Shortage specialties: changes in career intentions from medical student to newly qualified doctor

There is currently a shortage of doctors in Britain, especially in general practice, psychiatry and pathology. This study aimed to examine whether career intention, especially in the shortage specialties, changes between undergraduate level and graduation. The 234 participants were Senior House Officers and Pre-Registration House Officers, who had provided information about their career intentions in their fourth year of medical school. Participants completed a postal questionnaire about their current career intentions. 38.9% of medical students rising to 63.3% of doctors definitely intended to pursue a particular specialty. While the numbers of people who definitely wanted to pursue general practice and psychiatry increased, in line with nearly all other specialties, the overall attractiveness of these shortage specialties fell. Early career advice and support during medical school and immediately after graduation may help doctors to be confident in pursuing shortage specialties to which they were originally attracted.     

Developing and evaluating ambulatory care: problem-based learning cases

Medical educators have raised concerns about the quality of teaching and learning in busy ambulatory care settings. Problem-based learning (PBL), which allows students to learn to diagnose and manage common ambulatory care problems as they discuss patients away from the clinical setting, is one possible solution for addressing these concerns. This article describes a process for developing realistic and well-written PBL cases for an ambulatory care clerkship. The process details specific steps for writing and evaluating cases to ensure they contain relevant learning issues students often encounter in outpatient training sites. Faculty at other institutions can adapt this process to develop and evaluate PBL cases reflecting the common presenting problems and patient issues at their sites.     

Evaluating an instrument for the peer review of inpatient teaching

The purpose of this study was to assess an instrument for the peer review of inpatient teaching at Mayo. The Mayo Teaching Evaluation Form (MTEF) is an instrument, based on the Stanford seven-category educational framework, which was developed for the peer review of inpatient teaching. The MTEF has 28 Likert-scaled items derived from the Stanford Faculty Development Program form (SFDP-26), the Mayo electronic evaluation form and three additional items. In this study three physician-evaluators used the MTEF to evaluate 10 attending physicians on the Mayo general internal medicine hospital services. Cronbach's alphas were used to assess the internal consistency of the MTEF, and Kendall's coefficient of concordance was used to summarize the inter-rater reliability. Results of this study reveal that the MTEF is internally consistent, based on average ratings across all evaluators (Cronbach's alpha=0.894). Stanford categories with the highest alphas are Self-Directed Learning, Learning Climate, Communication of Goals, and Evaluation. Categories with lower alphas are Feedback, Understanding and Retention, and Control of Teaching Session. Additionally, the majority of items on the MTEF show significant agreement across all evaluators, and teacher enthusiasm was among the most reliable items. In conclusion, the MTEF is overall internally consistent for the peer review of inpatient teaching at Mayo. Hence, the MTEF may be a useful element in the peer evaluation of teaching at our institution.     

Medical students' experiences of diseases in internal medicine in university and community hospitals

Because medical students in The Netherlands should achieve common national objectives, it is important to know whether clinical experiences in different hospitals are comparable. The research questions were: (1) Do students achieve learning experiences of the required diseases during the internship in Internal Medicine and to what extent do they achieve these experiences? (2) Are there differences between the diseases experienced at a university hospital and at community hospitals? Completed logbooks of students were analysed; the percentage of students that achieved the required diseases and the mean number of experiences of diseases were calculated. A t-test was done to test for differences. Medical students in the university and in community hospitals get broad experience (76-131%) of the required diseases. In both hospitals there are many students who are not achieving the requirements, but the mean number of experiences of students at the community hospitals is higher than those at the university hospital. To eliminate the differences between students from the university hospital and the community hospitals, the educational programmes within both hospitals should be adjusted.     

Sleeping like a baby: attitudes and experiences of bedsharing in northeast England

This paper reports findings from a study that investigated infant care practices in a small population of Northeast England in order to determine whether parent-infant bedsharing is common parenting behavior. In a year-long prospective study we examined the opinions and practices of parents with regard to their infants' nighttime sleeping strategies before and after the birth of their babies. Results confirm that parents pursue a heterogeneous array of nighttime parenting strategies and that 65 percent of the sample had actually bedshared. Parents with no previous intention to do so slept with their babies for a variety of reasons. One of this study's most important findings is that babies were being brought into bed with both parents. Ninety five percent of the bedsharing infants slept with both mother and father. This study has shown that bedsharing is a relatively common parenting practice. Despite initial worries and fears, mainly concerning overlaying, some parents found bedsharing an effective option yet were covert in their practices, fearing the disapproval of health professionals and relatives.     

Bioethics and deliberative democracy: five warnings from Hobbes

Thomas Hobbes is one of the most ardent and thoroughgoing opponents of participatory democracy among Western political philosophers. Though Hobbes's alternative to participatory democracy-assent by subjects to rule by an absolute sovereign-no longer constitutes a viable political alternative for Westerners, his critique of participatory democracy is a potentially valuable source of insight about its liabilities. This essay elaborates five theses from Hobbes that stand as cogent warnings to those who embrace participatory democracy, especially those (such as most bioethicists) advocating for deliberative democracy based on a rational consensus model. In light of these warnings, the author suggests an alternative, modus vivendi approach to deliberative democracy that would radically alter the current practice of bioethics.     

Twelve tips for undertaking reflexive global health experiences in medicine

Background: While interest and opportunities for global health experiences (GHE) continue to grow, the preparation of students and health professionals alike to engage in these GHEs remains limited.

Aims: This article provides tips for reflexivity prior to undertaking a GHE and suggests ways to debrief the experience in order to ensure that trainees and professionals that engage in GHEs can both help their intended communities and also get the most out of the experience.

Methods: The authors conducted a scoping review using Medline, PubMed and Google scholar using searching the terms: global health, global health experience, global health research, and international medical elective. We supplemented this search with our own experiences working with international partners.

Conclusions: GHEs should be undertaken with reflexivity prior to, during and subsequent to the experience in order to ensure that all collaborators in the partnership meet their intended goals.     

Mutual mentoring: Effect on faculty career achievements and experiences

Abstract

Introduction: In an ever-changing academic environment, the traditional model of one senior mentor is no longer sufficient to provide faculty with the interdisciplinary perspective needed for success. We adapted, implemented and examined an interschool/interprofessional Mutual Mentoring Program.

Methods: Participants were expected to expand their mentoring networks, formulate career goals and achievement plans, and, achieve concrete career goal(s). Participants were offered a 1-year mentoring network grant. To examine short-term outcomes, we collected participants’ lists of contacts and accomplished goals, and asked for immediate feedback on the program. To examine intermediate outcomes, we conducted 30-min interviews with participants after 1 year of participation. We used quantitative and qualitative approaches to analyze the data from four program cohorts.

Results: Thirty-seven faculty participated throughout the four academic years. Participants reported 260 contacts made, and achieved goals related to academic products and outcomes. Eleven participants were interviewed and highlighted professional achievements, the power of the established networks, gained career resources, and the accomplishment of significant personal changes.

Conclusions: This approach provides the type of multiple mentoring support that is necessary for today’s academic climate for faculty to obtain their career goals, to demonstrate the institutional commitment to faculty success and to provide avenues for interdisciplinary connections.     

Flexible teaching for inflexible schedules: an online resident curriculum in acute ambulatory care

The authors report on a work in progress: a web-based curriculum for residents working shifts, addressing management of common acute outpatient problems. All components of the curriculum are available online, and residents may complete modules and submit tests at a time and from any location. There are few reports of web-based curricula in postgraduate training. Our interactive model avoids scheduling conflicts, is easily updated, encourages self-directed earning and facilitates resident assessment.     

Student participation in the development of interprofessional education courses: Perceptions and experiences of faculty members and the students

Abstract

Introduction: Student participation has shown positive effects on the curriculum development process for a single health profession. This qualitative study explores faculty members’ and students’ perceptions and experiences regarding student participation in interprofessional course development.

Methods: Interprofessional courses were developed and implemented by interprofessional teams of faculty members and students. Two focus group discussions were carried out: one with faculty members and one with students.

Results: Students contributed to both the process and the results of interprofessional course development in a complementary manner. Student participation was facilitated via motivation for and through work on interprofessional education, a balance between clarity on tasks and students’ autonomy, and a low-hierarchy team atmosphere. Students developed professionally, and faculty members saw them as future ambassadors for interprofessional collaboration.

Conclusions: This study provides multiple qualitative evidence for a positive, complementary role of student participation in interprofessional course development. A number of factors were identified that should be nurtured to facilitate this effect. Our findings may stimulate and guide other schools to actively involve students in the development of interprofessional education.