American Medical Trainee Perspectives on Ethical Conflicts during a Short-Term Global Health Rotation in Ethiopia: A Qualitative Analysis of 30 Cases.

There has been a significant increase in the number of students, residents, and fellows from high-income settings participating in short-term global health experiences (STGHEs) during their medical training. This analysis explores a series of ethical conflicts reported by medical residents and fellows from Emory University School of Medicine in the United States who participated in a 1-month global health rotation in Ethiopia. A constant comparative analysis was conducted using 30 consecutive reflective essays to identify emerging categories and themes of ethical conflicts experienced by the trainees. Ethical conflicts were internal; based in the presence of the visiting trainee and their personal interactions; or external, occurring due to witnessed events. Themes within internal conflicts include issues around professional identity and insufficient preparation for the rotation. External experiences were further stratified by the trainee's perception that Ethiopian colleagues agreed that the scenario represented an ethical conflict (congruent) or disagreed with the visiting trainee's perspective (incongruent). Examples of congruent themes included recognizing opportunities for collaboration and witnessing ethical conflicts that are similar to those experienced in the United States. Incongruent themes included utilization of existing resources, issues surrounding informed consent, and differing expectations of clinical outcomes. By acknowledging the frequency and roots of ethical conflicts experienced during STGHEs, sponsors may better prepare visiting trainees and reframe these conflicts as collaborative educational experiences that benefit both the visiting trainee and host providers.

Ethics Education During Palliative Medicine Fellowship.

BACKGROUND: Palliative care clinicians frequently encounter situations in which there are ethical dilemmas about the right thing to do. Palliative medicine fellowships are required to include education about ethics. Our fellowship increased fellows' ethics education through monthly didactics, lectures in a professional development series, and a month-long ethics rotation. METHODS: We sought input from graduates of our palliative medicine fellowship about the content and amount of the ethics education they received. Fellowship graduates were invited via e-mail to complete an online survey about the ethics education they received during fellowship. They were asked questions about their work environment, frequency with which they encounter ethical dilemmas, their perspectives on the ethics content, the amount of ethics education they received during fellowship, and their input on ways to improve the ethics education within the fellowship. RESULTS: Twenty-eight (82%) of 34 fellowship graduates completed the survey; 93% noted that they encounter ethical dilemmas in their work, with half encountering these on a daily or weekly basis, and 86% noted that colleagues ask them questions about ethics because of their palliative medicine training. None responded that they had received too much ethics education. Fellowship graduates identified ethics content that has been useful since completing fellowship and suggested ways to improve ethics education for future fellows. CONCLUSION: Graduates of a palliative medicine fellowship encounter ethical dilemmas often and frequently are asked questions about ethics. Palliative medicine fellowships may want to examine their ethics curriculum to ensure that graduating fellows are learning about relevant ethics topics and are comfortable discussing ethical dilemmas with others.

Global Surgery Symposium.

This article describes the Global Surgery Symposium held within the 65th British Association of Paediatric Surgeons (BAPS) Annual Congress in 2018. Global surgery is a rapidly expanding and developing field and is of particular importance in paediatrics since children account for up to 50% of the population in low- and middle-income countries (LMICs). It is estimated that up to a third of childhood deaths in LMICs are the result of a surgical condition, and congenital anomalies have risen to become the 5th leading cause of death in children less than 5-years of age globally. Trainees in high-income countries (HICs) are increasingly interested in global surgery engagement through clinical placements, research, or education, or a combination of these. There is considerable controversy regarding the ethics, practicalities, usefulness, safety, and sustainability of these initiatives. In addition, there is debate as to whether such placements should occur within the paediatric surgery training pathway. LEVEL OF EVIDENCE: 5 (Expert Opinion).

The Ethics of Scholarship With Social Media.

The use of social media by professional nurses is increasing at exponential rates. What are the possible nursing ethics involved as nurses utilize the various emerging digital electronic platforms? This article begins a discussion on the usage of social media and the responsibilities of nurse scholars who utilize social media platforms both personally and professionally. A humanbecoming paradigm perspective undergirds a discussion of ethical implications for future disciplinary scholar perspectives and position statements.

Stakeholder-driven, consensus development methods to design an ethical framework and guidelines for engaged research.

Increasingly, researchers seek to engage communities, patients, and stakeholders as partners in the process and products of health research. However, there is no existing stakeholder-driven ethical framework for such engaged scholarship. We employed an iterative, stakeholder-engaged method to develop a data-driven framework for the ethical review and conduct of engaged scholarship. We used consensus development conference methods and a modified Delphi survey to engage 240 community members, ethicists, and academic researchers. This multi-staged process produced a framework with 4 domains: vision of equitable and just research, relationship dynamics, community-informed risk/benefits assessment, and accountability. Within the framework, 4 cross-cutting considerations and 15 statements explicate the stakeholders' priorities for the ethical review and conduct of engaged scholarship. Though the findings are promising, the study is limited in that it focuses on stakeholder perspectives, but does not actually evaluate or apply the findings in the field. The stakeholder-engaged framework provides a platform for further articulation of ethical practices and policy for engaged scholarship.

Differentiating predatory scholarship: best practices in scholarly publication.

OBJECTIVE: The intent of this article is to define predatory publishing, identify the risks and costs associated with publishing scholarship with these types of organizations and to provide recommendations for best practices how a potential author can protect themselves against predatory organizations. METHODS: A thorough review of the literature concerning predatory publishing was conducted and gleaned for best practices along with the authors' experiences. KEY FINDINGS: Pharmacy scholars and researchers worldwide recognize the virtues of the open access (OA) publication system, which is intended to freely disseminate research electronically, stimulate innovation and improve access to scholarship. Both subscription-based and OA publication systems, however, have potential areas of conflicts, including coordination of the peer-review process and the potential for the publisher to capitalize on selling the commodity in a capitalistic society. The intent of OA is welcomed; however, publishers are still in a business and profits need to be made. It is by the exploitation of the model that has given rise to a small but growing subset known as predatory publishers. CONCLUSIONS: Pharmacy researchers and clinicians alike need to be aware of predatory organizations, both publishers and meeting organizers, when seeking a venue to publish their own scholarly research. Additionally, this knowledge is critical when evaluating medical literature in providing direct patient care services to assure the best available evidence is utilized.

Misrepresentation in multidisciplinary pain medicine fellowship applications to a single academic program.

BACKGROUND AND OBJECTIVES: Publication misrepresentation by residency applicants has been well documented, but fewer studies have investigated it in fellowship applicants, specifically in pain medicine. We therefore sought to evaluate the demographics of pain medicine fellowship applicants and the type, number, and accuracy of referenced publications they reported. METHODS: Applications to the Multidisciplinary Pain Medicine fellowship program in the Mayo School of Graduate Medical Education, Rochester, Minnesota were reviewed for three consecutive academic years (2009-2012). Demographic information and publications claimed by applicants were compiled, and publications were scrutinized by a medical librarian for accuracy. RESULTS: Over a 3-year period, 179 fellowship applications were received. Of the 179 applicants, more than half (106 [59%]) listed at least one publication. Of 324 listed publications, 263 were verifiable; of these, 14 (5.3%) were deemed fraudulent, and six (2.3%) contained an inaccuracy possibly conferring a competitive advantage. In our small sample size, we found no difference in the rate of publications or in the accuracy of listed publications across subspecialties, or between US medical graduates and international medical graduates. CONCLUSIONS: The lack of national data, specifically on applicant misrepresentation, due to the heretofore absence of a universal application process or match, impedes assessment of the extent to which these findings are representative of the national applicant pool. We observed notable trends (few female applicants; numerous international medical graduate applicants) different from those reported by other specialties. Despite the low rate (5.3%) of fraudulent publications, fellowship program directors and selection committees should be aware of this possibility to ensure selection of fellows with the highest degree of professional and ethical integrity.

Too few, too weak: conflict of interest policies at Canadian medical schools.

INTRODUCTION: The education of medical students should be based on the best clinical information available, rather than on commercial interests. Previous research looking at university-wide conflict of interest (COI) policies used in Canadian medical schools has shown very poor regulation. An analysis of COI policies was undertaken to document the current policy environment in all 17 Canadian medical schools. METHODS: A web search was used to initially locate COI policies supplemented by additional information from the deans of each medical school. Strength of policies was rated on a scale of 0 to 2 in 12 categories and also on the presence of enforcement measures. For each school, we report scores for all 12 categories, enforcement measures, and summative scores. RESULTS: COI policies received summative scores that ranged from 0 to 19, with 0 the lowest possible score obtainable and 24 the maximum. The highest mean scores per category were for disclosure and ghostwriting (0.9) and for gifts and scholarships (0.8). DISCUSSION: This study provides the first comprehensive evaluation of all 17 Canadian medical school-specific COI policies. Our results suggest that the COI policy environment at Canadian medical schools is generally permissive. Policy development is a dynamic process. We therefore encourage all Canadian medical schools to develop restrictive COI policies to ensure that their medical students are educated based on the best clinical evidence available, free of industry biases and COI relationships that may influence the future medical thinking and prescribing practices of medical students in Canada once they graduate.

Ghost publications in the pediatric surgery match.

INTRODUCTION: Pediatric surgery fellowship is considered one of the most competitive subspecialties in medicine. With fierce competition increasing the stakes, publications and first authorship are paramount to the success rate of matching. We analyzed Electronic Residency Application Service applications for verification of authorship to determine rate of misrepresentation. METHODS: After institutional review board approval, the bibliographies of fellowship applications from 2007-2009 were reviewed to allow time for publication. Only peer-reviewed journal articles were evaluated. A Medline search was conducted for the article, by author or by title. If the article could not be found, other authors and journal were used as search parameters. If the article was still not found, the website for the journal was searched for abstract or manuscript. Finally, an experienced medical sciences librarian was consulted for remaining unidentified articles. Differences between misrepresented and accurate applications were analyzed, including: age, gender, medical and undergraduate school parameters, advanced degrees, other fellowships, number of publications, first author publications, American Board of Surgery In-Training Examination scores, and match success. RESULTS: There were 147 applications reviewed. Evidence of misrepresentation was found in 17.6% of the applicants (24/136), with 34 instances in 785 manuscripts (4.3%). Manuscripts classified as published were verified 96.7% of the time, were not found in 1.4%, and had incorrect authors or journal in less than 1% each. "In press" manuscripts were verified 88.3% of the time, 6.4% could not be found, and 4.3% had an incorrect journal listing. Number of publications (P = 0.026) and first author publications (P = 0.037) correlated with misrepresentation. None of the remaining variables was significant. CONCLUSIONS: The pediatric surgical pool has a very low incidence of suspicious citations; however, authorship claims should be verified.

Desarrollo y validación de la becaD, un instrumento de evaluación basado en la clasificación internacional del funcionamiento, de la discapacidad y de la salud / Development and validation of BECAD. An Instrument derived from the International Classification of Functioning, Disability and Health

Fundamentos: La Clasificación Internacional del Funcionamiento, de la Discapacidad y la Salud (CIF) proporciona un marco conceptual muy útil en la rehabilitación de personas con trastornos crónicos, con problemas complejos y atendidos por equipos interdisciplinares. El objetivo de este trabajo fue el desarrollo de una batería de escalas basadas en la CIF para la planificación de tratamientos y la evaluación de resultados. Métodos: Un grupo de expertos realizó una modificación de los elementos de las Actividades de la CIF. Se diseñaron preguntas y tareas que fueron sometidas a valoración por un segundo grupo. Se diseñó una aplicación informática en línea. La muestra estuvo formada por 116 participantes, 34 con daño cerebral adquirido, 38 con trastorno mental grave y 44 controles. La administración de las escalas la realizaron psicólogos entrenados y profesionales sanitarios. Se realizaron análisis factoriales exploratorios de tres escalas: “Aprendizaje, aplicación del conocimiento y tareas y demandas generales”, “Autocuidado y “Movilidad”, análisis de consistencia interna, MANCOVAs y análisis de regresión. Resultados: En Aprendizaje, aplicación del conocimiento y tareas y demandas generales se obtuvieron tres factores que explicaron el 52,58% de la varianza. En Movilidad se obtuvieron dos factores que explicaron el 76,91 % y en “Autocuidado” se obtuvieron otros dos, que explicaron el 77,60 %. Los test de MANCOVAs mostraron diferencias entre las tres muestras en todos los factores y los coeficientes de fiabilidad tuvieron valores entre 0,91 y 0,99. Conclusiones: Los resultados de este estudio indicaron adecuadas propiedades métricas de las nuevas escalas, cuyos factores discriminaron entre muestras y tuvieron alta fiabilidad(AU)

Background: The International Classification of Functioning, Disability and Health (ICF) provides a useful theoretical framework for the rehabilitation of chronic diseases with complex problems that require interdisciplinary teams. The aim of this study was the development of a set of scales based on ICF for treatment planning and outcome assessment. Methods: A group of experts conducted several changes of the elements from the Activities and Participation ICF chapter. Tasks and questions were designed and then, submitted to review from another group of experts.An online application was designed. The sample consisted of 116 participants, 34 of them with brain injury, 38 with severe mental disorders and 44 controls. Trained psychologists and other health professionals administered the scales. Exploratory factor analysis of the scales “Learning and applying knowledge and general tasks and demands”, “Self-care” and “Mobility” besides reliability coefficients, MANCOVAs and regression analyses were performed. Results: In the scale “Learning and applying knowledge and general tasks and demands” three factors have been extracted, which explain 52,58% of variance. In the scale “Mobility” two factors have been extracted, explaining 76,91 % of variance; and in “Self-care”, another two factors were extracted, explaining 77,60%of variance.MANCOVAs showed significant differences between the three groups in all seven new factors. All factors presented coefficients between 0.91 and 0.99. Conclusions: These results showed appropriate metric properties of the newscales,whose factors discriminate between groups and have a high reliability(AU)