Medicine needs to swallow a bitter pill for a healthier future

Many doctors will recall as a student or trainee hanging nervously off the end of a Deaver – a large retractor used in pre-keyhole gall bladder surgery – while simultaneously trying to answer the surgeon’s barked questions about the anatomy in the cavity. The problem is you can’t actually see into the cavity without loosening your grip. A looser grip means less vision for the surgeon and usually a torrent of abuse for the trainee. Such moments of “teaching by humiliation” during medical training underscore the nature of medical culture: a totem pole that places surgeons very much at the top. Indeed, doctors have long enjoyed both enormous autonomy and deference to their apparent god-like power to stave off death. Within this mythology, medicine has built a hierarchical and autocratic workplace culture in which incivility, and even frank bullying, towards subordinates is commonplace. Medical students gradually acculturate to this during their training, often at the cost of their empathy and compassion. A recent meta-analysis of 51 studies on harassment and discrimination in medical training showed 59.4% of medical trainees had experienced at least one form of these. “Teaching by humiliation” – regarded by some as a kind of necessary hardening experience – was experienced by 74% of students and witnessed by 84%. Many still felt the sting decades later. Such power-oriented, stratified workplaces are good for no one. And, in medicine, many of the worst consequences fall on patients

A hybrid evaluation approach and guidance for mHealth education applications

© Springer International Publishing AG 2018. Mobile health education applications (MHEAs) are used to support different users. However, although these applications are increasing in number, there is no effective evaluation framework to measure their usability and thus save effort and time for their many user groups. This paper outlines a useful framework for evaluating MHEAs, together with particular evaluation metrics: an efficient hybrid of selected heuristic evaluation (HE) and usability evaluation (UE) factors to enable the determination of the usefulness and usability of MHEAs. We also propose a guidance tool to help stakeholders choose the most suitable MHEA. The outcome of this framework is envisioned as meeting the requirements of different users, in addition to enhancing the development of MHEAs using software engineering approaches by creating new and more effective evaluation techniques. Finally, we present qualitative and quantitative results for the framework when used with MHEAs

Mistreatment in Australian medical education: a student-led scoping of experiences

Background: Evidence of bullying and harassment of medical students and junior doctors has existed for over 30 years. However, there has been little attempt to explore the dimensions of this issue in Australia to date. Given the evidence which indicates that experiencing abusive behaviour has a detrimental effect on professional identity formation and on mental health, the Australian Medical Students’ Association (AMSA) undertook a national scoping study to better understand the experiences of Australian medical students. Methods: We conducted a mixed methods survey of the 16,959 students enrolled in a medical degree at an Australian university in 2015. An anonymous, voluntary online questionnaire was distributed through AMSA’s social media, email newsletter and website, and medical students’ societies. Results: We received 519 responses, including 194 (37%) detailing at least one incident of bullying or harassment. 335 (65%) survey respondents were women and 345 (67%) were in the clinical years of their training. 60% of all respondents reported experiencing or witnessing mistreatment during their medical education. The most common theme in the free text was belittlement of the student’s competence and capacity to be a good doctor. Some gave details about how universities failed to prevent or appropriately respond to students’ experiences of bullying and harassment. Conclusion: In line with international data, this study shows that many Australian medical students perceive mistreatment as an important problem that is not always managed well by faculties. Multi-pronged policy and practice responses are needed to instigate cultural change in Australian medical education

Dynamical Monodromy

Integrable Hamiltonian systems are said to display nontrivial monodromy if fundamental action-angle loops defined on phase-space tori change their topological structure when the system is carried around a circuit. In an earlier paper it was shown that this topological change can occur as a result of time evolution under certain rather abstract flows in phase space. In the present paper, we show that the same topological change can occur as a result of application of ordinary forces. We also show how this dynamical phenomenon could be observed experimentally in classical or in quantum systems