New perspectives - approaches to medical education at four new UK Medical Schools

To create more UK doctors, the government has funded an increase in medical student numbers of 57% (from 3749 to 5894)1 between 1998 and 2005. This has been done by increasing student places at existing medical schools; creating shortened programmes open to science graduates; “twinning” arrangements, which host an existing curriculum at a new site; and four entirely new schools (table 1). Through reflection on our experiences and the literature evidence, we examine to what extent these new schools have a common vision and approach to undergraduate medical education, and we discuss the rationale for and likely outcomes of these new ventures

Could Neuro-Phenomenology Deepen an Interpretative Phenomenological Analysis of Seizure Consciousness Drawings

This article proposes a methodological stance, an Interpretative Phenomenological Analysis (IPA) of participants’ drawings as one that is useful for research into people’s experiences of seizure consciousness. Using empirical examples located in an original, larger study, this article offers a rationale for, and illustrates the analytic potential of, this combination. It also considers that elicitation interviewing techniques and methods from the field of neuro - phenomenology could take this work further in terms of deepening the analysis by reaching people’s pre - reflexive conscious experiences. This theoretical and practical combination has the potential to develop this work significantly

The Engagement of Faculty Members with Disabilities

University of Minnesota D.Ed. dissertation. 2021. Major: Educational Policy and Administration. Advisor: Rebecca Ropers. 1 computer file (PDF); 176 pages.Employee engagement has been studied in many contexts, but studies have often failed to consider how a disability affects engagement. A deeper understanding about the engagement of faculty members with disabilities is necessary to ensure that research and practice are inclusive of all scholars’ experiences. This qualitative study explored how disabilities and relationships relate to employee engagement, disclosure, and accommodation seeking. The research was based on 22 interviews with 11 faculty members from 3 public university campuses in the Midwest. Participants included assistant, associate, and full professors who were registered and receiving accommodations from a university resource center as well as some individuals who had not disclosed their disabilities. Findings illustrated how universities can foster organizational cultures and meaningful relationships that support faculty members with disabilities. Initiatives that facilitate employee engagement for faculty members with disabilities are likely to lead to increased disclosure and accommodation-seeking behaviors. Findings also suggested that universities must bolster support by offering resources and training in order to enable faculty members to overcome the stigma that they experience related to their disabilities. Resources should explain how to navigate both the accommodation-seeking and tenure processes as well as how to effectively work with a disability liaison. Finally, they should help faculty members to advocate for themselves and others

Terahertz electrical writing speed in an antiferromagnetic memory

The speed of writing of state-of-the-art ferromagnetic memories is physically limited by an intrinsic gigahertz threshold. Recently, realization of memory devices based on antiferromagnets, in which spin directions periodically alternate from one atomic lattice site to the next has moved research in an alternative direction. We experimentally demonstrate at room temperature that the speed of reversible electrical writing in a memory device can be scaled up to terahertz using an antiferromagnet. A current-induced spin-torque mechanism is responsible for the switching in our memory devices throughout the 12-order-of-magnitude range of writing speeds from hertz to terahertz. Our work opens the path toward the development of memory-logic technology reaching the elusive terahertz band

Towards a Toolset for Intranet Evaluation

Usability is an important component of information systems acceptance. Independent consultants in the assessment of organisational intranets often perform heuristic appraisal, a common method of usability evaluation. However, there are alternative usability models that offer valuable analysis in the evaluation process. Using a government organisation’s intranet as a case study, this paper assesses the value of an independent heuristic-based intranet audit by providing a comparable approach to assessment realisable internally in the organisation using questionnaires. Using a single case study, we empirically apply the Technology Acceptance Model (TAM), together with some heuristic aspects, to provide an alternative tool for intranet usability and acceptance. We provide insight into the usability impact of intranet design changes, and compare the findings of an external usability audit with the approach outlined. An overall toolset for intranet evaluation is proposed as an initial step for further exploration and potential use

On structures in medical interactions : a conversation analytic study of general practice consultations.

This thesis addresses from within the research paradigm of Conversation Analysis (CA) the question "How are interactions between patients and general practitioners organised? ". CA is a relatively recent tradition within the "interpretative paradigm" of sociology, growing out of the ethnomethodology of Garfinkel. The thesis first reviews the relevant literature of CA and medical interactions, and critically discusses the methodology. The empirical analysis used naturally occurring consultations in British general practice, video-recorded in five practices, involving 14 doctors, and about 50 hours of recording, made between 1987 and 1992. Recordings were observed first in an unmotivated way, to note occurrences of interesting interactional phenomena. Objects for further study were copied onto secondary "collection" tapes, which were then examined in depth, and transcribed in detail using conventions developed within CA. The analyses described here are: the use of time in the consultation; the impact of medical records on the interaction; prescribing and associated talk; the phenomenon of "facilitation", how doctors appear to enable patients to talk; patient-initiated questions, and rejection of patients' ideas by doctors; and finally the use of the word "we". The aim was to describe and explore, but not necessarily to explain, although in describing the mechanism of interaction in these areas of activity, empirical evidence is advanced for particular explanations. The phenomenon of patients raising new topics at the end of consultations is described, with its interactional implications: the "by-the-way" phenomenon is explored and documented. Case-notes are seen to contribute to consultations in a complex way, and like talk, are both context-dependent and context-forming. Utterances such as "right", "uhuh", "mmhm" which appear on the face of it to be facilitatory, can be the reverse. The phenomenon of dispreference for disagreements by patients is re-examined, and contexts in which patients do disagree are explored. Doctors' rejections of patients' ideas are described, and implications for teaching about the consultation are drawn. Finally the various ways in which the word "we" is used by doctors are described and critically appraised, in the context of a philosophical understanding of "intersubjectivity". The study adds to the body of transcribed interactions drawn from general practice, and sheds some light on ways in which general practitioners and patients structure their consultations. It has implications for the way medical students learn how to consult, and for how research on the consultation can be conducted. Conversation analysis is shown to be a powerful qualitative analytic methodology, relevant to the study of medical interactions

A Disease Register for ME/CFS: Report of a Pilot Study.

BACKGROUND: The ME/CFS Disease Register is one of six subprojects within the National ME/CFS Observatory, a research programme funded by the Big Lottery Fund and sponsored by Action for ME. A pilot study in East Anglia, East Yorkshire, and London aimed to address the problem of identifying representative groups of subjects for research, in order to be able to draw conclusions applicable to the whole ME/CFS population.While not aiming for comprehensive population coverage, this pilot register sought to recruit participants with ME/CFS in an unbiased way from a large population base. Those recruited are constituting a cohort for long-term follow-up to shed light on prognosis, and a sampling frame for other studies. FINDINGS: Patients with unidentified chronic fatigue were identified in GP databases using a READ-code based algorithm, and conformity to certain case definitions for ME/CFS determined. 29 practices, covering a population aged 18 to 64 of 143,153, participated.510 patients with unexplained chronic fatigue were identified. 265 of these conformed to one or more case definitions. 216 were invited to join the register; 160 agreed. 96.9% of participants conformed to the CDC 1994 (Fukuda) definition; the Canadian definition defined more precisely a subset of these. The addition of an epidemiological case definition increased case ascertainment by approximately 4%. A small-scale study in a specialist referral service in East Anglia was also undertaken.There was little difference in pattern of conformity to case definitions, age or sex among disease register participants compared with subjects in a parallel epidemiological study who declined to participate.One-year follow-up of 50 subjects showed little change in pain or fatigue scores. There were some changes in conformity to case definitions. CONCLUSIONS: Objective evaluation indicated that the aim of recruiting participants with ME/CFS to a Disease Register had been fulfilled, and confirmed the feasibility of our approach to case identification, data processing, transmission, storage, and analysis. Future developments should include expansion of the ME/CFS Register and its linkage to a tissue sample bank and post mortem tissue archive, to facilitate support for further research studies

Excisional treatment in women with cervical adenocarcinoma in situ (AIS): a prospective randomised controlled noninferiority trial to compare AIS persistence/recurrence after loop electrosurgical excision procedure with cold knife cone biopsy: protocol for a pilot study

Introduction: Adenocarcinoma in situ (AIS) of the uterine cervix is the precursor to invasive endocervical adenocarcinoma. An excisional biopsy such as a cold knife cone biopsy (CKC) should be performed to exclude invasive adenocarcinoma. Loop electrosurgical excision procedure (LEEP) is an alternative modality to CKC but is controversial in AIS. There is a perception that there is a greater likelihood of incomplete excision of AIS with LEEP because the depth of excised tissue tends to be smaller and the tissue margins may show thermal artefact which can interfere with pathology assessment. In the USA, guidelines recommend that any treatment modality can be used to excise AIS, provided that the specimen remains intact with interpretable margins. However, there are no high-quality studies comparing LEEP with CKC and well-designed prospective studies are needed. If such a study were to show that LEEP was non-inferior to CKC for the outcomes of post-treatment persistence, recurrence and adenocarcinoma, LEEP could be recommended as an appropriate treatment option for AIS in selected patients. This would benefit women because, unlike CKC, LEEP does not require general anaesthesia and may be associated with reduced morbidity. Methods and analysis: The proposed exploratory study is a parallel group trial with an allocation ratio of 2:1 in favour of the intervention (LEEP: CKC). Participants are women aged ≥18 to ≤45 years diagnosed with AIS on cervical screening and/or colposcopically directed biopsy in Australia and New Zealand, who are to receive excisional treatment in a tertiary level centre. Ethics and dissemination: Ethical approval for the study has been granted by the St John of God Healthcare Human Research Ethics Committee (reference number #1137)