"You're actually part of the team": a qualitative study of a novel transitional role from medical student to doctor.

BACKGROUND: Optimizing transitions from final year of medical school and into first post graduate year has important implications for students, patients and the health care system. Student experiences during novel transitional roles can provide insights into potential opportunities for final year curricula. We explored the experiences of medical students in a novel transitional role and their ability to continue learning whilst working as part of a medical team. METHODS: Novel transitional role for final year medical students were created in partnership by medical schools and state health departments in 2020 in response to the COVID-19 pandemic and the need for a medical surge workforce. Final year medical students from an undergraduate entry medical school were employed as Assistants in Medicine (AiMs) in urban and regional hospitals. A qualitative study with semi-structured interviews at two time points was used to obtain experiences of the role from 26 AiMs. Transcripts were analyzed using deductive thematic analysis with Activity theory as a conceptual lens. RESULTS: This unique role was defined by the objective of supporting the hospital team. Experiential learning opportunities in patient management were optimized when AiMs had opportunities to contribute meaningfully. Team structure and access to the key instrument, the electronic medical record, enabled participants to contribute meaningfully, whilst contractual arrangements and payments formalized the obligations to contribute. CONCLUSIONS: The experiential nature of the role was facilitated by organizational factors. Structuring teams to involve a dedicated medical assistant position with specific duties and access to the electronic medical record sufficient to complete duties are key to successful transitional roles. Both should be considered when designing transitional roles as placements for final year medical students.

Medical student perceptions of curricular influences on their wellbeing: a qualitative study.

BACKGROUND: Medical student mental health and wellbeing is highly topical and the subject of much research. While theoretically informed definitions of wellbeing abound, how do medical students themselves understand and perceive wellbeing? What aspects of the curriculum do they regard as affecting their wellbeing and mental health? This study explored these questions, and aimed to identify factors associated with student acceptability of wellbeing programs and interventions. METHODS: All students at an Australian undergraduate medical school (n = 619) were invited to complete a qualitative online questionnaire between 2017 and 2018 following the introduction of several wellbeing initiatives, including "Wellbeing Days" (WBD). WBD allow students to take single absence days for self-care. Open-ended questions were asked about perceptions and experience of mental health and wellbeing, and views on interventions to improve wellbeing such as WBD. Thematic analysis was conducted across all responses. Three authors developed preliminary themes, which were then refined and confirmed by all researchers. Thematic saturation was achieved within data from the 68 respondents, which included participants from all cohorts. RESULTS: Participants described wellbeing as positively experienced work/life balance, impacted by four factors; contact hours, peer relationships, staff relationships, and trust in how wellbeing initiatives were used. Long contact hours were deemed incompatible with self-care activities, maintaining employment, and seeking professional medical/psychological help. Peers could promote wellbeing by offering social and academic support, but also undermine wellbeing by being competitors. Degree of trust, engagement and communication with staff influenced acceptability of interventions. Participants viewed initiatives such as WBD favourably, but distrust of peers, and of staff, led to perceptions that WBD could be prone to misuse, or used for surveillance rather than support. CONCLUSION: Our findings suggest that wellbeing days which allow self-care, reduction in contact hours, and peer support may promote student wellbeing, but the acceptability of any interventions is influenced by relationships between staff and students, and in particular, trust in these relationships. We suggest strategies to strengthen trust and further research to investigate the relationship between trust and perceptions of wellbeing in self and peers.

Uterus transplantation: Perspectives of Australian women with absolute uterine factor infertility regarding desirability and utility.

BACKGROUND: Uterus transplantation is an emerging surgical innovation offering the option of genetic and gestational motherhood to women with absolute uterine factor infertility. More than 15 centres worldwide have now commenced clinical trials, but the procedure has not been performed in Australia. AIM: To explore the awareness, attitudes and perceptions regarding uterus transplantation among Australian women with absolute uterine infertility. MATERIALS AND METHODS: An online survey targeting Australian women with absolute uterine factor infertility was performed. Data collected included demographic data, infertility circumstances, considered motherhood options and wellbeing, followed by specific questions regarding uterus transplantation. In total, the participants completed 50 items. RESULTS: All 57 respondents (90% response rate) indicated awareness of uterus transplantation. Of the women who desired parenthood, more than two-thirds indicated a strong desire to carry their own child, with an even higher number (80%) endorsing the need for the procedure to be an option in Australia. Which donor model is preferred (deceased or live), requires further exploration. CONCLUSION: This study indicates that uterus transplantation is desired by the majority of Australian women with absolute uterine factor infertility. Clinical introduction of uterus transplantation in Australia has strong support from the women who would benefit from the procedure.

"A doctor who really knows ": a survey of community perspectives on medical students and practitioners with disability.

BACKGROUND: In Australia, the proportion of medical students with disability remains low compared to students with disability in other university courses and to the prevalence of disability in society. Arguments for inclusion include medical school obligations to respond to community values in their programs, and that doctors with disabilities can offer valuable insights for patient care from their experiences. This study aimed to inform inclusive and socially accountable medical programs by investigating community views on doctors and medical students with disability. METHODS: A concurrent mixed methods study was conducted, simultaneously collecting quantitative fixed responses, and qualitative free text responses to provide in-depth and triangulated data on community views. Frequency and thematic analysis within and across response categories was used to identify patterns and relationships, providing context and meaning to the quantitative data for the integrated findings. RESULTS: Of 207 respondents aged 17 to 71 years, 71% were female, and 60.2% had university level education. Most (92.3%) knew someone with a long standing disability, illness, mental health condition or learning difficulty, 74.7% agreed that a person with a disability should be encouraged to study medicine, 79.7% agreed that a person with a disability should be accepted into medical school, and 81.4% that including people with disability would be an advantage in the medical profession. Five integrated themes explained these views: 1) Fair selection, support and monitoring is expected of medical schools, 2) Life experiences of disability promotes real empathy in doctors, 3) Career considerations for those with disability, 4) Medical role models to address disabling social barriers, and 5) Responsibility to monitor own health and ability to perform. CONCLUSIONS: This study indicates Australian community support for inclusion of people with disability as medical students and practitioners. Findings also suggest community expectations and trust in medical schools to effectively select and graduate only those who will be capable doctors, and to support health and development of all students towards being competent graduates. These findings provide support for medical schools to develop inclusive practices in medical education and training relevant to the health services and communities they serve.

Bridging the gap: a five stage approach for developing specialty-specific entrustable professional activities.

BACKGROUND: Entrustable Professional Activities (EPAs) are increasingly used as a focus for assessment in graduate medical education (GME). However, a consistent approach to guide EPA design is currently lacking, in particular concerning the actual content (knowledge, skills and attitude required for specific tasks) for EPAs. This paper describes a comprehensive five stage approach, which was used to develop two specialty-specific EPAs in emergency medicine focused on the first year of GME. METHODS: The five stage approach was used to gain consensus on the task, content and entrustment scale for two specialty-specific EPAs in emergency medicine. The participants consisted of twelve clinical supervisors working in the emergency department. The five stages were: 1) Selecting the EPA topic; 2) Developing the EPA content by collecting data from participants using focus group and individual interviews; 3) Drafting the EPAs based on analysis of collected data; 4) Seeking feedback on the draft EPAs from the participants and other stakeholders; 5) Refining and finalising the EPAs based on feedback. RESULTS: Two specialty-specific EPAs were developed using the five stage approach. The participants reached consensus on the specific tasks and criteria for performance for the two EPAs. They also agreed that both day-to-day (ad hoc) and formal (summative) entrustment decisions were put into practice through the intensity of supervision provided to PGY1 doctors. As a result, a three level entrustment and supervision scale consisting of direct active, indirect active, passive was developed reflecting the shift in the intensity of supervision from close supervision to minimal supervision. CONCLUSIONS: The five stage approach described in this paper was used successfully to develop two specialty-specific EPAs in emergency medicine along with a three level entrustment scale.We propose that the five stage approach is transferable to a range of medical training contexts to design specialty-specific EPAs.

The meaning of a label for teenagers negotiating identity: experiences with autism spectrum disorder.

There is a lack of consideration for the effects that labels such as autism, and the associated diagnostic processes, have on the children to whom they are applied. In this article we present research conducted with five teenagers diagnosed with autism. Through a collaborative, participatory research approach, these teenagers shared their experiences of their diagnosis using communication methods of their choice. The young people's accounts illustrate the understandings they had of autism. Important findings from the research illustrate how the participants integrated this knowledge with their sense of self, how they negotiated issues of identity and the meanings that feeling 'different' had for them. Whether the diagnosis was experienced as advantage or disadvantage by the young people depended on the extent to which it facilitated knowledge and control. The article concludes with a discussion of the significance a diagnosis may have for the ways in which children and young people construct their personal identity and their social relations, and in terms of negotiating control in their lives. We suggest that ways of minimising stigma and marginalisation associated with a diagnosis of autism need to be considered at a policy level.

The development, content validity and inter-rater reliability of the SMART-Goal Evaluation Method: A standardised method for evaluating clinical goals.

INTRODUCTION: Goal setting is a complex skill. The use of formal goal writing procedures (including the use of the SMART goal model) has been advocated. However, a standardised method of writing and evaluating SMART goals is currently lacking. This study comprised of two phases. The aims of phase one was to (i) develop the SMART Goal Evaluation Method (SMART-GEM) based on a SMART goal model; and (ii) investigate the content validity of the SMART-GEM. The aim of phase two of the study was to test the inter-rater reliability of the SMART-GEM. METHODS: Development of the SMART- GEM involved defining and constructing evaluation criteria suitable for auditing goal statements. A content validity assessment was conducted using an expert panel of Occupational Therapists (n = 10). Inter-rater reliability of the SMART-GEM was examined using a purposive sample of multiple raters (n = 24). RESULTS: The SMART- GEM was rated as having good content validity (individual items CVI ranged from 0.90 to 1.00; total SMART- GEM CVI = 0.99, ρ = 0.05). Agreement between raters on individual items ranged from poor (κ = 0.254) to excellent (κ = 0.965) and agreement of overall grades was fair to good (κ = 0.582). Inter-rater agreement on total scores was found to be very good (ICC = 0.895, 95% CI = 0.743 to 0.986, ρ = 0.001) with excellent internal consistency (α = 0.995). CONCLUSION: The SMART-GEM demonstrated good construct validity and very good inter-rater reliability on total score and shows promise as a standardised method to writing and evaluating clinical goals.

Turning back the hands of time: autobiographical memories in dementia cued by a museum setting.

The current study examined the effects of cuing autobiographical memory retrieval in 12 older participants with dementia through immersion into a historically authentic environment that recreated the material and cultural context of the participants' youth. Participants conversed in either an everyday setting (control condition) or a museum setting furnished in early twentieth century style (experimental condition) while being presented with condition matched cues. Conversations were coded for memory content based on an adapted version of Levine, Svoboda, Hay, Winocur, and Moscovitch (2002) coding scheme. More autobiographical memories were recalled in the museum setting, and these memories were more elaborated, more spontaneous and included especially more internal (episodic) details compared to memories in the control condition. The findings have theoretical and practical implications by showing that the memories retrieved in the museum setting were both quantitatively and qualitatively different from memories retrieved during a control condition.

Disruption, Slowness, and Collective Effervescence: Children's Perspectives on COVID-19 Lockdowns.

The COVID-19 pandemic represented not only a health crisis, but a social crisis for children, one that has disrupted notions of what a good childhood is. However, the longer-term implications of the pandemic are still to be seen, for children, their families and communities. This article is concerned with what these ongoing changes may be, based on a qualitative multi-stage study that asks children about their experiences of well-being before the pandemic, during lockdowns and post-COVID-19 lockdowns. This included asking seven children in online semi-structured interviews about what aspects of life brought on by COVID-19 restrictions they would like to see continue post-lockdown. We outline some of our findings. We describe new rituals and ways of organising time developed by children, facilitated by the use of digital technologies. We describe these new ways of managing time as task-based rather than rule-based, with children experiencing slowness of and greater control over their time. We found that lockdowns provided a possibility for children to assert a public agency through banal acts of sociability, for example, by conforming to public health measures such as mask-wearing and hand-washing. Whilst small acts, children discussed these in terms of being moral agents (protecting the safety of others) and as part of a larger civic attitude they observed around them. Thus, their acts can be seen as expressions of larger forms of social solidarity that contributed to a sense of collective effervescence.

Senior medical students as assistants in medicine in COVID-19 crisis: a realist evaluation protocol.

INTRODUCTION: The assistant in medicine is a new and paid role for final-year medical students that has been established in New South Wales, Australia, as part of the surge workforce management response to the COVID-19 pandemic. Eligibility requires the applicant to be a final-year medical student in an Australian Medical Council-accredited university and registered with the Australian Health Practitioner Regulation Agency. While there are roles with some similarities to the assistant in medicine role, such as assistantships (the UK) and physician assistants adopted internationally, this is completely new in Australia. Little is known about the functionality and success factors of this role within the health practitioner landscape, particularly within the context of the COVID-19 pandemic. Given the complexity of this role, a realist approach to evaluation has been undertaken as described in this protocol, which sets out a study design spanning from August 2020 to June 2021. METHODS AND ANALYSIS: The intention of conducting a realist review is to identify the circumstances and mechanisms that determine the outcomes of the assistant in medicine intervention. We will start by developing an initial programme theory to explore the potential function of the assistant in medicine role through realist syntheses of critically appraised summaries of existing literature using relevant databases and journals. Other data sources such as interviews and surveys with key stakeholders will contribute to the refinements of the programme theory. Using this method, we will develop a set of hypotheses on how and why the Australian assistants in medicine intervention might 'work' to achieve a variety of outcomes based on examples of related international interventions. These hypotheses will be tested against the qualitative and quantitative evidence gathered from all relevant stakeholders. ETHICS AND DISSEMINATION: Ethics approval for the larger study was obtained from the Western Sydney Local Health District (2020/ETH01745). The findings of this review will provide useful information for hospital managers, academics and policymakers, who can apply the findings in their context when deciding how to implement and support the introduction of assistants in medicine into the health system. We will publish our findings in reports to policymakers, peer-reviewed journals and international conferences.

Problematizing medical students with disabilities: A critical policy analysis.

This article was migrated. The article was marked as recommended. Background: Ensuring diversity, and that the medical profession is representative of the varied communities it serves is a worldwide equity concern. The widening participation movement in higher education aims to attract more students from non-traditional backgrounds into university. Yet, there is persistent under-representation of students with disabilities in medical education, and subsequently, the profession. The inclusion of these students is greatly influenced by the policies which regulate and accredit medical schools, which demand that educators consider students with disabilities as future doctors. While these policies may aim to promote inclusion, they may also have unintended consequences. In this paper we critically analyse key policies in undergraduate medical education to examine how disability in medical students is represented and problematized, and the educational implications of such representations. Method: Key policies concerning medical school accreditation and educational standards from the General Medical Council (UK), Australian Medical Council (Australia) were selected for analysis. Carol Bacchi's 'What's the Problem Represented to Be?' six critical questions approach was applied to conduct a critical interpretive analysis of how disability is problematized in these policies. Findings: Our analysis revealed a distinctive construction of disability in medicine, supported by themes of containment of disability, disability and competence, and disability and risk. Disability is framed as risk and potential educational burden for schools which must adapt practices to meet legal requirements. Risk is conceptualised as a quality of individuals, rather than being constructed through interactions between persons and environments. The ways in which disability is problematized relates to presuppositions which have the effect of restricting access for learners with disabilities. Conclusions: The policies which regulate medical education can inadvertently limit inclusion of students with disabilities by being silent on the value of a diverse medical workforce. Bacchi's six critical questions are an accessible and practical method for identifying the norms and assumptions which may impede change in educational policy and practice. By making visible these hidden suppositions and their consequences for learners, their impact may be ameliorated, and progress made.