Professional paradox: identity formation in qualified doctors pursuing further training.

CONTEXT: Many newly qualified specialists and subspecialists pursue additional training. Although their motivations are many, the pursuit of further training as an alternative to unemployment is an emerging trend. Paradoxically, doctors continue as trainees with a consultant's credentials, and without the guarantee of eventual employment. This study explores seven doctors' experiences, the effects of further training on their professional identity formation (PIF), and how these effects are reconciled on a personal and professional level. METHODS: This phenomenological study involved interviews with seven qualified Canadian specialists (three were female) who pursued additional training in response to a lack of available positions in their respective specialties. Template analysis generated theoretical constructs of influences on their PIF, and characteristics of their lived experiences. RESULTS: Four themes shaped PIF: setting and context; language and communication; responsibilities and privileges; and participants' visions of their future selves. Professional identity formation (PIF) continued to develop in further training, but was inconsistently affirmed by participants' communities of practice. Four major themes characterised training experiences: prescription; managing multiple masters; limiting access to others and community ties; and constantly questioning the value of extra training. CONCLUSION: Qualified doctors traverse professional paradoxes as they seek further education with no guarantee of employment and provide consultant-level care as 'trainees'. An identity dissonance emerges that may continue until a clear identity is prescribed for them. Although disruptive to these doctors' PIF and personal and professional lives, the long-term effects of additional training are unknown. Its utility and influence on securing employment and future job satisfaction are areas for further research.

Motivators to participation in actual HIV vaccine trials.

An examination of actual HIV vaccine trials can contribute to an understanding of motivators for participation in these studies. Analysis of these motivators reveals that they can be categorized as social and personal benefits. Social benefits are generally altruistic, whereas personal benefits are psychological, physical, and financial. In this systematic review, the authors performed a literature search for actual preventive HIV vaccine trials reporting motivators to participation. Of studies conducted in the Organization for Economic Co-operation and Development (OECD) countries, the authors retrieved 12 studies reporting on social benefits and seven reporting on personal benefits. From the non-OECD countries, nine studies reported on social benefits and eight studies on personal benefits. Social benefits were most frequently described on macroscopic, altruistic levels. Personal benefits were most frequently psychological in nature. Rates of participation were compared between the OECD and the non-OECD countries. Knowledge of actual motivators in specific countries and regions can help target recruitment in various types of actual HIV vaccine trials.

Helping students reflect: lessons from cognitive psychology.

The challenges of teaching students to reflect on experience and, thus, learn from it, are better understood with the application of constructs from cognitive psychology. The present paper focuses on two such constructs-self-schemas and scripts-to help educators better understand both the threats and opportunities associated with effective reflection. Emotion is presented as an important accompaniment to reflection. Suggestions are presented, using the notions of self-schemas and scripts, to help students manage the emotion associated with reflection and to enhance the value of that reflection.

Motivators to participation in medical trials: the application of social and personal categorization.

The Health Belief Model provides a framework to understand motivators for volunteering for medical research. Motivators can take the form of social and personal benefits. In this systematic review of review articles, we contrast motivators of participation in actual cancer trials to those in actual HIV vaccine trials. We retrieved eight review articles from 2000 to 2012 examining motivators to participation in actual cancer trials. Personal benefits were most often psychological in nature, such as "coping with symptoms." Social benefits included "advancing research," "helping other cancer patients," and "for their family." While specific motivators vary between considerations - cancer research and HIV vaccine trials, these motivators fall into similar categories at similar frequencies. For example, personal/psychological benefits are common in each. Participant recruitment must be mindful of these categories of motivators for both cancer and HIV vaccine research.

Cognitive factors and willingness to participate in an HIV vaccine trial among HIV-positive injection drug users.

There are gaps in our knowledge of the role cognitive factors play in determining people's willingness to participate (WTP) in therapeutic HIV vaccine trials. Using a cross-sectional study of HIV-positive injection drug users (IDU), we determined the role of three cognitive factors: HIV treatment optimism, self-efficacy beliefs, and knowledge of vaccine trial concepts in relation to WTP in a hypothetical phase 3 therapeutic HIV vaccine trial. WTP was 54%. Participants tended to be low in HIV treatment optimism (mean = 3.9/10), high in self-efficacy (mean = 79.8/100), and low in knowledge (mean = 4.1/10). Items pertaining to HIV treatment optimism and knowledge of HIV vaccine trial concepts were generally unrelated to WTP. An increase in self-efficacy had a statistically significant positive association with WTP (OR = 1.61, 95% CI = 1.04-2.46, p < 0.05). Furthermore, most of these HIV-positive participants had high levels of self-efficacy, so we are most confident about this relationship at such levels. These findings indicate that interventions focused on increasing self-efficacy could enhance WTP among HIV-positive IDU.

Motivators of enrolment in HIV vaccine trials: a review of HIV vaccine preparedness studies.

HIV vaccine preparedness studies (VPS) are important precursors to HIV vaccine trials. As well, they contribute to an understanding of motivators and barriers for participation in hypothetical HIV vaccine trials. Motivators can take the form of altruism and a desire for social benefits. Perceived personal benefits, including psychological, personal, and financial well-being, may also motivate participation. The authors performed a systematic review of HIV VPS using the Cochrane Database for Systematic Reviews, Medline, PubMed, Embase, and Google Scholar. The authors independently searched the literature for individual HIV VPS that examined motivators of participation in a hypothetical HIV vaccine trial, using the same search strategy. As the denominators employed in the literature varied across studies, the denominators were standardized to the number of respondents per survey item, regardless of their willingness to participate (WTP) in an HIV vaccine trial. The authors retrieved eight studies on social benefits (i.e., altruism) and 11 studies on personal benefits conducted in the Organization for Economic Co-operation and Development (OECD) countries, as well as 19 studies on social benefits and 20 studies on personal benefits in the non-OECD countries. Various different forms of altruism were found to be the major motivators for participation in an HIV vaccine trial in both the OECD and the non-OECD countries. In a large number of studies, protection from HIV was cited as a personal motivator for participation in a hypothetical HIV vaccine trial in the OECD and the non-OECD countries. Knowledge of motivators can inform and target recruitment for HIV vaccine trials, although it must be remembered that hypothetical motivators may not always translate into motivators in an actual vaccine trial.

Exploring the role of social capital in supporting a regional medical education campus.

INTRODUCTION: To help address physician shortages in the underserved community of Prince George, Canada, the University of British Columbia (UBC) and various partners created the Northern Medical Program (NMP), a regional distributed site of UBC's medical doctor undergraduate program. Early research on the impacts of the NMP revealed a high degree of social connectedness. The objective of the present study was to explore the role of social capital in supporting the regional training site and the benefits accrued to a broad range of stakeholders and network partners. METHODS: In this qualitative study, 23 semi-structured interviews were conducted with community leaders in 2007. A descriptive content analysis based on analytic induction technique was employed. Carpiano's Bourdieu-based framework of 'neighbourhood' social capital was adapted to empirically describe how social capital was produced and mobilized within and among networks during the planning and implementation of the NMP. RESULTS: Results from this study reveal that the operation of social capital and the related concept of social cohesion are multifaceted, and that benefits extend in many directions, resulting in somewhat unanticipated benefits for other key stakeholders and network partners of this medical education program. Participants described four aspects of social capital: (i) social cohesion; (ii) social capital resources; (iii) access to social capital; and (iv) outcomes of social capital. CONCLUSIONS: The findings of this study suggest that the partnerships and networks formed in the NMP planning and implementation phases were the foundation for social capital mobilization. The use of Carpiano's spatially-bounded model of social capital was useful in this context because it permitted the characterization of relations and networks of a tight-knit community body. The students, faculty and administrators of the NMP have benefitted greatly from access to the social capital mobilized to make the NMP operational. Taking account of the dynamic and multifaceted operation of social capital helps one move beyond a view of geographic communities as simply containers or sinks of capital investment, and to appreciate the degree to which they may act as a platform for productive network formation and expansion.

Nurturing social responsibility through community service-learning: Lessons learned from a pilot project.

BACKGROUND: Community service-learning (CSL) has been proposed as one way to enrich medical and dental students' sense of social responsibility toward people who are marginalized in society. AIM: We developed and implemented a new CSL option in the integrated medical/dental curriculum and assessed its educational impact. METHODS: Focus groups, individual open-ended interviews, and a survey were used to assess dental students', faculty tutors' and community partners' experiences with CSL. RESULTS: CSL enabled a deeper appreciation for the vulnerabilities that people who are marginalized experience; students gained a greater insight into the social determinants of health and the related importance of community engagement; and they developed useful skills in health promotion project planning, implementation and evaluation. Community partners and faculty tutors indicated that equal partnership, greater collaboration, and a participatory approach to course development are essential to sustainability in CSL. CONCLUSIONS: CSL can play an important role in nurturing a purposeful sense of social responsibility among future practitioners. Our study enabled the implementation of an innovative longitudinal course (professionalism and community service) in all 4 years of the dental curriculum.

Brief report: cognitive functioning and academic achievement in children and adolescents with chronic pain.

OBJECTIVE: To examine the patterns of cognitive functioning and academic achievement in children and adolescents with chronic pain attending a tertiary-care interdisciplinary pain service. METHODS: The standardized psychoeducational testing results of 57 children and adolescents with chronic pain aged 8-18 were retrospectively reviewed. RESULTS: On average, participants scored higher in general intelligence, verbal ability, nonverbal reasoning, word reading, and math reasoning than the general population. The level of academic achievement for most participants was consistent with their intellectual ability. CONCLUSIONS: In this clinical sample with complex, disabling pain, the group mean data do not indicate overall cognitive impairment, or a single atypical achievement pattern. Future research will need to look beyond cognitive and achievement scores to explore the links between school functioning and chronic pain in children.

Difficult incidents and tutor interventions in problem-based learning tutorials.

CONTEXT: Tutors report difficult incidents and distressing conflicts that adversely affect learning in their problem-based learning (PBL) groups. Faculty development (training) and peer support should help them to manage this. Yet our understanding of these problems and how to deal with them often seems inadequate to help tutors. OBJECTIVES: The aim of this study was to categorise difficult incidents and the interventions that skilled tutors used in response, and to determine the effectiveness of those responses. METHODS: Thirty experienced and highly rated tutors in our Year 1 and 2 medical curriculum took part in semi-structured interviews to: identify and describe difficult incidents; describe how they responded, and assess the success of each response. Recorded and transcribed data were analysed thematically to develop typologies of difficult incidents and interventions and compare reported success or failure. RESULTS: The 94 reported difficult incidents belonged to the broad categories 'individual student' or 'group dynamics'. Tutors described 142 interventions in response to these difficult incidents, categorised as: (i) tutor intervenes during tutorial; (ii) tutor gives feedback outside tutorial, or (iii) student or group intervenes. Incidents in the 'individual student' category were addressed relatively unsuccessfully (effective < 50% of the time) by response (i), but with moderate success by response (ii) and successfully (> 75% of the time) by response (iii). None of the interventions worked well when used in response to problems related to 'group dynamics'. Overall, 59% of the difficult incidents were dealt with successfully. CONCLUSIONS: Dysfunctional PBL groups can be highly challenging, even for experienced and skilled tutors. Within-tutorial feedback, the treatment that tutors are most frequently advised to apply, was often not effective. Our study suggests that the collective responsibility of the group, rather than of the tutor, to deal with these difficulties should be emphasised.

Determinants of condom use: results of the Canadian Community Health Survey 3.1.

OBJECTIVES: To examine the independent effects of mood disorder, age, race/ethnicity, personal income, being a current student, having a regular medical doctor and substance use in relationship to condom use at last intercourse in a Canadian population stratified by sex. METHODS: We used Cycle 3.1 of the 2006 Canadian Community Health Survey (CCHS 3.1), a population-based, voluntary, cross-sectional survey of subjects ages 12-85 years. Data collection took place between January and December 2005. From the survey, a study sample of 20,975 people was drawn, consisting of individuals providing valid responses (yes/no) to mood disorder and last-time condom use. The question of sexual behaviours was asked only of those ages 15-49 years. Logistic regression was used to examine individual variables as potential determinants of last-time condom use stratified by sex. RESULTS: The relationship between mood disorder and condom use was non-significant in both males (AOR = 0.85, 95% CI = 0.70-1.04) and females (AOR = 0.90, 95% CI = 0.78-1.03). Increasing age was found to be inversely associated with last-time condom use in both males and females. Male factors significantly associated with last-time condom use were being of white ethnicity (AOR = 0.71, 95% CI = 0.64-0.79) and being a current student (AOR = 1.28, 95% CI =1.16-1.42). Female factors associated with last-time condom use were being of white ethnicity (AOR = 0.71, 95% CI = 0.63-0.79) and being a former drinker (AOR = 2.25, 95% CI = 1.63-3.11). CONCLUSION: Our results identify important determinants of last-time condom use in both males and females in the CCHS 3.1. These findings may have important implications for the devising and implementation of safe sex programs in a Canadian population ages 15-49 years.

Innovation in collaborative health research training: the role of active learning.

This paper describes and discusses the essential pedagogical elements of the Partnering in Community Health Research (PCHR) program, which was designed to address the training needs of researchers who participate in collaborative, interdisciplinary health research. These elements were intended to foster specific skills that helped learners develop research partnerships featuring knowledge, capabilities, values and attitudes needed for successful research projects. By establishing research teams called "clusters", PCHR provided research training and experience for graduate students and post-doctoral fellows, as well as for community health workers and professionals. Pedagogical elements relied on active learning approaches such as inquiry-based and experience-based learning. Links between these elements and learning approaches are explained. Through their work in cluster-based applied research projects, the development of learning plans, and cross-cluster learning events, trainees acquired collaborative research competencies that were valuable, relevant and theoretically informed.

Development of an instrument to assess the impact of an enhanced experiential model on pharmacy students' learning opportunities, skills and attitudes: a retrospective comparative-experimentalist study.

BACKGROUND: Pharmacy schools across North America have been charged to ensure their students are adequately skilled in the principles and practices of pharmaceutical care. Despite this mandate, a large percentage of students experience insufficient opportunities to practice the activities, tasks and processes essential to pharmaceutical care. The objective of this retrospective study of pharmacy students was to: (1) as "proof of concept", test the overall educational impact of an enhanced advanced pharmacy practice experiential (APPE) model on student competencies; (2) develop an instrument to measure students' and preceptors' experiences; and (3) assess the psychometric properties of the instrument. METHODS: A comparative-experimental design, using student and preceptor surveys, was used to evaluate the impact of the enhanced community-based APPE over the traditional APPE model. The study was grounded in a 5-stage learning model: (1) an enhanced learning climate leads to (2) better utilization of learning opportunities, including (3) more frequent student/patient consultation, then to (4) improved skills acquisition, thence to (5) more favorable attitudes toward pharmaceutical care practice. The intervention included a one-day preceptor workshop, a comprehensive on-site student orientation and extending the experience from two four-week experiences in different pharmacies to one eight-week in one pharmacy. RESULTS: The 35 student and 38 preceptor survey results favored the enhanced model; with students conducting many more patient consultations and reporting greater skills improvement. In addition, the student self-assessment suggested changes in attitudes favoring pharmaceutical care principles. Psychometric testing showed the instrument to be sensitive, valid and reliable in ascertaining differences between the enhanced and traditional arms. CONCLUSION: The enhanced experiential model positively affects learning opportunities and competency acquisition, as measured by a new instrument showing sound psychometric properties.

An application of the transactional model to the analysis of chronic illness narratives.

The authors' aim in this study was to describe the chronic illness experience and its relationship to the concept to finding meaning. They conducted interviews using a narrative approach with 15 adults experiencing various chronic illnesses and analyzed narrative data using a combination of holistic-content and categorical-content approaches. The three major categories were the context of the chronic illness experience, personal reactions, and coping efforts. These categories were best interpreted in terms of a transactional model. The authors categorized finding meaning under cognitive coping strategies and described it as a strategy that was part of a larger coping repertoire.

Socioeconomic status and HIV vaccine preparedness studies in North America.

Educational level, employment, and income are key components of socioeconomic status (SES). This article is a systematic review of SES variables in North American countries, and their relationship to willingness to participate (WTP) and retention in a hypothetical preventive phase 3 HIV vaccine trial and in actual HIV vaccine trials. Men who have sex with men (MSM) tended to have higher educational levels, be more employed, and had higher income levels than injection drug users (IDU) and women at heterosexual risk (WAHR). In large part, there was no relationship between educational level and WTP, as well as between educational level and retention. Similarly, there was no relationship between employment and WTP. In WAHR who were African-American, those employed were less likely than others to complete the study at 18 months. The exact occupations of participants analyzed have not been specified, and specification of these occupations may help determine whether enhanced retention (ER) strategies are required.

Effect of race/ethnicity on participation in HIV vaccine trials and comparison to other trials of biomedical prevention.

INTRODUCTION: Racial/ethnic minorities are underrepresented in actual HIV vaccine trials in North America, and willingness to participate (WTP) and retention in an HIV vaccine trial may differ from that in Whites. METHODS: In this review, the authors identified HIV vaccine preparedness studies (VPS) in North America in high-risk populations that examined the relationship between race/ethnicity and WTP in a preventive phase 3 HIV vaccine trial, and the relationship to retention. Studies were categorized by risk group, and comparison group (Whites vs. non-Whites). Other types of trials of biomedical prevention were also identified, and WTP and retention rates were compared and contrasted to actual HIV vaccine trials. RESULTS: In the studies identified, WTP in a hypothetical trial HIV vaccine trial did not differ by race/ethnicity. In contrast, actual HIV vaccine trials, an HIV acquisition trial, and a phase 2B preexposure prophylaxis (PrEP) trial have enrolled a large percentage of White men. Human papilloma virus (HPV) privately-funded trials have also enrolled a large number of Whites, due to convenience sampling. Retention in the HIV acquisition trial was lower in African-Americans compared with Whites. CONCLUSION: Strategies to increase WTP and enhanced retention (ER) strategies may help in recruiting and retaining minority participants in actual HIV vaccine trials and other trials of biomedical prevention.

Barriers to participation in actual HIV vaccine trials.

Cognitive barriers to participation in actual HIV vaccine trials have not been previously comprehensively reviewed. In this review article, barriers in actual early phase, phase 2B, and phase 3 HIV vaccine trials are quantified and categorized, and compared between the Organization for Economic Co-operation and Development (OECD) countries and the non-OECD countries. Participation rates were standardized to allow for comparisons. In both the OECD and the non- OECD countries, barriers included subjective norms and discrimination, vaccine safety concerns, and logistical concerns. More actual HIV vaccine trials can incorporate questions about and quantify barriers to participation, and this may aid future recruitment strategies.