A phenomenological exploration of experience of Syrian dentists with online Course “Traumatic dental injuries”

BackgroundSeveral learning modalities have been implemented to improve learning about Traumatic Dental Injuries (TDIs) worldwide. Free online courses about TDIs might be an effective and convenient approach for equipping Syrian dentists with essential competencies during the Syrian crisis. Therefore, this qualitative study with a descriptive phenomenological method was undertaken to explore the lived experience of Syrian dentists enrolled in an online course about TDIs and investigate areas requiring improvement.MethodsEthical approval was obtained from the Faculty of Dentistry, Damascus University, and the University of Dundee. Educational contents of the TDI course were developed. About 10 dentists who completed the TDI course, were interviewed. The interviews were recorded, transcribed, and analyzed to identify emerging themes. Inductive thematic analysis was performed to extract all data.ResultsAbout 10 clustered categories were first developed and this has led to the emergence of 3 themes that represent the lived experience including usefulness, challenges, and recommendations. Participants were so motivated and keen to take advantage of the course despite the personal, technical problems, and crisis-related challenges. TDIs course was effective for general and specialists despite the challenges they experienced. Factors that lead to effective TDIs courses as reported by participants were flexibility in time and location, interactivity with colleagues, other commitments, quantity and quality of content, easiness, and variety of virtual environment tools. Conversely, negative attitudes were linked to factors like lack of interest, unfamiliarity with the learning environment and tools, late participation, lack of confidence, anxiety about independent learning and insufficient interactivity and engagement tools.ConclusionSyrian dentists can benefit from online courses if constraints and various learning needs are addressed during the design and delivery of online courses. Future work is still required to identify other effective instructional modalities that equip Syrian dentists to overcome challenges and enhance their learning

Multi-source qualitative analysis of emergency medicine residency programmes in Chile:A case study

Resumen: Introducción: la Medicina de Urgencia (MDU) es una especialidad en desarrollo a nivel mundial. En Chile se inició hace más de 2 décadas y aún está avanzando académicamente. Objetivo: explorar el estado actual del desarrollo curricular de la MDU en Chile e identificar formas de estandarizarlo y mejorarlo. Métodos: se realizó un estudio de caso cualitativo para explorar las perspectivas sobre el desarrollo del currículo de la MDU a través de entrevistas a residentes, graduados y directores de programas y análisis documental. Ambos conjuntos de datos fueron evaluados a través de análisis temático. Resultados: se analizaron 4 documentos y se realizaron 8 entrevistas. Surgieron 4 temas principales: estructura curricular, influencia del contexto, expectativas de un médico de urgencia, perspectivas de la MDU. Los programas actuales se centran en el aprendizaje en el lugar de trabajo y tiempo protegido para el aprendizaje; sin embargo, difieren en la exposición clínica y la calidad de la capacitación. Como prioridad, se identificó la colaboración, enfatizando la necesidad de que los programas trabajen juntos para garantizar la calidad. Conclusión: este estudio identifica el estado de situación del desarrollo curricular de la MDU en Chile, identificando similitudes y diferencias entre los programas y las áreas de mejora. Existe acuerdo sobre la necesidad de un currículo mínimo, considerando el contexto local y las necesidades de la sociedad. Abstract: Background: Emergency medicine (EM) is a developing specialty worldwide. In Chile, it has been developing for 25 years, however, there is a need for further progress. Aim: We aimed to explore the current postgraduate curriculum in Chile and identify ways to standardise and improve it. Methods: A qualitative case study approach was used to explore perspectives on EM curriculum development via interviewing residents, graduates and programme directors and documentary analysis of academic and governmental guidelines. Both data sets were evaluated through thematic analysis. Results: Four documents were analyzed, and eight interviews were conducted. Four main themes emerged: curricular structure, influence of context, expectations of an emergency physician, EM perspectives. Current programs focus on workplace learning and protected time for learning; however, they differ in clinical exposure and quality of training. Collaboration was identified as a priority, emphasizing the need for programs to work together to ensure quality. Conclusion: This study identifies the state of curriculum development of EM in Chile. It identifies similarities and differences between programs and areas for improvement. There is agreement on the need for a standardized curriculum, considering local context and societal needs

Enabling and inhibiting doctors transitions: introducing the social identity resource and belonginess model (SIRB)

The transition into postgraduate medical training is complex, requiring an integration into the workplace, adjustment to new identities, and understanding of the social and organisational structure of healthcare. Studies suggest that social resources, including a sense of belonging, inclusivity from social groups, and having strong social identities can facilitate positive transitions. However, little is known about the role these resources play in junior doctors’ transitions into the healthcare community. This study aimed to explore the implications of having access to social resources for junior doctors. This study undertook secondary analysis from a longitudinal qualitative study which followed 19 junior doctors (residents within two years of qualification) for nine months. Data were thematically analysed using an abductive approach, with the social identity resource and belongingness (SIRB) model as a conceptual lens to explore how social networks of support act as identity resources (IRs) for junior doctors as they experience transitions. The doctors narrated that having accessible IRs in the form of supportive workplace relationships enabled an integration and a sense of belonging into healthcare practice, supported the construction of new professional identities, and strengthened career intentions. Those with inaccessible IRs (i.e. poor workplace relationships) expressed a lack of belonging, and casted doubt on their identity as a doctor and their career intentions. Our study indicates that SIRB model would be beneficial for medical educators, supervisors, and managers to help them understand the importance and implications of having IRs within the workplace environment and the consequences of their accessibility for healthcare staff experiencing transitions

Heard, valued, supported? : Doctors' wellbeing during transitions triggered by COVID-19

Funding Information: The authors would like to thank all study participants who invested significant time and energy into participating in this study in exceptional circumstances. The authors would also like to thank study funders: Chief Scientist Office (Scotland) and Scottish Medical Education Research Consortium (SMERC). Publisher Copyright: © 2021 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.Peer reviewedPublisher PD

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Heard, valued, supported? Doctors' wellbeing during transitions triggered by COVID-19

Introduction: Supporting doctors' wellbeing is crucial for medical education to help minimise negative long-term impacts on medical workforce retention and ultimately patient care. There is limited study of how doctors' transitions experiences impact wellbeing, particularly socially and culturally. Multiple Multidimensional Transitions (MMT) theory views transitions as dynamic, incorporating multiple contexts and multiple domains. Using MMT as our lens, we report a qualitative analysis of how transitions experienced by doctors during the pandemic impacted on social and cultural aspects of wellbeing.Methods: Longitudinal narrative inquiry was employed, using interviews and audio-diaries. Data were collected over 6 months in three phases: (i) interviews with doctors from across the career spectrum (n = 98); (ii) longitudinal audio-diaries for 2–4 months (n = 71); (iii) second interviews (n = 83). Data were analysed abductively, narrowing focus to factors important to social and cultural wellbeing.Results: Doctors described experiencing multiple interacting transitions triggered by the pandemic in multiple contexts (workplace, role, homelife and education). Patterns identifiable across the dataset allowed us to explore social and cultural wellbeing crosscutting beyond individual experience. Three critical factors contributed to social and cultural wellbeing both positively and negatively: being heard (e.g., by colleagues asking how they are); being valued (e.g., removal of rest spaces by organisations showing lack of value); and being supported (e.g., through regular briefing by education bodies).Conclusions: This study is the first to longitudinally explore the multiple-multidimensional transitions experienced by doctors during the COVID-19 pandemic. Our data analysis helped us move beyond existing perceptions around wellbeing and articulate multiple factors that contribute to social and cultural wellbeing. It is vital that medical educators consider the learning from these experiences to help pinpoint what aspects of support might be beneficial to trainee doctors and their trainers. This study forms the basis for developing evidenced-based interventions that ensure doctors are heard, valued and supported

Interventions to promote physical distancing behaviour during infectious disease pandemics or epidemics: a systematic review

ObjectivesPhysical distancing, defined as keeping 1–2m apart when co-located, can prevent cases of droplet or aerosol transmitted infectious diseases such as SARS-CoV2. During the COVID-19 pandemic, distancing was a recommendation or a requirement in many countries. This systematic review aimed to determine which interventions and behavior change techniques (BCTs) are effective in promoting adherence to distancing and through which potential mechanisms of action (MOAs).MethodsSix databases were searched. The review included studies that were (a) conducted on humans, (b) reported physical distancing interventions, (c) included any comparator (e.g., pre-intervention versus post-intervention; randomized controlled trial), and (d) reported actual distancing or predictors of distancing behavior. Risk of bias was assessed using the Mixed Methods Appraisal Tool. BCTs and potential MoAs were identified in each intervention.ResultsSix reports (with seven studies and 19 comparisons) indicated that distancing interventions could successfully change MoAs and behavior. Successful BCTs (MoAs) included feedback on behavior (e.g., motivation); information about health consequences, salience of health consequences (e.g., beliefs about consequences), demonstration (e.g., beliefs about capabilities), and restructuring the physical environment (e.g., environmental context and resources). The most promising interventions were proximity buzzers, directional systems, and posters with loss-framed messages that demonstrated the behaviors.ConclusionsThe evidence indicates several BCTs and potential MoAs that should be targeted in interventions and highlights gaps that should be the focus of future research.<br/