Research knowledge and skills in primary medical training: A crosssectional audit

This article was migrated. The article was marked as recommended. Background: Internationally, medical education has either adopted, or is moving toward, a Masters level qualification at completion. This reflects the higher-level learning outcomes and potentially facilitation of thinking and decision-making required of medical graduates. In Australia, the main difference between bachelor and masters programs appears to be the level of research skills training. This study explores the characteristics of research training in medical schools and alignment with higher education qualification frameworks. Methods: A cross-sectional audit was conducted of 22 medical schools in Australia and New Zealand, seeking information on: degree type, entry requirement, research knowledge and skills taught, teaching format, and barriers to offering students research experiences. Results: Information about 15 medical programs was obtained, with Australian Qualifications Framework or New Zealand Qualifications Framework Level 7, 8 or 9E outcomes. All included a variety of teaching methods on biomedical ethics, principles of evidence-based practice, and search strategies for medical evidence, critical appraisal of the literature and disease surveillance/epidemiology. Small projects were available in all programs, although voluntary in Level 7/8 programs and mandatory in Level 9E programs. Conclusions: There appear to be few differences in research training and learning outcomes from Level 7 and Level 9E programs, although Level 9E programs have a more systematic approach and assurance that all graduates can achieve the higher outcomes. Barriers to successful implementation relate to finding curriculum space and sufficient research training capacity for all medical students.</ns4:p

Improving case study research in medical education: A systematised review

Context:Case study research (CSR) is a research approach that guides holistic investigation of a real phenomenon. This approach may be useful in medical education to provide critical analyses of teaching and learning, and to reveal the underlying elements of leadership and innovation. There are variations in the definition, design and choice of methods, which may diminish the value of CSR as a form of inquiry.Objectives:This paper reports an analysis of CSR papers in the medical education literature. The review aims to describe how CSR has been used and how more consistency might be achieved to promote understanding and value.Methods:A systematised review was undertaken to quantify the number of CSR articles published in scholarly medical education journals over the last 10 years. A typology of CSR proposed by Thomas and Myers to integrate the various ways in which CSR is constructed was applied.Results:Of the 362 full‐text articles assessed, 290 were excluded as they did not meet the eligibility criteria; 76 of these were titled ‘case study’. Of the 72 included articles, 50 used single‐case and 22 multi‐case design; 46 connected with theory and 26 were atheoretical. In some articles it was unclear what the subject was or how the subject was being analysed.Conclusions:In this study, more articles titled ‘case study’ failed than succeeded in meeting the eligibility criteria. Well‐structured, clearly written CSR in medical education has the potential to increase understanding of more complex situations, but this review shows there is considerable variation in how it is conducted, which potentially limits its utility and translation into education practice. Case study research might be of more value in medical education if researchers were to follow more consistently principles of design, and harness rich observation with connection of ideas and knowledge to engage the reader in what is most interesting

I probably have a closer relationship with my internet provider: Experiences of belonging (or not) among mature-aged regional and remote university students

While fostering a sense of belonging among university students is an objective of many universities, the landscape of belonging is complex and multifaceted. It is worthy of deeper interrogation, particularly for “non-traditional” students. This article draws on data from a national mixed-methods study that explored proactive ways of supporting the mental wellbeing of mature-aged students in regional and remote Australia. One of the overarching findings was students feeling invisible, misunderstood and undervalued. While this theme was relevant for many participants, it was also the case that other participants reported feeling visible, known and a sense of belonging. These inconsistencies prompted us to conduct further analyses of the quantitative and qualitative data, which were collected from a cross-sectional online survey of 1,879 mature-aged undergraduate students in regional and remote Australia and 51 interviews. We employed Yuval-Davis’s analytical framework for the study of belonging. In the quantitative analyses, several variables were found to have a significant association with inclusion/connection/belonging. They included: study mode; socio-economic status; having a diagnosed mental health condition; and supports. In the qualitative analysis, we explored students’ experiences in greater depth to gain insights into why some students experience belonging and others do not. Connections and relationships with university staff; familiarity with university systems and places; and feeling included and “part of” a subject/course/campus manifested in students feeling understood, known and a sense of belonging. Due to certain entrenched institutional approaches, in many cases, students’ experiences fell short of the supportive and caring learning communities that pedagogical approaches advocate

Translating Hemoglobin A1c Scores across an Ethnically Diverse Population: Is the Language Consistent across All Races?

Hemoglobin A1c testing is an accepted measure of how well the blood glucose level has been controlled in the recent past (six to eight weeks) among individuals with diabetes. The purpose of this study was to evaluate the relationship between hemoglobin A1c (HbA1c) and blood glucose in an ethnically diverse population in a clinical setting. A cross-sectional research design was employed to explore associations between these two diabetes control measures in a sample of African American, White and Hispanic patients receiving diabetes treatment and follow-up in an outpatient clinic in Tallahassee, Florida. Data collection included a questionnaire, medical examinations, and lab results. Although we found a significant association between the glucose level and the HbA1c levels, the A1c value did not predict the mean glucose value as closely as previously found in less diverse groups. These findings suggest there is need for further study of these two variables among minority groups

The foot-health of people with diabetes in regional and rural Australia:Baseline results from an observational cohort study

Background: There is limited Australian epidemiological research that reports on the foot-health characteristics ofpeople with diabetes, especially within rural and regional settings. The objective of this study was to explore theassociations between demographic, socio-economic and diabetes-related variables with diabetes-related footmorbidity in people residing in regional and rural Australia.Methods: Adults with diabetes were recruited from non-metropolitan Australian publicly-funded podiatry services. Theprimary variable of interest was the University of Texas diabetic foot risk classification designated to each participant atbaseline. Independent risk factors for diabetes-related foot morbidity were identified using multivariable analysis.Results: Eight-hundred and ninety-nine participants enrolled, 443 (49.3%) in Tasmania and 456 (50.7%) in Victoria.Mean age was 67 years (SD 12.7), 9.2% had type 1 diabetes, 506 (56.3%) were male, 498 (55.4%) had diabetes for longerthan 10 years and 550 (61.2%) either did not know the ideal HbA1c target or reported that it was ≥7.0. A majority hadperipheral neuropathy or worse foot morbidity (61.0%). Foot morbidity was associated with male sex (OR 2.42, 95% CI1.82–3.22), duration of diabetes > 20 years (OR 3.25, 95% CI 2.22–4.75), and Tasmanian residence (OR 3.38, 95% CI 2.35–4.86).Conclusions: A high proportion of the regional Australian clinical population with diabetes seen by the publiclyfunded podiatric services in this study were at high risk of future limb threatening foot morbidity, and participantsresiding in Northern Tasmania are more likely to have worse diabetes-related foot morbidity than those from regionalVictoria. Service models should be reviewed to ensure that diabetes-related foot services are appropriately developedand resourced to deliver interdisciplinary evidence-based care

The RIPPER Experience: A 3 Year Evaluation of an Australian Interprofessional Rural Health Education Pilot

AbstractBackground: The Rural Interprofessional Program Educational Retreat (RIPPER) uses interprofessional learning and educational strategies to prepare final year Tasmanian nursing, medical, and pharmacy students for effective healthcare delivery. RIPPER provided students (n = 90) with the opportunity to learn about working in an interdisciplinary team using authentic and relevant situational learning. RIPPER allowed students to work and learn interprofessionally in small teams and to apply their different professional skills and knowledge to a variety of rural healthcare situations.Methods and Findings: This article reports on three years of results from the program’s evaluation which used a pre-post test mixed method design. The findings show a significant and positive shift in students’ attitudes and understanding of interprofessional learning and practice following their participation in RIPPER. The evaluation findings suggest the need for sustainable interprofessional rural health education that is embedded in undergraduate curricula.Conclusion: The evaluation of RIPPER suggests that exposure of healthcare students to interprofessional education can positively affect their perceptions of collaboration, patient care, and teamwork. The evaluation also points to the rural context as an ideal place to showcase elements of effective interprofessional practice

Catt Hall Review Committee: Final Report

The mission of the Committee for Review of the Catt Controversy is to review the controversy over the name of Catt Hall and to make recommendations of specific action items that will help bring about closure of the issue. Closure is defined as establishing open communication, reviewing and considering all relevant information, and taking all reasonable steps to generate a proposal that shows evidence of active and fair consideration of the diverse viewpoints on the issue. This is by no means intended to close or limit dialogue-in a sense closure is a process of expansion in that the Committee will encourage different views and freedom of debate on a college campus where people have been impassioned about this issue for a very long time. The intent is for this process to be a means by which the Iowa State University community can openly and legitimately address this issue. The communication and dialogue will facilitate a sense of closure being developed on an individual basis, and in tum, a larger sense of closure will come about when the community as a whole is able to successfully move on to focus on other pressing issues of diversity and student needs

The Origin of Massive O-type Field Stars. Part II: Field O stars as runaways

In two papers we try to confirm that all Galactic high-mass stars are formed in a cluster environment, by excluding that O-type stars found in the Galactic field actually formed there. In de Wit et al. (2004) we presented deep K-band imaging of 5 arcmin fields centred on 43 massive O-type field stars that revealed that the large majority of these objects are single objects. In this contribution we explore the possibility that the field O stars are dynamically ejected from young clusters, by investigating their peculiar space velocity distribution, their distance from the Galactic plane, and their spatial vicinity to known young stellar clusters. We (re-)identify 22 field O-type stars as candidate runaway OB-stars. The statistics show that ~4% of all O-type stars with V < 8 can be considered as formed outside a cluster environment. Most are spectroscopically single objects, some are visual binaries. The derived percentage for O-type stars that form isolated in the field based on our statistical analyses is in agreement with what is expected from calculations adopting a universal cluster richness distribution with power index of beta = 1.7, assuming that the cluster richness distribution is continuous down to the smallest clusters containing one single star.Comment: 9 pages, 4 figures. Accepted for publication in A&

Engaging End-users to Inform the Development of the Global Standard for the Identification of Key Biodiversity Areas

We report results from an end-user engagement process, convened by the International Union for Conservation of Nature (IUCN), which informed the development of the Global Standard for the Identification of Key Biodiversity Areas. Key Biodiversity Areas are sites contributing significantly to the global persistence of biodiversity. We used a mixed methods approach involving interviews and an online questionnaire with end-users to determine their needs and concerns in relation to the Key Biodiversity Area approach. We found a remarkable level of convergence in end-user opinion on 12 important topics. Four topics resulted in a divergence in end-user opinion requiring further dialogue and consideration, including: (i) the value of a global standard compared to various national approaches; (ii) the prioritisation of Key Biodiversity Areas over other areas; (iii) whether Key Biodiversity Area data should be made freely available; and (iv) whether or not development activities should be permitted in Key Biodiversity Areas. Our results informed the development of the Global Standard for the Identification of Key Biodiversity Areas and a new governance structure, the Key Biodiversity Area Consultative Forum, which provides a mechanism for ongoing dialogue with end-users. We conclude by sharing five good practice recommendations for future end-user engagement processes

Decision regret in men living with and beyond nonmetastatic prostate cancer in the United Kingdom: A population‐based patient‐reported outcome study

Objective: Clinical options for managing nonmetastatic prostate cancer (PCa) vary. Each option has side effects associated with it, leading to difficulty in decision‐making. This study aimed to assess the relationship between patient involvement in treatment decision‐making and subsequent decision regret (DR), and quantify the impact of health‐related quality of life (HRQL) outcomes on DR. Methods: Men living in the United Kingdom, 18 to 42 months after diagnosis of PCa, were identified from cancer registration data and sent a questionnaire. Measures included the Decision Regret Scale (DRS), Expanded Prostate cancer Index Composite short form (EPIC‐26), EQ‐5D‐5L, and an item on involvement in treatment decision‐making. Multivariable ordinal regression was utilized, with DR categorized as none, mild, or moderate/severe regret. Results: A total of 17 193 men with stage I‐III PCa completed the DRS: 36.6% reported no regret, 43.3% mild regret, and 20.0% moderate/severe regret. The odds of reporting DR were greater if men indicated their views were not taken into account odds ratio ([OR] = 6.42, 95% CI: 5.39‐7.64) or were involved “to some extent” in decision‐making (OR = 4.63, 95% CI: 4.27‐5.02), compared with men who were “definitely” involved. After adjustment, including for involvement, men reporting moderate/big problems with urinary, bowel, or sexual function were more likely to experience regret compared with men with no/small problems. Better HRQL scores were associated with lower levels of DR. Conclusions: This large‐scale study demonstrates the benefit of patient involvement in treatment decision‐making for nonmetastatic PCa. However, men experiencing side effects and poorer HRQL report greater DR. Promoting engagement in clinical decision‐making represents good practice and may reduce the risk of subsequent regret