[Family and community medicine: The most chosen specialty in the MIR]. / Medicina familiar y comunitaria: la especialidad más elegida en el MIR.

Family and Community Medicine is the most offered and chosen specialty in the MIR (Spanish medical residency examination), however, every year its attractiveness is questioned due to not all offered positions being filled and a certain number of resident doctors deciding not to continue in this specialty once started. In this context, some of the proposals to address the problem focus on increasing the supply when the facts show that the challenge lies in addressing the demand by making the specialty and its professional scope more attractive. The problem and its determinants are analyzed in this context by focusing on four elements that may be influencing it: the vocational aspects of medical graduates who pursue specialization, the characteristics of the specialty program and the teaching units where training is carried out, the presence of family medicine in the university as a key element for knowledge and affinity to this specialty from undergraduate studies, and finally, the situation of primary care as the space where training is materialized and the priority setting for the professional practice of future specialists.

Learning experiences of first year graduate entry nursing students in New Zealand and Australia: a qualitative case study.

BACKGROUND: Graduate entry nursing programmes provide students with an accelerated pathway to becoming a registered nurse. Motivations for study, together with commonly shared characteristics of students enrolling in such programmes is becoming well documented, however, their experiences of studying for a professional qualification in this manner is less understood. As a means of maintaining the relevance of these fast-tracked programmes in the future, an understanding of graduate entry nursing students' experiences of academic teaching and clinical placements is imperative. OBJECTIVE: To explore the academic and clinical experiences of students enrolled in the first year of graduate entry nursing programmes in New Zealand and Australia. METHODS: A qualitative case study approach was taken. Here we report the experiences of nine students enrolled in their first year of a two-year graduate entry nursing programme during 2020. Semi-structured interviews were used for data collection and analysed using Braun and Clarke's thematic analysis. FINDINGS: Three overarching themes were developed-affirmation, reflections on expectations and clinical experiences. CONCLUSION: This study highlights the experiences of first year graduate entry nursing students, with many experiencing affirmation that their altruistic career visions came to fruition. The findings indicate that these graduate-entry nursing students interviewed for this study tended to be flexible and adaptable in their approach to study as a means of meeting the challenges of the programme, all of which are key characteristics for a registered nurse; with personal growth and the development of the self, providing preparation for their second year of study.

Exam prediction and the general Practice Registrar Competency Assessment Grid (GPR-CAG).

BACKGROUND: In GP training, identifying early predictors of poor summative examination performance can be challenging. We aimed to establish whether external clinical teaching visit (ECTV) performance, measured using a validated instrument (GP Registrar Competency Assessment Grid, GPR-CAG) is predictive of Royal Australian College of General Practitioners (RACGP) Fellowship examination performance. METHODS: A retrospective cohort study including GP registrars in New South Wales/Australian Capital Territory with ECTV data recorded during their first training term (GPT1), between 2014 and 2018, who attempted at least one Fellowship examination. Independent variables of interest included the four GPR-CAG factors assessed in GPT1 ('patient-centredness/caring', 'formulating hypotheses/management plans', 'professional responsibilities', 'physical examination skills'). Outcomes of interest included individual scores of the three summative examinations (Applied Knowledge Test (AKT); Key Feature Problem (KFP); and the Objective Structured Clinical Examination (OSCE)) and overall Pass/Fail status. Univariable and multivariable regression analyses were performed. RESULTS: Univariably, there were statistically significant associations (p < 0.01) between all four GPR-CAG factors and all four summative examination outcomes, except for 'formulating hypotheses/management plans' and OSCE score (p = 0.07). On multivariable analysis, each factor was significantly associated (p < 0.05) with at least one exam outcome, and 'physical examination skills' was significantly associated (p < 0.05) with all four exam outcomes. DISCUSSION: ECTV performance, via GPR-CAG scores, is predictive of RACGP Fellowship exam performance. The univariable findings highlight the pragmatic utility of ECTVs in flagging registrars who are at-risk of poor exam performance, facilitating early intervention. The multivariable associations of GPR-CAG scores and examination performance suggest that these scores provide predictive ability beyond that of other known predictors.

Design and implementation of a health systems science curriculum at a large teaching hospital.

BACKGROUND: Physicians must increasingly lead change for improvement in the value of health care for individuals and populations. Leadership, stewardship, and population health competencies are not explicitly part of the Accreditation Council for Graduate Medical Education (ACGME) requirements and are best appreciated in the context of Health Systems Science (HSS). HSS education is best approached at the institutional level, yet almost all graduate medical education (GME) curriculum is at the program level. We describe the process of designing and implementing an institutional HSS GME curriculum in a hospital-based sponsoring institution. METHODS: A group of diverse stakeholders drafted a curriculum to build competencies in leadership, stewardship, and population health, which was further refined by our Graduate Medical Education Committee (GMEC) and Resident Forum in the academic years 2015-2017. The refined curriculum was implemented at the institutional level of a large urban teaching hospital with over 80 ACGME accredited programs in the 2017-2018 academic year, participation was tracked and impact surveys were conducted. RESULTS: All programs participate in at least parts of the curriculum with sustained use. Annual surveys show a progression in assessment of our target competencies and/or opportunities to reflect and provide feedback. The annual program review meeting and GMEC meetings are used to troubleshoot and identify new curricular opportunities. CONCLUSION: This innovative institutional curriculum has been sustained for over four years and we believe that other training institutions with similar goals will find our experience implementing an institutional curriculum translatable to their clinical learning environment.

Academic integrity among medical students and postgraduate trainees in the teaching hospitals of South Punjab Pakistan.

This study investigated the topic of the academic integrity among medical students and postgraduate trainees in the teaching hospitals of South Punjab, Pakistan. A cross-sectional survey was conducted involving 318 medical students and postgraduate trainees of teaching hospitals. The results found that medical students of pre-clinical years engaged in unethical behaviour, that is, exam cheating and plagiarism to cope with internal and external evaluation and the range of subjects needed to be studied. For postgraduate trainees, results showed trainees unintentionally engaged in the practice of plagiarism due to lack of understanding about what constitutes plagiarism, coupled with externally perceived pressures associated with expectations of research publication, promotions and tenured positions. To address these concerns, it is recommended that information literacy sessions for undergraduate and postgraduate medical students on plagiarism prevention and ethical practice be designed and facilitated by medical librarians in collaboration of faculty members.

An evaluation of community placements for GP registrars in Yorkshire and the Humber: 'a home visit not to a patient but to the community'.

BACKGROUND: GP registrars are required to demonstrate capabilities in 'community orientation', reflecting skills in developing and working with services that respond to community needs. These skills have sometimes been seen as vague and difficult to obtain. In the Yorkshire and the Humber Deanery of Health Education England we developed a novel programme of community placements to overcome this. Registrars spent two half-days with a community organisation of their choosing, working in their practice area. AIM: To evaluate if and how community placements enabled registrars to develop capabilities in community orientation. METHODS: All registrars completing placements were invited to participate in the evaluation; 13 (7%) accepted. Semi-structured, face-to-face and telephone interviews explored registrars' perceptions and experiences of the programme. Interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS: The majority of participants reported that placements enabled them to attain a range of capabilities in community orientation. Registrars described an improved understanding of their practice community and the social determinants of health. Placements impacted their clinical practice by stimulating a holistic approach to the assessment and management of health needs. Our analysis described five key mechanisms for this learning: building confidence, building communities and networks of practice, gaining novel perspectives, generating a hunger for general practice and experiential learning. CONCLUSION: Community placements enabled GP registrars to attain capabilities in community orientation. Further research is required to determine the transferability of our findings and further evaluate mechanisms of learning through placements outside of training and their role in the development of professional practice.

Information behaviour of the millennial generation: a scoping review of medical residents and their use of social media.

BACKGROUND: Medical residents can offer ideas for new information services, as most of them are 'digital natives', although reviews of the use of social media in health care settings do not provide data on their information behaviour. OBJECTIVE: A scoping review aimed at providing a research map for the information behaviour of medical residents and their use of social media, listing the aspects of the information behaviour studied and the theories and methods used. METHODS: A search was carried out in pubmed, embase, cinahl and lisa in April of 2018, with the results limited to the period from 2010 onwards. RESULTS: Thirty-nine relevant articles from 38 different studies were identified. The presence and use of social media was the most researched aspect, followed by information sharing, the relationships established and, finally, the search for and use of information. These aspects are researched mainly from the point of view of doctor-patient interactions. Only one study incorporated a theory of its design. Surveys were the most frequently used method. CONCLUSION: Research does not delve into medical residents' information behaviour on social media, despite the residents themselves using these media (in the context of everyday life, at least). More research is required.

Telehealth and the Psychiatric Mental Health Nurse Practitioner: Beyond the COVID-19 Pandemic.

OBJECTIVE: Examine the advantages, disadvantages, and challenges of telehealth for the psychiatric mental health nurse practitioner (PMHNP) in practice and student education. Describe areas for future research and policy development regarding telehealth in PMHNP practice and training during and beyond the COVID-19 pandemic. METHODS: Review current evidence, standards of practice, and education for the PMHNP. RESULTS: Recent rapid pandemic-related shifts in utilization of telehealth for clinical practice and student education have highlighted the advantages, disadvantages, and areas in need of additional study. CONCLUSIONS: Postpandemic telehealth care delivery will likely persist or expand. PMHNPs must advocate for high practice and education standards.

What Do Nursing Students Tell Us About Their Communication With People With Mental Illness? A Qualitative Study.

BACKGROUND: Communication with individuals with mental disorder (IMDs) may often be a nonlinear, complex, and variable situation. In general, the first contact of nurses with IMDs occurs during training rotations at a psychiatric clinic. Psychiatric nursing students' initial communication experiences with IMDs may be critical to their thinking of psychiatric nursing as a career. AIM: To determine the communication experiences of psychiatric nursing students with IMDs. METHOD: A qualitative interview study was conducted with psychiatric nursing students studying at a nursing faculty in the east of Turkey in 2019 who completed the clinical practice. Semistructured interviews were conducted by an independent researcher. The data were analyzed using content analysis with an inductive approach. RESULTS: In this study, maximum effort was made for data saturation criteria, and data saturation was achieved with 26 students. As a result of the data analysis, four main themes and 11 categories were developed. The main themes were as follows: (1) restrictions caused by psychological barriers, (2) restrictions caused by thinking and perceptions, (3) restrictions caused by personal and behavioral barriers, and (4) effective communication and therapeutic environment. CONCLUSIONS: In this study, although it is seen that nursing students encounter many communication barriers with IMDs, it is an important development that they implement approaches to provide effective therapeutic communication. The results show the importance of effective nurse-patient communication skills as the first step in improving the clinical practice of nurses in psychiatry clinics.

The Development of Trauma and Resilience Competencies for Nursing Education.

BACKGROUND: Trauma and its consequences have been identified as a high-priority public health risk. A growing body of research reveals the devastating long-term consequences from common and widespread adverse events across the life span. In addition, recent research links medical procedures and medical illnesses with posttraumatic stress disorder. Nurses too are at risk and suffer vicarious trauma. Nurses must be able to recognize and assess for early trauma symptoms and assist in enhancing resilience in order to prevent and care for those with trauma. However, there is a lack of trauma-informed and trauma-specific training in nursing education. Given the ubiquity of traumatic events, the pervasive physical and emotional sequelae of trauma, and the existence of evidence-based treatment for trauma; there is a critical need to develop core competencies for nursing education and practice. AIM: The purpose of this study was to develop and validate Trauma and Resilience Competencies for Nursing Education. METHOD: An expert panel of 16 nurses met in 2018 to develop Trauma and Resilience Competencies for undergraduate and graduate nursing programs, and for psychiatric mental health nurse practitioner education. Following the Expert Panel's work and approval from the institutional review board, a modified e-Delphi survey was sent to experts in trauma and resilience to validate this work. RESULTS: The competencies were validated and edited to 88 competencies through two rounds of a Delphi survey. CONCLUSIONS: Implications for education, practice, and research are discussed. The Trauma and Resilience Competencies for Nursing Education will be disseminated widely through publications and are available online.