Does undergraduate curriculum design make a difference to readiness to practice as a junior doctor?

Background: Undergraduate medicine curricula can be designed to enable smoother transition to work as a junior doctor. Evaluations should improve curriculum design. Aim: To compare a graduate cohort from one medical school with a cohort from other medical schools in the same Foundation Year 1 (FY1) programme in terms of retrospective perceptions of readiness for practice. Method: A Likert-scale questionnaire measured self-perception of readiness to practice, including general capabilities and specific clinical skills. Results: Response rate was 74% (n=146). The Peninsula Medical School cohort reported readiness for practice at a significantly higher level than the comparison cohort in 14 out of 58 items (24%), particularly for ‘coping with uncertainty’. In only one item (2%) does the comparison cohort report at a significantly higher level. Conclusions: Significant differences between cohorts may be explained by undergraduate curriculum design, where the opportunity for early, structured work-based, experiential learning as students, with patient contact at the core of the experience, may promote smoother transition to work as a junior doctor. Evaluation informs continuous quality improvement of the curriculum

Content moderators’ strategies for coping with the stress of moderating content online

Content moderators are exposed to a range of stressors at work, including analysing content that has been flagged as harmful. However, not much is known about their specific coping strategies. Depth interviews were conducted with 11 content moderators exposed to child sexual abuse material (CSAM) as part of their job, and thematically analysed to investigate both individual coping strategies and those deployed organisationally. Results highlighted the importance of social support especially from colleagues. Supportive relationships fulfilled several needs including helping content moderators process emotions, normalise their reactions and reducing feelings of isolation. Additionally, the ability to create boundaries between work and home life was important for distancing and distracting themselves from the work. Moderators expressed a preference for mandatory, individual therapy with professionals who had specific experience supporting those exposed to CSAM and reported disclosure was hindered if not, due to worries about traumatising the therapist. How content moderators cope and can be further supported are discussed

Deworming and Development: Asking the Right Questions, Asking the Questions Right

Two billion people are infected with intestinal worms. In many areas, the majority of schoolchildren are infected, and the World Health Organization (WHO) has called for school-based mass deworming. The key area for debate is not whether deworming medicine works—in fact, the medical literature finds that treatment is highly effective, and thus the standard of care calls for treating any patient known to harbor an infection. As the authors of the Cochrane systematic review point out, a critical issue in evaluating current soil-transmitted helminth policies is whether the benefits of deworming exceed the costs or whether it would be more prudent to use the money for other purposes. While in general we think the Cochrane approach is very valuable, we argue below that many of the underlying studies of deworming suffer from three critical methodological problems: treatment externalities in dynamic infection systems, inadequate measurement of cognitive outcomes and school attendance, and sample attrition. We then argue that the currently available evidence from studies that address these issues is consistent with the consensus view expressed by other reviews and by policymakers that deworming is a very cost-effective way to increase school participation and has a high benefit to cost ratio.Economic

Do ACL Injury Risk Reduction Exercises Reflect Common Injury Mechanisms? A Scoping Review of Injury Prevention Programs

CONTEXT: Anterior cruciate ligament (ACL) injury risk reduction programs have become increasingly popular. As ACL injuries continue to reflect high incidence rates, the continued optimization of current risk reduction programs, and the exercises contained within them, is warranted. The exercises must evolve to align with new etiology data, but there is concern that the exercises do not fully reflect the complexity of ACL injury mechanisms. It was outside the scope of this review to address each possible inciting event, rather the effort was directed at the elements more closely associated with the end point of movement during the injury mechanism. OBJECTIVE: To examine if exercises designed to reduce the risk of ACL injury reflect key injury mechanisms: multiplanar movement, single limb stance, trunk and hip dissociative control, and a flight phase. DATA SOURCES: A systematic search was performed using PubMed, Medline, EBSCO (CINAHL), SPORTSDiscus, and PEDro databases. STUDY SELECTION: Eligibility criteria were as follows: (1) randomized controlled trials or prospective cohort studies, (2) male and/or female participants of any age, (3) exercises were targeted interventions to prevent ACL/knee injuries, and (4) individual exercises were listed and adequately detailed and excluded if program was unable to be replicated clinically. STUDY DESIGN: Scoping review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: A total of 35 studies were included, and 1019 exercises were extracted for analysis. RESULTS: The average Consensus on Exercise Reporting Template score was 11 (range, 0-14). The majority of exercises involved bilateral weightbearing (n = 418 of 1019; 41.0%), followed by single limb (n = 345 of 1019; 33.9%) and nonweightbearing (n = 256 of 1019; 25.1%). Only 20% of exercises incorporated more than 1 plane of movement, and the majority of exercises had sagittal plane dominance. Although 50% of exercises incorporated a flight phase, only half of these also involved single-leg weightbearing. Just 16% of exercises incorporated trunk and hip dissociation, and these were rarely combined with other key exercise elements. Only 13% of exercises challenged more than 2 key elements, and only 1% incorporated all 4 elements (multiplanar movements, single limb stance, trunk and hip dissociation, flight phase) simultaneously. CONCLUSION: Many risk reduction exercises do not reflect the task-specific elements identified within ACL injury mechanisms. Addressing the underrepresentation of key elements (eg, trunk and hip dissociation, multiplanar movements) may optimize risk reduction in future trials

The transition from medical student to junior doctor: today's experiences of Tomorrow's Doctors.

CONTEXT Medical education in the UK has recently undergone radical reform. Tomorrow's Doctors has prescribed undergraduate curriculum change and the Foundation Programme has overhauled postgraduate education. OBJECTIVES This study explored the experiences of junior doctors during their first year of clinical practice. In particular, the study sought to gain an understanding of how junior doctors experienced the transition from the role of student to that of practising doctor and how well their medical school education had prepared them for this. METHODS The study used qualitative methods comprising of semi-structured interviews and audio diary recordings with newly qualified doctors based at the Peninsula Foundation School in the UK. Purposive sampling was used and 31 of 186 newly qualified doctors self-selected from five hospital sites. All 31 participants were interviewed once and 17 were interviewed twice during the year. Ten of the participants also kept audio diaries. Interview and audio diary data were transcribed verbatim and thematically analysed with the aid of a qualitative data analysis software package. RESULTS The findings show that, despite recent curriculum reforms, most participants still found the transition stressful. Dealing with their newly gained responsibility, managing uncertainty, working in multi-professional teams, experiencing the sudden death of patients and feeling unsupported were important themes. However, the stress of transition was reduced by the level of clinical experience gained in the undergraduate years. CONCLUSIONS Medical schools need to ensure that students are provided with early exposure to clinical environments which allow for continuing 'meaningful' contact with patients and increasing opportunities to 'act up' to the role of junior doctor, even as students. Patient safety guidelines present a major challenge to achieving this, although with adequate supervision the two aims are not mutually exclusive. Further support and supervision should be made available to junior doctors in situations where they are dealing with the death of a patient and on surgical placements