An Exploration of Pediatricians' Professional Identities: A Q-Methodology Study

Professional identities may influence a wide range of attitudes, ethical standards, professional commitments and patient safety. This study aimed to explore the important elements that comprise pediatricians' professional identities. A Q-methodology was used to identify the similarities and differences in professional identity. Forty pediatricians were recruited from two tertiary referral hospitals in Taiwan. A list of statements was developed by five attending physicians and three residents. R software was used to analyze the Q-sorts to load the viewpoints and formulate the viewpoint arrays. Additional qualitative data-one-to-one personal interviews-were analyzed. Twenty-eight of forty pediatricians, 11 males and 17 females, with an average age of 39.9 (27-62) years, were associated with four viewpoints. We labeled the four viewpoints identified for professional identity as (1) professional recognition, (2) patient communication, (3) empathy and (4) insight. The professional recognition viewpoint comprised of youngest participants-28-36 years-with the majority as residents (77.8%), while the empathy viewpoint comprised the oldest participants-38-62 years-with all as attending physicians. All participants in the empathy and insight viewpoints were married. This study found professional identity to be a multifaceted concept for pediatricians, especially in the areas of professional recognition, patient communication, empathy and insight into patient care.

Prenatal High-Fat Diet Combined with Microplastic Exposure Induces Liver Injury via Oxidative Stress in Male Pups

Prenatal high-fat diet (HFD) or exposure to microplastics can affect the accumulation of liver fat in offspring. We sought to determine the effects of maternal HFD intake and microplastic exposure on fatty liver injury through oxidative stress in pups. Pregnant female Sprague-Dawley rats were randomly divided into maternal HFD (experimental group) or normal control diet (NCD; control group) groups with or without microplastic exposure. As a result, the following groups were established: HFD-L (HFD + microplastics, 5 µm, 100 μg/L), HFD-H (HFD + microplastics, 5 µm, 1000 μg/L), NCD-L (NCD + microplastics, 5 µm, 100 μg/L), and NCD-H (NCD + microplastics, 5 µm, 1000 μg/L). The pups were sacrificed on postnatal day 7 (PD7). Liver histology revealed increased hepatic lipid accumulation in pups in the HFD-L and HFD-H groups compared to those in the HFD, NCD-L, NCD-H, and NCD groups on PD7. Similarly, liver TUNEL staining and cellular apoptosis were found to increase in pups in the HFD-L and HFD-H groups compared to those in the HFD, NCD-L, NCD-H, and NCD groups. The expression levels of malondialdehyde, a lipid peroxidation marker, were high in the HFD, HFD-L, and HFD-H groups; however, the highest expression was observed in the HFD-H group (p < 0.05). The levels of glutathione peroxidase, an antioxidant enzyme, decreased in the HFD, HFD-L, and HFD-H groups (p < 0.05). Overall, oxidative stress with cellular apoptosis plays a vital role in liver injury in offspring after maternal intake of HFD and exposure to microplastic; such findings may shed light on future therapeutic strategies.

Emergency residents' self-perceived readiness for practice: the association of milestones, entrustable professional activities, and professional identities-a multi-institutional survey

Background

As a successful innovation, competency-based medical education and its assessment tools continue to be a key strategy in training future doctors and tracking their performance trajectories. Linked to professional identity, evidence suggests that clinical competence is related to thinking, acting and feeling like a physician. Thus, incorporating the values and attitudes of healthcare professions as part of their professional identity in the clinical workplace improves professional performance.

Methods

Through a cross-sectional study, we examined the association of milestone, entrustable professional activities (EPA) and professional identity using self-reported tools among emergency medicine residents from 12 teaching hospitals across Taiwan. Milestone, EPA and professional identity were assessed using the Emergency Medicine Milestone Scale, Entrustable Professional Activity Scale and Emergency Physician Professional Identity and Value Scale, respectively.

Results

The results of a Pearson correlation indicated a significant positive correlation between milestone-based core competencies and EPAs (r = 0.40 ~ 0.74, p < 0.01). The professional identity domain of skills acquisition, capabilities and practical wisdom was positively correlated with milestone-based core competencies of patient care, medical knowledge, practice-based learning and improvement, and system-based practice (r = 0.18 ~ 0.21, p ≤ 0.05), and six items of EPA (r = 0.16 ~ 0.22, p < 0.05). Additionally, the professional identity domain of professional recognition and self-esteem was positively correlated with practice-based learning and improvement, and system-based practice milestone competencies (r = 0.16 ~ 0.19, p < 0.05).

Conclusion

This study demonstrates milestone and EPA assessment tools are highly linked and therefore, can be synergistically used by supervisors and clinical educators to evaluate clinical performance during residency training. Emergency physicians' professional identity is partly influenced by the advancement of skills and a resident's ability to learn, effectively perform tasks and make appropriate medical decisions at the system level in their clinical practice. Further research is warranted to understand the importance of residents' competency in relation to their professional identity development trajectory during clinical training.

The Chichewa Wijma delivery expectancy/experience questionnaire: a factor analytic study for postpartum women in Malawi

OBJECTIVE

To test the validity and reliability of the Chichewa Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) in Malawian postpartum women.

METHODS

A cross-sectional study of postnatal women (N= 415) at 1 day after vaginal birth was conducted at a district hospital in Malawi. The W-DEQ, Edinburgh Postnatal Depression Scale and the World Health Organization Quality of Life Scale were used to measure fear of birth (FOB), depressive symptoms and quality of life (QoL). Principal component analysis (PCA) and confirmatory factor analysis (CFA), Cronbach's alpha, the average variance extracted (AVE) and the composite reliability (CR) and Pearson correlation were used to test the construct validity, reliability, convergent and divergent validity of the Chichewa W-DEQ (CW-DEQ).

RESULTS

The participants had a mean age of 28.3 ± 6.7 years. A multidimensional structure containing three factors - a lack of positive feelings, fear and concerns about childbirth - with an appropriate model fit was reported for the CW-DEQ version. The Cronbach's α of the CW-DEQ was 0.87. The AVE and CR values were highly acceptable in lack of positive feelings - 0.17 (0.68), and concerns about childbirth - 0.79 (0.88) factors which proved the convergent validity of each; however, was marginally acceptable in the fear factor - 0.14 (0.53). Low range of correlations between the CW-DEQ constructs (r = 0.27 ∼ 0.42, p < .001), confirmed the divergent validity.

CONCLUSIONS

In this study, we found the CW-DEQ to be a reliable and valid tool for assessing FOB in postpartum women.

The Influence of Breastfeeding Promotion Programs on Exclusive Breastfeeding Rates in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

BACKGROUND

The benefits of breastfeeding in promoting child survival are well recognized. As one of the nutritional interventions for children, exclusive breastfeeding protects babies from various diseases that contribute to infant morbidity and mortality. However, no systematic review and meta-analysis has examined the influence of breastfeeding promotion programs on exclusive breastfeeding rates in sub-Saharan Africa.

RESEARCH AIM

We examined the influence of breastfeeding promotion programs on exclusive breastfeeding rates at < 1 month, and at 1-5 months of breastfeeding in sub-Saharan countries including Ghana, Burkina Faso, Uganda, South Africa, Guinea-Bissau, Kenya, Tanzania, and the Democratic Republic of Congo.

METHODS

A systematic review and meta-analyses study of randomized controlled trials and quasi-experimental studies was conducted by searching in electronic databases and articles' reference lists. Two investigators independently evaluated and extracted the data. A total of 131 studies were identified using five databases. Of the 10 studies meeting the inclusion criteria for systematic review, seven studies were included in the meta-analysis. We used a random-effects model to pool studies together and performed a subgroup analysis.

RESULTS

Breastfeeding promotion programs resulted in significantly higher exclusive breastfeeding rates at < 1 month (OR = 1.60, 95% CI [1.36,1.86]). However, there was no significant effect observed for exclusive breastfeeding at 1-5 months. Combined interventions were more effective in improving exclusive breastfeeding rates than individual counseling or home-based counseling alone.

CONCLUSION

Breastfeeding promotion programs in sub-Saharan Africa are effective in increasing exclusive breastfeeding rates at 6 months after birth.

Bridging the Gap: Using Consensus to Explore Entrustment Decisions and Feedback Receptivity in Competency-Based Emergency Medicine Residency Programs Through the Construction of a Q-Sample Incorporating a Delphi Technique

Background

Recent changes in medical education calls for a shift toward student-centered learning. Therefore, it is imperative that clinical educators transparently assess the work-readiness of their medical residents through entrustment-based supervision decisions toward independent practice. Similarly, it is critical that medical residents are vocal about the quality of supervision and feedback they receive. This study aimed to explore the factors that influence entrustment-based supervision decisions and feedback receptivity by establishing a general consensus among Taiwanese clinical educators and medical residents regarding entrustment decisions and feedback uptake, respectively.

Methods

In Q-methodology studies, a set of opinion statement (i.e., the Q-sample) is generated to represent the phenomenon of interest. To explore the factors that influence entrustment-based supervision decisions and feedback receptivity, a Q-sample was developed using a four-step approach: (1) literature search using electronic databases, such as PubMed and Google Scholar, and interviews with emergency clinical educators and medical residents to generate opinion statements, (2) thematic analysis and grouping using The Model of Trust, the Ready, Wiling, and Able model, and the theory of self-regulated learning, (3) translation, and (4) application of a Delphi technique, including two expert panels comprised of clinical educators and medical residents, to establish a consensus of the statements and validation for a subsequent Q-study.

Results

A total of 585 and 1,039 statements from the literature search and interviews were extracted to populate the sample of statements (i.e., the concourse) regarding entrustment-based supervision decisions for clinical educators and feedback receptivity emergency medicine residents, respectively. Two expert panels were invited to participate in a Delphi Technique, comprised of 11 clinical educators and 13 medical residents. After two-rounds of a Delphi technique, the panel of clinical educators agreed on 54 statements on factors that influence entrustment-based supervision decisions and were categorized into five themes defined by the Model of Trust. Similarly, a total of 60 statements on the factors that influence feedback receptivity were retained by the panel of medical residents and were categorized into five themes defined by the Ready, Willing, and Able model and the theory of self-regulated learning.

Conclusion

Though not exhaustive, the key factors agreed upon by clinical educators and medical residents reflect the characteristics of entrustment-based supervision decisions and feedback receptivity across specialties. This study provides insight on an often overlooked issue of the paths to teaching and learning in competency-based residency training programs. Additionally, incorporation of the Delphi technique further adds to the existing literature and puts emphasis as an important tool that can be used in medical education to rigorously validate Q-statements and develop Q-samples in various specialties.

Validation of the Wijma delivery expectancy/experience questionnaire for pregnant women in Malawi: a descriptive, cross-sectional study

BACKGROUND

Fear of childbirth is a common health concern for women during pregnancy. The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) is widely used to measure childbirth fear during pregnancy. However, this instrument is yet to be validated in Malawi, Africa. Our study aimed to assess the psychometric properties of the W-DEQ questionnaire in Malawi.

METHODS

Healthy pregnant women in the third trimester (N = 476) at a district hospital in Malawi were included. Fear of childbirth, depressive symptoms, and quality of life were assessed using the W-DEQ, the Edinburg Postnatal Depression Scale, and the World Health Organization Quality of Life scale, respectively. The construct validity, reliability, and convergent validity of the W-DEQ were examined using exploratory and confirmatory factor analyses, Cronbach's alpha, and Pearson correlations.

RESULTS

The mean age of participants was 28.2 (standard deviation = 6.8) years. Exploratory and confirmatory factor analysis of the Malawian version of the W-DEQ indicated a multidimensional structure with three factors: fear, negative appraisal, and a lack of self-efficacy, with acceptable goodness of model fit. The Malawian version of the W-DEQ showed a satisfactory internal consistency (α = 0.84) and was significantly correlated with depressive symptoms (r = 0.23, p < 0.001) and quality of life (r = - 0.17 ~ -0.26, ps < 0.05).

CONCLUSIONS

Our findings support the Malawian W-DEQ version being a reliable and valid instrument for measuring childbirth fear in African women.

Childbirth fear and related factors among pregnant and postpartum women in Malawi

BACKGROUND

Childbirth fear is a health concern in women living in high-income countries; however, little is known about childbirth fear among women living in low-income countries like Malawi. In this study, we explored childbirth fear and associated factors among pregnant and postpartum women in Malawi.

METHODS

A cross-sectional study of 152 pregnant and 153 postpartum women was conducted at a district hospital in Malawi. Participants were assessed for childbirth fear using the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ). Demographic and obstetric variables were collected using a structured questionnaire. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure social support. Using a multinomial logistic regression, factors related to childbirth fears were examined, namely demographic and obstetric characteristics, and social support.

RESULTS

The mean age of participants was 26 (standard deviation: 6.4) years. During pregnancy, 39% women reported a low level of fear, 41% reported moderate fear, and 20% reported high fear; while after birth, 49, 41, and 10% women reported low, moderate, and high fear, respectively. Pregnant women who were illiterate (odds ratio (OR): 5.0, p < 0.01) or unemployed (OR: 12.6, p < 0.01) were more likely to report moderate and high fear. Postpartum mothers who were illiterate (OR: 4.2, p < 0.01) or unemployed (OR: 11.8, p < 0.01) were more likely to have moderate and high fear. Furthermore, postpartum women who sustained perineal tears had significantly higher odds of experiencing moderate (OR: 5.3, p < 0.01) or high (OR: 19.9, p < 0.01) fear than their counterparts.

CONCLUSIONS

Childbirth fear is common in Malawi, and pregnant women are more likely to experience high levels of fear than postpartum women. This study highlighted the connection between childbirth fear with mother's education, employment, and perineal tears during delivery. Identifying and developing interventions for women with these associated characteristics is of clinical importance for the reduction of childbirth fear before and after childbirth in Malawi.