The Mental Imagery for Suicidality in Students Trial (MISST): study protocol for a feasibility randomised controlled trial of broad-minded affective coping (BMAC) plus risk assessment and signposting versus risk assessment and signposting alone.

BACKGROUND: Going to university is an important milestone in many people's lives. It can also be a time of significant challenge and stress. There are growing concerns about mental health amongst student populations including suicide risk. Student mental health and counselling services have the potential to prevent suicide, but evidence-based therapies are required that fit these service contexts. The Broad-Minded Affective Coping intervention (BMAC) is a brief (6 sessions), positive imagery-based intervention that aims to enhance students access to past positive experiences and associated emotions and cognitions. Pilot data provides preliminary support for the BMAC for students struggling with suicidal thoughts and behaviours, but this intervention has not yet been evaluated in the context of a randomised controlled trial (RCT). The Mental Imagery for Suicidality in Students Trial (MISST) is a feasibility RCT that aims to determine the acceptability and feasibility of evaluating the BMAC as an intervention for university students at risk of suicide within a larger efficacy trial. Key feasibility uncertainties have been identified relating to recruitment, retention, and missing data. Intervention acceptability and safety will also be evaluated. METHOD: MISST is a feasibility randomised controlled trial design, with 1:1 allocation to risk assessment and signposting plus BMAC or risk assessment and signposting alone. Participants will be university students who self-report experiences of suicidal ideation or behaviour in the past 3 months. Assessments take place at baseline, 8, 16, and 24 weeks. The target sample size is 66 participants. A subset of up to 20 participants will be invited to take part in semi-structured qualitative interviews to obtain further data concerning the acceptability of the intervention. DISCUSSION: The BMAC intervention may provide an effective, brief talking therapy to help university students struggling with suicidal thoughts that could be readily implemented into university student counselling services. Depending on the results of MISST, the next step would be to undertake a larger-scale efficacy trial. TRIAL REGISTRATION: The trial was preregistered (17 December 2021) on ISRCTN (ISRCTN13621293) and ClinicalTrials.gov (NCT05296538).

Professional paradox: identity formation in qualified doctors pursuing further training.

CONTEXT: Many newly qualified specialists and subspecialists pursue additional training. Although their motivations are many, the pursuit of further training as an alternative to unemployment is an emerging trend. Paradoxically, doctors continue as trainees with a consultant's credentials, and without the guarantee of eventual employment. This study explores seven doctors' experiences, the effects of further training on their professional identity formation (PIF), and how these effects are reconciled on a personal and professional level. METHODS: This phenomenological study involved interviews with seven qualified Canadian specialists (three were female) who pursued additional training in response to a lack of available positions in their respective specialties. Template analysis generated theoretical constructs of influences on their PIF, and characteristics of their lived experiences. RESULTS: Four themes shaped PIF: setting and context; language and communication; responsibilities and privileges; and participants' visions of their future selves. Professional identity formation (PIF) continued to develop in further training, but was inconsistently affirmed by participants' communities of practice. Four major themes characterised training experiences: prescription; managing multiple masters; limiting access to others and community ties; and constantly questioning the value of extra training. CONCLUSION: Qualified doctors traverse professional paradoxes as they seek further education with no guarantee of employment and provide consultant-level care as 'trainees'. An identity dissonance emerges that may continue until a clear identity is prescribed for them. Although disruptive to these doctors' PIF and personal and professional lives, the long-term effects of additional training are unknown. Its utility and influence on securing employment and future job satisfaction are areas for further research.

The Big D(eal): professional identity through discursive constructions of 'patient'.

CONTEXT: Professional identity formation has become a key focus for medical education. Who one becomes as a physician is contingent upon learning to conceptualise who the other is as a patient, yet, at a time when influential ideologies such as patient-centred care have become espoused values, there has been little empirical investigation into assumptions of 'patient' that trainees take up as they progress through their training. METHODS: Our team employed a critical discourse analysis approach to transcripts originally produced from a micro-ethnography of medical student learning on an acute care in-patient paediatric ward. The dataset included 20 case presentations and 14 sign-over rounds taken from a 3-week observation period. We paid specific attention to how trainees used language to talk about, refer to and categorise patients. RESULTS: Identified discourses included patient-as-disease-category, patient-as-educational-commodity and patient-as-marginalised-actor. These discourses conceptualise 'patient' as an entity that is principally biomedical, useful for clinical learning and spoken for and about. Medical student participation in these discourses contributes to an identity that allows them to move further into the professional medical world they are joining. CONCLUSIONS: We contend that as learners participate in these discourses, they are also performatively produced by them. By making these discourses visible, we can consider how to minimise unintended effects such discourses may cause. Our findings, although limited, offer a glimpse of the effects that those assumptions may have as we look to align better the formation of professional medical identity with the ideals of patient-centred care and socially responsible health care systems.

The Cross-Canada Quintet presents variations on music: movements in the keys of H, P and E.

Whether it is rock playing in the background during a surgery, cool jazz that wafts from our office computer speakers as we write up our clinical notes, or the soaring of a symphony on the radio that inspires that perfect flourish to an article, music is woven throughout much of our clinical and academic lives. For the five of us, however, music alternates between the background and foreground in our lives as health professions educators. Music balances the working day, illuminates our research, and reconciles the utility of our training with the originality of our practice. We invite you to discover the interplays, dissonances and harmonies inspired by and reflected in this leitmotif. Pull up a chair, sit back, put on one of your own favourite pieces and explore these ideas as we riff and rhapsodise on variations on this theme.

Student perceptions of assessment and feedback in longitudinal integrated clerkships.

OBJECTIVES: This study was conducted to elucidate how the learning environment and the student-preceptor relationship influence student experiences of being assessed and receiving feedback on performance. Thus, we examined how long-term clinical clerkship placements influence students' experiences of and views about assessment and feedback. METHODS: We took a constructivist grounded approach, using authentic assessment and communities of practice as sensitising concepts. We recruited and interviewed 13 students studying in longitudinal integrated clerkships across two medical schools and six settings, using a semi-structured interview framework. We used an iterative coding process to code the data and arrive at a coding framework and themes. RESULTS: Students valued the unstructured assessment and informal feedback that arose from clinical supervision, and the sense of progress derived from their increasing responsibility for patients and acceptance into the health care community. Three themes emerged from the data. Firstly, students characterised their assessment and feedback as integrated, developmental and longitudinal. They reported authenticity in the monitoring and feedback that arose from the day-to-day delivery of patient care with their preceptors. Secondly, students described supportive and caring relationships and a sense of safety. These enabled them to reflect on their strengths and weaknesses and to interpret critical feedback as supportive. Students developed similar relationships across the health care team. Thirdly, the long-term placement provided for multiple indicators of progress for students. Patient outcomes were perceived as representing direct feedback about students' development as doctors. Taking increasing responsibility for patients over time is an indicator to students of their increasing competence and contributes to the developing of a doctor identity. CONCLUSIONS: Clerkship students studying for extended periods in one environment with one preceptor perceive assessment and feedback as authentic because they are embedded in daily patient care, useful because they are developmental and longitudinal, and constructive because they occur in the context of a supportive learning environment and relationship.

High-fidelity simulation in anesthesiology training: a survey of Canadian anesthesiology residents' simulator experience.

PURPOSE: The objective of this survey was to explore Canadian anesthesiology residents' educational experience with high-fidelity simulation and to improve understanding of the factors perceived to have either a positive or a negative effect on residents' learning. METHODS: In 2008, all Canadian anesthesiology residents (n = 599) were invited to complete a ten-minute anonymous online survey. Survey questions were derived from two sources, a literature search of MEDLINE (1966 to present), EMBASE (1980 to present), and the Cochrane and Campbell collaboration libraries and the experience of 25 pilot residents and the lead author. RESULTS: The survey response rate was 27.9% (n = 167). Junior residents (PGY1-3) responded that it would be helpful to have an introductory simulation course dealing with common intraoperative emergencies. The introduction of multidisciplinary scenarios (where nurses and colleagues from different specialties were involved in scenarios) was strongly supported. With respect to gender, male anesthesia residents indicated their comfort in making mistakes and asking for help in the simulator more frequently than female residents. In accordance with the ten Best Evidence Medical Education (BEME) principles of successful simulator education, Canadian centres could improve residents' opportunities for repetitive practice (with feedback), individualization of scenarios, and defined learning outcomes for scenarios. DISCUSSION: Anesthesiology residents indicate that simulation-based education is an anxiety provoking experience, but value its role in promoting safe practice and enhancing one's ability to deal with emergency situations. Suggestions to improve simulation training include increasing residents' access, adopting a more student-centred approach to learning, and creating a safer learning environment.

Teaching and learning in the operating room is a two-way street: resident perceptions.

BACKGROUND: The transformation of a trainee into a surgeon is influenced strongly by communication patterns in the operating room (OR). In the current era of limited educational opportunities, elucidation of teaching and learning strategies in this environment is critical. The aim of this study was to further understand the elements of an effective communicative instructional interaction (CII) as perceived by surgical residents. METHODS: Qualitative research methodology was used to explore University of British Columbia surgery residents' perceptions of what constitutes an effective CII in the OR. Purposeful sampling was used to select participants from various years of training. Eighteen residents participated in semistructured interviews to facilitate reflection of their OR experiences. Interviews were transcribed, analyzed, and fed back to residents to confirm their accuracy. Independent coding and analysis led to the development of key emergent themes. RESULTS: Themes represented the interplay of ideals expressed by the residents. The primary emergent theme was that both teacher and learner play a major role in the creation of an effective CII. The ideal teacher had an instructional plan, facilitated surgical independence, and showed support and empathy for the surgical resident. The ideal resident was receptive, prepared, and acknowledged limitations. The contextual constraints of the OR played a central role in learning, and residents identified ways to maintain educational value despite primarily nonmodifiable contextual elements (ie, time constraints). CONCLUSIONS: In a unique environment such as the OR, both teacher and learner may benefit by an enhanced understanding of the elements of an effective CII.

Practice patterns of Canadian glaucoma specialists: planning for the next generation.

BACKGROUND: To identify practice patterns of Canadian glaucoma specialists in order to begin identifying the needs of the work force to care for the next generation of glaucoma patients. METHODS: Survey of 130 Canadian glaucoma specialists whose names were obtained from the Canadian Ophthalmological Society specialist list. RESULTS: The response rate was 62% (81/130); 77% (62/81) considered themselves glaucoma specialists, but only 77% (48/62) of these had at least 1 year of formal glaucoma training. Specialists had a mean of 6.4 half days per month in the operating room, devoting the majority of their surgical time to glaucoma but performing more cataract surgery than glaucoma surgery. Forty percent of glaucoma specialists do not perform glaucoma drainage implant surgery. All the respondents stated that wait time for emergency care was within hours, but only 21% could perform their nonurgent cases within the benchmark set in this study of 4 weeks, wait times averaging 9.2 (range: 3-24) weeks. Forty-eight percent of the glaucoma specialists were not satisfied with their mix of clinical, laser, surgery, and nonophthalmology activities. Forty-four percent plan to decrease their clinical load over the next 5 years: 23% plan to increase their teaching, 19% their research, and 35% plan to devote less time to ophthalmology over the next 5 years. INTERPRETATION: Forty-eight percent of glaucoma specialists had concerns regarding timely intervention for semiurgent care, in that only 21% of these cases are performed within 1 month of a confirmed need for surgery. With a benchmark that surgery be performed within 1 month in patients whose glaucoma is progressing despite medical, laser, or prior incisional surgical care, we do not have adequate resources to care for current glaucoma needs. With the aging population and ongoing attrition of ophthalmologists, we need to plan for improved access to glaucoma surgery.

An update on master's degrees in medical education.

Planning and implementing educational programs in medicine optimally requires a background in educational theory and practice. An avenue of training open to such practitioners is a master's degree in medical education. A single 1998 report lists the programs known at that time and information about them remains scarce. The authors have re-examined all current programs offering master's degrees in medical or health sciences education in the English-speaking world, including the Netherlands. The authors contacted the programs identified in the 1998 report to establish how many were still in operation. The search was extended using Pubmed and other search engines. A further verification targeted a selected sample of 10 prominent US medical schools. Twenty-one currently operating programs were identified: six in the US, eight in the UK, three in Canada, three in Australia and one in Holland. Seven of nine original master's programs were still in existence. URLs, website and other logistical information about each program are tabled. A master's degree in medical or health sciences education is the most specific method for medical faculty to obtain a credentialed grounding in educational theory and practice. The authors provide up-to-date contact information for current programs and summarize other related essential logistical data.