The experiences of medical students and junior doctors with dyslexia: a survey study

Little research exists concerning dyslexia in medical education. A qualitative study highlighted issues such as bullying and a lack of support. This project aimed to quantify those findings. An online survey was sent to junior doctors in parts of the United Kingdom. Seventy-five participated. Most (53%) were diagnosed with dyslexia at university / medical school. Most reported that dyslexia impacted upon their self-image (59%) and self-esteem (73%). Nearly half (46%) felt it influenced their career pathway choices within medicine. Participants reported bullying at medical school-from peers (24%), from academic teachers (14%), and from clinical teachers (27%); and also at work-from peers (25%), from academic teachers (13%), and from clinical teachers (23%). 88% reported that foundation schools provided no support, 92% that NHS Trusts provided none, and 90% that their deaneries provided none. The sorts of supports which seemed to be lacking were "psychological" or "pastoral" supports

The exam performance of medical students with dyslexia: a review of the literature

Introduction: Dyslexia is a common condition. Estimates suggest it effects approximately 10% of the worldwide population, and 1.7% of UK medical students. This review aimed to explore the existing literature concerning the exam performance of medical students with dyslexia. Methods: A Review of Medline, ERIC, PsychInfo, The Cochrane Library, and Google Scholar was conducted in accordance with the PRISMA checklist. Papers were accepted if they concerned the exam performance of medical students with dyslexia. Results: Three papers were selected for review. These were all cross-sectional studies comparing exam results in students with dyslexia and without dyslexia – and the impacts of extra time in exams. A risk of bias assessment determined that all three were appropriate to include in this review. A meta-analysis was planned but could not be performed because the number of studies was low and heterogeneity between the studies too high. There was consensus that Multiple Choice Question exams were fair for students with dyslexia, when extra time was allowed. Essay type exams were found to be particularly challenging for students with dyslexia. Students with dyslexia were also found to be at a disadvantage in their first year. Discussion: Overall, the evidence suggests that medical students with dyslexia are slower to adapt to medical school and under-perform early in the course. However, with appropriate supports, they appear to perform on a par with their non-dyslexic peers as they progress through their course. Our review highlights the need for more research in the medical student population. Keywords: Dyslexia, Specific Learning Difficulties, Neurodiversity, Literature Review, Medical Student

Safe and Effective Prescribing with Dyslexia: A Collaborative Autoethnography

Prescribing medicines is the most common patient-level intervention made by doctors in the United Kingdom. However, this is associated with a potential for harm. Whilst dyslexia can bring many strengths, it also impacts reading and writing abilities and therefore has the potential to contribute to errors in the prescribing process if dyslexic doctors are unsupported. This paper explores the experiences of Seb – regarding prescribing and prescribing education – as a dyslexic medical student and doctor. We hope that this might spark more research on this overlooked issue. This is a collaborative, analytic, autoethnographic study within an interpretivist paradigm. Firstly, Seb wrote an autobiographical account; he was then interviewed by Mike. The interview audio-recording was transcribed verbatim and both data sources were thematically analysed. Emerging themes included: learning to prescribe, coping, struggling and support, errors, near misses and handwritten charts, and moving forward. Specific issues included a deficiency in active learning/assessment at an undergraduate level, a lack of support, and potential safety concerns regarding handwritten charts. Electronic prescribing was felt to be a positive step forwards for both safety and accessibility. Our findings suggest that further consideration of specific supports is needed to assist dyslexic trainee doctors in the prescribing of medicines, so as to prevent the clinical environment acting to disadvantage them. They also suggest that we may need to review the ways in which we teach and assess this vital skill at an undergraduate level

Studying medicine with dyslexia: a collaborative autoethnography

The topic of this article is the experience of the impact of dyslexia on medical studies, explored using a collaborative autoethnographic methodological approach. The study was prompted by an initial and ongoing full search of the literature, which revealed an absence of autoethnographic research into the experiences of medical students with dyslexia. It has four aims: to provide an in-depth, multi-layered account of the impact of dyslexia on a UK undergraduate medical student; to help other students and academic support staff in similar situations; to outline improvements that could be made to medical and other educational curricula and examination procedures, globally; finally, to call for further qualitative research to test out, possibly enhance, and qualify the cultural transferability of our study

Safe and effective prescribing with dyslexia

Background: The term ‘dyslexia’ refers to a condition that impacts upon reading and writing abilities whilst not altering intelligence. Individuals with dyslexia may have difficulties with the speed and accuracy and their reading and writing, amongst other issues. Dyslexia is not automatically considered a disability but is a protected characteristic under the UK Equality Act (2010), and therefore employers and educational institutions are required to provide ‘reasonable adjustments’ in order to allow individuals to reach their full potential. There is a lack of research on this issue, but what little there is suggests that doctors feel as though any support they received ended when they graduated from medical school. Main body: A core distinction between medical school and medical practice is the requirement to prescribe medicines as registered medical practitioners. Junior doctors have to master this complex and potentially hazardous skill “on the job”, with a perceived lack of support. Here, we open up a debate about the potential impact of dyslexia on prescribing, and the need to find supports that may be effective in enabling doctors with dyslexia prescribe medicines safely and effectively – and thus reach their full potential as medical practitioners and promote patient safety. Conclusion: We argue that medical schools and hospitals could immediately provide dyslexia awareness training in both undergraduate and postgraduate settings. We discuss electronic prescribing systems, and conclude that research is required to identify effective supports for junior doctors with dyslexia

Fluctuating epidemics on adaptive networks

A model for epidemics on an adaptive network is considered. Nodes follow an SIRS (susceptible-infective-recovered-susceptible) pattern. Connections are rewired to break links from non-infected nodes to infected nodes and are reformed to connect to other non-infected nodes, as the nodes that are not infected try to avoid the infection. Monte Carlo simulation and numerical solution of a mean field model are employed. The introduction of rewiring affects both the network structure and the epidemic dynamics. Degree distributions are altered, and the average distance from a node to the nearest infective increases. The rewiring leads to regions of bistability where either an endemic or a disease-free steady state can exist. Fluctuations around the endemic state and the lifetime of the endemic state are considered. The fluctuations are found to exhibit power law behavior.Comment: Submitted to Phys Rev

Coping with medical school: an interpretive phenomenological study

Anecdotal evidence suggested that hopelessness and helplessness (HH) were often reported by undergraduate medical students. It is known that medical students are more susceptible to high levels of stress and depression than other student groups. There is currently concern about suicide rates in students and high drop-out rates in junior doctors. But what can be said of HH within this population? This study was aimed at eliciting medical students’ experiences of HH. An interpretive phenomenological approach was adopted. Participants were recruited from a single medical school. Loosely structured, audio-recorded interviews were carried out. Recordings were then transcribed verbatim, then underwent an interpretive phenomenological analysis. Three participants were recruited. Their stories report some devastating experiences – ranging from social isolation to homelessness and suicidal ideation. Our cases complement the existing literature. Awareness of the issues raised in these cases may help medical educators to better understand and support others in similar situations. These may also benefit those experiencing HH themselves. We hope that this exploratory project paves the way to further study

Acute high-intensity interval exercise-induced redox signaling is associated with enhanced insulin sensitivity in obese middle-aged men

Background: Obesity and aging are associated with increased oxidative stress, activation of stress and mitogen activated protein kinases (SAPK), and the development of insulin resistance and metabolic disease. In contrast, acute exercise also increases oxidative stress and SAPK signaling, yet is reported to enhance insulin sensitivity and reduce the risk of metabolic disease. This study explored this paradox by investigating the effect of a single session of high-intensity interval-exercise (HIIE) on redox status, muscle SAPK and insulin protein signaling in eleven middle-aged obese men. Methods: Participants completed a 2 h hyperinsulinaemic-euglycaemic clamp at rest, and 60 min after HIIE (4 × 4 mins at 95% HRpeak; 2 min recovery periods), separated by 1–3 weeks. Results: Irrespective of exercise-induced changes to redox status, insulin stimulation both at rest and after HIIE similarly increased plasma superoxide dismutase activity, plasma catalase activity, and skeletal muscle 4-HNE; and significantly decreased plasma TBARS and hydrogen peroxide. The SAPK signaling pathways of p38 MAPK, NF-κB p65, and JNK, and the distal insulin signaling protein AS160Ser588, were activated with insulin stimulation at rest and to a greater extent with insulin stimulation after a prior bout of HIIE. Higher insulin sensitivity after HIIE was associated with higher insulin-stimulated SOD activity, JNK, p38 MAPK and NF-κB phosphorylation (r = 0.63, r = 0.71, r = 0.72, r = 0.71; p < 0.05, respectively). Conclusion: These findings support a role for redox homeostasis and SAPK signaling in insulin-stimulated glucose uptake which may contribute to the enhancement of insulin sensitivity in obese men 3 h after HIIE

Acute exercise alters skeletal muscle mitochondrial respiration and H2O2 emission in response to hyperinsulinemic-euglycemic clamp in middle-aged obese men

Obesity, sedentary lifestyle and aging are associated with mitochondrial dysfunction and impaired insulin sensitivity. Acute exercise increases insulin sensitivity in skeletal muscle; however, whether mitochondria are involved in these processes remains unclear. The aim of this study was to investigate the effects of insulin stimulation at rest and after acute exercise on skeletal muscle mitochondrial respiratory function (JO2) and hydrogen peroxide emission (JH2O2), and the associations with insulin sensitivity in obese, sedentary men. Nine men (means ± SD: 57 ± 6 years; BMI 33 ± 5 kg.m2) underwent hyperinsulinemic-euglycemic clamps in two separate trials 1–3 weeks apart: one under resting conditions, and another 1 hour after high-intensity exercise (4x4 min cycling at 95% HRpeak). Muscle biopsies were obtained at baseline, and pre/post clamp to measure JO2 with high-resolution respirometry and JH2O2 via Amplex UltraRed from permeabilized fibers. Post-exercise, both JO2 and JH2O2 during ADP stimulated state-3/OXPHOS respiration were lower compared to baseline (P<0.05), but not after subsequent insulin stimulation. JH2O2 was lower post-exercise and after subsequent insulin stimulation compared to insulin stimulation in the rest trial during succinate supported state-4/leak respiration (P<0.05). In contrast, JH2O2 increased during complex-I supported leak respiration with insulin after exercise compared with resting conditions (P<0.05). Resting insulin sensitivity and JH2O2 during complex-I leak respiration were positively correlated (r = 0.77, P<0.05). We conclude that in obese, older and sedentary men, acute exercise modifies skeletal muscle mitochondrial respiration and H2O2 emission responses to hyperinsulinemia in a respiratory state-specific manner, which may have implications for metabolic diseases involving insulin resistance