The Path to Donation: factors influencing the provision of unrelated haematopoietic stem cell donors

The demand for unrelated haematopoietic stem cell (HSC) donors has risen threefold over the last decade, and is likely to continue to rise over the next 10 years. The time taken from diagnosis to transplant is recognised to adversely affect patient outcome, and provision of unrelated donors (UDs) has been identified as a key source of delay. Obstacles to provision of UD include: delays in referral to a transplant centre, awaiting sibling typing, lack of matched donors (particularly for those from ethnic minorities and/or with rare HLA phenotypes), low- or intermediate-resolution donor HLA typing, donor attrition from the registries, donor ineligibility on grounds of health and difficulties encountered transporting HSC across international borders. A prospective study of 401 patients explores timescales prior to transplantation, and the causes and duration of delays in the pre-transplant period. However, it also shows that the provision of transplantation to those of non-white Northern European descent is now similar to white Northern Europeans (WNE). However, donor attrition at the confirmatory typing stage is found to significantly impact on donor selection, and disproportionately affects WNE patients. A retrospective study of over 7000 donors identifies that donor ethnicity, gender and duration on the register are associated with increased donor attrition, and that a risk score based on these factors may help predict those donors most likely to defer. Donor medical deferrals form the basis of a project to improve the consistency and availability of medical guidance at Anthony Nolan, and this project was extended internationally to form the WMDA medical guidelines. Finally, a retrospective study of second donations made by Anthony Nolan donors shows those who donate by bone marrow are more likely to be called for a second donation

The Role of the Student-Teacher Relationship in the Formation of Physicians: The Hidden Curriculum as Process

Relationship-Centered Care acknowledges the central importance of relationships in medical care. In a similar fashion, relationships hold a central position in medical education, and are critical for achieving favorable learning outcomes. However, there is little empirical work in the medical literature that explores the development and meaning of relationships in medical education. In this essay, we explore the growing body of work on the culture of medical school, often termed the “hidden curriculum.” We suggest that relationships are a critical mediating factor in the hidden curriculum. We explore evidence from the educational literature with respect to the student-teacher relationship, and the relevance that these studies hold for medical education. We conclude with suggestions for future research on student-teacher relationships in medical education settings