Beyond 'health and safety':The challenges facing students asked to work outside of their comfort, qualification level or expertise on medical elective placement

Background: On elective students may not always be clear about safeguarding themselves and others. It is important that placements are safe, and ethically grounded. A concern for medical schools is equipping their students for exposure to and response to uncomfortable and/or unfamiliar requests in locations away from home, where their comfort and safety, or that of the patient, may be compromised. This can require legal, ethical, and/or moral reasoning on the part of the student. The goal of this article is to establish what students actually encounter on elective, to inform better preparing students for safe and ethical medical placements. We discuss the implications of our findings, which are arguably applicable to other areas of graduate training, e.g. first medical roles post-qualification.Method: An anonymised survey exploring clinical and ethical dilemmas on elective was issued across 3 years of returning final year elective medical students. Questions included the prevalence and type of potentially unsafe scenarios encountered, barriers to saying 'no' in unsafe situations, perceived differences between resource poor and developed world settings and the degree to which students refused or consented to participation in events outside of the 'norms' of their own training experience.Results: Three hundred seventy-nine students participated. 45% were asked to do something "not permissible" at home. 27% were asked to do something they felt "uncomfortable" with, often an invasive clinical task. Half asked to do something not usually permissible were "comfortable". 48% felt it more acceptable to bypass guidelines in developing settings. 27% refused an offer outside their experience.Conclusion: Of interest are reasons for "going along with" uncomfortable invitations, e.g. "emergency", self-belief in 'capability' and being 'more qualified' than host-personnel. This "best pair of hands available" merits scrutiny. Adverse scenarios were not exclusive to developing settings. We discuss preparing students for decision-making in new contexts, and address whether 'home' processes are too inflexible to prepare students for 'real' medical life? Ethical decision-making and communicating reluctance should be included in elective preparation.</p

Evaluating Metacognitive Self-reports: Systematic Reviews of the value of self-report in metacognitive research

Metacognitive skills have been shown to be strongly associated with academic achievement and serve as the basis of many therapeutic treatments for mental health conditions. Thus, it is likely that training metacognitive skills can lead to improved academic skills and health and well-being. Because metacognition is an awareness of one’s own thoughts, and as such is not directly observable, it is often measured by self-report. This study reviews and critiques the use of self-report in evaluating metacognition by conducting systematic reviews and a meta-analysis of studies assessing metacognitive skills. Keyword searches were performed in EbscoHost, ERIC, PsycINFO, PsycArticles, Scopus, Web of Science, and WorldWideScience.org to locate all articles evaluating metacognition through self-report. 24,396 articles from 1982 through 2018 were screened for inclusion in the study. Firstly, a systematic review of twenty-two articles was conducted to review the ability of self-report measures to evaluate a proposed taxonomy of metacognition. Secondly, a systematic review and meta-analyses of 37 studies summarizes the ability of self-report to relate to metacognitive behavior and the possible effects of differences in research methods. Results suggest that self-reports provide a useful overview of two factors – metacognitive knowledge and metacognitive regulation. However, metacognitive processes as measured by self-report subscales are unclear. Conversely, the two factors of metacognition do not adequately relate to metacognitive behavior, but subscales strongly correlate across self-reports and metacognitive tasks. Future research should carefully consider the role of self-reports when designing research evaluating metacognition

Asante Stools and the Matrilineage

Discussions of Asante stools in Western literature and museum records have focused exclusively on their association with male chiefs. My research, which combines archival and oral histories, and sets the existing literature and documentation on stools in comparative perspective, reframes existing thinking by asserting that asese dwa (sing. sese dwa), or conventional Asante stools, are intimately connected with women, and especially, queen mothers. Although the stool today is known widely as a symbol of male chieftaincy, chiefs do not sit on them in public. They use them only in very specific private spheres. It is queen mothers who sit on stools publically as seats of authority. The physical form of the stool, especially the mmaa dwa or "woman's stool" is a powerful symbol of female fecundity and the propagation of the Asante peoples. By exploring queen mother’s archives of stools and their dynamic uses of them, I present a more expansive history of these important cultural objects that challenges the taxonomies established by R. S. Rattray (1927) and others during the twentieth century. Contrary to the clearly defined hierarchies of symbolism, materials and structure that have informed assessments of historical stools in the West, Asante queen mothers have commissioned and used stools in an ongoing and context-dependent process of negotiation for at least a century. In this dissertation I explore the history of Asante stools since the late-nineteenth century through the lens of queen mothers’ perspectives.History of Art and Architectur

A Proposal to Protect Injured Workers from Employers\u27 Shield of Immunity.

The current workers’ compensation system shields negligent employers from liability and fails to encourage compliance with safety standards. A practical solution is to broaden the judicial definition of intentional conduct and reinstate a common-law negligence action in workers’ compensation statutes. The Texas Workers’ Compensation Act awards compensation to employees for accidental injuries sustained in the course of employment. The Act bars an employee who accepts these benefits from bringing a common-law suit for damages against the employer. The exclusive nature of the workers’ compensation remedy thus leaves employers immune from common-law negligence actions by employees who accept the plan. An exception exists when an employer intentionally injures an employee, or when the employer’s intentional or grossly negligent conduct causes an employee’s death. The application of these exceptions, however, leaves large gaps in the law, thus allowing severe employer misconduct to continue without reprimand or penalty. Two alternatives exist to deter safety violations and failures to maintain a safe working environment. First, the courts may take the initial step in solving this problem by broadening the judicial definition of intentional conduct to include willful, wanton, and reckless behavior. Second, the legislature should amend the workers’ compensation statutes to reinstate a common-law negligence action for an employee injured by the grossly negligent conduct of his employer. Either of these actions would promote compliance with safety statutes and deter employer misconduct, thus providing a safer working environment. Regardless of the measures taken, immediate action is necessary to remove the shield of immunity currently protecting employers’ balance sheets and to begin protecting the work force

Causal and functional interpretation of mu- and delta-opioid receptor profiles in mesoaccumbens and nigrostriatal pathways of an oral stereotypy phenotype

Spontaneous stereotypic behaviours are repetitive, compulsive, topographically invariant response patterns commonly observed in captive or domestic animals, which have been linked to dysfunction of basal ganglia input/output pathways. There is evidence that endogenous opioids play a key regulatory role in basal ganglia direct and indirect pathways, but their precise role, both causally and functionally, in spontaneous stereotypic behaviour is unclear. Here we examined the profile of mu- and delta-opioid receptors (density [Bmax] and affinity [Kd]) of basal ganglia structures in stereotypy (n = 10) and non-stereotypy (n = 10) animals using a competitive ligand binding approach. Mu receptor densities were significantly higher in the nucleus accumbens (p  0.15). Receptor binding affinity was only found to be significantly different between control and stereotypy animals for mu receptors on the caudate region; (p < 0.001). Our findings suggest that increased inhibition (via mu-opioid receptors) of the indirect (dorsal striatopallidal) pathways are associated with spontaneous stereotypy development. Data also suggested that different types of spontaneous stereotypies (e.g. oral versus locomotor) within or a cross species may have a different neurological basis. This may have important implications for understanding the aetiology and function of these behaviours. In some instances (oral stereotypy), the behaviour may be associated with allostasis, a process that could enhance the reward value of appetitive behaviour performance (as a starting point of stereotypy development)

Preparing for operation GRITROCK : military medical ethics challenges encountered in the planning stages of the UK Ebola response mission

In early September 2014, Médecins sans Frontières (MSF) took the unusual step of calling on governments to deploy military, as well as civilian, assets to help combat the Ebola Virus Disease (EVD) epidemic raging in West Africa (MSF, 2014). The UK government announced a package of aid in response to the outbreak, including the deployment of military experts, targeted primarily on Sierra Leone. (Gov.UK 2014) The scale of the outbreak and the responses to it attracted comment from many quarters and raised ethical issues. We were interested in the ethical challenges that would confront the troops on the ground in Sierra Leone, particularly those who were healthcare professionals. We successfully secured UK funding council research funds to explore these challenges. During the preparatory stages of this project, however, it became clear that ethical decisions had also been made during the planning stages of the deployment in anticipation of issue that may be faced on the deployment. These planning issues are of interest in their own right, even though they fell outside the aims of our project, and we explore of some these in this chapter