Peer feedback in graduate training: A phenomenological investigation of possibilities.

BACKGROUND: Whilst feedback is an essential component of clinical education, it is often lacking in clinical workplaces due to competing priorities. Peer feedback has been proposed as a potential solution but remains underexplored in terms of practicality and effects. We aimed to examine the experiences of peer feedback among paediatric trainees, and the associated feedback culture. METHODS: Following an Interpretative Phenomenological Analysis approach, the personal experiences of 12 paediatric trainees were explored using semi-structured interviews. Interpretive themes were developed between the transcripts using processes of abstraction, subsumption, contextualisation, and cross-case analysis. Themes were subsequently subjected to member checking and peer debriefing processes. RESULTS: We found that peer feedback was influenced by three contextual factors, namely, prevalent feedback culture, interpersonal consent, and the quality of relationships. Peer feedback culture was lacking in clinical workplaces. Feedback between peers was constrained by avoiding criticism and maintaining work relationships. Social and cultural norms inhibited constructive peer feedback without explicit consent. CONCLUSIONS: Enabling peer feedback in clinical settings requires attention to cultural, relational, and consent barriers. Potential approaches should include helping clinicians to develop greater cultural reflexivity, resident training in how to be peer educators, and enhancing institutional supports for peer feedback.

Development and preliminary evaluation of a novel physician-report tool for assessing barriers to providing care to autistic patients.

BACKGROUND: Individuals on the autism spectrum face significant disparities in health and physicians often report difficulties in providing care to autistic patients. In order to improve the quality of care autistic individuals receive, it is important to identify the barriers that physicians experience in providing care so that these may be addressed. This paper reports the initial development and preliminary evaluation of a physician-report 'Barriers to Providing Healthcare' measurement tool. METHOD: An established taxonomy of healthcare barriers for autistic individuals informed the initial draft of a 22-item measurement tool. This measurement tool was distributed to physicians working in various healthcare specialties and settings. Exploratory factor analysis (EFA) was conducted to determine the construct validity of the tool; discriminant validity between, and internal consistency of, the resultant factors were assessed. Multiple regressions were used to explore variables potentially associated with barriers endorsed by physicians. RESULTS: A total of 203 physicians were included in the analyses. The EFA resulted in a 17-item tool with three distinct factors which explained 37.6% of the variance: 1) Patient-related barriers (Cronbach's α = 0.83; e.g., the patient's reactivity to the healthcare environment); 2) Healthcare provider (HCP)/family-related barriers (Cronbach's α = 0.81; e.g., a lack of providers willing to work with autistic patients); and 3) System-related barriers (Cronbach's α = 0.84; e.g., there is a lack of support for patients and families). Discriminant validity between the factors was adequate (r < .8). The barriers that were most frequently endorsed as occurring 'often' or 'very often' included a lack of support for patients and families (endorsed by 79.9% of physicians); communication difficulties (73.4%); and a lack of coordination between services (69.9%). The regression analyses identified no significant associated variables. CONCLUSION: A preliminary version of a novel physician-report tool to assess barriers to providing care to autistic patients has been developed although further validation work is required. The use of this tool will help physicians to identify issues specific to different medical specialities and healthcare settings. This information may help identify the supports physicians require to recognise and implement the required accommodations. Future research which elucidates barriers to healthcare provision for autistic patients is required to support systemic change in healthcare so as to improve care experiences and health outcomes for people on the autism spectrum.

Experience-based learning: how a crisis solution informed fundamental change in a clinical education curriculum.

BACKGROUND: Clinical education represents the most important formative period in undergraduate medical education. It is often criticised as haphazard and inefficient. Experience-based learning (ExBL) is a novel clinical education design that utilises practices of support, learner participation and real patient learning to enhance students' development of vital professional capabilities. We introduced ExBL to address the challenges of a 50% reduction in clinical placement time that arose during the COVID-19 pandemic. APPROACH: Final year medical students were assimilated into clinical teams as co-workers to facilitate learning through participation rather than observation. Placement education was supported by an integrated case-based learning and high-fidelity simulation program. Real patient learning in workplace contexts was supported by a network of clinician mentors. EVALUATION: A qualitative evaluation revealed that granting students co-worker status strongly supported participatory learning and professional identity formation. Furthermore, the triangulation of placements with cognitive coaching and high-fidelity simulation greatly enhanced skills development and students' sense of readiness for practice. IMPLICATIONS: Utilisation of ExBL significantly enhanced the quality of informal learning on clinical placements despite the reduced clinical placement time. In addition, the integration of cognitive coaching with simulation opportunities meant students were better prepared for meaningful participation as members of clinical teams. The introduction of ExBL increased the workload of clinical teachers. Moreover, favouring learning through participatory experience reduced exposure to more traditional formal bedside teaching encounters. Despite these challenges, we have adopted an ExBL model created in a crisis as our core educational design for our final year clinical programme.

Descriptive bibliometric analysis of global publications in lifestyle-based preventive cardiology.

BACKGROUND: Lifestyle-based preventive cardiology aims to combat the global burden of cardiovascular disease. There have been rapid advances in lifestyle and behavioural interventions aimed at preventing cardiovascular disease in individuals at high risk and in the general population. This study is the first bibliometric analysis of publications in the field of lifestyle-based preventive cardiology. METHODS: Journal articles relating to lifestyle-based preventive cardiology published from 1996 to 2017 were retrieved from the Scopus database. The publications were limited to those in the English language. The data were indexed using bibliometric methodology and exported to Microsoft Excel for analysis. VOS viewer software was used to conduct co-occurrence and collaboration analysis between authors, institutions and countries. RESULTS: A total of 3300 publications were identified. The annual growth rate of publications increased globally during the study period. The USA made the highest contribution to global publications (1402) and total citation counts (68,540). Harvard Medical School was the most prolific institution and David Wood was the most prolific author in the field. The European Journal of Preventive Cardiology published the largest number of articles in this field. Obesity was the most common theme. CONCLUSIONS: The current growth trends predict a large increase in the number of global publications on lifestyle-based preventive cardiology. Further research could focus on smoking cessation, which at present is under-represented in lifestyle-based preventive cardiology output.

Severe obesity as a barrier to international travel: a qualitative analysis.

BACKGROUND: It is unknown whether obesity is a barrier to international travel. The purpose of this qualitative study was to describe the travel experiences of a cohort of severely obese individuals attending a hospital-based bariatric service, to identify their perceived barriers to travel and to generate recommendations that address the needs of severely obese individuals. METHODS: Semi-structured interviews were conducted with severely obese patients attending a regional, structured, multidisciplinary lifestyle modification programme. Coding and thematic analysis of the transcripts were completed by three independent researchers. A thematic analysis was performed based on examination of the transcribed interviews. Demographic and clinical data such as gender, age and body mass index were also recorded. RESULTS: Twelve patients (six males), with a mean age of 54 ± 5.98 years and a mean body mass index of 46.2 ± 8.2 kg/m2, agreed to semi-structured interviews (14-52-minute duration). The principal themes emerging from the interviews included obese air traveller embarrassment, physical discomfort on commercial flights, perceived weight bias, challenges in accessing hotel rooms, heat intolerance in warm climates, restricted leisure travel activities and medical co-morbidities. Most of the interviewees perceived a health benefit to travel but regarded obesity as a significant barrier to international travel. CONCLUSION: These findings highlight the limitations experienced by obese travellers when engaging in international travel. Our results may inform the pre-travel health advice given to obese travellers. They might also serve to raise awareness among operators within the travel industry of the difficulties travellers with severe obesity face.

Protecting the health of medical students on international electives in low-resource settings.

Background: Increasingly, medical students from developed countries are undertaking international medical electives in developing countries. Medical students understand the many benefits of these electives, such as the opportunity to develop clinical skills, to gain insight into global health issues and to travel to interesting regions of the world. However, they may be much less aware of the risk to their health and wellbeing while abroad. Compounding this problem, medical students may not seek advice from travel medicine practitioners and often receive inadequate or no information from their medical school prior to departure. Methods: The PubMed database was searched for relevant literature relating to the health of medical elective students. Combinations of the following key words were used as search terms: 'international health elective', 'medical student' and 'health risks'. Articles were restricted to those published in English from 1997 through June 2017. A secondary review of the reference lists of these articles was performed. The grey literature was also searched for relevant material. Results: This narrative literature review outlines the risks of clinical electives in resource-poor settings which include exposure to infectious illness, trauma, sexual health problems, excessive sun exposure, mental health issues and crime. Medical students may mitigate these health risks by being informed and well prepared for high-risk situations. The authors provide evidence-based travel advice which aims to improve pre-travel preparation and maximize student traveller safety. A safer and more enjoyable elective may be achieved if students follow road safety advice, take personal safety measures, demonstrate cultural awareness, attend to their psychological wellbeing and avoid risk-taking behaviours. Conclusion: This article may benefit global health educators, international elective coordinators and travel medicine practitioners. For students, a comprehensive elective checklist, an inventory of health kit items and useful web-based educational resources are provided to help prepare for electives abroad.