Rewarding educators and education leaders in research-intensive universities

The reward and recognition of staff focused on learning and teaching is an issue that affects all types of higher education institutions. Research-intensive institutions, for example, have always been conscious of the balance between research and teaching, particularly in relation to funding streams and the REF, but have ensured that their students receive the excellent teaching that they deserve. One indication of this is the increasing number of HEA Fellows at such institutions. At a time of growing emphasis on the importance of high quality student education, the HEA’s research into career structures and prospects - which includes Rebalancing promotion in the HE sector: Is teaching excellence being rewarded by Annette Cashmore et al, and Shifting landscapes: Meeting the staff development needs of the changing academic workforce by William Locke et al – can help to inform policy and practice. The HEA will continue to commission high quality research - from across the sector - to address key issues in this area. The research offered below by Dilly Fung et al focuses solely on the Russell Group – which it is acknowledged comprises only a small section of the UK’s research-intensive institutions - and examines the challenges at those particular institutions. It is hoped that some of the findings, analysis and recommendations might be applicable more broadly, however, in the UK and elsewhere

Learning by chance: Investigating gaps in transgender care education amongst family medicine, endocrinology, psychiatry and urology residents

Background: The transgender (trans) population is one of the most underserved in health care.  Not only do they face discrimination and stigma from society as a whole, they also have difficulty accessing transition-related care, leading to adverse outcomes such as suicide. We aimed to increase understanding on how our current postgraduate education system contributes to a lack of care for trans patients. Methods: Our study consisted of 11 semi-structured interviews conducted in 2016 with residents in the following specialties: family medicine (3), endocrinology (3), psychiatry (3), and urology (2). We used Framework Analysis to qualitatively analyze our data. Results: Residents described a lack of trans care education in the core curriculum, in part due to a lack of exposure to experts in this area. They also expressed discomfort when dealing with trans patients, due to inexperience and lack of knowledge. Furthermore, residents in each specialty had false assumptions that other specialties had sufficient knowledge and expertise in trans care. Discussion: This study highlights how the lack of teaching and clinical experiences with trans patients during residency contributes to the poor access to healthcare. By systematically embedding trans care in the curriculum, medical education can play a prominent role in addressing the healthcare disparities of this underserved population

Marginalised or enabled voices? 'User participation' in policy and practice

The idea of participation has been central to many policy developments in recent years. Both Conservative and Labour governments have used notions of participation and involvement in attempts to justify and implement their social policies. Yet, despite a plethora of initiatives and guidance around ‘participation’ emerging from all levels of government, and a substantial academic literature, there remains a major, and potentially damaging, lack of clarity over many aspects of participation, while the secret of achieving ‘real’ participation appears to continue to remain elusive

Introduction de carnets d’apprentissage expérientiel portant sur la responsabilité sociale à l’externat au doctorat de premier cycle en médecine

Implication Statement Medical schools have a responsibility to ensure students meet and advocate for the needs of the community. However, addressing the social determinants of health is not always emphasized in clinical learning objectives. Learning logs are useful tools that can engage students to reflect on clinical encounters and direct students in their learning to target the development of highlighted skills. Despite their efficacy, the use of learning logs in medical education is largely applied towards biomedical knowledge and procedural skills. Thus, students may lack competence to address the psychosocial challenges involved in comprehensive medical care. Social accountability experiential logs were developed for third year medical students at the University of Ottawa to address and intervene on the social determinants of health. Students completed quality improvement surveys and results demonstrated this initiative to be beneficial to their learning and contributed to greater clinical confidence. Experiential logs in clinical training can be adapted across other medical schools and tailored to fit the needs and priorities of each institution’s local communities.Énoncé des implications de la recherche Les facultés de médecine ont la responsabilité de s’assurer que les étudiants répondent aux besoins de la collectivité et militent pour leur satisfaction. Or, les objectifs d’apprentissage clinique ne sont pas toujours axés sur les déterminants sociaux de la santé. L’utilité des carnets d’apprentissage est d’inciter les étudiants à réfléchir sur les rencontres cliniques et de les orienter dans leur apprentissage vers le développement des compétences ciblées. Malgré leur efficacité, les carnets d’apprentissage sont surtout appliqués aux connaissances biomédicales et aux compétences procédurales. Par conséquent, les étudiants pourraient ne pas disposer des compétences nécessaires pour relever les enjeux psychosociaux, qui sont à considérer aux fins d’une prise en charge médicale globale. Des carnets d’apprentissage expérientiel portant sur la responsabilité sociale ont été élaborés pour les étudiants en médecine de troisième année de l’Université d’Ottawa afin d’aborder et d’intervenir sur les déterminants sociaux de la santé. Les étudiants ont participé à des sondages sur l’amélioration de la qualité et les résultats de ceux-ci ont montré que cette initiative était bénéfique pour leur apprentissage et qu’elle contribuait à améliorer leur confiance en eux en tant que cliniciens. Les carnets expérientiels en formation clinique peuvent être adaptés par les diverses facultés de médecine pour qu’ils correspondent aux besoins et aux priorités des collectivités locales qu’elles desservent

Analyzing 10 years of early awareness and alert activity in the United kingdom

Objectives: The aim of this study was to assess the accuracy of the English National Horizon Scanning Centre (NHSC) in identifying and filtering pharmaceutical developments using end user and international collaborator databases of emerging technologies as proxies for new drugs of likely significance to health services and/or patients.Methods: We used the NHSC information system and the list of National Institute for Health and Clinical Excellence (NICE) technology appraisals to estimate the false positive rate for NHSC identification, filtration, and reporting. We assessed the sensitivity of NHSC identification and filtration of pharmaceuticals for NICE technology appraisals from 1999 to the end of December 2010, and for pharmaceuticals entered into the EuroScan International Network database.Results: We estimate that overall NHSC identification, filtration and reporting had a positive predictive value of 0.39 (95 percent CI, 0.36 to 0.43) and a false positive rate of 60 percent. Using NICE appraisals and EuroScan's database as proxies for pharmaceuticals of significance, we estimate the NHSC sensitivity over the 10-year period at 0.92 (95 percent CI, 0.89 to 0.95) and 0.89 (95 percent CI, 0.82 to 0.96) respectively.Conclusions: Our results suggest that the NHSC has performed well in terms of sensitivity over the past decade, but that the false positive rate of 60 percent may indicate that the filtration criteria for pharmaceuticals could be tightened for increased efficiency. Future evaluations of EAA systems should include an element of external review and explore the level of accuracy acceptable to funders and customers of such systems.</jats:p

Heart Rate Variability Measurement and Clinical Depression in Acute Coronary Syndrome Patients: Narrative Review of Recent Literature

Aim: We aimed to explore links between heart rate variability (HRV) and clinical depression in patients with acute coronary syndrome (ACS), through a review of recent clinical research literature. Background: Patients with ACS are at risk for both cardiac autonomic dysfunction and clinical depression. Both conditions can negatively impact the ability to recover from an acute physiological insult, such as unstable angina or myocardial infarction, increasing the risk for adverse cardiovascular outcomes. HRV is recognized as a reflection of autonomic function. Methods: A narrative review was undertaken to evaluate state-of-the-art clinical research, using the PubMed database, January 2013. The search terms “heart rate variability” and “depression” were used in conjunction with “acute coronary syndrome”, “unstable angina”, or “myocardial infarction” to find clinical studies published within the past 10 years related to HRV and clinical depression, in patients with an ACS episode. Studies were included if HRV measurement and depression screening were undertaken during an ACS hospitalization or within 2 months of hospital discharge. Results: Nine clinical studies met the inclusion criteria. The studies’ results indicate that there may be a relationship between abnormal HRV and clinical depression when assessed early after an ACS event, offering the possibility that these risk factors play a modest role in patient outcomes. Conclusion: While a definitive conclusion about the relevance of HRV and clinical depression measurement in ACS patients would be premature, the literature suggests that these measures may provide additional information in risk assessment. Potential avenues for further research are proposed

Maternal disability and newborn discharge to child protection in Ontario, Canada

Objectives One in 8 pregnancies are to women with disabilities. These mothers can face additional social, structural, and health-related challenges, and negative health care provider assumptions about their parenting capacity. We aimed to examine rates of newborn discharge to child protection comparing newborns of mothers with and without a disability. Method We are conducting a population-based cohort study in Ontario, Canada using linked administrative health data. The cohort includes all women in Ontario with a live birth between 2003 and 2020. Diagnostic algorithms were applied to health care encounters prior to pregnancy to identify maternal disability. We will use modified Poisson regression to estimate the relative risk of discharge to child protection immediately after the birth hospital stay, comparing newborns of women with physical, sensory, developmental, and multiple disabilities to those without disabilities. Models will be adjusted for socio-demographic factors, antenatal care receipt, and maternal mental illness and substance use disorders. Results The study cohort includes of over 1.4 million newborns delivered to women with physical disabilities (n=120,014), sensory disabilities (n=39,892), developmental disabilities (n=2,182), multiple disabilities (n=8,428), and no known disability (n=1,269,633). Analyses are ongoing and results will be concluded by the conference date. Conclusion Early infancy is a critical period for breastfeeding and maternal-infant bonding. Findings will inform the development of tailored services and resources for supporting women with disabilities in antenatal care and after birth by identifying those most at-risk of child protection intervention, thus potentially reducing maternal-newborn separations

The Formation of a Self-Funded Global Health Fellowship within a Department of Family Medicine

Introduction: The need for global health training for early-career family medicine physicians is greater than the supply. This paper details the formation of a one-year, self-funded global health fellowship for early-career family medicine physicians. Methods: In August of 2012, the University of Washington Department of Family Medicine established a self-funded, non-ACGME (Accreditation Council for Graduate Medical Education)-accredited fellowship in global health. The fellowship is targeted at early-career family medicine physicians. During the one-year fellowship, the global health fellow rotates through a variety of clinics in the greater Seattle area, including HIV, TB, STD, and other infectious disease clinics. Other activities include selected global health courses at the University of Washington, practice in a continuity clinic seeing both family medicine and pre- and post-travel patients, and a variety of teaching, speaking, and publishing opportunities. The fellow may spent up to two months overseas engaged in clinical practice and/or research; one option for fellows is to work and teach at the district hospital in Naivasha, Kenya, at which the University of Washington has established an ongoing teaching and practice program.  The majority of the fellow’s salary and benefits is funded by the fellow’s clinical activities. This funding mechanism allowed the fellowship to be launched with minimal of institutional financial support.   Results: Of the first three graduating fellows, two now practice primarily in the US and one works in Malawi with Seed Global Health. The fifth fellow will begin in August 2016. The robust and increasing number of applications suggest that this fellowship is meeting an ongoing need.  Conclusion: This fellowship demonstrates that the need for global health training of early-career, family medicine physicians can at least be met in part by self-funded fellowships of this nature

Implementing experiential learning logs addressing social accountability into undergraduate medical clerkship education

Implication Statement Medical schools have a responsibility to ensure students meet and advocate for the needs of the community. However, addressing the social determinants of health is not always emphasized in clinical learning objectives. Learning logs are useful tools that can engage students to reflect on clinical encounters and direct students in their learning to target the development of highlighted skills. Despite their efficacy, the use of learning logs in medical education is largely applied towards biomedical knowledge and procedural skills. Thus, students may lack competence to address the psychosocial challenges involved in comprehensive medical care. Social accountability experiential logs were developed for third year medical students at the University of Ottawa to address and intervene on the social determinants of health. Students completed quality improvement surveys and results demonstrated this initiative to be beneficial to their learning and contributed to greater clinical confidence. Experiential logs in clinical training can be adapted across other medical schools and tailored to fit the needs and priorities of each institution’s local communities