Exploring the Experiences and Expectations of Trainee Representatives in Medical Specialities:A Qualitative Study in the West Midlands, UK

Introduction: Despite its importance, there is a paucity of evidence describing the role and responsibilities of trainee representatives.Aim: This study explored key stakeholders' experiences and expectations of the trainee representative role.Method: All eligible individuals in the West Midlands Deanery's School of Medicine were invited to participate in an interview exploring their experiences and expectations of the trainee representative role. Recurring themes were identified through thematic analysis using NVivo12 software.Results: Five themes—Support for trainee representatives, Deanery events for trainee representatives, Roles and responsibilities of trainee representatives, Representation and recruitment, and Benefits of being a trainee representative—were identified. Formalising appointments to such roles and providing induction and information on key responsibilities were highlighted as steps to minimise the gap.Conclusion: Trainee representative positions allow trainees to explore leadership roles; however, further work is needed to improve the resources to support the professional development of trainee representatives

Is there a difference in clinical skills gained between healthcare professionals of high- and low and middle-income countries with online simulation-based learning?

Background: Healthcare professionals in low- and middle-income countries (LMICs) compared with those in high-income countries (HICs) face unequal clinical learning opportunities, caused by barriers such as cost, time, and accessibility. Simulation via Instant Messaging - Birmingham Advance (SIMBA) overcomes these barriers, acting as a free virtual simulation-based model which supports clinicians’ professional development. The study compared the impact of SIMBA in LMICs and HICs. Method: Sixteen SIMBA sessions were conducted between May 2020 and October 2021. Participants solved anonymised real-life clinical scenarios by interacting with moderators over WhatsApp. Participants completed pre- and post- SIMBA surveys; responses were grouped into HICs and LMICs using the 2022 World Bank Report. Participants’ performance, perceptions, and improvements in core competencies were compared using the Chi-square test. Thematic analysis of open-ended questions was also performed. Findings: 462 participants (29.7% from LMICs, n137) completed both the pre- and postSIMBA surveys. Participants from HICs showed better knowledge on patient management (p=.01), whereas participants from LMICs reported higher improvement in professionalism (p=.02). Both groups reported similar gains in patient care (p=.28), systems-based practice (p=.052), practice-based learning (p=.15), communication skills (p=.22), application to practice (p=.266), engagement (p=.197), and overall quality of the session (p=.101). In thematic analysis, strengths of SIMBA included providing individualised, structured, and engaging sessions. Conclusions: Healthcare professionals from both LMICs and HICs improved in their competencies, illustrating that SIMBA produces equivalent teaching experiences. Furthermore, SIMBA’s virtual nature enables international accessibility and potential for global scalability. This model could steer future standardised education policy development in LMICs

Concerns and expectations in women with polycystic ovary syndrome vary across age and ethnicity: findings from PCOS Pearls Study

ObjectiveTo understand and explore the perceptions and opinions of women with polycystic ovary syndrome (PCOS) and further delineate the variations across age and ethnicity.DesignQualitative survey focussed on lived experiences of people with PCOS. Participants could share their views either as written text or as voice note audio recording(s) on WhatsApp. The data from the audio were transcribed verbatim. Responses were coded by two study members independently, using a thematic inductive method with NVivo 12. Two senior study members then reviewed these codes to identify common themes.SubjectsWomen with PCOS aged 18-60 years.Results43 of 45 participants had a formal diagnosis of PCOS, the remaining two had suspected PCOS which was under investigation. Four participants opted to share their views as voice note recordings. Poor mental health was the most reported (83.3% of participants), followed by dermatological (81.0%) and menstrual issues (76.2%). Participants were generally dissatisfied with the care they received (88.1%). A lengthy diagnostic journey was reported in 35.7% of cases. 52.6% felt less feminine, particularly regarding weight gain and infertility. As part of the recommendations by participants, it was emphasised that others with the condition should educate themselves and be proactive in their management. 46.3% reported that being more enlightened regarding their condition improved their health outcomes and enabled them to advocate for their own care. Women in their 20s expressed distress due to poor mental health, needing a longer time to get the diagnosis, and having weight and eating concerns. While women with PCOS in their 30s discussed their menstrual irregularities and fertility issues, those in their 40s expressed their concerns about the societal expectations of women when diagnosed with PCOS. The concerns varied across ethnicities as well.ConclusionPCOS has wide-ranging consequences for women living with the condition, with many dissatisfied with the clinical support they currently receive. The concerns and expectations vary across ages and ethnicities. Therefore, we propose involving women with PCOS to co-create clinical and educational resources informed by lived experiences to provide end-user-informed services

11-oxygenated C19 steroids are the predominant androgens in polycystic ovary syndrome

Abstract Context: Androgen excess is a defining feature of polycystic ovary syndrome (PCOS), but the exact origin of hyperandrogenemia remains a matter of debate. Recent studies have highlighted the importance of the 11-oxygenated C19 steroid pathway to androgen metabolism in humans. In this study, we analyzed the contribution of 11-oxygenated androgens to androgen excess in women with PCOS. Methods: One hundred fourteen women with PCOS and 49 healthy control subjects underwent measurement of serum androgens by liquid chromatography-tandem mass spectrometry. Twenty-four–hour urinary androgen excretion was analyzed by gas chromatography-mass spectrometry. Fasting plasma insulin and glucose were measured for homeostatic model assessment of insulin resistance. Baseline demographic data, including body mass index, were recorded. Results: As expected, serum concentrations of the classic androgens testosterone (P &amp;lt; 0.001), androstenedione (P &amp;lt; 0.001), and dehydroepiandrosterone (P &amp;lt; 0.01) were significantly increased in PCOS. Mirroring this, serum 11-oxygenated androgens 11β-hydroxyandrostenedione, 11-ketoandrostenedione, 11β-hydroxytestosterone, and 11-ketotestosterone were significantly higher in PCOS than in control subjects, as was the urinary 11-oxygenated androgen metabolite 11β-hydroxyandrosterone. The proportionate contribution of 11-oxygenated to total serum androgens was significantly higher in patients with PCOS compared with control subjects [53.0% (interquartile range, 48.7 to 60.3) vs 44.0% (interquartile range, 32.9 to 54.9); P &amp;lt; 0.0001]. Obese (n = 51) and nonobese (n = 63) patients with PCOS had significantly increased 11-oxygenated androgens. Serum 11β-hydroxyandrostenedione and 11-ketoandrostenedione correlated significantly with markers of insulin resistance. Conclusions: We show that 11-oxygenated androgens represent the majority of circulating androgens in women with PCOS, with close correlation to markers of metabolic risk. </jats:sec

A systematic review of models of care for polycystic ovary syndrome highlights a gap in the literature, especially in developing countries

Introduction The aim of the study was to identify available polycystic ovary syndrome (PCOS) models of care (MoCs) and describe their characteristics and alignment with the international PCOS guideline. Methods Ovid MEDLINE, All EBM, PsycINFO, Embase, and CINAHL were searched from inception until 11 July 2022. Any study with a description of a PCOS MoC was included. Non-evidence-based guidelines, abstracts, study protocols, and clinical trial registrations were excluded. We also excluded MoCs delivered in research settings to minimize care bias. Meta-analysis was not performed due to heterogeneity across MoCs. We describe and evaluate each MoC based on the recommendations made by the international evidence-based guideline for assessing and managing PCOS. Results Of 3,671 articles, six articles describing five MoCs were included in our systematic review. All MoCs described a multidisciplinary approach, including an endocrinologist, dietitian, gynecologist, psychologist, dermatologist, etc. Three MoCs described all aspects of PCOS care aligned with the international guideline recommendations. These include providing education on long-term risks, lifestyle interventions, screening and management of emotional well-being, cardiometabolic diseases, and the dermatological and reproductive elements of PCOS. Three MoCs evaluated patients’ and healthcare professionals’ satisfaction, with generally positive findings. Only one MoC explored the impact of their service on patients’ health outcomes and showed improvement in BMI. Conclusion There is limited literature describing PCOS MoCs in routine practice. Future research should explore developing cost-effective co-created multidisciplinary PCOS MoCs globally. This may be facilitated by the exchange of best practices between institutions with an established MoC and those who are interested in setting one up. Systematic review registratio