Medical Educators' Perceptions and Experiences of Transgender Curriculum in Barbados.

Purpose: This study explored medical educators' understanding of the term transgender and their attitudes and perspectives regarding (1) health system responsiveness to transgender needs and (2) transgender curriculum in medical education. Methods: The study employed purposive sampling of medical educators responsible for design and delivery of curriculum. Fifteen of 18 eligible educators participated in Zoom focus groups (FG1 n=7, FG2 n=8). FGs averaged 93 min and were recorded, transcribed verbatim, and analyzed using a qualitative interpretivist methodology with deductive and inductive coding assisted by NVivo 12 Pro software. Results: Educators were knowledgeable about the term transgender and the physical and psychosocial needs of transgender people. Participants viewed transgender care as a significant emerging health area. However, infrequent personal or clinical contact, coupled with constraints in human and other resources, resulted in the perception that transgender content as a stand-alone component of curriculum is difficult to justify. Participants articulated a need for broad-based diversity content, including disabilities, primarily at the undergraduate level. Educators saw transgender health as relevant for undergraduate-level psychiatry and postgraduate medical specializations. Analysis and discussion framed participant perspectives in the context of stigma, discrimination, and medicolegal and health systems that impede access to health care for transgender people. Conclusion: Participants demonstrated knowledge of transgender and transgender health care needs. Areas for improvements in health care responsiveness were identified, particularly related to structural stigma and discrimination. Although participants expressed interest in including transgender health in the curriculum, this would require pragmatic optimization of teaching resources.

Student Satisfaction and Self-Efficacy in a Novel Online Clinical Clerkship Curriculum Delivered During the COVID-19 Pandemic.

Purpose: The COVID-19 pandemic has caused significant disruption to medical education and clinical training and resulted in stressors that impede student learning. This study aimed to assess student satisfaction and self-efficacy in a novel online clinical clerkship curriculum delivered during the COVID-19 pandemic. Methods: Fourth- and fifth-year medical students completed an online survey in January 2021 covering the following areas: student satisfaction, self-efficacy, and perceived effectiveness of online versus face-to-face learning. Results: Just over half of students (51%) were satisfied with online clerkship delivery. However, fewer than half of students (46%) believed online learning effectively increased their knowledge, compared to 56% of students who believed face-to-face learning was effective. The perception of the effectiveness of online learning and face-to-face teaching for clinical skills was 18% and 89%, respectively (p < 0.0001). Few students perceived online teaching to be effective for developing social competencies (27%) compared to face-to-face instruction (67%) (p < 0.001). In addition, mean self-efficacy scores were higher for persons who perceived online teaching to be effective for increasing knowledge, improving clinical skills, and developing social competencies. Overall, students' perception of online learning was strongly associated with online self-efficacy. Conclusion: Student satisfaction and perceived self-efficacy in online learning were higher than reported acceptance of online clerkship curriculum.

Attitudes Toward Transgender People Among Future Caribbean Doctors.

The attitudes of medical students toward transgender people have important implications for the future quality of healthcare for Caribbean transgender patients. This paper examined the attitudes and beliefs of Caribbean medical students toward transgender people, provides psychometric evaluation of a promising instrument, and considers implications for the development of transgender curricula in Caribbean medical education. Medical students (N = 205; 155 women, 43 men, 7 unstated) enrolled at a publicly supported Caribbean university completed the Transgender Attitudes and Beliefs Scale (TABS; Kanamori et al., 2017). Internal consistency was strong for the total TABS (α = .93) and more variable for the three subscales: interpersonal comfort (IC: α = .91), sex/gender beliefs (SGB: α = .89), and human value (HV: α = .74). Confirmatory factor analysis demonstrated acceptable overall fit for the three-factor model. There were no significant gender differences in overall attitudes toward transgender people as measured by the total TABS score; women reported higher IC scores. Scores were not correlated with age or with year in medical school. Students reported significantly more tolerant attitudes on the HV scale than on IC or SGB scales. Psychometric findings establish measurement invariance and provide support for further use of the TABS in the Caribbean. We discuss implications for medical curriculum development, including use of the TABS as a tool for medical students to reflect on their individual attitudes and beliefs regarding transgender people.

Characterizing psychosis-relevant phenomena and cognitive function in a unique population with isolated, chronic and very heavy cannabis exposure.

BACKGROUND: The literature on psychosis-relevant outcomes in cannabis users does not adequately address the confounding effects of other substance use/misuse and psychiatric disorders. METHODS: We studied a unique population for whom cannabis use is central and necessary to their way of life. They are forbidden from using other substances, including tobacco and alcohol. Their use of cannabis is heavy, chronic, and begins early. The cases were compared with matched controls who did not use cannabis, alcohol, or drugs. The controls were from the same location and shared similar beliefs and lifestyle, except for cannabis use. Attenuated psychosis-relevant phenomena were assessed with the Schizotypal Personality Questionnaire (SPQ) and cognitive functioning with a culture-neutral computerized cognitive battery. RESULTS: Fifteen cases and 12 matched controls were studied. The cases averaged >30 000 lifetime cannabis exposures. Relative to controls, the cases had significantly higher mean (s.d.) SPQ scores 24 (14.32) v. 13 (8.92), p = 0.031; and poorer cognitive performance, reflected by a lower mean (s.d.) composite cognitive score -0.23 (0.32) v. +0.28 (0.52), p = 0.03. Moderate to large effect sizes were noted for differences in tests of attention, psychomotor speed, working memory, cognitive flexibility, visuo-spatial processing, and verbal memory. A subsample of cases had higher SPQ scores and worse cognitive performance than their siblings not using cannabis. CONCLUSION: Heavy, chronic, and early cannabis use that is not confounded by other drug use is associated with psychosis-relevant phenomena and cognitive deficits. The findings are relevant to the evolving attitudes and laws about cannabis.

Sociocultural Context and Application of Criteria for Capacity to Marry.

We write to comment on the contribution of Glezer and Devido, which we found to be a cogent synopsis of the extant scholarship on the capacity to marry. The article raises several important matters that merit further consideration. In this commentary, we expand the discussion, emphasizing cultural and regional contexts. We submit that this is an important policy area, given the lack of capacity criteria for marriage both domestically and internationally.

Commentary: homicide-suicide in the Caribbean.

With the exception of Guyana and Trinidad, suicide rates in the Caribbean are relatively low compared with those in other countries. Homicide rates, however, have increased over the past 15 years, especially in Jamaica and Trinidad. The link between suicide, homicide, and homicide followed by suicide (H-S) is not well established. A newspaper review of H-S events in a selection of Caribbean territories revealed a surprising number of these events. Characteristics of perpetrators were similar to those documented in the literature. The authors agree with Roma et al. that national tracking systems for H-S are needed. Empirical research on this topic in the Caribbean is also desperately needed.

Factorial structure of depressive symptoms in Anglophone Caribbean university students: psychometric properties of the beck depression inventory-II / La estructura factorial de los síntomas de depresión en estudiantes universitarios del Caribe angloparlante: rasgos psicometricospsicométricos del inventario de depresión de beck-II

This study sought to establish psychometric properties of the Beck Depression Inventory-Second Edition (BDI-II) with Caribbean university students (n=400, 76 percent women, mean age=25.2). Additionally, we administered the Ego Resiliency Scale-89, Perceived Stress Scale-Ten Item Version, State-Trait Anxiety Inventory-Trait Version, and Zung Self-Rating Depression Scale. Confirmatory factor analysis compared the observed structure with the oblique structures proposed in two-factor models. Factorial estimates and goodness-of-fit indices suggested adequate fit for two-factor models. Internal consistency (α=.86) and test-retest reliabilities (n=57, r=.78) were strong. Correlations assessing validity were significant in the theoretically expected directions. Results support use of the BDI-II with Caribbean students.(AU)

Este estudio buscó establecer propiedades psicométricas del Inventario de Depresión de Beck-Segunda Edición (BDI-II) con estudiantes de una universidad del Caribe (n=400, 76 por ciento mujeres, edad media=25.2). Además, administramos la Escala de Elasticidad de Ego-89, La Escala de Tensión Percibida, La Escala de Ansiedad Estado-Rasgo (Versión de Rasgo) y La Escala de Depresión de Zung. El análisis factorial confirmativo comparó la estructura observada con las estructuras oblicuas propuestas en los modelos de dos factores. Las estimaciones factoriales y los índices de calidad de ajuste sugirieron adecuado ajuste para modelos de dos factores. La consistencia interna (α=.86) y la fiabilidad test-retest (n=57, r=.78) eran fuertes. Las correlaciones de validez eran significativas en las direcciones teóricamente esperadas. Los resultados apoyan el uso del BDI-II con estudiantes del Caribe.(AU)

Comparing staff and client perceptions of needs in a British single-sex medium secure unit.

The Camberwell Assessment of Need-Forensic Research Version (CANFOR-R) was used to compare perceptions of total met, and unmet needs of patients and clinical staff. Staff reported more total and met needs. There were no statistical differences in needs of Black-Caribbean, Asian, and White patients. This study underscores the importance of communication between patients and staff to identify and address needs.