Developing a career as a GP educationalist: contemporary challenges and workforce solutions

GP educationalists are crucial in training the future medical workforce and in developing and advancing the field of primary care medical education, yet opportunities in the UK are patchy and varied. In this article, a group of GP educationalists summarise the challenges facing the sustainability of this particular group of clinical academics and outline opportunities available at each career stage, from medical students through to senior GP educationalists. Recommendations to support the growth of this workforce include the development of a nationally recognised framework for GP educationalist careers, collaboration with professional and educational bodies and taking steps to level out opportunities in order to reduce existing inequity

Ten-year mortality, disease progression, and treatment-related side effects in men with localised prostate cancer from the ProtecT randomised controlled trial according to treatment received

Background The ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy. Objective To report outcomes according to treatment received in men in randomised and treatment choice cohorts. Design, setting, and participants This study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy. Intervention Two cohorts included 1643 men who agreed to be randomised and 997 who declined randomisation and chose treatment. Outcome measurements and statistical analysis Analysis was carried out to assess mortality, metastasis and progression and health-related quality of life impacts on urinary, bowel, and sexual function using patient-reported outcome measures. Analysis was based on comparisons between groups defined by treatment received for both randomised and treatment choice cohorts in turn, with pooled estimates of intervention effect obtained using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores. Results and limitations According to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p = 0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p = 0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6 mo) and urinary incontinence (55% at 6 mo) after surgery, and of sexual dysfunction (88% at 6 mo) and bowel dysfunction (5% at 6 mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and changes in the protocol for AM during the lengthy follow-up required in trials of screen-detected PCa. Conclusions Analyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group. Patient summary More than 95 out of every 100 men with low or intermediate risk localised prostate cancer do not die of prostate cancer within 10 yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are better after active monitoring, but the risks of spreading of prostate cancer are more common

The Science Performance of JWST as Characterized in Commissioning

This paper characterizes the actual science performance of the James Webb Space Telescope (JWST), as determined from the six month commissioning period. We summarize the performance of the spacecraft, telescope, science instruments, and ground system, with an emphasis on differences from pre-launch expectations. Commissioning has made clear that JWST is fully capable of achieving the discoveries for which it was built. Moreover, almost across the board, the science performance of JWST is better than expected; in most cases, JWST will go deeper faster than expected. The telescope and instrument suite have demonstrated the sensitivity, stability, image quality, and spectral range that are necessary to transform our understanding of the cosmos through observations spanning from near-earth asteroids to the most distant galaxies.Comment: 5th version as accepted to PASP; 31 pages, 18 figures; https://iopscience.iop.org/article/10.1088/1538-3873/acb29

Using markets to leverage investment in forest and landscape restoration in the tropics

Governments and international organizations are promoting or drafting programs to undertake Forest and Landscape Restoration (FLR) of hundreds of millions of hectares of degraded tropical landscapes to support the provision of ecosystem goods and services. But the challenge to recover economic and ecological functionality could be far beyond their financial capacity. Here, we explore the potential of markets and their interaction with policies to leverage investment for FLR in the tropics. We first review the challenges and opportunities of exploiting market forces for FLR, which can be essential for kick-starting the implementation of programs globally. We identify four key opportunities for regulating markets to promote FLR: economic mechanisms; technological, educational or infrastructural investment; legal and enforcement mechanisms; and market-led standards and certification schemes. Finally, we present five pitfalls that may arise when relying on markets to promote FLR. Governments will need to play a critical role in establishing appropriate policy frameworks and institutional arrangements to leverage investments when market signals are not strong enough to initiate changes in traditional land use or farming practices, or to regulate reforestation activities when market signals become so strong that they overwhelm all other land-use activities, leading to a transformed and homogenized landscape

Medical Students using Theatre to Engage Seniors in Long-Term Care Facilities: Fostering Empathy Through a Humanities Pilot Project

Background: The implementation of humanities, and particularly theatre, into the medical curriculum is a nascent but promising field. Here, we report on the Theatre in Community Health Project (TCHP), an initiative devised by University of Ottawa medical students focused on the use of performative theatre with residents in a long-term care facility. We also describe the impact on medical students’ developing communication skills and empathy after they complete the TCHP.Methods: Two cohorts of first year medical students at the University of Ottawa participated in the TCHP at Villa Marconi Long Term Care Facility (LTC) over two consecutive years. Medical student participants subsequently each completed a critical reflection of their experience and these were used as the basis of our thematic analysis. Using an inductive thematic analysis, 17 themes and the frequency of statements pertaining to each theme were identified.Results: The analysis of the students’ reflections showed two overarching themes: insight into communicating with geriatric populations and improved insights into long term facilities.Conclusion: Our study of the TCHP programshows a relationship between medical students’ experiences with audience-oriented performative theatre and increased capacity for empathy and communication toward the targeted audience. The mechanisms by which this increased capacity takes place may be twofold: first, enhanced awareness of the behavioural components of empathy and communication; and second, deeper appreciation for how each patient’s individual context shapes the clinical encounter

CONSORT 2010 statement:Extension to randomised pilot and feasibility trials

The Consolidated Standards of Reporting Trials (CONSORT) statement is a guideline designed to improve the transparency and quality of the reporting of randomised controlled trials (RCTs). In this article we present an extension to that statement for randomised pilot and feasibility trials conducted in advance of a future definitive RCT. The checklist applies to any randomised study in which a future definitive RCT, or part of it, is conducted on a smaller scale, regardless of its design (eg, cluster, factorial, crossover) or the terms used by authors to describe the study (eg, pilot, feasibility, trial, study). The extension does not directly apply to internal pilot studies built into the design of a main trial, non-randomised pilot and feasibility studies, or phase II studies, but these studies all have some similarities to randomised pilot and feasibility studies and so many of the principles might also apply.  The development of the extension was motivated by the growing number of studies described as feasibility or pilot studies and by research that has identified weaknesses in their reporting and conduct. We followed recommended good practice to develop the extension, including carrying out a Delphi survey, holding a consensus meeting and research team meetings, and piloting the checklist.  The aims and objectives of pilot and feasibility randomised studies differ from those of other randomised trials. Consequently, although much of the information to be reported in these trials is similar to those in randomised controlled trials (RCTs) assessing effectiveness and efficacy, there are some key differences in the type of information and in the appropriate interpretation of standard CONSORT reporting items. We have retained some of the original CONSORT statement items, but most have been adapted, some removed, and new items added. The new items cover how participants were identified and consent obtained; if applicable, the prespecified criteria used to judge whether or how to proceed with a future definitive RCT; if relevant, other important unintended consequences; implications for progression from pilot to future definitive RCT, including any proposed amendments; and ethical approval or approval by a research review committee confirmed with a reference number.  This article includes the 26 item checklist, a separate checklist for the abstract, a template for a CONSORT flowchart for these studies, and an explanation of the changes made and supporting examples. We believe that routine use of this proposed extension to the CONSORT statement will result in improvements in the reporting of pilot trials.  Editor’s note: In order to encourage its wide dissemination this article is freely accessible on the BMJ and Pilot and Feasibility Studies journal websites.Additional co-authors: Freedom Gumedze, Jenny Hewison, Allison Hirst, Sarah E Lamb, Tom Lang, Elaine McColl, Alicia O’Cathain, Daniel R Shanahan, Chris Sutton, and Peter Tugwel