"I couldn't do this with opposition from my colleagues": A qualitative study of physicians' experiences as clinical tutors

<p>Abstract</p> <p>Background</p> <p>Clinical contact in the early curriculum and workplace learning with active tutorship are important parts of modern medical education. In a previously published study, we found that medical students' tutors experienced a heavier workload, less reasonable demands and less encouragement, than students. The aim of this interview study was to further illuminate physicians' experiences as clinical tutors.</p> <p>Methods</p> <p>Twelve tutors in the Early Professional Contact course were interviewed. In the explorative interviews, they were asked to reflect upon their experiences of working as tutors in this course. Systematic text condensation was used as the analysis method.</p> <p>Results</p> <p>In the analysis, five main themes of physicians' experiences as clinical tutors in the medical education emerged: <it>(a) Pleasure and stimulation</it>. Informants appreciated tutorship and meeting both students and fellow tutors, <it>(b) Disappointment and stagnation</it>. Occasionally, tutors were frustrated and expressed negative feelings, <it>(c) Demands and duty</it>. Informants articulated an ambition to give students their best; a desire to provide better medical education but also a duty to meet demands of the course management, <it>(d) Impact of workplace relations</it>. Tutoring was made easier when the clinic's management provided active support and colleagues accepted students at the clinic, and <it>(e) Multitasking difficulties</it>. Combining several duties with those of a tutorship was often reported as difficult.</p> <p>Conclusions</p> <p>It is important that tutors' tasks are given adequate time, support and preparation. Accordingly, it appears highly important to avoid multitasking and too heavy a workload among tutors in order to facilitate tutoring. A crucial factor is acceptance and active organizational support from the clinic's management. This implies that tutoring by workplace learning in medical education should play an integrated and accepted role in the healthcare system.</p

Quantum ergodicity for graphs related to interval maps

We prove quantum ergodicity for a family of graphs that are obtained from ergodic one-dimensional maps of an interval using a procedure introduced by Pakonski et al (J. Phys. A, v. 34, 9303-9317 (2001)). As observables we take the L^2 functions on the interval. The proof is based on the periodic orbit expansion of a majorant of the quantum variance. Specifically, given a one-dimensional, Lebesgue-measure-preserving map of an interval, we consider an increasingly refined sequence of partitions of the interval. To this sequence we associate a sequence of graphs, whose directed edges correspond to elements of the partitions and on which the classical dynamics approximates the Perron-Frobenius operator corresponding to the map. We show that, except possibly for subsequences of density 0, the eigenstates of the quantum graphs equidistribute in the limit of large graphs. For a smaller class of observables we also show that the Egorov property, a correspondence between classical and quantum evolution in the semiclassical limit, holds for the quantum graphs in question.Comment: 20 pages, 1 figur

The voices of youth in envisioning positive futures for nature and people

The unpredictable Anthropocene poses the challenge of imagining a radically different, equitable and sustainable world. Looking 100 years ahead is not easy, and especially as millennials, it appears quite bleak. This paper is the outcome of a visioning exercise carried out in a 2-day workshop, attended by 33 young early career professionals under the auspices of IPBES. The process used Nature Futures Framework in an adapted visioning method from the Seeds of Good Anthropocene project. Four groups envisioned more desirable future worlds; where humanity has organised itself, the economy, politics and technology, to achieve improved nature-human well-being. The four visions had differing conceptualisations of this future. However, there were interesting commonalities in their leverage points for transformative change, including an emphasis on community, fundamentally different economic systems based on sharing and technological solutions to foster sustainability and human-nature connectedness. Debates included questioning the possibility of maintaining local biocultural diversity with increased connectivity globally and the prominence of technology for sustainability outcomes. These visions are the first step towards a wider galvanisation of youth visions for a brighter future, which is often missing in the arena where it can be taken seriously, to trigger more transformative pathways towards meeting global goals

High (but Not Low) Urinary Iodine Excretion Is Predicted by Iodine Excretion Levels from Five Years Ago

Background: It has not been investigated whether there are associations between urinary iodine (UI) excretion measurements some years apart, nor whether such an association remains after adjustment for nutritional habits. The aim of the present study was to investigate the relation between iodine-creatinine ratio (ICR) at two measuring points 5 years apart. Methods: Data from 2,659 individuals from the Study of Health in Pomerania were analyzed. Analysis of covariance and Poisson regressions were used to associate baseline with follow-up ICR. Results: Baseline ICR was associated with follow-up ICR. Particularly, baseline ICR >300 mu g/g was related to an ICR >300 mu g/g at follow-up (relative risk, RR: 2.20; p < 0.001). The association was stronger in males (RR: 2.64; p < 0.001) than in females (RR: 1.64; p = 0.007). In contrast, baseline ICR <100 mu g/g was only associated with an ICR <100 mu g/g at follow-up in males when considering unadjusted ICR. Conclusions: We detected only a weak correlation with respect to low ICR. Studies assessing iodine status in a population should take into account that an individual with a low UI excretion in one measurement is not necessarily permanently iodine deficient. On the other hand, current high ICR could have been predicted by high ICR 5 years ago. Copyright (C) 2011 S. Karger AG, Base

Control and stabilization of waves on 1-d networks

We present some recent results on control and stabilization of waves on 1-d networks.The fine time-evolution of solutions of wave equations on networks and, consequently, their control theoretical properties, depend in a subtle manner on the topology of the network under consideration and also on the number theoretical properties of the lengths of the strings entering in it. Therefore, the overall picture is quite complex.In this paper we summarize some of the existing results on the problem of controllability that, by classical duality arguments in control theory, can be reduced to that of observability of the adjoint uncontrolled system. The problem of observability refers to that of recovering the total energy of solutions by means of measurements made on some internal or external nodes of the network. They lead, by duality, to controllability results guaranteeing that L 2-controls located on those nodes may drive sufficiently smooth solutions to equilibrium at a final time. Most of our results in this context, obtained in collaboration with R. Dáger, refer to the problem of controlling the network from one single external node. It is, to some extent, the most complex situation since, obviously, increasing the number of controllers enhances the controllability properties of the system. Our methods of proof combine sidewise energy estimates (that in the particular case under consideration can be derived by simply applying the classical d'Alembert's formula), Fourier series representations, non-harmonic Fourier analysis, and number theoretical tools.These control results belong to the class of the so-called open-loop control systems.We then discuss the problem of closed-loop control or stabilization by feedback. We present a recent result, obtained in collaboration with J. Valein, showing that the observability results previously derived, regardless of the method of proof employed, can also be recast a posteriori in the context of stabilization, so to derive explicit decay rates (as) for the energy of smooth solutions. The decay rate depends in a very sensitive manner on the topology of the network and the number theoretical properties of the lengths of the strings entering in it.In the end of the article we also present some challenging open problems

Medical students' and facilitators' experiences of an Early Professional Contact course: Active and motivated students, strained facilitators

Background: Today, medical students are introduced to patient contact, communication skills, and clinical examination in the preclinical years of the curriculum with the purpose of gaining clinical experience. These courses are often evaluated from the student perspective. Reports with an additional emphasis on the facilitator perspective are scarce. According to constructive alignment, an influential concept from research in higher education, the learning climate between students and teachers is also of great importance. In this paper, we approach the learning climate by studying both students' and facilitators' course experiences.\ud \ud In 2001, a new "Early Professional Contact" longitudinal strand through term 1–4, was introduced at the Sahlgrenska Academy, University of Gothenburg, Sweden. General practitioners and hospital specialists were facilitators.\ud \ud The aim of this study was to assess and analyse students' and clinical facilitators' experiences of the Early Professional Contact course and to illuminate facilitators' working conditions.\ud \ud Methods: Inspired by a Swedish adaptation of the Course Experience Questionnaire, an Early Professional Contact Questionnaire was constructed. In 2003, on the completion of the first longitudinal strand, a student and facilitator version was distributed to 86 students and 21 facilitators. In the analysis, both Chi-square and the Mann-Whitney tests were used.\ud \ud Results: Sixty students (70%) and 15 facilitators (71%) completed the questionnaire. Both students and facilitators were satisfied with the course. Students reported gaining [inspiration] for their future work as doctors along with increased confidence in meeting patients. They also reported increased motivation for biomedical studies. Differences in attitudes between facilitators and students were found. Facilitators experienced a greater workload, less reasonable demands and less support, than students.\ud \ud Conclusion: In this project, a new Early Professional Contact course was analysed from both student and facilitator perspectives. The students experienced the course as providing them with a valuable introduction to the physician's professional role in clinical practice. In contrast, course facilitators often experienced a heavy workload and lack of support, despite thorough preparatory education. A possible conflict between the clinical facilitator's task as educator and member of the workplace is suggested. More research is needed on how doctors combine their professional tasks with work as facilitators

Patient experiences of psychological therapy for depression: a qualitative metasynthesis

Background Globally, national guidelines for depression have prioritised evidence from randomised controlled trials and quantitative meta-analyses, omitting qualitative research concerning patient experience of treatments. A review of patient experience research can provide a comprehensive overview of this important form of evidence and thus enable the voices and subjectivities of those affected by depression to have an impact on the treatments and services they are offered. This review aims to seek a comprehensive understanding of patient experiences of psychological therapies for depression using a systematic and rigorous approach to review and synthesis of qualitative research. Method PsychINFO, PsychARTICLES, MEDLINE, and CINAHL were searched for published articles using a qualitative approach to examine experiences of psychological therapies for depression. All types of psychological therapy were included irrespective of model or modes of delivery (e.g. remote or in person; group or individual). Each article was assessed following guidance provided by the Critical Appraisal Skill Programme tool. Articles were entered in full into NVIVO and themes were extracted and synthesized following inductive thematic analysis. Results Thirty-seven studies, representing 671 patients were included. Three main themes are described; the role of therapy features and setting; therapy processes and how they impact on outcomes; and therapy outcomes (benefits and limitations). Subthemes are described within these themes and include discussion of what works and what’s unhelpful; issues integrating therapy with real life; patient preferences and individual difference; challenges of undertaking therapy; influence of the therapist; benefits of therapy; limits of therapy and what happens when therapy ends. Conclusions Findings point to the importance of common factors in psychotherapies; highlight the need to assess negative outcomes; and indicate the need for patients to be more involved in discussions and decisions about therapy, including tailoring therapy to individual needs and taking social and cultural contexts into account