Common Problems! and Common Solutions? - Teaching at the Intersection Between Public Health and Criminology: A Public Health Perspective.

Public health and criminology share similar current and future challenges, mostly related to crime and health causation, prevention, and sustainable development. Interdisciplinary and transdisciplinary approaches to education at the intersection of public health and criminology can be an integral part of future training in areas of mutual interest. Based on reflections on teaching criminology students, this viewpoint discusses the main interconnections between public health and criminology teaching through the public health lens. The paper discusses potential challenges associated with interdisciplinarity and transdisciplinarity. Among these challenges is communication across the different fields and their perspectives to be able to achieve the desired complementarity at the intersection of the two disciplines.

Perceptions of Health and Wellbeing Among Employees in a Work Integration Social Enterprise in Sweden.

Background: Work Integration Social Enterprises (WISEs) constitute an important vehicle for providing employment opportunities for disadvantaged groups. Objective: The goal of this qualitative case study is to explore perceptions of health and wellbeing among employees working in a WISE located in the Gävleborg region, in east central Sweden. Methods: Data were gathered using 16 in-depth, semi-structured interviews with the social enterprise employees. Results: Findings were categorized into three main categories: the importance of financial independence and societal benefits; team spirit and a sense of belonging; and improved quality of life and wellbeing. Conclusion: The participants perceived that working in the WISE gave them a feeling of freedom and increased their self-esteem because of the possibility to earn an income. Also, they were satisfied with their job (e.g., with regard to work quality and flexibility) and believed that their work contributed to society. Moreover, through working in a WISE, the participants felt a sense of belonging and togetherness through interaction with co-workers and managers, and an improved quality of life for themselves and their families.

The Association between Fear of Crime, Educational Attainment, and Health.

Fear of crime is an important public health problem that impacts people's quality of life, health, and wellbeing, and causes mental health ailments (e.g., anxiety). This study aimed to determine whether there was an association between fear of crime, educational attainment, and self-rated health and anxiety among women residing in a county in east-central Sweden. A sample (n = 3002) of women aged 18-84 years surveyed in the Health on Equal Terms survey carried out in 2018 was included in the study. Bivariate and multivariate regression analysis was performed on the relationship between the composite variables fear of crime, educational attainment, and self-rated health and anxiety. Women with primary education or similar who reported fear of crime had increased odds of poor health (odds ratio (OR) 3.17; 95% confidence interval (CI) 2.40-4.18) compared with women with primary education/similar and no fear of crime (OR 2.90; CI 1.90-3.20). A statistically significant relationship persisted in the multivariate analysis after controlling for other covariates, although the odds were reduced (OR 1.70; CI 1.14-2.53 and 1.73; CI 1.21-2.48, respectively). Similarly, in the bivariate analysis, women who reported fear of crime and who only had primary education had statistically significant odds of anxiety (OR 2.12; CI 1.64-2.74); the significance was removed, and the odds were reduced (OR 1.30; CI 0.93-1.82) after adjusting for demographic, socioeconomic, and health-related covariates. Women with only primary education or similar who reported fear of crime had higher odds of poor health and anxiety compared with those with university education or similar, with and without fear of crime. Future studies (including longitudinal ones) are warranted-on the one hand, to understand possible mechanisms of the relationship between educational attainment and fear of crime and its consequences to health, and on the other, to explore low-educated women's own perceptions regarding factors underlining their fear of crime (qualitative studies).

Navigating Affordances for Learning in Clinical Workplaces: A Qualitative Study of General Practitioners' Continued Professional Development.

Medical specialists' lifelong learning is essential for improving patients' health. This study identifies affordances for learning general practitioners (GPs) engage in, and explores what influences engagement in those affordances. Eleven GPs were interviewed and the interview transcripts were analysed thematically. Stephen Billett's theoretical framework of workplace participatory practices was used as an analytical lens to explore the topic. Challenging patient cases were identified as the main trigger for engagement in learning. Local, national and international colleagues from the same and other specialties, were found to be an important affordance for learning, as was written material such as websites, journals and recommendations. Other inputs for learning were conferences and courses. Workplace aspects that were essential for GPs to engage in learning related to: place and time to talk, relevance to work, opportunity for different roles, organisation of work and workload, and working climate. Importantly, the study identifies a need for a holistic approach to lifelong learning, including spontaneous and structured opportunities for interaction over time with colleagues, establishment of incentives and arenas for exchange linked to peer learning, and acknowledgement of the workplace as an important place for learning and sufficient time with patients. This study contributes with a deepened understanding of how GPs navigate existing affordances for learning both within and outside their workplaces.

Threshold concepts in health professions education research: a scoping review.

Threshold concepts (TCs) are increasingly used in health professions education (HPE) research. TCs are claimed to be conceptual gateways which are often traversed with substantial difficulty. In this paper, we report on a scoping review investigating the following research question: What is the scope and nature of the currently available research on threshold concepts in health professions education literature? We employed Arksey and O'Malley's model for scoping reviews. A search for literature on TCs in HPE research between 2003 and 2020 yielded 999 records of which 59 were included in the review. The data set was subject to quantitative descriptive analysis of article characteristics as well as qualitative thematic analysis of the scope of research on TCs. Among the 59 articles selected for review, there were 30 empirical, 26 conceptual and three reviews. A majority were published in 2015 or later. Almost half of the included articles attempted to identify possible TCs within HPE. Others investigated how TCs can be traversed or suggested how TCs could influence curriculum design. Some critically appraised the framework of TC. Although TCs are increasingly utilised in HPE, the present review identified how researchers came across methodological challenges related to identifying possible TCs and definitional challenges around identifying the essential characteristics of TCs. Before embracing TCs as the next go-to theory for learning in HPE, we acknowledge the need for methodological stringeny and rigour as well as more data to support TCs. Until then, any implementation of TCs in HPE curricula should be done cautiously.

Safeguarding fairness in assessments-How teachers develop joint practices.

INTRODUCTION: In light of reforms demanding increased transparency of student performance assessments, this study offers an in-depth perspective of how teachers develop their assessment practice. Much is known about factors that influence assessments, and different solutions claim to improve the validity and reliability of assessments of students' clinical competency. However, little is known about how teachers go about improving their assessment practices. This study aims to contribute empirical findings about how teachers' assessment practice may change when shared criteria for assessing students' clinical competency are developed and implemented. METHODS: Using a narrative-in-action research approach grounded in narrative theory about human sense-making, one group including nine health professions teachers was studied over a period of 1 year. Drawing upon data from observations, interviews, formal documents and written reflections from these teachers, we performed a narrative analysis to reveal how these teachers made sense of experiences associated with the development and implementation of joint grading criteria for assessing students' clinical performances. RESULTS: The findings present a narrative showing how a shared assessment practice took years to develop and was based on the teachers changed approach to scrutiny. The teachers became highly motivated to use grading criteria to ensure fairness in assessments, but more importantly, to fulfil their moral obligation towards patients. The narrative also demonstrates how these teachers reasoned about dilemmas that arose when they applied standardised assessment criteria. DISCUSSION: The narrative analysis shows clearly how teachers' development and application of assessment standards are embedded in local practices. Our findings highlight the importance of teachers' joint discussions on how to interpret criteria applied in formative and summative assessments of students' performances. In particular, teachers' different approaches to assessing 'pieces of skills' versus making holistic judgements on students' performances, regardless of whether the grading criteria are clear and well-articulated on paper, should be acknowledged. Understanding the journey that these teachers made gives new perspectives as to how faculty can be supported when assessments of professionalism and clinical competency are developed.

Using a ring to locate femoral head centre in total hip arthroplasty.

AIMS: Traditional methods of determining femoral head centre (FHC) during total hip arthroplasty (THA) rely on measuring the distance from a fixed point on the femur or using a calliper. The aim of this experiment was to investigate how accurately a simple circular ring could locate FHC. METHODS: 144 consecutively available femoral heads (FHs) were collected from patients undergoing THA. Each FH was orientated and mounted on a Sawbone, to create a model of its position on a proximal femur. The ring was applied to the posterior aspect of the FH and a head-centre pin (HCP) was then drilled into the FH and the ring removed, leaving the HCP in place.Each FH was then photographed normal to the axis of the HCP. A MATLAB analysis program then assessed the accuracy of the ring in locating FHC. RESULTS: Mean location accuracy for FHC was 1.77 (range 0.07-5.83) mm with 97.2% within 4 mm and all but 1 within 5 mm. CONCLUSIONS: This ring device located FHC to within 4 mm in 97% of a series of osteoarthritic FHs. This indicates that the posterior aspect of the FH maintains its sphericity late into the osteoarthritic process. Having a simple FHC location device during THA would be of value to control leg length and offset when using the posterior approach.

[Medical doctor specialists - an overview of the research on formal and informal continued professional development]. / Specialistläkares fortbildning ­ effekt, förutsättningar, drivkrafter.

An overview of the research literature about physicians' continuing development was conducted and shows that formal learning activities often target individuals and their development, and focus on increasing knowledge and influencing attitudes. Research studies showing changes in practice are less common. Regulated continuous medical education may lead to instrumental approaches to learning. Informal learning occurs continuously during work, is often spontaneous and focussed on problem solving. Patients and colleagues as well as the physical and social environment provide opportunities for learning. Organizations can offer time and space to facilitate physicians' continuing development, enabling possibilities for formal and informal sharing of knowledge to take place, for example, by enabling collegial discussions.

Structural Violence and Health-Related Outcomes in Europe: A Descriptive Systematic Review.

In recent years, there has been a revival of the term "structural violence (SV)" which was coined by Johan Galtung in the 1960s in the context of Peace Studies. "Structural violence" refers to social structures-economic, legal, political, religious, and cultural-that prevent individuals, groups and societies from reaching their full potential. In the European context, very few studies have investigated health and well-being using an SV perspective. Therefore, this paper sought to systematically and descriptively review studies that used an SV framework to examine health-related outcomes across European countries. The review included two studies each from Spain and France, one each from the UK, Ukraine and Russia, and another study including the three countries Sweden, Portugal and Germany. With the exception of one mixed-method study, the studies used a qualitative design. Furthermore, the eight studies in the review used different conceptualizations of SV, which indicates the complexity of using SV as a concept in public health in the European context. Future research that attempts to identify and standardize measures of SV is needed; the knowledge gained is hoped to inform appropriate interventions aiming to reduce the effects of SV on population health.

Lifelong learning and nurses' continuing professional development, a metasynthesis of the literature.

BACKGROUND: Continuing professional development (CPD) is central to nurses' lifelong learning and constitutes a vital aspect for keeping nurses' knowledge and skills up-to-date. While we know about the need for nurses' continuing professional development, less is known about how nurses experience and perceive continuing professional development. A metasynthesis of how nurses experience and view continuing professional development may provide a basis for planning future continuing professional development interventions more effectively and take advantage of examples from different contexts. The aim of this paper is to conduct such a metasynthesis, investigating the qualitative research on nurses' experiences of continuing professional development. METHODS: A metasynthesis of the qualitative literature was conducted. A total of 25 articles fulfilled the inclusion criteria and were reviewed. RESULTS: We determined five overarching themes, Organisational culture shapes the conditions, Supportive environment as a prerequisite, Attitudes and motivation reflect nurse's professional values, Nurses' perceptions of barriers and Perceived impact on practice as a core value. This metasynthesis highlights that nurses value continuing professional development and believe that it is fundamental to professionalism and lifelong learning. Moreover CPD is identified as important in improving patient care standards. CONCLUSIONS: Based on the metasynthesis, we argue that access to continuing professional development could be made more attainable, realistic and relevant. Expediently, organizations should adequately fund and make continuing professional development accessible. In turn, nurses should continue to actively engage in continuing professional development to maintain high standards of nursing care through competent practice. This paper highlights the perceived benefits and challenges of continuing professional development that nurses face and offers advice and understanding in relation to continuing professional development. We believe that this metasynthesis contributes with insights and suggestions that would be valuable for nurses and policy makers and others who are involved in nurse education and continuing professional development.

Clinical quantitative MRI and the need for metrology.

MRI has been an essential diagnostic tool in healthcare for several decades. It offers unique insights into most tissues without the need for ionising radiation. Historically, MRI has been predominantly used qualitatively, images are formed to allow visual discrimination of tissues types and pathologies, rather than providing quantitative measurements. Increasingly, quantitative MRI (qMRI) is also finding clinical application, where images provide the basis for physical measurements of, e.g. tissue volume measures and represent aspects of tissue composition and microstructure. This article reviews some common current research and clinical applications of qMRI from the perspective of measurement science. qMRI not only offers additional information for radiologists, but also the opportunity for improved harmonisation and calibration between scanners and as such it is well-suited to large-scale investigations such as clinical trials and longitudinal studies. Realising these benefits, however, presents a new kind of technical challenge to MRI practioners. When measuring a parameter quantitatively, it is crucial that the reliability and reproducibility of the technique are well understood. Strictly speaking, a numerical result of a measurement is meaningless unless it is accompanied by a description of the associated measurement uncertainty. It is therefore necessary to produce not just estimates of physical properties in a quantitative image, but also their associated uncertainties. As the process of determining a physical property from the raw MR signal is complicated and multistep, estimation of uncertainty is challenging and there are many aspects of the MRI process that require validation. With the clinical implementation of qMRI techniques and its continued expansion, there is a clear and urgent need for metrology in this field.

Corporate social responsibility and internal stakeholders' health and well-being in Europe: a systematic descriptive review.

Corporate social responsibility (CSR) can contribute to the triple bottom line of economic, social and environmental performance in organizations. However, the relationship between CSR, employee health and well-being has not been frequently assessed despite an increased awareness that this relationship can contribute to sustainable workplaces. To identify studies addressing the relationship between CSR and employee health and well-being within the EuCIropean context, we conducted a systematic literature search using Web of Science and Medline. Of the 60 articles screened for inclusion, 16 were retained. The results suggest that the majority (n = 14) of the identified studies aimed to understand the impact of CSR strategies on employees' job satisfaction. None of the studies investigated the relationship between internal CSR and physical health. There was no clarity in the measurement of either internal CSR or the extent to which it affected employee outcomes. There is a need for consensus on measurement of internal CSR and of the health and well-being-related outcomes. Public health and occupational health researchers should be part of the discussion on the potential role of CSR in physical and psychological health outcomes beyond job satisfaction.

You say it, we say it, but how do we use it? Communities of practice: A critical analysis.

OBJECTIVES: As educational theories are increasingly used in medical education research there are concerns over how these theories are used, how well they are presented and what the authors intend. Communities of practice (CoP) is one example of an often-used theory and conceptual framework. This paper presents a critical analysis of how CoP theory is used in medical education research. METHODS: A critical literature analysis was undertaken of articles published between 1998 and 2018 in eight internationally recognised medical education journals. From a total of 541 articles, 80 articles met the inclusion criteria and were analysed and mapped according to various patterns of use. RESULTS: We discerned five categories of use, two misleading and cosmetic, off target and cosmeticising, and three functional, framing, lensing and transferring. A considerable number of articles either misrepresented the point of communities of practice or used it in a cosmetic fashion. The remainder used the theory to frame an ongoing study in relation to other work, as a lens through which to design the study and collect or analyse data, or as a way of discussing or demonstrating the transferability of the findings. CONCLUSIONS: We conclude that almost half of the reviewed articles did not offer a functional and rigorous definition of what is meant by CoP; instead, they used it in a potentially misleading or cosmetic manner. This study therefore calls on editors, reviewers and authors alike to increase clarity and quality in the application of CoP theory in medical education.

Fiducial markers visibility and artefacts in prostate cancer radiotherapy multi-modality imaging.

BACKGROUND: In this study, a novel pelvic phantom was developed and used to assess the visibility and presence of artefacts from different types of commercial fiducial markers (FMs) on multi-modality imaging relevant to prostate cancer. METHODS AND MATERIALS: The phantom was designed with 3D printed hollow cubes in the centre. These cubes were filled with gel to mimic the prostate gland and two parallel PVC rods were used to mimic bones in the pelvic region. Each cube was filled with gelatine and three unique FMs were positioned with a clinically-relevant spatial distribution. The FMs investigated were; Gold Marker (GM) CIVCO, GM RiverPoint, GM Gold Anchor (GA) line and ball shape, and polymer marker (PM) from CIVCO. The phantom was scanned using several imaging modalities typically used to image prostate cancer patients; MRI, CT, CBCT, planar kV-pair, ExacTrac, 6MV, 2.5MV and integrated EPID imaging. The visibility of the markers and any observed artefacts in the phantom were compared to in-vivo scans of prostate cancer patients with FMs. RESULTS: All GMs were visible in volumetric scans, however, they also had the most visible artefacts on CT and CBCT scans, with the magnitude of artefacts increasing with FM size. PM FMs had the least visible artefacts in volumetric scans but they were not visible on portal images and had poor visibility on lateral kV images. The smallest diameter GMs (GA) were the most difficult GMs to identify on lateral kV images. CONCLUSION: The choice between different FMs is also dependent on the adopted IGRT strategy. PM was found to be superior to investigated gold markers in the most commonly used modalities in the management of prostate cancer; CT, CBCT and MRI imaging.

A Free Virtual Reality Experience to Prepare Pediatric Patients for Magnetic Resonance Imaging: Cross-Sectional Questionnaire Study.

BACKGROUND: A magnetic resonance image (MRI) is a diagnostic test that requires patients to lie still for prolonged periods within a claustrophobic and noisy environment. This can be difficult for children to tolerate, and often general anesthetic (GA) is required at considerable cost and detriment to patient safety. Virtual reality (VR) is a newly emerging technology that can be implemented at low cost within a health care setting. It has been shown to reduce fear associated with a number of high-anxiety situations and medical procedures. OBJECTIVE: The goal of the research was to develop a VR resource to prepare pediatric patients for MRI, helping to reduce anxieties in children undergoing the procedure. METHODS: A freely accessible VR preparation resource was developed to prepare pediatric patients for their upcoming MRI. The resource consists of an app and supporting preparation book and used a series of panoramic 360 degree videos of the entire MRI journey, including footage from within the bore of the scanner. The app, deployed via the Android Play Store and iOS App Store, can be viewed on most mobile phones, allowing a child to experience an MRI in VR using an inexpensive Google Cardboard headset. The app contains 360 degree videos within an animated, interactive VR interface designed for 4 to 12-year-olds. The resource was evaluated as part of a clinical audit on 23 patients (aged 4 to 12 years), and feedback was obtained from 10 staff members. In 5 patients, the resource was evaluated as a tool to prepare patients for an awake MRI who otherwise were booked to have an MRI under GA. RESULTS: The VR preparation resource has been successfully implemented at 3 UK institutions. Of the 23 patients surveyed, on a scale of 1 to 10, the VR resource was rated with a median score of 8.5 for enjoyment, 8 for helpfulness, and 10 for ease of use. All patients agreed that it made them feel more positive about their MRI, and all suggested they would recommend the resource to other children. When considering their experiences using the resource with pediatric patients, on a scale of 1 to 10, the staff members rated the VR resource a median score of 8.5 for enjoyment, 9 for helpfulness, and 9 for ease of use. All staff believed it could help prepare children for an awake MRI, thus avoiding GA. A successful awake MRI was achieved in 4 of the 5 children for whom routine care would have resulted in an MRI under GA. CONCLUSIONS: Our VR resource has the potential to relieve anxieties and better prepare patients for an awake MRI. The resource has potential to avoid GA through educating the child about the MRI process.

Twelve tips for conducting qualitative research interviews.

The qualitative research interview is an important data collection tool for a variety of methods used within the broad spectrum of medical education research. However, many medical teachers and life science researchers undergo a steep learning curve when they first encounter qualitative interviews, both in terms of new theory but also regarding new methods of inquiry and data collection. This article introduces the concept of qualitative research interviews for novice researchers within medical education, providing 12 tips for conducting qualitative research interviews.

Modelling Feedback in Virtual Patients: An Iterative Approach.

Virtual Patients (VPs) offer learners the opportunity to practice clinical reasoning skills and have recently been integrated in Massive Open Online Courses (MOOCs). Feedback is a central part of a branched VP, allowing the learner to reflect on the consequences of their decisions and actions. However, there is insufficient guidance on how to design feedback models within VPs and especially in the context of their application in MOOCs. In this paper, we share our experiences from building a feedback model for a bladder cancer VP in a Urology MOOC, following an iterative process in three steps. Our results demonstrate how we can systematize the process of improving the quality of VP components by the application of known literature frameworks and extend them with a feedback module. We illustrate the design and re-design process and exemplify with content from our VP. Our results can act as starting point for discussions on modelling feedback in VPs and invite future research on the topic.

Promoting international collaboration and creativity in doctoral students.

Staff from the Mayo Clinic in the US and the Karolinska Institute in Sweden describe a joint transatlantic course intended to broaden the horizons of the next generation of researchers in the field of regenerative medicine.

Virtual Patients in a Behavioral Medicine Massive Open Online Course (MOOC): A Qualitative and Quantitative Analysis of Participants' Perceptions.

OBJECTIVE: The purpose of this article is to explore learners' perceptions of using virtual patients in a behavioral medicine Massive Open Online Course (MOOCs) and thereby describe innovative ways of disseminating knowledge in health-related areas. METHODS: A 5-week MOOC on behavioral medicine was hosted on the edX platform. The authors developed two branched virtual patients consisting of video recordings of a live standardized patient, with multiple clinical decision points and narration unfolding depending on learners' choices. Students interacted with the virtual patients to treat stress and sleep problems. Answers to the exit survey and participant comments from the discussion forum were analyzed qualitatively and quantitatively. RESULTS: In total, 19,236 participants enrolled in the MOOC, out of which 740 received the final certificate. The virtual patients were completed by 2317 and 1640 participants respectively. Among survey respondents (n = 442), 83.1% agreed that the virtual patient exercise was helpful. The qualitative analysis resulted in themes covering what it was like to work with the virtual patient, with subthemes on learner-centered education, emotions/eustress, game comparisons, what the participants learned, what surprised them, how confident participants felt about applying interventions in practice, suggestions for improvement, and previous experiences of virtual patients. CONCLUSIONS: Students were enthusiastic about interacting with the virtual patients as a means to apply new knowledge about behavioral medicine interventions. The most common suggestion was to incorporate more interactive cases with various levels of complexity. Further research should include patient outcomes and focus on interprofessional aspects of learning with virtual patients in a MOOC.