The lecturer-tutor in undergraduate medical education; navigating complexity as “a recruiter, a timetabler, an administrator, a counsellor”

Abstract Background Tutors play an important role in the delivery of effective undergraduate medical education (UGME). These roles commonly involve competing clinical, educational and research commitments. We sought to obtain a rich description of these posts from doctors working in them. Methods We used a pragmatist, sequential explanatory mixed-methods design with a sampling frame of clinical lecturer/tutors in 5 Irish medical schools. Purposive sampling was used for recruitment. Quantitative data collected from a validated online questionnaire were used to inform a semi-structured interview question guide. Thematic analysis was conducted independently by each of the study researchers, using a coding frame derived in part from the findings of the online questionnaire. Quantitative and qualitative mixing occurred during data collection, analysis and reporting. Results 34 tutors completed the online survey with 7 volunteers for interview. Most respondents took the job to gain experience in either educational practice (79.4%) or in research (61.8%). Major themes to emerge were the diverse interactions with students, balancing multiple professional commitments, a high degree of role-autonomy, mis-perception of role by non-tutor colleagues, challenges around work-life balance and unpredictable work demands. Using a complexity theory lens, the tutor role was defined by its relational interactions with numerous stakeholders, all in the context of an environment that changed regularly and in an unpredictable manner. Conclusions The undergraduate tutor works in a demanding role balancing educational and non-educational commitments with suboptimal senior guidance and feedback. The role is notable for its position within a complex adaptive system. An understanding of the system’s interactions recognises the non-linearity of the role. Using a complex systems lens, we propose improvements to undergraduate education centred around the tutor

LETTER Hyperlactatemia in critical illness and cardiac surgery

We read with interest the article by Nichol and colleagues [1] in a recent issue of Critical Care. Their study of more than 7,000 medical and surgical patients supports the claim that an admission plasma lactate level in the upper normal range is associated with increased mortality. However, we are concerned about the lack of data regarding patient baseline characteristics. Specifically, although 3,166 and 1,614 patients had diagnoses of ‘surgery ’ and ‘cardiac/vascular’, respectively, it is likely, but not stated, that numerous patients were admitted following cardiac surgery. This is of great importance as changes in lactate in this patient group are not homogenous in nature. In post-cardiac surgery patients, early hyperlactatemia and late hyperlactatemia (LHL) differ in both risk profile and physiological rationale. Early hyperlactatemia (on intensive care unit arrival) is associated with adverse outcome. This association is not seen in the 10 % to 20% of patients who develop LHL (pooled odds ratio [OR] of death with LHL in two published trials 1.39, 95% confidence interval [CI] 0.28 to 7.04) [2-4]. Moreover, in our recent single-center review of prospectively collated data from 529 post-cardiac surgical patients in a tertiary Australian cardiac surgical intensive care unit, 25% developed LHL (>2.5 mmol/L). When compared with patients with a normal lactate profile, patients with LHL showed no increase in hospital mortality (OR 0.57, 95% CI 0.07 to 5.05) (unpublished data). Therefore, we believe that inclusion of such patients in studies of lactate in critical illness should be avoided and, as in the study by Nichol and colleagues, may actually weaken any association demonstrated between lactate levels and hospital mortality. Authors ’ respons

Perceptions of Concussion and Associated Anxiety in Irish Collegiate Athletes

Background: Concussion nondisclosure and poor management after a concussion are a concern in Irish collegiate sports. How athletes perceive concussions and appraise their own concussion may affect their decisions and behaviors after a suspected concussion. However, this has yet to be examined in an Irish context. This study aimed to (1) establish concussion perceptions and associated anxiety in Irish collegiate athletes; (2) examine how sex, concussion, and mood disorder history influenced their perceptions; and (3) investigate factors associated with higher anxiety perceptions. Hypothesis: Irish collegiate athletes will display negative concussion perceptions and anxiety related to concussion, especially in female athletes and those without a concussion history. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Irish collegiate athletes [n = 268 (141 women,127 men), mean age = 21.5 ± 2.2 years] from high-risk sports completed a survey including the Perceptions of Concussion Inventory for Athletes (PCI-A), demographics, diagnosed concussion history, self-reported mood disorder history, and a concussion knowledge assessment. Differences in concussion perceptions by sex, concussion history, mood disorder history were examined using Mann-Whitney U tests, and factors associated with anxiety-related concussion perceptions were identified using multivariate logistic regression. Results: Over half (53.0%, n = 142) of participants reported concerns regarding concussion. The thoughts of sustaining a concussion made participants feel upset (63.4%, n = 170), fearful (47.7%, n = 128), and anxious (35.1%, n = 94). Women reported significantly higher anxiety (P \u3c 0.01, r = 0.23), effects (P = 0.04, r = 0.12), and clarity (P = 0.01, r = 0.16) perception scores. Participants with a diagnosed concussion history displayed greater symptom variability perception scores (P = 0.04, r = 0.12), but lower anxiety (P = 0.03, r = 0.13) and treatment (P \u3c 0.01, r = 0.19) beliefs on the PCI-A. No differences were observed for those with a history of a mood disorder (P \u3e 0.05). A significant multivariate model was established (χ2 = 55.44, P \u3c 0.01), with female sex [odds ratio (OR) = 1.53], concussion history (OR = 0.63), effects (OR = 1.31), and treatment (OR = 1.15) subscales associated with greater anxiety. Conclusion: Concerns about sustaining a concussion are prevalent in Irish collegiate athletes. Women displayed more negative perceptions and those with a concussion history displayed fewer perceived benefits of treatment. Clinical Relevance: The findings support the need for concussion awareness campaigns to provide accurate concussion information to mitigate anxiety-related concussion perceptions and injury belief misconceptions

Locations of first running related injury.

BackgroundGiven the high incidence and heavy burden of running related injuries, large-scale, prospective multifactorial investigations examining potential risk factors are warranted. This study aimed to identify factors associated with running related injuries and to evaluate their potential in injury screening.Study designProspective cohort study.Materials and methodsTwo hundred and seventy-four recreational runners were recruited. Clinical measures (strength, range of motion, foot position), injury and training history (via questionnaire), impact loading (via accelerometery) and running technique measures were collected at baseline. Runners were tracked for injury for one year via fortnightly check-ins. A binary logistic regression, (injury versus no injury), was performed for each variable univariably, and then adjusting for age, sex and mileage. A multivariable regression was also performed to evaluate the model’s discriminative ability.ResultsOf the 225 runners included in the final analysis 52% experienced a running related injury. Injury history in the past year, less navicular drop, and measures of running technique (knee, hip, and pelvis kinematics) were associated with increased odds of injury (p 2(11) = 56.45, p 95% = 0.73–0.85), demonstrating acceptable discriminative ability.ConclusionsThis study found a number of clinical and running technique factors to be associated with prospective running related injuries among recreational runners. With the exception of injury history, the factors identified as being significantly associated with injury may be modifiable and therefore, could form the basis of interventions. Range of motion, spatiotemporal parameters and strength measures were not associated with injury and thus their utilisation in injury prevention practices should be reconsidered.</div