Impact of COVID-19 on continuing professional development: Perspectives of audiologists.

BACKGROUND:  The coronavirus disease 2019 (COVID-19) pandemic triggered unprecedented disruptions to continuing professional development (CPD) activities, which are essential for healthcare professionals (HCPs) to stay abreast on best practices, current knowledge and emerging technologies, ultimately enhancing patient care. Audiologists encountered multiple challenges during the pandemic, necessitating adaptations and innovations in their CPD practices. While literature was published during the pandemic on shifting education systems to online platforms, little is known about its impact on the CPD of young audiologists working in the private sector. METHODS:  A descriptive, qualitative research design was adopted to collect rich data from 11 audiologists using online semi-structured interviews which were thematically analysed using Braun and Clark's steps. RESULTS:  COVID-19 brought about both positive adaptations and negative disruptions to the CPD activities of young audiologists. Eight major themes were identified in this study. These include (1) the adoption of online learning, (2) improved flexibility, (3) cost-effectiveness, (4) diverse learning opportunities, (5) keeping current, (6) isolation and networking, (7) limited interactivity and (8) uncertain quality assurance. CONCLUSION:  The COVID-19 pandemic had a considerable influence on the CPD activities of young audiologists in the private sector. While presenting significant challenges, including disruptions to traditional learning modalities, the pandemic also catalysed innovation and adaptation within the profession.Contribution: This study highlights the resilience exhibited by young audiologists towards their CPD and also provides actionable insights for informing professional development initiatives, tailored to the evolving needs of audiologists in the post-COVID-19 era.

Doctors' understanding of their learning and learning needs in Kwazulu-Natal district hospitals.

BACKGROUND:  Medicine is a self-regulating profession. Doctors must learn how to self-regulate to keep up-to-date with evolving health care needs. This is challenging for those working at District Hospitals (DHs) in rural settings, where limited resources and understaffing may compound a poor approach and understanding of how to become a self-directed learner. AIM:  To explore perspectives of doctors working in rural DHs, regarding their understanding of learning and learning needs. SETTING:  This study was conducted in Bethesda and Mseleni DHs, in rural KwaZulu-Natal. METHODS:  This was a qualitative study. Data was collected through 16 semi-structured interviews and non-participatory observations. RESULTS:  Four major themes emerged: "Why I learn," "What I need to learn," "How I learn," and our learning environment." This paper focussed on the first three themes. Doctors' learning is influenced by various factors, including their engagement with clinical practice, personal motivation, and their learning process. Deliberate practice and engagement in reflective practice as key principles for workplace learning became evident. CONCLUSION:  In rural DHs, doctors need to take a proactive self-regulated approach to their learning due to difficulties they encounter. They must build competence, autonomy, a sense of connection in their learning process, thus recognizing the need for continuous learning, motivating themselves, and understanding where they lack knowledge, all essential for achieving success.Contribution: This article contributes towards strengthening medical education in African rural context, by empowering medical educators and facility managers to meet the learning needs of doctors, thus contributing to the provision of quality health care.

Medical student learning on a distributed training platform in rural district hospitals.

BACKGROUND:  Decentralising medical school training enhances curriculum relevance, exposing students to generalist patient care in diverse contexts. AIM:  The aim of the study was to understand the student experiences of learning during their 7-week Family Medicine rural rotation. SETTING:  Final year medical students who had completed their Family Medicine rotation in November 2022. METHODS:  A qualitative study involving 24 final year students (four semi- structured interviews and four focus group discussions [4 x 5 students]). All interviews were recorded, transcribed verbatim and analysed thematically. RESULTS:  Analysis revealed positive learning experiences and identified the following themes: taking responsibility for learning, the generalist context, teaching and learning in context and managing the learning environment. CONCLUSION:  Active participation in hospital activities, exposure to disorientating dilemmas that challenged assumptions and reflection on these experiences led to transformative learning and knowledge co-construction.Contribution: The study contributes to the discussion and reinforces the advantages of distributed, experiential training, highlighting the positive impact of meaningful participation and transformative learning opportunities.

Continuing professional development barriers and recommendations: Perspectives of audiologists.

BACKGROUND:  Continuing professional development (CPD), a compulsory requirement of the Health Professions Council of South Africa (HPCSA), is undertaken by healthcare professionals (HCPs), including audiologists, to remain up-to-date with the latest developments, technology and best practices within their discipline. However, the low compliance rates of audiologists engaging in CPD need to be investigated to establish the barriers that audiologists encounter as well as possible interventions to improve their participation. OBJECTIVES:  This study aimed to explore the barriers that audiologists encounter when participating in CPD activities and to highlight their suggestions for improving its uptake. METHOD:  The descriptive qualitative research design entailed the use of semi-structured online interviews with 11 audiologists practising within the private sector in the province of KwaZulu-Natal, South Africa, their responses being thematically analysed. RESULTS:  Three barriers were identified, namely: (1) personal, (2) financial and (3) structural barriers, with eight subthemes and nine recommendations provided by participants. CONCLUSION:  It is anticipated that implementing the proposed strategies will address the barriers and allow active engagement of audiologists in their continued education.Contribution: Limited literature has been documented on the barriers that young, private sector audiologists encounter within the South African context while also providing suggestions to address these barriers.

Conceptualising the experiences of continuing professional development of young private sector audiologists as an attribute of andragogy.

Background: Continuing professional development (CPD) is an ongoing learning process that builds on initial training and education to improve competency. Low compliance rates of audiologists adhering to CPD have been reported by the Health Professions Council of South Africa. However, there is an absence of research on the uptake of CPD from the perspective of young audiologists working in the private sector. Aim: This study aimed to explore the experiences and views of young audiologists working in the private sector on continuing professional development. Setting: The study was conducted in KwaZulu-Natal province, South Africa. Methods: The descriptive, qualitative approach entailed conducting 11 online, semi-structured interviews with audiologists working in the private sector. Semi-structured interviews consisted of open-ended questions, and the qualitative data were thematically analysed. The adult learning theory, andragogy, was used as both the conceptual and analytical framework. Results: Five andragogy concepts were used to analyse the data, with eight sub-themes emerging related to: self-concept, adult learning experiences, readiness to learn, orientation to learning and internal motivation. Conclusion: The experiences of audiologists in the private sector on CPD aligned with the concepts of andragogy. Audiologists' experiences need to be taken into consideration during the planning and implementation of CPD for it to be relevant, effective and purposeful. Contribution: This study highlighted the experiences of audiologists on CPD working in the private sector with continuing professional development.

Patterns of childhood maltreatment and maternal substance use disorder on the development of emerging adult offspring substance use.

Exposure to child maltreatment and maternal substance use disorder represent two highly consequential and co-occurring experiences of family-level adversity for the development of concerning substance use behaviors among offspring. The present study uses latent class analysis to identify how characteristics of childhood maltreatment and maternal substance use disorder naturally cluster. Further, this study investigates how distinct patterns of maltreatment and maternal substance use differentially predict emerging adult substance use in offspring. Participants (N = 405) were drawn from a longitudinal follow-up study of emerging adults who participated in a research summer camp program as children. Wave 1 of the study included 674 school-aged children with and without maltreatment histories, all of whom experienced low socioeconomic status. Patterns of child maltreatment experiences, based on coded Child Protective Services record data, and maternal substance use behaviors, per a diagnostic interview, were used to predict Wave 2 (emerging adulthood) substance use. Results indicated that children who were exposed to a pattern of multitype maltreatment and multitype maternal substance dependence, relative to those exposed to multitype maltreatment alone, reported greater alcohol dependence symptoms during emerging adulthood. Additionally, these same individuals reported greater past-year hard liquor consumption relative to those who experienced chronic, multitype maltreatment and maternal alcohol dependence. These findings highlight how a pattern of maternal polysubstance use and multitype maltreatment is particularly consequential for the intergenerational transmission of substance use behaviors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Community service rehabilitation therapists' understanding of social accountability.

BACKGROUND:  Social accountability is the obligation of health care providers to address the priority health concerns of the community they serve and of universities to ensure that graduates understand these social responsibilities. Although social accountability can combat systemic health inefficiencies, it is not well-understood or practised. AIM:  The study aimed to explore community service rehabilitation therapists' understanding of social accountability. SETTING:  The study was conducted in KwaZulu-Natal, South Africa. METHODS:  This study used an interpretive exploratory design and purposively recruited 27 community service rehabilitation therapists namely, audiologists, speech-language therapists, occupational therapists, and physiotherapists working in public sector health facilities in rural and peri-urban areas. Four focus group discussions and four free attitude interviews were conducted, the results being thematically analysed. RESULTS:  Despite most of the participants not being instructed in social accountability as part of their formal training or institutional induction, three themes emerged based on their experiences. These themes include describing social accountability, values of social accountability, and values of community-based rehabilitation applicable to social accountability. CONCLUSION:  Inclusion of instruction on social accountability as part of their formal training and health facility induction would contribute to rehabilitation therapists' understanding of social accountability.Contribution: The study contributes to data on rehabilitation education and community service training regarding social accountability within a South African context and has captured how experiences gained during community service contribute to the rehabilitation therapists' understanding of social accountability.

Social accountability challenges and recommendations by community service rehabilitation therapists.

BACKGROUND:  Social accountability entails providing equitable and accessible services that are tailor-made for the community's healthcare needs and enable rehabilitation therapists to improve the efficiency and efficacy of healthcare delivery and their response. Enabling them to provide optimal care during their community service year requires understanding the gaps in their knowledge, experience and the support they provide to the communities they service. METHODS:  Four in-depth individual interviews and four focus group discussions were conducted via Zoom. The qualitative responses to the questions related to the challenges and recommendations associated with social accountability in clinical settings were analysed using an inductive thematic approach via NVIVO. RESULTS:  Four sub-themes emerged for each of the two areas of interest: the challenges relating to (1) budget and equipment constraints, (2) staff shortages, (3) cultural and language barriers and (4) scope of practice limitations. The recommendations related to (5) collaboration with community caregivers, (6) service inclusion in primary health care clinics, (7) improved executive management support and (8) continuing professional development. CONCLUSION:  Equipping graduates with the knowledge, skills and support needed to work in an under-resourced setting is essential for community service rehabilitation therapists to ensure social accountability, given that they often work alone, specifically in rural settings.Contribution: Being aware of the challenges that face community service rehabilitation therapists, having the necessary tools and health facility management support will enable ongoing improvements in their ability to provide socially accountable services.

Health budget cuts will be paid for by the most vulnerable.

No abstract available.

Interpersonal Mechanisms Between Child Maltreatment Timing and Young Adult Internalizing and Externalizing Symptomatology.

OBJECTIVE: Children who experience maltreatment are prone to exhibit interpersonal deficits and lack secure attachment, which can lead to internalizing and externalizing symptomatology. This study investigated timing and chronicity of maltreatment and its impacts on psychopathology outcomes in young adulthood. Two interpersonal mediators were examined: problems with peers and childhood attachment security. METHOD: Children with and without maltreatment exposure were recruited to take part in a 1-week research summer camp (N = 697; mean [SD] age = 11.29 [0.97] years; 71.3% Black or African American; 50.5% male). Participants were recontacted in young adulthood to complete a second wave of assessments (n = 427; mean [SD] age = 19.67 [1.16] years; 78.0% Black or African American; 48.9% male). Structural equation modeling was used to estimate indirect effects from child maltreatment timing to young adult internalizing and externalizing symptomatology via childhood attachment security and peer problems. RESULTS: Findings highlighted the detrimental impact of chronic maltreatment, which was associated with higher levels of peer problems (ß = .24, p < .001) and less secure attachment (ß = -.13, p < .01) in childhood. Also, lower attachment quality in childhood mediated the association between chronic maltreatment and self-reported internalizing (a × b = 0.02, p < .05) and externalizing symptomatology (a × b = 0.02, p < .05). Additionally, childhood peer problems mediated the association between chronic maltreatment and caregiver-reported internalizing problems (a × b = 0.04, p < .05). CONCLUSION: Chronic maltreatment is particularly harmful for interpersonal outcomes of children. Mediation findings differed by who reported on psychopathology, showing the importance of considering multireporter measures of psychopathology. PLAIN LANGUAGE SUMMARY: Child maltreatment is an interpersonal stressor that may impact developmental outcomes throughout a youth's life. In this study of 697 children who participated in a 1-week research summer camp and were contacted in young adulthood, the authors found that chronic maltreatment significantly increased the risk of difficulties in forming secure attachments as well as having problems with peers during childhood. In turn, these challenges were linked to emotional and behavioral symptomology in young adulthood. These findings emphasize the need to support children facing chronic maltreatment to improve their long-term mental health.

The relative effects of parental alcohol use disorder and maltreatment on offspring alcohol use: Unique pathways of risk.

Childhood adversity represents a robust risk factor for the development of harmful substance use. Although a range of empirical studies have examined the consequences of multiple forms of adversity (i.e., childhood maltreatment, parental alcohol use disorder [AUD]), there is a dearth of information on the relative effects of each form of adversity when considered simultaneously. The current study utilizes structural equation modeling to investigate three unique and amplifying pathways from parental AUD and maltreatment exposure to offspring alcohol use as emerging adults: (1) childhood externalizing symptomatology, (2) internalizing symptomatology, and (3) affiliation with substance-using peers and siblings. Participants (N = 422) were drawn from a longitudinal follow-up study of emerging adults who participated in a research summer camp program as children. Wave 1 of the study included 674 school-aged children with and without maltreatment histories. Results indicated that chronic maltreatment, over and above the effect of parent AUD, was uniquely associated with greater childhood conduct problems and depressive symptomatology. Mother alcohol dependence was uniquely associated with greater affiliation with substance-using peers and siblings, which in turn predicted greater alcohol use as emerging adults. Results support peer and sibling affiliation as a key mechanism in the intergenerational transmission of substance use between mothers and offspring.

Negative Perceptions of Peer Relationships as Mechanisms in the Association Between Maltreatment Timing and the Development of Psychopathology.

Despite findings that developmental timing of maltreatment is a critical factor in predicting subsequent outcomes, children's developmental stage is understudied in maltreatment research. Moreover, childhood maltreatment is associated with the development of maladaptive peer relationships and psychopathology, with social cognition identified as a process underlying this risk. The current study utilizes structural equation modeling to examine the impact of developmental timing of maltreatment (i.e., infancy through preschool versus elementary and middle school years) on psychopathology via negative perceptions of peer relationships. Multi-informant methods were used to assess 680 socioeconomically disadvantaged children. Results did not support differential effects of early versus later maltreatment on children's internalizing symptomatology or disruptive behavior, but indicated that chronic maltreatment, relative to episodic maltreatment, has more severe consequences for children's internalizing symptomatology. Results further support the mediating role of children's perceptions of relationships in the effect of maltreatment on negative developmental outcomes.

The Role of Peer- and Self-Appraisals in the Association Between Maltreatment and Symptomatology.

Recent research highlights the use of artificial boundaries between distinct types of adverse experiences, including forms of maltreatment. Commonly-utilized methods that isolate the impact of one maltreatment subtype over others and fail to consider the often co-occurring nature of maltreatment may not adequately capture the complex heterogeneous nature of maltreatment and may obscure understanding of developmental pathways. Moreover, childhood maltreatment is associated with the development of maladaptive peer relationships and psychopathology, with negative conceptions of relationships identified as a risk pathway. The current study utilizes structural equation modeling to examine the impact of an adapted threat versus deprivation framework for conceptualizing maltreatment via children's negative conceptions of relationships, which have not been previously tested as mechanisms in the context of this conceptual framework. Participants included 680 socioeconomically disadvantaged children who attended a week-long summer camp. Multi-informant methods were used to assess children's symptomatology and interpersonal functioning. Results did not support differences between threatening versus depriving maltreatment experiences, but indicated that all groups of children who experienced maltreatment, including those enduring both threatening and depriving experiences, showed more maladaptive functioning and more negative conceptions of relationships relative to non-maltreated peers. Results of the current study support the mediating role of children's appraisals of the self and peers in the effect of maltreatment on children's internalizing and externalizing symptomatology.

A person-centered data analytic approach to dopaminergic polygenic moderation of child maltreatment exposure.

The present study illustrates the utility of latent class analysis, a person-centered data analytic approach, as an innovative method for identifying naturally occurring patterns of polygenic risk, specifically within the dopaminergic system. Moreover, this study tests whether latent classes of polygenic variation moderate the effect of child maltreatment exposure on internalizing symptoms among African ancestry youth. African ancestry youth were selected for this study because youth of color are overrepresented in the child welfare system and because African ancestry individuals are significantly underrepresented in genomics research. Results identified three latent classes of dopaminergic gene variation. Class 1 was marked predominately by homozygous minor alleles, Class 2 was characterized by homozygous major and heterozygous presentations, and Class 3 was marked by heterozygous alleles on the DAT-1 single-nucleotide polymorphisms (SNPs) and a combination of homozygous major and minor alleles on the other SNPs. Results indicated that a greater number of maltreatment subtypes experienced were associated with higher internalizing symptoms only for children with the latent polygenic Class 2 pattern. This latent class was distinctly characterized by more homozygous major or heterozygous allelic presentations along all three DAT-1 SNPs. This significant latent polygenic class by environment interaction was replicated in an independent replication sample. Together, findings suggest that African ancestry children with a pattern of dopaminergic variation characterized by this specific combination of polygenic variation are more vulnerable to developing internalizing symptoms following maltreatment exposure, relative to their peers with other dopamine-related polygenic patterns.

An integrated review of social information processing as a mechanism in the association between maltreatment and depression among youth of color.

BACKGROUND: Child maltreatment is a potent risk factor for depression across the life course, with maltreatment and depression demonstrated to disproportionately impact youth of color. Despite evidence for mechanisms (e.g., social information processing; SIP) accounting for the effects of maltreatment on youth broadly, pathways of risk for depression among maltreated youth of color specifically remain largely under-investigated. OBJECTIVE: In an effort to address this gap in the literature, the present review synthesizes available research regarding SIP as a mechanism underlying the impact of maltreatment on the development of depression in general, and among youth of color specifically. PARTICIPANTS & SETTING: A review of literature was conducted on English language articles published between 1989 and 2022 involving maltreatment, depression, social information processing, and/or youth of color. METHODS: An electronic database search using terms "Maltreatment," "Depression," "Social Information Processing," "Social Cognition," and "Youth of Color" identified relevant literature. RESULTS: Synthesis of literature supports SIP as a salient mechanism in the effect of maltreatment on depressive symptomatology for youth broadly, identifying the need for additional empirical work explicitly assessing this pathway among youth of color. CONCLUSION: In addition to support for SIP as a risk pathway for youth broadly, this review highlights associated processes that can lend support to SIP as a meaningful mechanism of risk for youth of color. Additionally, this review addresses the deficit-based approach through which research and intervention tools evaluate youth of color experiencing maltreatment and depression, proposing alternative approaches towards prevention and intervention efforts with this marginalized population.

Child maltreatment and youth suicide risk: A developmental conceptual model and implications for suicide prevention.

Experiences of child abuse and neglect are risk factors for youth suicidal thoughts and behaviors. Accordingly, suicide risk may emerge as a developmental process that is heavily influenced by the rearing environment. We argue that a developmental, theoretical framework is needed to guide future research on child maltreatment and youth (i.e., adolescent and emerging adult) suicide, and to subsequently inform suicide prevention efforts. We propose a developmental model that integrates principles of developmental psychopathology and current theories of suicide to explain the association between child maltreatment and youth suicide risk. This model bears significant implications for future research on child maltreatment and youth suicide risk, and for suicide prevention efforts that target youth with child maltreatment experiences.

Persistent Frustration-Induced Reconfigurations of Brain Networks Predict Individual Differences in Irritability.

OBJECTIVE: Aberrant responses to frustration are central mechanisms of pediatric irritability, which is a common reason for psychiatric consultation and a risk factor for affective disorders and suicidality. This pilot study aimed to characterize brain network configuration during and after frustration and test whether characteristics of networks formed during or after frustration relate to irritability. METHOD: During functional magnetic resonance imaging, a transdiagnostic sample enriched for irritability (N = 66, mean age = 14.0 years, 50% female participants) completed a frustration-induction task flanked by pretask and posttask resting-state scans. We first tested whether and how the organization of brain regions (ie, nodes) into networks (ie, modules) changes during and after frustration. Then, using a train/test/held-out procedure, we aimed to predict past-week irritability from global efficiency (Eglob) (ie, capacity for parallel information processing) of these modules. RESULTS: Two modules present in the baseline pretask resting-state scan (one encompassing anterior default mode and temporolimbic regions and one consisting of frontoparietal regions) contributed most to brain circuit reorganization during and after frustration. Only Eglob of modules in the posttask resting-state scans (ie, after frustration) predicted irritability symptoms. Self-reported irritability was predicted by Eglob of a frontotemporal-limbic module. Parent-reported irritability was predicted by Eglob of ventral-prefrontal-subcortical and somatomotor-parietal modules. CONCLUSION: These pilot results suggest the importance of the postfrustration recovery period in the pathophysiology of irritability. Eglob in 3 specific posttask modules, involved in emotion processing, reward processing, or motor function, predicted irritability. These findings, if replicated, could represent specific intervention targets for irritability.

Perceptions of specialists in the public sector, on the role and value of family medicine.

BACKGROUND: Family medicine (FM) is often perceived to be a 'lesser' speciality compared with other disciplines, despite its importance as a generalist discipline in the healthcare system. Family physicians (FPs) provide comprehensive care at the district level and act as a gatekeeper for patient's upward referral to other specialists. This study aimed to explore the perceptions of healthcare specialists other than FPs involved in registrar training regarding FM at the University of KwaZulu-Natal, South Africa (SA). METHODS: This was a qualitative study, with seven consultants, other than FPs, who worked at three public sector regional hospitals using purposive sampling. Individual semistructured interviews were conducted, audio-recorded and transcribed verbatim and analysed thematically. RESULTS: Four themes emerged (perception of FM as a medical speciality, role of FPs in the healthcare system and proposed National Health Insurance, FM registrars rotating in units and the scope of their training and how to improve the perceptions of FM by other specialities). Family medicine was regarded as a major and relevant specialist field with a significant contribution to make in advancing patients' care. The country's healthcare system is yet to make the best use of the FM specialist's role in improving quality of care. CONCLUSION: The perceptions of FM from other specialists were generally positive and reinforced its importance in facilitating improved healthcare in SA. These specialists have high regard for FM and emphasised the large responsibility of practitioners.

Impact of COVID-19 - Experiences of 5th year medical students at the University of KwaZulu-Natal.

BACKGROUND: The global pandemic associated with coronavirus disease 2019 (COVID-19) had a considerable effect on higher education in South Africa, with online instruction replacing traditional lectures for many students. Medical students were required to vacate their residences in March 2020 but returned to campus in July 2020 to enable them to continue with clinical teaching and learning. The aim of this study was to understand the learning experiences of 5th year medical students at the University of KwaZulu-Natal (UKZN) during 2020. METHODS: This was a qualitative study conducted via Zoom in December 2020 with 18 students in four focus group discussions and four semi-structured interviews. These were all facilitated by an independent researcher with experience in qualitative research. All the interviews were recorded, transcribed verbatim and analysed qualitatively through the identification of codes, categories and themes. RESULTS: The following major themes emerged: A stressful and at times an overwhelming year, mental health issues, developing strategies to cope, and issues that related to teaching and learning. CONCLUSION: The disruptions caused by COVID-19, the lockdown, a condensed academic programme and uncertainty about their competency resulted in high levels of anxiety and stress among medical students. Participants highlighted strategies that had helped them to cope with the isolation and academic pressures. Given the large volume of work, careful thought needs to be given to what should be taught and how it should be taught to ensure that graduates have the competencies they need to practise.