Professional identity formation at medical school: a qualitative study to explore the effect of cultural factors on professional identity formation of medical undergraduates.

Medical education is subject to competing discourses; the discourse of standardisation which promotes competencies and the discourse of diversity which celebrates inclusivity and difference. Recently the diversity discourse has encouraged widening participation to ensure the gender, social class and ethnicity of medical students reflects the composition of the population. However, this initiative is subject to the standardisation discourse often delivered by the hidden curriculum. Culturally diverse students experience dissonance from negative experiences and are expected to conform in ways that challenge their underlying identity. This study sought to explore the culture-related experiences of medical students and how they negotiated the discourses as they developed a professional identity. Student data was collected at two contrasting medical schools in the UK via an online survey (n=79) and semi-structured interviews (n=12). Students described how cultural factors affected their experience at medical school and development of professionalism. Responses were analysed using Bourdieusian concepts of habitus, capital and field. The students’ use of social constructivism to manage professionalism was explored through the lens of Goffman’s performance theories. Using Bourdieu’s theory, medical school was considered as subfields of education and care giving. Students reported incidences of classism, sexism and racism particularly in the field of care giving and this challenged their habitus. The students demonstrated options including (i) maintaining their original habitus (ii) changing their habitus to match that expected by the discourse of standardisation or (iii) using social constructivism to manage their responses through impression management. I observed some students acknowledging the competing discourses and using social constructivism to form emerging professional identities. As educators we can enable students to maintain this critical reflexivity and develop confidence to recognise the gaps in the system and adapt in appropriate ways. Students will therefore gain from being active participants in the system and can effect change

Using QFD As A Method To Develop Functional Medical Products For Children With Cancer.

Quality Function Deployment (QFD) is a recognised method of translating customer needs into appropriate technical requirements to inform ergonomic design development. This paper details how QFD has been used to develop a tactile advanced product for a medical application. The project has undertaken innovative experimental and industrial research which has led to the design of a child-focused “Wiggle Bag” which will be used to safely harness and reduce infection at the site of a venous catheter placed in the chest wall of long-term child cancer sufferers. Children with cancer regularly have long term central venous catheters inserted through their upper chest wall to deliver medication. They can result in medical issues, particularly infections or accidental removal, but also discomfort for the children, particularly when sleeping. The research uses an inductive approach, triangulating various research strategies including questionnaires, focus groups and interviews from parents, carers and medical personnel. QFD was used to bring together the key findings from the primary data analysis to establish design criteria and inform the product development. The outcome of the research was a functional product ergonomically designed for maximum comfort and safety, with the added unique selling point of having antibacterial properties

Improving everyday life experiences for young children with cancer

Children with cancer regularly have long term central line catheters inserted in the chest to deliver medication. Often termed ‘Hickman Lines’, they result in tubing protruding from the chest, which can result in medical issues including infections, but also discomfort for the child, particularly when sleeping. A team of researchers, led by Dr Jess Power, including Professor David Leaper and Joanne Marie Harris, has been investigating the design and development of a product to contain these external lines, providing greater comfort and safety for the child whilst also meeting the needs of the medical communit

Mucin glycosylation and sulphation in airway epithelial cells is not influenced by cystic fibrosis transmembrane conductance regulator expression

Abnormalities in mucus properties and clearance make a major contribution to the pathology of cystic fibrosis (CF). Our aim was to test the hypothesis that the defects in CF mucus are a direct result of mutations in the CF transmembrane conductance regulator (CFTR) protein. We evaluated a single mucin molecule MUC1F/5ACTR that carries tandem repeat sequence from MUC5AC, a major secreted airway mucin, in a MUC1 mucin vector. To establish whether the presence of mutant or normal CFTR directly influences the O-glycosylation and sulphation of mucins in airway epithelial cells, we used the CFT1-LC3 (DeltaF508 CFTR mutant) and CFT1-LCFSN (wild-type CFTR corrected) human airway epithelial cell lines. MUC1F/5ACTR mucin was immunoprecipitated, centricon purified, and O-glycosylation was evaluated by Matrix-assisted laser desorption ionization and electrospray tandem mass spectrometry to determine the composition of different carbohydrate structures. Mass spectrometry data showed the same O-glycans in both CFTR mutant and wild-type CFTR corrected cells. Metabolic labeling assays were performed to evaluate gross glycosylation and sulphation of the mucins and showed no significant difference in mucin synthesized in six independent clones of these cell lines. Our results show that the absence of functional CFTR protein causes neither an abnormality in mucin O-glycosylation nor an increase in mucin sulphation

Water Governance: Retheorizing Politics

This republished Special Issue highlights recent and emergent concepts and approaches to water governance that re-centers the political in relation to water-related decision making, use, and management. To do so at once is to focus on diverse ontologies, meanings and values of water, and related contestations regarding its use, or its importance for livelihoods, identity, or place-making. Building on insights from science and technology studies, feminist, and postcolonial approaches, we engage broadly with the ways that water-related decision making is often depoliticized and evacuated of political content or meaning—and to what effect. Key themes that emerged from the contributions include the politics of water infrastructure and insecurity; participatory politics and multi-scalar governance dynamics; politics related to emergent technologies of water (bottled or packaged water, and water desalination); and Indigenous water governance

Primary-Secondary School Transition: Impacts and Opportunities for Adjustment

The transition from primary to secondary education is an important period in children’s lives: academically, socially and emotionally, and can be particularly challenging for some children. Occurring alongside puberty and a change in focus from parents to peer relationships, the transition can be a difficult adjustment for some to navigate. This paper reviews the existing literature on this important school transfer, focusing particularly on three key areas of adjustment: academic, social and emotional. We outline the factors that impact successful school transfer, whilst also highlighting that the transition can create positive opportunities for children. We also highlight from the existing literature how multiple social categorisations can influence how children navigate and experience the transition and argue that future research needs to consider social stratification and adopt an intersectional approach. Implementing an intersectional approach will create new forms of knowledge about the transition resulting in new strategies for policy makers, schools and parents that can be beneficial in assisting children through the transitio

Improving employee engagement and distributed leadership through lean systems process mapping in the NHS

Background / Aims: Evidence of the effectiveness and impact of Lean Systems Thinking in healthcare settings remains mixed. This study explores the impact of participation in a process mapping activity on employee engagement and distributed leadership in the NHS. Methods: A qualitative study was undertaken using semi-structured interviews with 9 employees within an NHS Trust in the North-East of England. Questions sought to explore the experiences of those involved in the process mapping activity. A thematic analysis was carried out and results presented. Findings: Following the implementation of process mapping, staff appeared more engaged and there was a closer relationship between teams and management. Factors found to affect participation were: if participation was mandatory, history of the team, team dynamics, inter-personal concerns. Participation broke down barriers with management, helped participants to feel listened to and increased staff confidence in their role. The end result was: increased employee engagement, greater team working and distributed leadership, increased job satisfaction and reduced stress levels. Conclusions: The research provides a significant contribution to our understanding of how process mapping activities can be used in the NHS