Influence of social networks in healthcare on preparation for selection procedures of health professions education:a Dutch interview study

OBJECTIVES: Health professions education (HPE) students are often not representative of the populations they will serve. The underrepresentation of non-traditional students is problematic because diversity is essential for promoting excellence in health education and care. This study aimed to understand the perceptions of traditional and non-traditional students regarding facilitators and barriers in preparing for HPE selection procedures, and to determine the role of social networks in their decision-making and preparations to apply. METHODS: A qualitative study was conducted with 26 Dutch youth who were interested in university-level HPE programmes. Semistructured interviews and sociograms were analysed using thematic analysis, adopting a constructivist approach. RESULTS: Twenty-six high school students participated, with traditional and non-traditional backgrounds, with and without social networks in healthcare and higher education. Two themes were constructed. First, four high-impact facilitators helped to overcome barriers to apply and in preparation for selection: access to a social network connection working or studying in healthcare, to correct information, to healthcare experience and to a social network connection in higher education. Lack of information was the main barrier while access to social network connections in healthcare was the main facilitator to overcome this barrier. However, this access was unevenly distributed. Second, access alone is not enough: the need for agency to make use of available facilitators is also essential. CONCLUSIONS: The themes are discussed using intersectionality. Traditional students with access to facilitators develop their self-efficacy and agency within social structures that privilege them, whereas non-traditional students must develop those skills without such structures. Our findings provide recommendations for the ways in which universities can remove barriers that cause unequal opportunities to prepare for the selection of HPE programmes. Along with equitable admissions, these recommendations can help to achieve a more representative student population and subsequently a better quality of health education and care

Diversity in the pathway from medical student to specialist in the Netherlands:a retrospective cohort study

Background: Medical specialist workforces are not representative of the society they serve, partially due to loss of diversity in the path from student to specialist. We investigated which demographic characteristics of bachelor students of medicine (BSM) are associated with becoming a physician and (particular type of) medical specialist; and whether this suggests ‘cloning’ (reproduction of sameness) of the existing workforce. Methods: We used a retrospective cohort design, based on Statistics Netherlands data of all first-year BSM in 2002–2004 in The Netherlands (N = 4503). We used logistic regression to analyze the impact of sex, migration background, urbanity of residence, parental income and assets categories, and having healthcare professional parents, on being registered as physician or medical specialist in 2021. We compared our results to the national pool of physicians (N = 76,845) and medical specialists (N = 49,956) to identify cloning patterns based on Essed's cultural cloning theory. Findings: Female students had higher odds of becoming a physician (OR 1.87 [1.53–2.28], p &lt; 0.001). Physicians with a migration background other than Turkish, Moroccan, Surinamese, Dutch Caribbean or Indonesian (TMSDI) had lower odds of becoming a specialist (OR 0.55 [0.43–0.71], p &lt; 0.001). This was not significant for TMSDI physicians (OR 0.74 [0.54–1.03], p = 0.073). We found a cloning pattern with regard to sex and migration background. Nationwide, physicians with a Turkish or Moroccan migration background, and female physicians with other migration backgrounds, are least likely to be a medical specialist. Interpretation: In light of equity in healthcare systems, we recommend that every recruitment body increases the representativeness of their particular specialist workforce. Funding: ODISSEI.</p

Effects of muscarinic receptor stimulation on Ca2+ transient, cAMP production and pacemaker frequency of rabbit sinoatrial node cells

We investigated the contribution of the intracellular calcium (Cai2+) transient to acetylcholine (ACh)-mediated reduction of pacemaker frequency and cAMP content in rabbit sinoatrial nodal (SAN) cells. Action potentials (whole cell perforated patch clamp) and Cai2+ transients (Indo-1 fluorescence) were recorded from single isolated rabbit SAN cells, whereas intracellular cAMP content was measured in SAN cell suspensions using a cAMP assay (LANCE®). Our data show that the Cai2+ transient, like the hyperpolarization-activated “funny current” (If) and the ACh-sensitive potassium current (IK,ACh), is an important determinant of ACh-mediated pacemaker slowing. When If and IK,ACh were both inhibited, by cesium (2 mM) and tertiapin (100 nM), respectively, 1 μM ACh was still able to reduce pacemaker frequency by 72%. In these If and IK,ACh-inhibited SAN cells, good correlations were found between the ACh-mediated change in interbeat interval and the ACh-mediated change in Cai2+ transient decay (r2 = 0.98) and slow diastolic Cai2+ rise (r2 = 0.73). Inhibition of the Cai2+ transient by ryanodine (3 μM) or BAPTA-AM (5 μM) facilitated ACh-mediated pacemaker slowing. Furthermore, ACh depressed the Cai2+ transient and reduced the sarcoplasmic reticulum (SR) Ca2+ content, all in a concentration-dependent fashion. At 1 μM ACh, the spontaneous activity and Cai2+ transient were abolished, but completely recovered when cAMP production was stimulated by forskolin (10 μM) and IK,ACh was inhibited by tertiapin (100 nM). Also, inhibition of the Cai2+ transient by ryanodine (3 μM) or BAPTA-AM (25 μM) exaggerated the ACh-mediated inhibition of cAMP content, indicating that Cai2+ affects cAMP production in SAN cells. In conclusion, muscarinic receptor stimulation inhibits the Cai2+ transient via a cAMP-dependent signaling pathway. Inhibition of the Cai2+ transient contributes to pacemaker slowing and inhibits Cai2+-stimulated cAMP production. Thus, we provide functional evidence for the contribution of the Cai2+ transient to ACh-induced inhibition of pacemaker activity and cAMP content in rabbit SAN cells

Te weinig aandacht voor basisvakken in medisch curriculum

Studying the pre-clinical foundations of the medical profession sharpens the mind, improves critical thinking skills, builds academic stamina, and stimulates scientific curiosity. However, incorporation of the ever-growing clinical knowledge body into medical curricula jeopardizes the time undergraduate medical students are exposed to covering the basic sciences. In addition, clinical practice guidelines and clinical protocols lessen the importance of fostering critical thinking skills in our students. Inasmuch as mastering basic sciences demands a substantial time consuming intellectual effort, medical students prefer memorization and reproduction tasks to analysing challenging basic science questions. These three factors increase the risk of training (future) generations of doctors less well equipped to manage complex patients and lacking the essential knowledge and academic inquisitiveness to advance health care and medicine

The effects of glutamate on membrane potential and discharge rate of suprachiasmatic neurons

The suprachiasmatic nucleus (SCN) is a major pacemaker for circadian rhythms in mammals. Photic entrainment of the circadian pacemaker is mediated by the retinohypothalamic tract (RHT). Most likely, excitatory amino acids function as neurotransmitters in this pathway. We have now investigated the effect of glutamate on the membrane potential of cultured SCN cells of the rat with the aid of the patch clamp technique. It was found that 1 mM glutamate depolarizes the cells by about +44 mV. In spontaneously active neurons, the glutamate induced depolarization caused either an increase in discharge or a depolarization block. We then investigated the effect of 1 mM glutamate on SCN discharge in the acutely prepared hypothalamic slice of the hamster. In most cells glutamate induced an increase in discharge whilst in a few cells discharge was suppressed. Both series of experiments indicate that glutamate in the used dosage was effective and its effect reversible. The data are discussed with respect to the failure of 1 mM glutamate injections to mimic the effect of light on the circadian activity rhythm of the hamster

Increased sarcolemmal Na+/H+ exchange activity in hypertrophied myocytes from dogs with chronic atrioventricular block

Dogs with compensated biventricular hypertrophy due to chronic atrioventricular block (cAVB), are more susceptible to develop drug-induced Torsade-de-Pointes arrhythmias and sudden cardiac death. It has been suggested that the increased Na+ influx in hypertrophied cAVB ventricular myocytes contribute to these lethal arrhythmias. The increased Na+ influx was not mediated by Na+ channels, in fact the Na+ current proved reduced in cAVB myocytes. Here we tested the hypothesis that increased activity of the Na+/H+ exchanger type 1 (NHE-1), commonly observed in hypertrophic hearts, causes the elevated Na+ influx. Cardiac acid-base transport was studied with a pH-sensitive fluorescent dye in ventricular myocytes isolated from control and hypertrophied cAVB hearts; the H+ equivalent flux through NHE-1, Na+-HCO3- cotransport (NBC), Cl-/OH- exchange (CHE) and Cl-/HCO3- exchange (AE) were determined and normalized per liter cell water and corrected for surface-to-volume ratio. In cAVB, sarcolemmal NHE-1 flux was increased by 65&#177;6.3% in the pHi interval 6.3-7.2 and NBC, AE and CHE fluxes remained unchanged. Accordingly, at steady-state intracellular pH the total sarcolemmal Na+ influx by NHE-1+NBC increased from 8.5&#177;1.5 amol/μm2/min in normal myocytes to 15&#177;2.4 amol/μm2/min in hypertrophied cAVB myocytes. We conclude that compensated cardiac hypertrophy in cAVB dogs is accompanied with an increased sarcolemmal NHE-1 activity. This in conjunction with unchanged activity of the other acid-base transporters will raise the intracellular Na+ in hypertrophied cAVB myocytes

An evidence-based roadmap to integrate planetary health education into the medical curriculum

The urgency for action on climate change is regarded as the defining issue of our time. Planetary health education prepares future healthcare professionals to promote the health of the planet, including sustainable healthcare. This has potential benefits for the healthcare system, patients, community, and the environment. However, many educators are not confident in explaining and inspiring students and many deans and educational staff report challenges when integrating planetary health into education. The roadmap presented in this paper uses evidence from medical education literature to support medical schools with implementing this type of education. The roadmap can be used as a guide for educators, university leadership, and policy-makers in the design of planetary health education