Not niche: eating disorders as an example in the dangers of overspecialisation.

Labelling specific psychiatric concerns as 'niche' topics relegated to specialty journals obstructs high-quality research and clinical care for these issues. Despite their severity, eating disorders are under-represented in high-impact journals, underfunded, and under-addressed in psychiatric training. We provide recommendations to stimulate broad knowledge dissemination for under-acknowledged, yet severe, psychiatric disorders.

Epilepsy professionals' views on sudden unexpected death in epilepsy counselling: A tale of two countries.

BACKGROUND AND PURPOSE: Sudden unexpected death in epilepsy (SUDEP) is a leading cause of epilepsy mortality. All international guidance strongly advocates for clinicians working with people with epilepsy (PWE) to discuss SUDEP. Clinician views working with PWE in the UK and Norway on SUDEP counselling are compared. METHODS: A cross-sectional online mixed methodology survey of 17 Likert and free-text response questions using validated themes was circulated via International League against Epilepsy/Epilepsy Specialist Nurses Association in the UK and International League against Epilepsy/Epilepsinet in Norway using a non-discriminatory exponential snowballing technique leading to non-probability sampling. Quantitative data were analysed using descriptive statistics and Mann-Whitney, Kruskal-Wallis, chi-squared and Fisher's exact tests. Significance was accepted at p < 0.05. Thematic analysis was conducted on free-text responses. RESULTS: Of 309 (UK 197, Norway 112) responses, UK clinicians were more likely to have experienced an SUDEP (p < 0.001), put greater importance on SUDEP communication (p < 0.001), discuss SUDEP with all PWE particularly new patients (p < 0.001), have access and refer to bereavement support (p < 0.001) and were less likely to never discuss SUDEP (p < 0.001). Significant differences existed between both countries' neurologists and nurses in SUDEP counselling with UK clinicians generally being more supportive. UK responders were more likely to be able to identify bereavement support (p < 0.001). Thematic analysis highlighted four shared themes and two specific to Norwegians. DISCUSSION: Despite all international guidelines stating the need/importance to discuss SUDEP with all PWE there remain hesitation, avoidance and subjectivity in clinicians having SUDEP-related conversations, more so in Norway than the UK. Training and education are required to improve communication, engagement and decision making.

Insights into the current state of knowledge, practice, and attitudes of physicians regarding gastrointestinal motility disorders in Egypt.

BACKGROUND: Gastrointestinal (GI) motility disorders are common in clinical settings, but physicians still lack sufficient understanding and effective management of these conditions. METHODS: This research assessed Egyptian physicians' knowledge, practices, and attitudes towards GI motility disorders. A cross-sectional survey employing a self-administered questionnaire was carried out among physicians in Egypt. The questionnaire addressed various aspects of physicians' understanding, practices, and attitudes regarding GI motility disorders. Data analysis was conducted using descriptive statistics and presented as frequencies and percentages. RESULTS: A total of 462 physicians took part in the study. Although nearly two-thirds of them knew about GI motility studies, a notable proportion lacked adequate knowledge about GI motility disorders. Notably, 84.2% correctly identified dysphagia as a critical symptom suggestive of an upper GI motility disorder. However, 13.4% incorrectly linked hematemesis with an upper GI motility disorder, and 16.7% expressed uncertainty. In terms of practice, around half of the participants encountered a small number of patients with GI motility disorders (less than 5 per week or even fewer). Only 29.7% felt confident in managing patients with motility disorders. Most participating physicians expressed a willingness to participate in training programs focused on motility disorders. CONCLUSIONS: This study underscores a knowledge gap among Egyptian physicians concerning GI motility disorders. It suggests the necessity of tailored education and training programs to improve their competency and practice in this domain.

First international consensus statement on sports psychiatry.

Sports psychiatry is a young field of medicine and psychiatry that focuses on mental health among athletes, and sports and exercise within psychiatry and mental disorders. However, the development of sports psychiatry and its fields of activity vary from region to region and are not uniform yet. Sports psychiatry and the role of sports psychiatrists have also already been discussed in the field of sports and exercise medicine, and within medical teams in competitive and elite sports. A uniform definition on sports psychiatry, its fields of activity, sports psychiatrist, and the essential knowledge, skills, and abilities (plus attitudes, eKSA+A) of the sports psychiatrist were developed as part of an International Society for Sports Psychiatry (ISSP) Summit, as well as First International Consensus Statement on Sports Psychiatry. Three fields of activity can be distinguished within sports psychiatry: (i) mental health and disorders in competitive and elite sports, (ii) sports and exercise in prevention of and treatment for mental disorders, and (iii) mental health and sport-specific mental disorders in recreational sports. Each of these fields have its own eKSA+A. The definitions on sports psychiatry and sports psychiatrists, as well as the framework of eKSA+A in the different fields of activity of sports psychiatrists will help to unify and standardize the future development of sports psychiatry, establish a standard of service within sports psychiatry and together with the neighboring disciplines, and should be included into current, and future sports psychiatry education and training.

Impact of the ActTeens Program on physical activity and fitness in adolescents: a cluster randomized controlled trial.

BACKGROUND: The aim of our study was to evaluate the impact of the ActTeens Program on physical activity and health-related physical fitness among adolescents in Brazil. METHODS: The "ActTeens Program" was conducted using a cluster-randomized controlled trial during 24-week school term. The sample consisted of 317 adolescents (52.7% girls; 13.61 ± 0.70 years) from four secondary schools that were randomly assigned to intervention group (N = 169) or control group (N = 148). This school-based physical activity (PA) intervention involved two components: (i) structured physical activity sessions delivered within physical education (PE) and (ii) healthy lifestyle guidance (mHealth). The primary outcome was PA assessed using Physical Activity Questionnaire for Adolescents (PAQ-A); secondary outcomes included muscular (MF) and cardiorespiratory fitness (CRF) assessed using 90-push-up, handgrip dynamometer, standing long jump, and 20 m PACER shuttle run test. Assessments were conducted at baseline, 12- and 24-week. Intervention effects were assessed using linear mixed models (LMM). RESULTS: For the primary outcome (PA), no significant group-by-time effects were observed for physical education based-PA (0.3 score; 95%CI: -0.1; 0.6; and - 0.01 score; 95%CI: -0.03; 0.03, at 12-wk and 24-wk respectively) and total PA (-0.02 score; 95%CI: -0.2; 0.2; and - 0.01score; 95%CI: -0.2; 0.2, at 12 and 24 weeks respectively). After 24 weeks, we observed a significant group by time effects for lower body muscular fitness (12.9 cm; 95%CI, 3.2 to 22.2). CONCLUSION: The implementation of aerobic and muscle-strengthening exercises used in the ActTeens intervention did not lead to improvements in physical activity. The intervention resulted in improved lower body muscular fitness, however, we found no significant differences for upper body muscular and cardiorespiratory fitness.

How to successfully secure a higher speciality training post in the United Kingdom: dermatology focus.

Navigating the labyrinthine process of securing higher speciality training poses formidable challenges for doctors in training. Achieving success in this endeavour demands more than a mere grasp of the prerequisites; it necessitates meticulous preparation and foresight. Dermatology, as a medical speciality, stands out on account of its appeal, encompassing a diverse patient population, expansive scope of work, work-life balance, a plethora of procedural variety, intellectual stimulation, and abundant research opportunities. Despite the evolving landscape of medical professions, dermatology maintains its appeal as an exceptionally sought-after speciality in the year 2023/2024. This is evident in the escalating competition ratios, rising from 5.46 in 2021 to 7.53 in 2023 for dermatology training posts. Notably, this fervent competition is not exclusive to dermatology, as evidenced by the competition ratios such as Emergency Medicine ST3 (competition ratio 10.95), Immunology ST3 (competition ratio 6.00), Occupational Medicine (competition ratio 7.14), and Plastic Surgery ST3 (competition ratio 4.23) in the 2023/2024 application cycle. In light of this intensifying competition, this article seeks to furnish aspiring candidates with current and invaluable insights, serving as a guide to clinching a coveted national training number in their preferred speciality. While the landscape of higher speciality training encompasses numerous possibilities, this article concentrates primarily on dermatology, intertwining its guidance with relevance to other medical and surgical specialties. Through this exploration, readers will gain essential perspectives to navigate the intricacies of the application process and emerge as competitive contenders in the higher speciality training application process.

Safeguarding healthcare professionals from sexual harassment in the workplace: urgent need for effective training and education.

Sexual harassment (SH) is a particularly harmful type of harassment that can inflict lasting psychological harm on victims. Within the healthcare sector, it negatively impacts teamwork, communication, and potentially compromises patient care. While concerns about workplace SH, including in healthcare, are long-standing, the #MeToo movement has brought renewed scrutiny to this issue since late 2017. Despite increased awareness, evidence suggests that SH remains prevalent in healthcare settings and shows no signs of decline over time. Therefore, there is an urgent need for effective training and intervention measures to enhance the identification of potential sexually offensive behaviors, thus fostering a work environment characterized by respect and inclusivity.

The effect of socioeconomic status and training programmes on burnout in postgraduate trainees in the United Kingdom: a cross-sectional analysis.

PURPOSE: Burnout is described as a state of mental exhaustion caused by one's professional life and is characterised by three domains: emotional exhaustion, depersonalisation, and a reduced sense of accomplishment. The prevalence of stress is high amongst doctors and varies by specialty, gender, trainee level, and socioeconomic status. The authors set out to examine the scale of the problem, as well as to determine the influence of both socioeconomic status and chosen training programme on burnout amongst postgraduate trainees. This would identify at-risk groups and aid in future targeted interventions. METHODS: Cross-sectional data were obtained, following approval from the General Medical Council, from The National Training Survey, completed annually by all trainees in the United Kingdom. Data were then anonymised and analysed. Burnout scores were derived from the Copenhagen Burnout Inventory and are positively framed (higher scores equal lower burnout). RESULTS: The questionnaire was completed by 63 122 participants from 2019 to 2020. Mean burnout amongst all trainees was 52.4 (SD = 19.3). Burnout scores from the most deprived quintile was significantly lower compared with those from the least deprived quintile: 51.0 (SD = 20.6) versus 52.9 (SD = 18.9), respectively (P < 0.001). The highest levels of burnout were reported in Internal Medical Training, Emergency Medicine, Obstetrics and Gynaecology, and Core Surgical Training, respectively. CONCLUSION: Postgraduates from lower socioeconomic backgrounds are more likely to encounter burnout during training. At-risk groups who may also benefit from targeted intervention have been identified, requiring further examination through future studies.

Sustaining our rural allied health workforce: experiences and impacts of the allied health rural generalist pathway.

INTRODUCTION: Rural and remote communities face significant disadvantages accessing health services and have a high risk of poor health outcomes. Workforce challenges in these areas are multifaceted, with allied health professionals requiring broad skills and knowledge to provide vital services to local communities. To develop the expertise for rural and remote practice, the allied health rural generalist pathway (AHRGP) was introduced to develop and recognise specialist skills and knowledge required for rural and remote practice, however the experiences of professionals has not been explored. This study gained the experiences and perceptions of allied health professionals undertaking the pathway as well as their clinical supervisors, line managers, profession leads and consumer representatives. METHODS: A qualitative study was undertaken drawing on pragmatic approaches across four research phases. This study was one component of a larger mixed methods study investigating the experience, impact and outcomes of the AHRGP across six regional Local Health Networks in South Australia (SA). Interviews, surveys and focus groups were conducted to explore the perceptions and experiences of participants. Data was analysed thematically across participant groups and research phases. RESULTS: A total of 54 participants including 15 trainees, 13 line managers, nine clinical supervisors, six profession leads, four program managers and seven consumer representatives informed this study. Five themes were generated from the data; gaining broad skills and knowledge for rural practice, finding the time to manage the pathway, implementing learning into practice, the AHRGP impacts the whole team and confident, consistent, skilled allied health professionals positively impact consumers. CONCLUSION: The AHRGP is offering allied health professionals the opportunity to develop skills and knowledge for rural and remote practice. It is also having positive impacts on individuals' ability to manage complexity and solve problems. Findings indicated consumers and organisations benefited through the provision of more accessible, consistent, and high quality services provided by trainees. Trainees faced challenges finding the time to manage study and to implement learning into practice. Organisations would benefit from clearer support structures and resourcing to support the pathway into the future. Incentives and career advancement opportunities for graduates would strengthen the overall value of the AHRPG.

A Journey of Innovation: 40 years of Pioneering Medical Education at the Aga Khan University Medical College in Karachi, Pakistan.

This article presents an overview of Aga Khan University's (AKU) pioneering medical education initiatives over the past 40 years, exploring its impact on healthcare in the region and its commitment to advancing medical education and research in the developing world. Established in 1983 as the first private university in Pakistan, AKU has evolved into a global institution with a focus on improving healthcare standards and addressing healthcare needs in the developing world. The article also discusses the undergraduate and postgraduate medical education programs at AKU Medical College, Pakistan, highlighting their unique features and pioneering approaches to medical education. The institution's journey highlights its ability to adapt to the evolving healthcare landscape while maintaining a focus on quality and excellence, offering a model for other institutions striving to meet healthcare needs in low- and middle-income countries.

The emergence of MedTok: a qualitative analysis of popular medical TikTok videos.

Social media is increasingly being used by the public as a medium for health information. Unfortunately, misinformation has become widely available on these sites, often being provided using content that is designed to be more popular and engaging, and it is difficult for the public to differentiate between what is true and what is false. TikTok is one of these platforms and has been rapidly growing over the last few years. As an increasing number of people look to TikTok for their health information, it is important that quality information is accessible and popular on the platform. We conducted a review of TikTok videos using the top 10 videos to show when searching for 13 common conditions. Characteristics of both the creator and video were recorded and analyzed. Videos on conditions commonly diagnosed younger were commonly produced by younger creators with the condition, often based on their own experiences. Conversely, videos on conditions commonly diagnosed older were commonly produced by healthcare professionals providing educational information. Though for conditions affecting older individuals healthcare professionals may be able to create didactic, educational videos, for those affecting younger individuals, it may be beneficial to partner with younger creators, or "influencers," to produce more viral content. Further studies may expand on these ideas to encompass more facets of healthcare. As this study did not analyze the quality of the information in the videos, future research should also focus on determining the quality of popular content on TikTok and other social media platforms.

Transitioning to sustainable, climate-resilient healthcare: insights from a health service staff survey in Australia.

BACKGROUND: More than 80 countries, including Australia, have made commitments to deliver climate-resilient and low carbon healthcare. Understanding how healthcare workers view their own and their organization's efforts to achieve sustainable and climate-resilient healthcare practice is vital to inform strategies to accelerate that transition. METHODS: We conducted an online staff survey in a large state government hospital-and-health-service organisation in Queensland, Australia, to ascertain attitudes and practices towards environmentally sustainable, climate-resilient healthcare, and views about the organizational support necessary to achieve these goals in their workplace. RESULTS: From 301 participants showed staff strongly support implementing sustainable and climate-resilient healthcare but require significantly more organizational support. Participants identified three categories of organizational support as necessary for the transition to environmentally sustainable and climate-resilient health services and systems: (1) practical support to make sustainability easier in the workplace (e.g. waste, energy, water, procurement, food, transport etc.); (2) training and education to equip them for 21st century planetary health challenges; and (3) embedding sustainability as 'business as usual' in healthcare culture and systems. CONCLUSIONS: The research provides new insight into health workforce views on how organizations should support them to realize climate and sustainability goals. This research has implications for those planning, managing, implementing, and educating for, the transition to environmentally sustainable and climate-resilient health services and systems in Queensland, Australia, and in similar health systems internationally.

'Not in it for huge profits but because it's right': The contested moral economies of UK-India exports in health worker education and training.

While the growth of global markets in health-related services may have significant consequences for healthcare provisioning and training, it has received relatively little attention from the social sciences. This article examines UK-India, and specifically England-India, exports in health worker education and training as one such global market, drawing on sociological scholarship on moral economies to understand how trading in this field is constructed and legitimated by the individuals and organisations involved, what tensions evolve, and what is at stake in them. We employ a qualitative mixed methods approach using publicly available materials on existing UK-India collaborations and primary data from interviews with key stakeholders in India and the UK, including government departments, arms-length bodies, NHS Trusts, trade associations and private providers. Our analysis illustrates the key discursive strategies used to legitimate engagement in these markets, and the complex and contested moral economies unfolding between and across these stakeholders and contexts. Not least, we demonstrate the conflicting moral sentiments and the boundary work required to realise commodification. Situating cross-border trade in health worker education and training in a moral economy framework thus illuminates the social context and moral worlds in which this evolving trade is embedded.

Serious illness communication skills training for emergency physicians and advanced practice providers: a multi-method assessment of the reach and effectiveness of the intervention.

BACKGROUND: EM Talk is a communication skills training program designed to improve emergency providers' serious illness conversational skills. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this study aims to assess the reach of EM Talk and its effectiveness. METHODS: EM Talk consisted of one 4-h training session during which professional actors used role-plays and active learning to train providers to deliver serious/bad news, express empathy, explore patients' goals, and formulate care plans. After the training, emergency providers filled out an optional post-intervention survey, which included course reflections. Using a multi-method analytical approach, we analyzed the reach of the intervention quantitatively and the effectiveness of the intervention qualitatively using conceptual content analysis of open-ended responses. RESULTS: A total of 879 out of 1,029 (85%) EM providers across 33 emergency departments completed the EM Talk training, with the training rate ranging from 63 to 100%. From the 326 reflections, we identified meaning units across the thematic domains of improved knowledge, attitude, and practice. The main subthemes across the three domains were the acquisition of Serious Illness (SI) communication skills, improved attitude toward engaging qualifying patients in SI conversations, and commitment to using these learned skills in clinical practice. CONCLUSION: Our study showed the extensive reach and the effectiveness of the EM Talk training in improving SI conversation. EM Talk, therefore, can potentially improve emergency providers' knowledge, attitude, and practice of SI communication skills. TRIAL REGISTRATION: Clinicaltrials.gov: NCT03424109; Registered on January 30, 2018.

Small Steps, Big Vision: using multi-stage qualitative research to develop a grab-and-go guide to support utilisation of the Ambitions for Palliative and End of Life Care framework.

BACKGROUND: The Ambitions for Palliative and End of Life Care is a national framework for local action in England co-produced by over 30 partners; little research has been conducted on how the Framework is received and used. This study sought to examine and support how people understand, interpret, and implement the Framework. METHODS: A multi-stage qualitative methodology involving four stages of data collection: (1) case study interviews, (2) focus groups, (3) interactive workshops, and (4) Evidence Cafés. From initial interviews, ongoing thematic data analysis informed the design and focus of subsequent stages as part of a process of knowledge transfer. RESULTS: A practical resource to support service provision and development was produced; a grab-and-go guide called "Small Steps, Big Visions". It focuses on the eight foundations in the Ambitions Framework, with additional guidance on collaboration and partnership working, and sharing learning. Each foundation is presented with a 'what' (definition), 'ask' (prompt questions), and 'examples in action' (drawn from case studies). CONCLUSIONS: Research can contribute to policy implementation to advance palliative and end of life care. The engagement and input of those responsible for implementation is key.

Adolescents' effort in vocational education and training and upper secondary general education: Analyses of stability, determinants, and group differences.

INTRODUCTION: The effort adolescents make determines the risk for dropping out of vocational education and training (VET) early and their chances of graduating upper secondary education. Studies have shown that adolescents' efforts decrease during the transition to upper secondary general education and increases for the transition to VET. In this study, we examined adolescent self-efficacy in lower secondary education, adolescent-instructor relationship (AIR) in VET and general education, and perceived person-environment fit (PEF) as predictors of adolescent effort. METHOD: We calculated two longitudinal multigroup structural equation models. Group 1 comprised 1266 (mean age in T1 = 15.7 years; female: 44%) lower secondary education graduates who moved on to VET with two learning contexts, company and vocational school in Switzerland. Group 2 included 517 (mean age in T1 = 15.7 years; female: 44%) lower secondary education graduates who moved on to upper secondary general education and thus stayed in a school. Adolescents' survey data was collected in 2016 and 2017. RESULTS: Self-efficacy in lower secondary education and AIR in upper secondary education indirectly predicted effort in upper secondary education via PEF, controlling for effort in lower secondary education. Findings were similar for general education and vocational school. However, the effects differed between company and general education (moderation). The positive effect of AIR on PEF was statistically significantly weaker for adolescents in general education than for adolescents in VET and their company learning context. CONCLUSION: We discuss strategies to enhance adolescents' efforts in upper secondary education.

Perceptions and challenges of online teaching and learning amidst the COVID-19 pandemic in India: a cross-sectional study with dental students and teachers.

BACKGROUND: Online education has emerged as a crucial tool for imparting knowledge and skills to students in the twenty-first century, especially in developing nations like India, which previously relied heavily on traditional teaching methods. METHODS: This study delved into the perceptions and challenges experienced by students and teachers in the context of online education during the COVID-19 pandemic. Data were collected from a sample of 491 dental students and 132 teachers utilizing a cross-sectional research design and an online-validated survey questionnaire. RESULTS: The study's findings revealed significant insights. Internet accessibility emerged as a major impediment for students, with online instruction proving more effective for theoretical subjects compared to practical ones. Although most teachers expressed comfort with online teaching, they highlighted the absence of classroom interaction as a significant challenge. CONCLUSION: This study comprehensively examines the perspectives of both students and teachers regarding online education during the pandemic. The results carry substantial implications for the academic community, underscoring the need to address internet access issues and explore ways to enhance engagement and interaction in online learning environments.

How developing a point of need training tool for evidence synthesis can improve librarian support for researchers.

Medical and health sciences librarians who are involved in evidence synthesis projects will know that systematic reviews are intensely rigorous, requiring research teams to devote significant resources to the methodological process. As expert searchers, librarians are often identified as personnel to conduct the database searching portion and/or are approached as experts in the methodology to guide research teams through the lifecycle of the project. This research method has surged in popularity at our campus and demand for librarian participation is unsustainable. As a response to this, the library created self-directed learning objects in the form of roadmap to assist researchers in learning about the knowledge synthesis methodology in an expedient, self-directed manner. This paper will discuss the creation, implementation and feedback around our educational offering: Systematic & Scoping Reviews: Your Roadmap to Conducting an Evidence Synthesis.

Developing a governance process for apps can help enhance and change the skills base and visibility of health librarians.

The traditional qualifications and work of a health librarian may not, at first glance, seem like they readily lend themselves to the wider work of an organisation. Too often librarians are seen as experts in a small specialist field. However, as librarians, we know that at our core is extensive digital experience and knowledge as well as a core set of transferrable skills that can be adapted to meet the ever-changing needs of the organisation. This article describes how the library evidence team became part of a wider board project to develop a governance system for Apps. It also describes how the skills of librarians can be developed to work in this area and raise the profile of the team within the board.

[Status of the implementation of simulation-based education in Germany: A cross-sectional study]. / Stand der Umsetzung des simulationsbasierten Lehrens in Deutschland.

Status of the implementation of simulation-based education in Germany: A cross-sectional study Abstract. Background: The importance of simulation-based learning in nursing education is growing. Its success depends on the qualification of facilitators and the use of standards. Up to now, there has been a lack of data on the state of implementation of simulation-based learning in nursing education in Germany. Research question: Which qualification level do simulation facilitators show in nursing education in Germany and which concepts and standards are used? Methods: A cross-sectional survey was conducted among simulation facilitators in three different educational areas. The questionnaire included socio-demographic and professional characteristics as well as qualification measures completed, and concepts and standards applied. Data were analysed descriptively by determining arithmetic means plus standard deviation (SD) or absolute and relative frequencies. Results: A total of 156 simulation facilitators (mean age 41.5 (SD 9.8) years, 74.2% female) participated. 95.4% of participants reported being (very) highly motivated for simulation-based learning. Specific simulation pedagogy training was completed by 16.8% of participants. The application of evidence-based concepts is not occurring across the board. Conclusions: Against the background of international standards, qualification needs for simulation facilitators in Germany become apparent. Increased specific, standardized continuing education and training as well as the establishment of evidence-based concepts are important for high quality in simulation facilitation.