The F3 phenomenon: Early‐career training breaks in medical training. A scoping review

BackgroundSince 2017 more than 50% of UK doctors have undertaken a ‘Foundation 3 (F3) Year’ training break after completing their Foundation Programme (the first two years following graduation), rather than immediately enter specialty training. The reasons for, and consequences of, the growing F3 trend are largely unknown. This scoping review presents the current evidence and identifies future research in this field.MethodsFollowing Arksey and O’Malley’s guidelines, 12 databases and three UK‐based national post‐graduate organisation websites were searched for articles published in English (final searches January 2020). Multiple search terms were used to capture articles relating to the ‘F3’ time‐period, including ‘post‐foundation’ or ‘pre‐specialty’ training. Title, abstract and full‐paper screening selected articles reporting any aspect of F3, including within a wider context (e.g., postgraduate training breaks), and then underwent mixed methods analysis .ResultsOf 4766 articles identified, 45 were included. All articles were published after 2009; 14/45 (31.1%) were published in 2019. 27 articles reported research, the remainder were opinion/commentaries. Specific personal (including demographic), professional and organisational factors, particularly the UK post‐graduate training structure, are associated with undertaking an F3. The majority of F3 training breaks last 1 year and involve working (clinically or non‐clinically) and/or travel. The decision to undertake an F3 is made either prior to, or during, foundation training. Evidence regarding the impact of F3 on healthcare service provision was limited but evenly balanced.ConclusionsIn summarising the existing F3 evidence, this review has highlighted important issues including healthcare workforce equality and diversity, training pathway inflexibility and the effect of negative early‐career experiences on subsequent career decisions. More research is needed to understand the financial impact of training‐breaks on healthcare service provision, how training programmes must adapt to retain more trainees, and the long‐term effects of training breaks, such as F3, on subsequent career progression

Twelve tips for organising a local or regional e-poster session

E-posters have been increasingly incorporated into medical education conferences over the past few years, but since the disruption to the ‘traditional’ conference circuit as a result of COVID-19 pandemic in 2020 they have become a necessary tool for larger national and international conferences to support ongoing scholarship dissemination. The authors of this article also recognise the potential for smaller-scale e-poster sessions to be organised at local or regional levels to either continue, or establish new, special interest groups and smaller medical education research networks. Our 12 tips article is designed to offer practical advice to support the implementation of local or regional e-poster sessions to potential organisers and is written from the perspective of two medical educational researchers with experience of designing e-posters and organising virtual conferences which include e-poster presentation sessions

When I say … social justice

Explore the term "Social Justice" in this new "When I Say" article. The authors consider its origin, advocate for a broader definition, and encourage renewed focus in the field

Beyond the Bedside: Protocol for a scoping review exploring the experiences of non-practicing healthcare professionals within health professions education

Background: The number of healthcare professionals leaving clinical practice and transitioning to alternative careers in health professions education is increasing. Among these non-practicing healthcare professionals, concerns have been reported regarding tensions in relation to identity, role, and credibility in their new field. There are suggestions that this is a particularly pressing issue for minoritised professionals who make this transition. Support is critical to attract and retain diverse talent within health professions education teaching and research. The purpose of this scoping review is to explore the career experiences of non-practicing healthcare professionals who work in health professions education internationally.Methods: Arksey and O’Malley’s framework has been utilised to guide the design of this scoping review process and will be used throughout the course of the review. A comprehensive search of seven electronic databases and limited search of Google Scholar will be conducted, as well as a hand search of eligible article reference lists. Two reviewers will independently screen all articles based on inclusion criteria, with conflicts resolved by a third reviewer. Data from included articles will be charted, collated, and analysed thematically. Meta-data will be summarised quantitatively.Discussion: This scoping review aims to explore the role and experiences of non-practicing healthcare professionals working within health professions education. The review will follow established scoping review guidelines and will include studies from various regions and languages, provided an English translation is available. The study remit will be broad, including both quantitative and qualitative studies, as well as reviews and opinion papers. Limitations may include the exclusion of non-English articles and potential difficulty of identifying papers which discuss the experiences of non-practicing clinicians. However, the review will provide insight into the current knowledge on what it is like to be a non-practicing clinician working within health professions education and identify gaps for both future research, and future support for those making this career transition

Beyond the bedside: A scoping review of the experiences of non‐practising health care professionals in Health Professions Education

AbstractIntroductionThe shortage of educators within Health Professions Education (HPE) threatens the optimal training of the future health care workforce. Furthermore, without recruitment of diverse and skilled faculty, targets to expand the workforce will not be possible. Non‐practising health care professionals offer extensive knowledge and qualifications within health care, without the competing clinical commitments of their clinical academic colleagues, and therefore are ideally positioned to support education and training initiatives. However, the limited available evidence suggests that these individuals face significant challenges transitioning from clinical to academic roles. The purpose of this scoping review is to address the research question ‘What is known about the career experiences of non‐practicing healthcare professionals (defined as individuals with clinical backgrounds who no longer engage in direct patient care) across various professions and internationally, within the field of health professions education?’. To do so, we aim to map the global experiences of non‐practising health care professionals from different specialties and disciplines transitioning to HPE, with a view to both current support strategies that aim to recruit and retain these individuals and fuel future research in this area.MethodsFollowing Arksey and O'Malley's scoping review guidelines, a research question was formulated focussing on exploring the career experiences of non‐practising health care professionals now working in HPE. Searching seven literature databases and grey literature identified 51 articles for analysis. Both quantitative and qualitative methods were utilised to chart and thematically analyse data to identify key themes.ResultsThere has been a rise in publications on this topic, with most studies originating from the United States and focusing on nursing. Transition to academia is marked by significant challenges, including identity shifts, renumeration and professional progression tensions, licencing issues and financial concerns. Support systems are crucial to navigating new roles alongside personal/professional development but often lacking.DiscussionThis scoping review highlights challenges and opportunities for non‐practising health care professionals in HPE. Additional support for making the transition to education, including structured onboarding processes and long‐term mentoring relationships, would be beneficial. Recognising the liminal space these professionals occupy might also facilitate more effective integration into academic roles, contributing to a more dynamic and inclusive HPE environment. Future research should explore these experiences from broader professional and geographical perspectives and employ an intersectional approach to fully understand and support this growing demographic in our field

Tertiary lymphoid structures critical for prognosis in endometrial cancer patients

B-cells play a key role in cancer suppression, particularly when aggregated in tertiary lymphoid structures (TLS). Here, we investigate the role of B-cells and TLS in endometrial cancer (EC). Single cell RNA-sequencing of B-cells shows presence of naive B-cells, cycling/germinal center B-cells and antibody-secreting cells. Differential gene expression analysis shows association of TLS with L1CAM overexpression. Immunohistochemistry and co-immunofluorescence show L1CAM expression in mature TLS, independent of L1CAM expression in the tumor. Using L1CAM as a marker, 378 of the 411 molecularly classified ECs from the PORTEC-3 biobank are evaluated, TLS are found in 19%. L1CAM expressing TLS are most common in mismatch-repair deficient (29/127, 23%) and polymerase-epsilon mutant EC (24/47, 51%). Multivariable Cox regression analysis shows strong favorable prognostic impact of TLS, independent of clinicopathological and molecular factors. Our data suggests a pivotal role of TLS in outcome of EC patients, and establishes L1CAM as a simple biomarker.Tertiary lymphoid structures (TLS) are associated with a reduced risk of cancer recurrence and improved response to immune checkpoint blockade in several tumor types. Here the authors identify L1CAM as a marker for mature TLS and show that the presence of TLS is associated with favorable prognosis in patients with endometrial cancer from the PORTEC-3 trial.Biological, physical and clinical aspects of cancer treatment with ionising radiatio

Wristband accelerometers to motivate arm exercise after stroke (WAVES): study protocol for a pilot randomized controlled trial

BACKGROUND: Loss of upper limb function affects up to 85 % of acute stroke patients. Recovery of upper limb function requires regular intensive practise of specific upper limb tasks. To enhance intensity of practice interventions are being developed to encourage patients to undertake self-directed exercise practice. Most interventions do not translate well into everyday activities and stroke patients continue to find it difficult remembering integration of upper limb movements into daily activities. A wrist-worn device has been developed that monitors and provides ‘live’ upper limb activity feedback to remind patients to use their stroke arm in daily activities (The CueS wristband). The aim of this trial is to assess the feasibility of a multi-centre, observer blind, pilot randomised controlled trial of the CueS wristband in clinical stroke services. METHODS/DESIGN: This pilot randomised controlled feasibility trial aims to recruit 60 participants over 15 months from North East England. Participants will be within 3 months of stroke which has caused new reduced upper limb function and will still be receiving therapy. Each participant will be randomised to an intervention or control group. Intervention participants will wear a CueS wristband (between 8 am and 8 pm) providing “live” feedback towards pre-set movement goals through a simple visual display and vibration prompts whilst undertaking a 4-week upper limb therapy programme (reviewed twice weekly by an occupational/physiotherapist). Control participants will also complete the 4-week upper limb therapy programme but will wear a ‘sham’ CueS wristband that monitors upper limb activity but provides no feedback. Outcomes will determine study feasibility in terms of recruitment, retention, adverse events, adherence and collection of descriptive clinical and accelerometer motor performance data at baseline, 4 weeks and 8 weeks. DISCUSSION: The WAVES study will address an important gap in the evidence base by reporting the feasibility of undertaking an evaluation of emerging and affordable technology to encourage impaired upper limb activity after stroke. The study will establish whether the study protocol can be supported by clinical stroke services, thereby informing the design of a future multi-centre randomised controlled trial of clinical and cost-effectiveness. TRIAL REGISTRATION: ISRCTN:82306027. Registered 12 July 2016. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13063-016-1628-2) contains supplementary material, which is available to authorized users

Sediment accumulation rates in subarctic lakes: Insights into age-depth modeling from 22 dated lake records from the Northwest Territories, Canada

Age-depth modeling using Bayesian statistics requires well-informed prior information about the behavior of sediment accumulation. Here we present average sediment accumulation rates (represented as deposition times, DT, in yr/cm) for lakes in an Arctic setting, and we examine the variability across space (intra- and inter-lake) and time (late Holocene). The dataset includes over 100 radiocarbon dates, primarily on bulk sediment, from 22 sediment cores obtained from 18 lakes spanning the boreal to tundra ecotone gradients in subarctic Canada. There are four to twenty-five radiocarbon dates per core, depending on the length and character of the sediment records. Deposition times were calculated at 100-year intervals from age-depth models constructed using the 'classical' age-depth modeling software Clam. Lakes in boreal settings have the most rapid accumulation (mean DT 20±10 yr/cm), whereas lakes in tundra settings accumulate at moderate (mean DT 70±10 yr/cm) to very slow rates, (>100yr/cm). Many of the age-depth models demonstrate fluctuations in accumulation that coincide with lake evolution and post-glacial climate change. Ten of our sediment cores yielded sediments as old as c. 9000cal BP (BP=years before AD 1950). From between c. 9000cal BP and c. 6000cal BP, sediment accumulation was relatively rapid (DT of 20-60yr/cm). Accumulation slowed between c. 5500 and c. 4000cal BP as vegetation expanded northward in response to warming. A short period of rapid accumulation occurred near 1200cal BP at three lakes. Our research will help inform priors in Bayesian age modeling

The Long-Baseline Neutrino Experiment: Exploring Fundamental Symmetries of the Universe

The preponderance of matter over antimatter in the early Universe, the dynamics of the supernova bursts that produced the heavy elements necessary for life and whether protons eventually decay --- these mysteries at the forefront of particle physics and astrophysics are key to understanding the early evolution of our Universe, its current state and its eventual fate. The Long-Baseline Neutrino Experiment (LBNE) represents an extensively developed plan for a world-class experiment dedicated to addressing these questions. LBNE is conceived around three central components: (1) a new, high-intensity neutrino source generated from a megawatt-class proton accelerator at Fermi National Accelerator Laboratory, (2) a near neutrino detector just downstream of the source, and (3) a massive liquid argon time-projection chamber deployed as a far detector deep underground at the Sanford Underground Research Facility. This facility, located at the site of the former Homestake Mine in Lead, South Dakota, is approximately 1,300 km from the neutrino source at Fermilab -- a distance (baseline) that delivers optimal sensitivity to neutrino charge-parity symmetry violation and mass ordering effects. This ambitious yet cost-effective design incorporates scalability and flexibility and can accommodate a variety of upgrades and contributions. With its exceptional combination of experimental configuration, technical capabilities, and potential for transformative discoveries, LBNE promises to be a vital facility for the field of particle physics worldwide, providing physicists from around the globe with opportunities to collaborate in a twenty to thirty year program of exciting science. In this document we provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess.Comment: Major update of previous version. This is the reference document for LBNE science program and current status. Chapters 1, 3, and 9 provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess. 288 pages, 116 figure

The evidence base for circulating tumour DNA blood-based biomarkers for the early detection of cancer: a systematic mapping review

Background: The presence of circulating cell-free DNA from tumours in blood (ctDNA) is of major importance to those interested in early cancer detection, as well as to those wishing to monitor tumour progression or diagnose the presence of activating mutations to guide treatment. In 2014, the UK Early Cancer Detection Consortium undertook a systematic mapping review of the literature to identify blood-based biomarkers with potential for the development of a non-invasive blood test for cancer screening, and which identified this as a major area of interest. This review builds on the mapping review to expand the ctDNA dataset to examine the best options for the detection of multiple cancer types. Methods: The original mapping review was based on comprehensive searches of the electronic databases Medline, Embase, CINAHL, the Cochrane library, and Biosis to obtain relevant literature on blood-based biomarkers for cancer detection in humans (PROSPERO no. CRD42014010827). The abstracts for each paper were reviewed to determine whether validation data were reported, and then examined in full. Publications concentrating on monitoring of disease burden or mutations were excluded. Results: The search identified 94 ctDNA studies meeting the criteria for review. All but 5 studies examined one cancer type, with breast, colorectal and lung cancers representing 60% of studies. The size and design of the studies varied widely. Controls were included in 77% of publications. The largest study included 640 patients, but the median study size was 65 cases and 35 controls, and the bulk of studies (71%) included less than 100 patients. Studies either estimated cfDNA levels non-specifically or tested for cancer-specific mutations or methylation changes (the majority using PCR-based methods). Conclusion: We have systematically reviewed ctDNA blood biomarkers for the early detection of cancer. Pre-analytical, analytical, and post-analytical considerations were identified which need to be addressed before such biomarkers enter clinical practice. The value of small studies with no comparison between methods, or even the inclusion of controls is highly questionable, and larger validation studies will be required before such methods can be considered for early cancer detection