IMPLICATIONS FOR FUTURE WORK The hallmark of social science is not a narrowing of focus and the search for one truth, but is a broadening of concepts, theories, paradigms, reported experience and method, and an intention for each to tell their own truth well. This will lead to a wealth of diverse views and analysed experience. The science of medical education must seek many truths.
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Affiliation(s)
- Janet Grant
- Centre for Medical Education in Context (CenMEDIC), London, UK
| | - Leonard Grant
- Centre for Medical Education in Context (CenMEDIC), London, UK
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Bazargan-Hejazi S, Negrete Manriquez JA, McDermoth-Grimes M, Parra EA, Prothrow-Stith D. Underrepresented in medicine students' perspectives on impactful medical education. BMC MEDICAL EDUCATION 2022; 22:904. [PMID: 36585706 PMCID: PMC9805279 DOI: 10.1186/s12909-022-03983-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 10/13/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Exploring the perceptions of underrepresented in medicine (URiM) students about the medical education curriculum and learning environment could optimize their education outcomes. The current study delineated perceptions of URiM medical students about the unique elements and characteristics of an impactful medical education program that create a positive, supportive learning environment culture. METHODS We conducted in-depth interviews with 15 URiM students between January 2018 and April 2018. Interviewees were recruited from an accredited medical education program in Historically Black Colleges and Universities (HBCUs). The University is also a member of the Hispanic Association of Colleges and Universities in the U.S. The main question that guided the study was, "What do URiM students at a Historically Black Colleges and Universities (HBCU) medical school believe would make a medical education program (MEP) impactful?" We used the grounded theory analytical approach and performed content analysis via qualitative thematic evaluation. RESULTS Of 112 enrolled medical students (MS), 15 verbally consented to participation. We identified four general themes and several subthemes. The themes include 1) Grounding learning in the community; 2) Progressive system-based practice competency; 3) Social justice competency and 4) Trauma-informed medical education delivery. Theme 1 included the following subthemes (a) community engagement, and (b) student-run clinic, mobile clinic, and homeless clinic rotations. Theme 2 includes (a) interprofessional learning and (b) multidisciplinary medicine for cultivating a 'just' healthcare system. Theme 3 includes (a) longitudinal social justice curriculum, (b) advocacy, and (c) health disparity research. Theme 4 had the following subdomains (a) early and ongoing mentoring and (b) provision of supportive policies, services and practices to maximize learning and mental health. CONCLUSION Our learners found that social justice, trauma-informed, community-based curricula are impactful for URiM learners. These findings highlight the need for further research to assess the impact of permeating the championship culture, community cultural wealth, and transformational education in all aspects of the MEP in providing a supporting and positive learning environment for URiM students.
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Affiliation(s)
- Shahrzad Bazargan-Hejazi
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA 90059 USA
- David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
| | - Jose A. Negrete Manriquez
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA 90059 USA
- David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
| | - Monique McDermoth-Grimes
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA 90059 USA
- College of Medicine, Howard University, Washington, DC, USA
| | - Elisabeth Alexandra Parra
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA 90059 USA
- David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
| | - Deborah Prothrow-Stith
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA 90059 USA
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Shinkaruk K, Carr E, Lockyer JM, Hecker KG. Exploring the development of interprofessional competence and professional identity: A Situated Learning Theory study. J Interprof Care 2022; 37:613-622. [DOI: 10.1080/13561820.2022.2140129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Kelly Shinkaruk
- Department of Anesthesiology, Perioperative, and Pain Medicine, Faculty of Medicine, Cumming School of Medicine, University of Calgary, T2N 4Z6, Calgary, AB, Canada
| | - Eloise Carr
- Faculty of Nursing, PF3238 Professional Faculties Building, 2500 University Drive NW, University of Calgary, T2N 1N4, Calgary, AB, Canada
| | - Jocelyn M Lockyer
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, T2N 4Z6, Calgary, AB, Canada
| | - Kent G. Hecker
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6, Calgary, AB, CANADA
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What Happened and Why: Responding to Racism, Discrimination, and Microaggressions in the Clinical Learning Environment. MEDEDPORTAL 2022; 18:11280. [PMID: 36381136 PMCID: PMC9622434 DOI: 10.15766/mep_2374-8265.11280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Within clinical learning environments, medical students are uniquely faced with power differentials that make acts of racism, discrimination, and microaggressions (RDM) challenging to address. Experiences of microaggressions and mistreatment are correlated with higher rates of positive depression screening and lower satisfaction with medical training. We developed a curriculum for medical students beginning clerkship rotations to promote the recognition of and response to RDM. METHODS Guided by generalized and targeted needs assessments, we created a case-based curriculum to practice communication responses to address RDM. The communication framework, a 6Ds approach, was developed through adaptation and expansion of established and previously learned communication upstander frameworks. Cases were collected through volunteer submission and revised to maintain anonymity. Faculty and senior medical students cofacilitated the small-group sessions. During the sessions, students reviewed the communication framework, explored their natural response strategies, and practiced all response strategies. RESULTS Of 196 workshop participants, 152 (78%) completed the evaluation surveys. Pre- and postsession survey cohort comparison demonstrated a significant increase in students' awareness of instances of RDM (from 34% to 46%), knowledge of communication strategies to mitigate RDM (presession M = 3.4, postsession M = 4.6, p < .01), and confidence to address RDM (presession M = 3.0, postsession M = 4.4, p < .01). DISCUSSION Students gained valuable communication skills from interactive sessions addressing RDM using empathy, reflection, and relatability. The workshop empowered students to feel prepared to enter professional teams and effectively mitigate harmful discourse.
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Frutiger M, Whillier S. Effects of a sudden change in curriculum delivery mode in postgraduate clinical studies, following the COVID-19 pandemic. THE JOURNAL OF CHIROPRACTIC EDUCATION 2022; 36:132-141. [PMID: 35394044 PMCID: PMC9536236 DOI: 10.7899/jce-21-31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/12/2021] [Accepted: 08/27/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To examine the effect of a change in the delivery mode of clinical neurology, a postgraduate subject at Macquarie University, following COVID-19 restrictions on face-to-face teaching. METHODS Participants were master of chiropractic students (n = 212) who completed 2019 or 2020 clinical neurology. The main outcome measure was a comparison of objective structured clinical examination (OSCE) marks between the 2019 and 2020 cohorts. The 2019 group underwent traditional, face-to-face learning, whereas the 2020 group were taught and examined remotely in session 1 but returned to campus in session 2. Descriptive analyses, between-group differences, and generalized linear models were performed. RESULTS Means for OSCE marks between the 2 groups were higher in the 2020 group in session 1 (p < .001). However, when students returned to campus in session 2, the means were significantly lower in the 2020 group compared with the 2019 group (p < .001). Generalized linear regression indicated that the web-based mode of delivery in 2020 might have had a significant impact on OSCE marks compared with their 2019 counterparts (p < .001). CONCLUSION The sudden change in the mode of delivery from face-to-face to remote learning and the change in testing methods in response to the global COVID-19 pandemic had a significant effect on clinical neurology student performance scores. The OSCE marks in the 2020 cohort for session 1 were higher than those in 2019. However, when the 2020 cohort returned to on-campus tutorials in session 2, their marks were lower than those of their 2019 counterparts.
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Hanum C, Findyartini A, Soemantri D. Collaborative clinical reasoning learning using an integrated care pathway in undergraduate interprofessional education: An explorative study. J Interprof Care 2022; 37:438-447. [PMID: 35880761 DOI: 10.1080/13561820.2022.2086221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Collaborative clinical reasoning (CCR) is part of interprofessional collaborative practice and aims to negotiate and manage patient problems. An integrated care pathway (ICP) can be used as a framework for developing comprehensive patient care, typically in a clinical setting. This study aims to explore the CCR process in undergraduate interprofessional teams and the use of ICP as guidance in discussing a patient's problem and its comprehensive management. This is a qualitative study following phenomenology and was performed in an interprofessional education (IPE) program held by Health Science Cluster Universitas Indonesia. A total of four observations involving 40 students and four focus-group discussions involving 18 students from different health professions backgrounds were conducted to explore the CCR process using the ICP framework. In-depth interviews with four tutors from different health professions backgrounds and document analysis were also conducted as triangulation processes. This study shows that CCR was held in two stages - individual and group. The ICP framework could be used as a guiding tool in the CCR process to discuss the patient's management and discharge plan. This study also demonstrates that there are several challenges in this learning process, including the clinical case used in the discussion, the need for prior knowledge and previous exposure to IPE and the ICP framework, and health professions' dominance during the discussion. This study provides evidence on learning of CCR using the ICP framework as a guiding tool in a pre-licensure IPE program. This approach is useful for preparing students to develop an interprofessional, comprehensive, and holistic health care plan and to help them understand the roles of each profession.
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Affiliation(s)
- Chaina Hanum
- Master Program in Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ardi Findyartini
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Faculty of Medicine, Medical Education Center, Indonesia Medical Education & Research Institute (IMERI), Universitas Indonesia, Jakarta, Indonesia
| | - Diantha Soemantri
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Faculty of Medicine, Medical Education Center, Indonesia Medical Education & Research Institute (IMERI), Universitas Indonesia, Jakarta, Indonesia
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Owolabi J, Ojiambo R, Seifu D, Nishimwe A, Masimbi O, Okorie CE, Ineza D, Bekele A. African Medical Educators and Anatomy Teachers' Perceptions and Acceptance of the Anatomage Table as an EdTech and Innovation: A Qualitative Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:595-607. [PMID: 35693029 PMCID: PMC9186529 DOI: 10.2147/amep.s358702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND This article presents a qualitative study of African anatomists and anatomy teachers on the Anatomage Table-a modern medical education technology and innovation, as an indicator of African anatomy medical and anatomy educators' acceptance of EdTech. The Anatomage Table is used for digital dissection, prosection, functional anatomy demonstration, virtual simulation of certain functions, and interactive digital teaching aid. MATERIALS AND METHODS Anatomy teachers [n=79] from 11 representative African countries, Ghana, Nigeria [West Africa], Ethiopia, Kenya, Rwanda [East Africa], Namibia [South Africa], Zambia [Southern Africa], Egypt [North Africa], and Sudan [Central Africa], participated in this study. Focus group discussions [FGDs] were set up to obtain qualitative information from stakeholders from representative institutions. In addition, based on the set criteria, selected education leaders and stakeholders in representative institutions participated in In-depth Interviews [IDIs]. The interview explored critical issues concerning their perceptions about the acceptance, adoption, and integration of educational technology, specifically, the Anatomage Table into the teaching of Anatomy and related medical sciences in the African continent. Recorded interviews were transcribed and analyzed using the Dedoose software. RESULTS African anatomists are generally technology inclined and in favor of EdTech. The most recurring opinion was that the Anatomage Table could only be a "complementary teaching tool to cadavers" and that it "can't replace the real-life experience of cadavers." Particularly, respondents from user institutions opined that it "complements the traditional cadaver-based approaches" to anatomy learning and inquiry, including being a good "complement for cadaveric skill lab" sessions. Compared with the traditional cadaveric dissections a majority also considered it less problematic regarding cultural acceptability and health and safety-related concerns. The lifelikeness of the 3D representation is a major factor that drives acceptability.
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Affiliation(s)
- Joshua Owolabi
- Department of Anatomy, Division of Basic Medical Science, University of Global Health Equity, Butaro, Rwanda
| | - Robert Ojiambo
- Department of Physiology, Division of Basic Medical Science, University of Global Health Equity, Butaro, Rwanda
| | - Daniel Seifu
- Department of Biochemistry, Division of Basic Medical Science, University of Global Health Equity, Butaro, Rwanda
| | - Arlene Nishimwe
- Division of Basic Medical Science, University of Global Health Equity, Butaro, Rwanda
| | - Ornella Masimbi
- The UGHE Simulation Centre, University of Global Health Equity, Butaro, Rwanda
| | | | - Darlene Ineza
- Division of Basic Medical Science, University of Global Health Equity, Butaro, Rwanda
| | - Abebe Bekele
- School of Medicine, University of Global Health Equity, Butaro, Rwanda
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Corral-Liria I, Alonso-Maza M, González-Luis J, Fernández-Pascual S, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias M. Holistic nursing care for people diagnosed with an eating disorder: A qualitative study based on patients and nursing professionals' experience. Perspect Psychiatr Care 2022; 58:840-849. [PMID: 34031892 DOI: 10.1111/ppc.12858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To analyze eating disorder patients and nursing professionals' views and experience of the relationship-based care established. DESIGN AND METHODS A qualitative study that employs an interpretative phenomenological analysis. Nineteen patients and 19 nurses participated in the research through interviews and narrations. FINDINGS Nurses' help is both unexpected and relevant during the patients' recovery process. They provide care not focusing just on nutritional aspects, other factors such as mutual help, the psychological, emotional, social, and personal aspects are highlighted. PRACTICE IMPLICATIONS This study provides a deep understanding of the relationship-based care established that makes it possible to expand knowledge and to individualize the care provided.
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Affiliation(s)
| | - Miriam Alonso-Maza
- Príncipe de Asturias University Hospital (Hospital Universitario Príncipe de Asturias), Alcalá de Henares, Madrid, Spain.,University of Alcalá de Henares, Madrid, Spain
| | - Julio González-Luis
- Príncipe de Asturias University Hospital (Hospital Universitario Príncipe de Asturias), Alcalá de Henares, Madrid, Spain.,University of Alcalá de Henares, Madrid, Spain
| | | | | | - Marta Losa-Iglesias
- Department of Nursing and Stomatology, University Rey Juan Carlos, Alcorcón, Madrid, Spain
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Sharma D, Yadav SK, Agarwal P. A Clarion Call for More Qualitative Studies in Surgery. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03022-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Patel MD, Jordan SG. Medical Education Research Design. J Am Coll Radiol 2022; 19:693-698. [DOI: 10.1016/j.jacr.2022.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 10/18/2022]
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Foo YY, Tan K, Xin X, Lim WS, Cheng Q, Rao J, Tan NC. Institutional ethnography - a primer. Singapore Med J 2022; 62:507-512. [PMID: 35001127 DOI: 10.11622/smedj.2021199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This review introduces a qualitative methodology called institutional ethnography (IE) to healthcare professionals interested in studying complex social healthcare systems. We provide the historical context in which IE was developed, and explain the principles and terminology in IE for the novice researcher. Through the use of worked examples, the reader will be able to appreciate how IE can be used to approach research questions in the healthcare system that other methods would be unable to answer. We show how IE and qualitative research methods maintain quality and rigour in research findings. We hope to demonstrate to healthcare professionals and researchers that healthcare systems can be analysed as social organisations, and IE may be used to identify and understand how higher-level processes and policies affect day-to-day clinical work. This understanding may allow the formulation and implementation of actionable improvements to solve problems on the ground.
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Affiliation(s)
| | - Kevin Tan
- Duke-NUS Medical School, Singapore.,Department of Neurology, National Neuroscience Institute, Singapore
| | - Xiaohui Xin
- Health Services Research Unit, Singapore General Hospital, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore
| | - Qianhui Cheng
- Department of Neuroradiology, National Neuroscience Institute, Singapore
| | - Jai Rao
- Duke-NUS Medical School, Singapore.,Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Nigel Ck Tan
- Duke-NUS Medical School, Singapore.,Department of Neurology, National Neuroscience Institute, Singapore
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Philibert L, Lapierre J. Vulnerabilities and Strengths of Pregnant Haitian Adolescents and their Families During Transition to Motherhood. Int J MCH AIDS 2022; 11:e564. [PMID: 36276930 PMCID: PMC9585836 DOI: 10.21106/ijma.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Teenage pregnancy is considered a social and health problem because of its multifaceted consequences for pregnant teens, their family and society. The objectives of this article are 1) to describe the vulnerabilities encountered by pregnant teenagers and their relatives throughout the time of transition from pregnancy to motherhood and 2) to identify the strengths that are mobilized by these individuals during this period. METHODS The qualitative data collection and analysis methodology was based on John Dewey's Social Inquiry. Participants were recruited from nine health institutions in the North and Northeast departments of Haiti. Data were collected through individual semi-structured interviews, which were audiotaped, transcribed, and exported for coding after verification and validation. The data were analyzed using the thematic analysis of Paillé and Mucchielli. RESULTS A total of 50 interviews were conducted with 33 pregnant teenagers (aged 14 - 19 years) and 17 relatives. This research identified vulnerabilities and strengths experienced by the adolescent participants and their relatives during the motherhood transition. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS The experiences, challenges, and vulnerabilities associated with the teenage-motherhood transition and the needs of pregnant teens, partners, and parents were identified in this study. The results indicated that more attention must be given to psychosocial and material support programs for pregnant adolescents and their loved ones during the motherhood transition and after-childbirth period. When logically and effectively implemented, the study results and suggested recommendations can be used as tools for reaching local and global public-health initiatives in Haiti.
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Affiliation(s)
- Léonel Philibert
- Faculty of Nursing, Laval University, 1050 Medicine Avenue, Québec G1V 0A6, Canada
| | - Judith Lapierre
- Faculty of Nursing, Laval University, 1050 Medicine Avenue, Québec G1V 0A6, Canada
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Motala M, Van Wyk JM. Professional experiences in the transition of Cuban-trained South African medical graduates. S Afr Fam Pract (2004) 2021; 63:e1-e8. [PMID: 34879689 PMCID: PMC8661298 DOI: 10.4102/safp.v63i1.5390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Medical educators have been tasked to provide Cuban-trained Foreign Medical Graduates (FMGs) with adequate learning exposures to become integrated into the South African healthcare workforce. International research suggests that FMGs face multiple challenges during the transition from practising medicine in countries other than where they had been trained. The transitional experiences of international FMGs are well documented, but little is known about the challenges faced by Cuban-trained graduates upon reintegration into South Africa. An improved understanding of the challenges will provide insight into how medical educators can best support Cuban trained graduates in their final phase of training in the South African context.This study explored the challenges experienced during the professional transition of Cuban-trained FMGs with reference to Schlossberg's transitional theory. METHODS A qualitative case study was used to interview a purposive sample of 20 Cuban-trained FMGs who studied between January 1997 and December 2007. Data were collected through audio-recorded, semi-structured interviews, which were analysed thematically. RESULTS The findings indicate that FMGs' experienced educational and social stress, which was linked to the transitional situation itself. Challenges during reintegration included bias and discrimination, language, educational differences, and becoming familiar with patients from diverse educational and cultural backgrounds. They drew on peer and institutional support that was mainly informal and varied across disciplines and the medical schools. CONCLUSION Recommendations include a national multidisciplinary consolidated approach to provide personal and professional support at national, institutional, and departmental levels. The creation of mentoring networks will optimise Cuban-trained FMGs' transitional experiences for returning students.
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Affiliation(s)
- Munirah Motala
- Department of Clinical and Professional Practice, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban.
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Sy MP, Yao DP, Panotes A, Kaw J, Mendoza T. Contemporary history: progress and resilience of occupational therapy in the Philippines (2004–2020). WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2021. [DOI: 10.1080/14473828.2021.1995226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Michael P. Sy
- National Teacher Training Center for the Health Professions, University of the Philippines Manila, Manila, Philippines
| | - Daryl Patrick Yao
- Department of Occupational Therapy, Tokyo Metropolitan University, Tokyo, Japan
| | - Arden Panotes
- National Teacher Training Center for the Health Professions, University of the Philippines Manila, Manila, Philippines
| | | | - Teresita Mendoza
- National Teacher Training Center for the Health Professions, University of the Philippines Manila, Manila, Philippines
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Iglesias B, Jeong H, Bengs BC, Sanders DP, SooHoo NF, Buerba RA. Total joint replacement surgeon choice: A qualitative analysis in a medicare population. J Natl Med Assoc 2021; 113:693-700. [PMID: 34474928 DOI: 10.1016/j.jnma.2021.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/24/2021] [Accepted: 08/09/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Previous research has shown that patients from historically marginalized groups in the United States tend to have poorer outcomes after joint replacement surgery and that they are less likely to receive joint replacement surgery at high-volume hospitals. However, little is known regarding how this group of patients chooses their joint replacement surgeon. The purpose of this study was to understand the factors influencing the choice of joint replacement surgeon amongst a diverse group of patients. METHODS Semi-structured interviews were conducted with Medicare patients who underwent a hip or knee replacement within the last 24 months (N = 38) at an academic and community hospital. Interviews were audio recorded, transcribed and verified for accuracy. Transcripts were reviewed using iterative content analysis to extract key themes related to how respondents chose their joint replacement surgeon. RESULTS AND DISCUSSION MD referral/recommendation appears to be the strongest factor influencing joint replacement surgeon choice. Other key considerations are hospital reputation and surgeon attributes-including operative experience, communication skills, and participation in shared decision-making. Gender/ethnicity of a surgeon, industry payments to surgeons, number of publications and cost did not play a large role in surgeon choice. CONCLUSION AND CLINICAL RELEVANCE The process of choosing a joint replacement surgeon is a complex decision-making process with several factors at play. Despite growing availability of information regarding surgeons, patients largely relied on referrals for choosing their joint replacement surgeon regardless of ethnicity. Referring physicians need to ensure that patients are able to access hospital and surgeon outcomes, operative volume, and industry-payment information to learn more about their orthopedic surgeons in order to make an informed choice.
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Affiliation(s)
- Brenda Iglesias
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Room 76-143 CHS, 10833 Le Conte Avenue, Los Angeles, CA, 90095 USA; Charles R. Drew University of Medicine and Science, 1731 E 120th St, Los Angeles, CA, 90059 USA
| | - Hajun Jeong
- John Peter Smith Hospital, 1500 S. Main St, Fort Worth, Texas, 76104 USA
| | - Benjamin C Bengs
- St. John's Medical Center, 2001 Santa Monica Blvd, Suite 760, Santa Monica, CA 90404 USA
| | - Don P Sanders
- Torrance Memorial Medical Center, 23560 Crenshaw Blvd, Suite 102, Torrance, CA 90505 USA
| | - Nelson F SooHoo
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Room 76-143 CHS, 10833 Le Conte Avenue, Los Angeles, CA, 90095 USA
| | - Rafael A Buerba
- Banner Health Medical Center, 7701 W. Aspera Blvd, Suite 102, Glendale, AZ, 85308 USA.
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Thatphet P, Kayarian FB, Ouchi K, Hogan T, Schumacher JG, Kennedy M, Liu SW. Lessons Learned From Emergency Department Fall Assessment and Prevention Programs. Cureus 2021; 13:e16526. [PMID: 34430136 PMCID: PMC8377387 DOI: 10.7759/cureus.16526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives This research describes the experiences of emergency departments (EDs) with geriatric fall programs and qualitatively synthesizes lessons learned to inform other EDs planning new fall program implementation. Methods By using grounded theory, we conducted semi-structured, open-ended telephone/skype interviews of emergency physicians and geriatric providers recruited from a purposeful sampling technique. The interviews were transcribed and reviewed by two investigators. The codes were generated and listed, and common concepts emerged. Lastly, the final codes were organized into concepts and themes with the aim to create a strong coding structure. Result The main lessons learned are: (1) understand the hospital’s existing local environment and resources, (2) utilize champions and interdisciplinary teams, (3) acknowledge that specific fall assessment tools and interventions vary widely between institutions, (4) engage in routine plan-do-study-act (PDSA) cycles to improve the quality of fall initiatives, and (5) operate under the principle that falls are a syndrome, which must be incorporated within the multifactorial medical needs of geriatric fall patients. Conclusion Based on the lessons learned from our ED fall implementation pioneers, implementing an effective geriatric fall protocol in an ED setting is complicated. Understanding a hospital’s resources, assigning champions, working as an interdisciplinary team, choosing proper fall assessment tools/interventions, and completing regular PDSA cycles are important lessons for ED programs planning to implement their own ED fall programs.
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Affiliation(s)
- Phraewa Thatphet
- Department of Emergency Medicine, Massachusetts General Hospital, Massachusetts, USA.,Emergency Medicine, Khon Kaen University, Khon Kaen, THA
| | - Fae B Kayarian
- Department of Emergency Medicine, Massachusetts General Hospital, Massachusetts, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Massachusetts, USA
| | - Teresita Hogan
- Department of Emergency Medicine, University of Chicago Medicine, Illinois, USA
| | - John G Schumacher
- Epidemiology and Public Health, University of Maryland, Maryland, USA
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Massachusetts, USA
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Massachusetts, USA
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Negrete Manriquez JA, Bazargan-Hejazi S, Nahm SJ, de Virgilio C. Exploring a novel approach to surgery clerkship didactics during the COVID-19 pandemic: A qualitative study. Am J Surg 2021; 223:662-669. [PMID: 34284882 PMCID: PMC8276550 DOI: 10.1016/j.amjsurg.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
Background The COVID-19 pandemic brings unforeseen challenges in medical education. The current study aims to: 1) describe third-year medical students’ experiences with the novel Shelf-Exam-Type Question Didactics (SET QD) before (in-person) and during (virtual) COVID-19. Methods In this qualitative study using grounded theory, we conducted purposive sampling and used 23 in-depth semi-structured interviews. Audio recordings were transcribed verbatim and the Atlas.Ti software was used to manage the thematic analysis. Results There are three themes and eight subthemes that emerged: 1) The SET QD Framework (sub-themes: questions as learning opportunities; interleaving; notable clinical scenarios; team learning; accountability). 2) Experienced Educator (subtheme: transformational teaching). 3) Virtual Accessibility (sub-themes: alleviating time constraints, and mitigating life-stressors). Conclusions Medical students regarded SET QD as impactful for shelf exam preparation, clinical preparation, and long-term retention of the material. This novel virtual didactic method may be used in non-surgical clerkships as well.
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Affiliation(s)
- Jose A Negrete Manriquez
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E 120th St, Los Angeles, CA, 90059, USA; David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Shahrzad Bazargan-Hejazi
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E 120th St, Los Angeles, CA, 90059, USA.
| | - Sue J Nahm
- David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Christian de Virgilio
- David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA; Department of Surgery, Harbor-UCLA Medical Center, 1000 W Carson St, Torrance, CA, 90502, USA.
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Velez-Florez MC, Reid JR, Gokli A. The value of qualitative inquiry in medical education research: evaluation of three successful publications. Pediatr Radiol 2021; 51:1284-1289. [PMID: 33630104 DOI: 10.1007/s00247-021-05002-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/16/2020] [Accepted: 02/08/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Maria C Velez-Florez
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Janet R Reid
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Ami Gokli
- Department of Radiology, Staten Island University Hospital, Staten Island, NY, USA
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Tomczyk M, Dieudonné-Rahm N, Jox RJ. A qualitative study on continuous deep sedation until death as an alternative to assisted suicide in Switzerland. BMC Palliat Care 2021; 20:67. [PMID: 33990204 PMCID: PMC8122537 DOI: 10.1186/s12904-021-00761-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND According to the European Association for Palliative Care, decisions regarding palliative sedation should not be made in response to requests for assisted dying, such as euthanasia or assisted suicide. However, several studies show that continuous deep sedation until death (CDSUD) - a particular form of sedation - has been considered as an alternative to these practices in some countries. In Switzerland, where assisted suicide is decriminalized and CDSUD is not legally regulated, no studies have comprehensively investigated their relation. Our study aimed to identify and describe the experience among palliative care physicians of CDSUD as a potential alternative to assisted suicide in the French-speaking part of Switzerland. METHODS We performed an exploratory multicentre qualitative study based on interviews with palliative care physicians in the French-speaking part of Switzerland and conducted linguistic and thematic analysis of all interview transcripts. The study is described in accordance with COREQ guidelines. RESULTS We included 10 interviews conducted in four palliative care units. Our linguistic analysis shows four main types of sedation, which we called 'rapid CDSUD', 'gradual CDSUD', 'temporary sedation' and 'intermittent sedation'. CDSUD (rapid or gradual) was not considered an alternative to assisted suicide, even if a single situation has been reported. In contrast, 'temporary' or 'intermittent sedation', although not medically indicated, was sometimes introduced in response to a request for assisted suicide. This was the fact when there were barriers to an assisted suicide at home (e.g., when transfer home was impossible or the patient wished not to burden the family). CONCLUSION These preliminary results can guide clinical, ethical, linguistic and legal reflection in this field and be used to explore this question more deeply at the national and international levels in a comparative, interdisciplinary and multiprofessional approach. They can also be useful to update Swiss clinical guidelines on palliative sedation in order to include specific frameworks on various sedation protocols and sedation as an alternative to assisted suicide. Potential negative impacts of considering palliative sedation as an alternative to assisted suicide should be nuanced by open and honest societal debate.
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Affiliation(s)
- Martyna Tomczyk
- Institute of Humanities in Medicine, Lausanne University Hospital & University of Lausanne, Av. de Provence 82, CH-1007, Lausanne, Switzerland.
| | - Nathalie Dieudonné-Rahm
- Palliative Care Unit, Geneva University Hospitals, Chemin de la Savonnière 11, 1245 Collonge Bellerive, Geneva, Switzerland
| | - Ralf J Jox
- Institute of Humanities in Medicine, Lausanne University Hospital & University of Lausanne, Av. de Provence 82, CH-1007, Lausanne, Switzerland
- Palliative & Supportive Care Service, Chair in Geriatric Palliative Care, Lausanne University Hospital & University of Lausanne, Av. Pierre-Decker 5, CH-1011, Lausanne, Switzerland
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Socratous G, Cloconi C, Tsatsou I, Charalambous A. Nurses' Knowledge in Relation to the Anorexia-Cachexia Syndrome in Cancer Patients: A Cross-National Comparison in Two European Countries. SAGE Open Nurs 2021; 7:23779608211035208. [PMID: 34632056 PMCID: PMC8493427 DOI: 10.1177/23779608211035208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 07/05/2021] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION The Anorexia-Cachexia Syndrome (ACS) is a severe complication of cancer and is considered to be a significant cause of morbidity and mortality affecting up to two-thirds of cancer patients and one that needs specialized nursing care. Studies showed that the ACS has been relatively under-researched and under-resourced whist the nurses' knowledge has not been systematically explored. OBJECTIVE Τo explores nurses' knowledge, understanding, and management of ACS in clinical practice in two European countries. METHODS Descriptive-comparative study with 197 cancer nurses recruited during two National Conferences in Greece and Cyprus. Data were retrieved with the "Investigation of anorexia-cachexia syndrome in Practice" questionnaire. RESULTS In terms of nurses' perceptions on ACS, the prevailing characteristic reported in both countries was anorexia (p = .65) followed by weight loss (p = .04). 189 nurses (95.9%, p = .176) do not currently use a tool to assess patients' nutritional status as part of their standard clinical practice. Statistically significant differences were found in relation to the routine assessment of nutritional-related symptoms including early satiety (Cyprus 64% vs. Greece 37%, p = .001), hiccough (66% vs. 36%, p < .001), alteration of the taste/odor sensation (77% vs. 45%, p < .001), problems in the oral cavity (84% vs. 68%, p = .032) and daily activities (85% vs. 69%, p = .032). The priority level for the ACS management differed significantly in the two countries (p = .006), with higher priority being reported in Cyprus. CONCLUSION The study showed that more education is needed for cancer nurses to better understand the ACS which can facilitate the better management of the syndrome in clinical practice.
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Affiliation(s)
| | | | - Ioanna Tsatsou
- Oncology-Hematology Department, Hellenic Airforce General
Hospital, Athens, Greece
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Cristancho S, Field E. Qualitative investigation of trace-based communication: how are traces conceptualised in healthcare teamwork? BMJ Open 2020; 10:e038406. [PMID: 33148735 PMCID: PMC7643497 DOI: 10.1136/bmjopen-2020-038406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This interview-based qualitative study aims to explore how healthcare providers conceptualise trace-based communication and considers its implications for how teams work. In the biological literature, trace-based communication refers to the non-verbal communication that is achieved by leaving 'traces' in the environment and other members sensing them and using them to drive their own behaviour. Trace-based communication is a key component of swam intelligence and has been described as a critical process that enables superorganisms to coordinate work and collectively adapt. This paper brings awareness to its existence in the context of healthcare teamwork. DESIGN Interview-based study using Constructivist Grounded Theory methodology. SETTING This study was conducted in multiple team contexts at one of Canada's largest acute-care teaching hospitals. PARTICIPANTS 25 clinicians from across professions and disciplines. Specialties included surgery, anesthesiology, psychiatry, internal medicine, geriatrics, neonatology, paramedics, nursing, intensive care, neurology and emergency medicine. INTERVENTION Not relevant due to the qualitative nature of the study. PRIMARY AND SECONDARY OUTCOME Not relevant due to the qualitative nature of the study. RESULTS The dataset was analysed using the sensitising concept of 'traces' from Swarm Intelligence. This study brought to light novel and unique elements of trace-based communication in the context of healthcare teamwork including focused intentionality, successful versus failed traces and the contextually bounded nature of the responses to traces. While participants initially felt ambivalent about the idea of using traces in their daily teamwork, they provided a variety of examples. Through these examples, participants revealed the multifaceted nature of the purposes of trace-based communication, including promoting efficiency, preventing mistakes and saving face. CONCLUSIONS This study demonstrated that clinicians pervasively use trace-based communication despite differences in opinion as to its implications for teamwork and safety. Other disciplines have taken up traces to promote collective adaptation. This should serve as inspiration to at least start exploring this phenomenon in healthcare.
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Affiliation(s)
- Sayra Cristancho
- Department of Surgery, Faculty of Education and Centre for Education Research & Innovation, Western University, London, Ontario, Canada
| | - Emily Field
- Centre for Education Research & Innovation, Western University, London, Ontario, Canada
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Sewell JL, Leep Hunderfund AN, Schumacher DJ, Zaidi Z. The Hiker's Guide to the RIME Supplement: Choosing Directions in Research. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:S1-S6. [PMID: 32769471 DOI: 10.1097/acm.0000000000003647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this Commentary, the authors seek to build on prior RIME commentaries by considering how researchers transition from worldviews, focal lengths, and research goals to research directions and methodological choices. The authors use the analogy of a hiker to illustrate how different researchers studying a similar phenomenon can choose among different research directions, which lead down different paths and offer different perspectives on a problem. Following the hiker analogy, the authors use the "Research Compass" to categorize the 15 research papers included in the 2020 Research in Medical Education supplement according to their research aim and corresponding methodological approach. The authors then discuss implications of the relative balance of these study types within this supplement and within health professions education research at large, emphasizing the critical importance of studying a topic from multiple vantage points to construct a richer and more nuanced understanding of health professions education challenges. The authors conclude by recognizing the challenges we face in the current era of COVID-19 and by calling health professions education researchers and practitioners to continue our collective efforts to improve learner education and patient care, as we together navigate the unfamiliar terrain of the present day.
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Affiliation(s)
- Justin L Sewell
- J.L. Sewell is associate professor, Department of Medicine, Division of Gastroenterology, San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California
| | - Andrea N Leep Hunderfund
- A.N. Leep Hunderfund is associate professor, Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Schumacher
- D.J. Schumacher is associate professor, Department of Pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Zareen Zaidi
- Z. Zaidi is professor of medicine, Division of General Internal Medicine, University of Florida College of Medicine, Gainesville, Florida
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Sy M, O'Leary N, Nagraj S, El-Awaisi A, O'Carroll V, Xyrichis A. Doing interprofessional research in the COVID-19 era: a discussion paper. J Interprof Care 2020; 34:600-606. [PMID: 32718262 DOI: 10.1080/13561820.2020.1791808] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The COVID-19 pandemic, and ensuing physical distancing measures, poses challenges for researchers in the field of interprofessional care. Pandemic management has highlighted the centrality of interprofessional working to effective healthcare delivery during crises. It is essential to find ways to maintain interprofessional research that has commenced, while also designing research to capture important learning from pandemic management and response. However, it also creates opportunities for new research projects and novel research designs. This discussion paper explores ways of adapting existing research methodologies and outlines potential avenues for new research. Specifically, considerations to bear in mind when designing interprofessional research during the pandemic include research ethics and integrity, research design, data collection methods, research opportunities, implications and limitations. Interprofessional research can continue to make a valuable contribution in informing global responses to COVID-19 and in planning for future global health crises. We call for, insofar as possible, for interprofessional research to continue to be developed during this time.
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Affiliation(s)
- Michael Sy
- National Teacher Training Center for the Health Professions, University of the Philippines Manila , Manila, Philippines
| | - Noreen O'Leary
- School of Allied Health, University of Limerick , Limerick, Ireland
| | - Shobhana Nagraj
- Nuffield Department of Women's & Reproductive Health, University of Oxford , Oxford, UK.,The George Institute for Global Health , Oxford, UK
| | | | - Veronica O'Carroll
- QU Health Chair of the Interprofessional Education Committee, Qatar UniversityCollege of Pharmacy , Doha, Qatar.,School of Medicine, University of St Andrews , St Andrews, UK
| | - Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London , London, UK
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50
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The effectiveness of online interventions for patients with gynecological cancer: An integrative review. Gynecol Oncol 2020; 158:143-152. [PMID: 32340692 DOI: 10.1016/j.ygyno.2020.04.690] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/16/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE With advantages of easy accessibility and various multimedia interactivity formats, online interventions have been developed to improve health outcomes for patients with a variety of gynecological cancers, but evidence regarding their effectiveness for such patients is not well-understood. This review aimed to synthesize study findings that were published in English or Chinese regarding the effectiveness of online interventions on the quality of life, symptom distress, social support, psychological distress, sexual well-being, and body image in patients with gynecological cancer. METHODS This integrative review adhered to five steps, including problem identification, literature search, quality appraisal, data analysis, and presentation. Ten electronic databases (MEDLINE, ScienceDirect, SpringerLink, PubMed, Wiley Online Journals, Web of Science, OVID, CINAHL Plus with Full Text, China National Knowledge Infrastructure, and Cochrane Library) were searched from the inception of each database to April 2019 in accordance with the rigid and explicit inclusion and exclusion criteria. Version 2018 of the Mixed Methods Appraisal Tool was used for the quality appraisal of the articles. RESULTS Out of 276 articles, 24 potentially eligible articles were initially identified. A manual search retrieved an additional eligible three articles. After nine articles were excluded, ten quantitative, six qualitative, and two mixed-methods articles were finally included. Online interventions improved quality of life and body images in patients with gynecological cancer, but there were inconclusive effects on symptom distress, social support, psychological distress, and sexual well-being. CONCLUSIONS Online interventions have been increasingly used as clinically promising interventions to promote health outcomes among patients with gynecological cancer. Studies with more rigorous designs and sufficient sample sizes are needed to elucidate the effectiveness of such online interventions. Healthcare workers can incorporate existing or new online interventions into their routine care to improve health outcomes for patients with gynecological cancer.
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