Social justice in undergraduate medical education: a meta-synthesis of learners’ perspectives

Introduction: The COVID-19 pandemic has illuminated disparities and inequities in healthcare globally, making it a necessity to identify, and address social and structural determinants of people’s everyday lives. Medical schools and education need to respond to and address social justice in undergraduate education. Social justice in medical education has the potential to be a foundational block to support the initiatives that have or are being implemented in our health systems. Methods: We carried out a meta-synthesis and used an interpretative approach for the analysis. Searches were conducted of three databases: PsycINFO, Embase and Medline and were carried out in May 2021. We excluded articles that were not related to undergraduate medical students. The aim of this review was to explore literature on SJ teaching to elicit the experiences of learners to inform future SJ teaching and curriculum. Results: Using meta-synthesis methodology, four themes emerged: personal growth of learners and professional identities; developing commitment to working with marginalised populations in their environments; integrating traditional clinical skills with advocacy, interests in human rights and SJ work; learning processes and methods. Conclusions: Findings confirm that SJ in undergraduate medical education has an essential role. However, social justice in medical education was understood as a non-essential piece of professionalism, or as something to be learnt in the abstract method rather than as a part of everyday practice realities. Our findings suggest that creating globally competent doctors through a globally equivalent curriculum, which is balanced and with a locally invested training programme could lead to a supply or workforce that is fit for purpose for local populations

Social justice in undergraduate medical education: a meta-synthesis of learners’ perspectives

Introduction: The COVID-19 pandemic has illuminated disparities and inequities in healthcare globally, making it a necessity to identify, and address social and structural determinants of people’s everyday lives. Medical schools and education need to respond to and address social justice in undergraduate education. Social justice in medical education has the potential to be a foundational block to support the initiatives that have or are being implemented in our health systems. Methods: We carried out a meta-synthesis and used an interpretative approach for the analysis. Searches were conducted of three databases: PsycINFO, Embase and Medline and were carried out in May 2021. We excluded articles that were not related to undergraduate medical students. The aim of this review was to explore literature on SJ teaching to elicit the experiences of learners to inform future SJ teaching and curriculum. Results: Using meta-synthesis methodology, four themes emerged: personal growth of learners and professional identities; developing commitment to working with marginalised populations in their environments; integrating traditional clinical skills with advocacy, interests in human rights and SJ work; learning processes and methods. Conclusions: Findings confirm that SJ in undergraduate medical education has an essential role. However, social justice in medical education was understood as a non-essential piece of professionalism, or as something to be learnt in the abstract method rather than as a part of everyday practice realities. Our findings suugest that creating globally competent doctors through a globally equivalent curriculum, which is balanced and with a locally invested training programme could lead to a supply or workforce that is fit for purpose for local populations

Use of virtual reality in the education of orthopaedic procedures : a randomised control study in early validation of a novel virtual reality simulator

Background Virtual reality (VR) simulation is a potential solution to the barriers surgical trainees are facing. There needs to be validation for its implementation within current training. We aimed to compare VR simulation to traditional methods in acquiring surgical skills for a TFN-ADVANCED™ Proximal Femoral Nailing System (TFNA; DePuy Synthes, Auckland, New Zealand) femoral nailing system. Methods Thirty-one surgical trainees were randomised to two groups: traditional-training group (control group) and a VR-training group (intervention group) for insertion of a short cephalomedullary TFNA nail. Both groups then inserted the same TFNA system into saw-bone femurs. Surveys evaluated validity of the relevant activities, perception of simulation, confidence, stress and anxiety. The primary outcomes were tip-apex distance (TAD) and user anxiety/confidence levels. Secondary outcomes included number of screw- and nail-guidewire insertion attempts, the time taken to complete and user validity of the VR system. Results There was no statistical difference in TAD between the intervention and control groups (9mm vs 15mm, p=0.0734). The only TAD at risk of cut-out was in the control group (25mm). There was no statistical difference in time taken (2547.5ss vs 2395ss, p=0.668), nail guide-wire attempts (two for both groups, p=0.355) and screw guide-wire attempts (one for both groups, p=0.702). The control group versus intervention had higher anxiety levels (50% vs 33%) and had lower confidence (61% vs 84%). Interpretation There was no objective difference in performance on a saw-bone model between groups. However, this VR simulator resulted in more confidence and lower anxiety levels whilst performing a simulated TFNA. Whilst further studies with larger sample sizes and exploration of transfer validity to the operating theatre are required, this study does indicate potential benefits of VR within surgical training

Anti-cholinergic drug burden in patients with dementia increases after hospital admission: a multicentre cross-sectional study

Background: Anticholinergic medications are drugs that block cholinergic transmission, either as their primary therapeutic action or as a secondary effect. Patients with dementia may be particularly sensitive to the central effects of anticholinergic drugs. Anticholinergics also antagonise the effects of the main dementia treatment, cholinesterase inhibitors. Our study aimed to investigate anticholinergic prescribing for dementia patients in UK acute hospitals before and after admission. Methods: We included 352 patients with dementia from 17 UK hospital sites in 2019. They were all inpatients on surgical, medical or Care of the Elderly wards. Information about each patient’s medications were collected using a standardised form, and the anticholinergic drug burden of each patient was calculated with an evidence-based online calculator. Wilcoxon’s rank test was used to look at the correlation between two subgroups upon admission and discharge. Results: On admission to hospital, 37.8% of patients had an anticholinergic burden score ≥ 1 and 5.68% ≥3. On discharge, 43.2% of patients with an anticholinergic burden score ≥ 1 and 9.1% ≥3. The increase in scores was statistically significant (p = 0.001). Psychotropics were the most common group of anticholinergic medications prescribed at discharge. Of those patients taking cholinesterase inhibitors, 44.9% were also prescribed anticholinergic medications. Conclusions: Our cross-sectional, multicentre study found that people with dementia are commonly prescribed anticholinergic medications, even if concurrently taking cholinesterase inhibitors, and are significantly more likely to be discharged from hospital with a higher anticholinergic burden than on admission

Anti-cholinergic drug burden in patients with dementia increases after hospital admission: a multicentre cross-sectional study.

Funder: Wellcome TrustBACKGROUND: Anticholinergic medications are drugs that block cholinergic transmission, either as their primary therapeutic action or as a secondary effect. Patients with dementia may be particularly sensitive to the central effects of anticholinergic drugs. Anticholinergics also antagonise the effects of the main dementia treatment, cholinesterase inhibitors. Our study aimed to investigate anticholinergic prescribing for dementia patients in UK acute hospitals before and after admission. METHODS: We included 352 patients with dementia from 17 UK hospital sites in 2019. They were all inpatients on surgical, medical or Care of the Elderly wards. Information about each patient's medications were collected using a standardised form, and the anticholinergic drug burden of each patient was calculated with an evidence-based online calculator. Wilcoxon's rank test was used to look at the correlation between two subgroups upon admission and discharge. RESULTS: On admission to hospital, 37.8% of patients had an anticholinergic burden score ≥ 1 and 5.68% ≥3. On discharge, 43.2% of patients with an anticholinergic burden score ≥ 1 and 9.1% ≥3. The increase in scores was statistically significant (p = 0.001). Psychotropics were the most common group of anticholinergic medications prescribed at discharge. Of those patients taking cholinesterase inhibitors, 44.9% were also prescribed anticholinergic medications. CONCLUSIONS: Our cross-sectional, multicentre study found that people with dementia are commonly prescribed anticholinergic medications, even if concurrently taking cholinesterase inhibitors, and are significantly more likely to be discharged from hospital with a higher anticholinergic burden than on admission