How a community-engaged therapeutic garden immersion shapes rural intentions among medical students and strengthens student-community partnerships.

Despite strong evidence of the benefits, Sweden has limited access to midwifery continuity of care (MCoC), particularly in rural areas. There is a knowledge gap regarding how MCoC would function in a rural Swedish context. Therefore, this study aimed to explore midwives' personal and professional views on a MCoC model and its implementation within a rural context in northern Sweden. A qualitative interview study using reflexive thematic analysis. Semi-structured interviews were conducted with fourteen midwives working in maternity care. The findings revealed a notable duality to MCoC, consisting of two major themes. In the first theme, 'Internal conditions of midwifery', midwives reported that working in a MCoC model would offer fulfillment but also present significant challenges, which they did not feel prepared to meet. Establishing a relationship of mutual trust with pregnant women emerged as a major positive aspect. The second theme, 'The impact of external forces', highlighted significant challenges, including organisational issues, staffing shortages, and concerns regarding work-life balance. Interprofessional collaboration and rural adaptation were considered key if the implementation of the model is to go ahead. For MCoC to succeed in rural Sweden, it is essential to have a supportive organisation that recognises the benefits of the model, and provides midwives with working conditions that meet their professional and personal needs. Involving midwives in the model's design, fostering interprofessional collaboration, and tailoring the model to rural settings are equally important. Addressing organisational challenges is crucial for establishing a functional and sustainable model.

Major documented disparities exist in health equity between individuals living in rural and metropolitan areas. Recruiting and retaining doctors in rural areas remains a considerable challenge. Students' exposure to rural experiences facilitates their development of professional identities aligned to this specific community of practice. Although previous studies have explored medical students' identity development in rural settings, a comprehensive picture of the development of medical students' professional identities in rural settings is yet to be established. Our study aims to address this, and as such, a scoping review was conducted to map the existing literature in this area. Our review follows the Joanna Briggs Institute methodology, with reporting being guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. We searched MEDLINE, Embase, Web of Science and PsycINFO databases. We use inductive thematic analysis to synthesise the evidence with reference to the review questions. We present our results based on our developed framework. We identified 1085 publications with 20 fully meeting the inclusion criteria. The majority of included studies were published in the last 9years, originating from Australia, South Africa and the United States. These are based on voluntary rural medical placements, with the commonest placement duration being 12 months. Included publications predominantly use qualitative methodologies, most commonly individual and/or group interviews. Only two of the included studies use an approach informed by established theories of identity development. We used inductive thematic analysis of the included studies, identifying three related themes: Acting Up, Rural Community and Feeling of Fit. Fewer than half of the included studies referenced students' future intention to practice rurally, and no paper specifically examined an association between students' professional identity and intention to practice rurally. It is a core remit of medical education to include professional identity as a key outcome. In a rural context, understanding the role that professional identity plays in medical students' future career choices may be key to understanding workforce maldistribution. Existing medical student identities research tends to lack theoretical grounding and alignment; subsequently failing to comprise a homogenous body of literature essential for facilitating our comprehensive understanding of professional identity, which is necessary for advancements within this field.

This symposium intends to broaden our understanding of individuals’ identity work within organizations by focusing on new sources and means of social influence. The burgeoning identity work literature has provided a rich understanding of how individuals in one’s immediate work environment – such as group members and superiors - affect identity work processes. In particular, this research illuminates how others contribute to identity formation, presentation, and maintenance. This symposium expands upon this scholarly work by (1) investigating additional sources of social influence within and outside of professional settings and (2) exploring how these social factors both contribute to and complicate identity work. For example, while mentors within an organization may be important for providing social feedback and serving as role models, influential figures outside of work may shape professional identity formation as well. Moreover, these myriad individuals may occasionally hinder identity work processes, such as when social feedback casts doubt on an aspirational identity. The combination of beneficial and detrimental influences from a variety of social forces creates a more complex, yet comprehensive, understanding of professional identity work. Collectively, the papers in this symposium expand the scholarly conversation in identity by illuminating how these less understood forms of social influence both enable and inhibit professional identity work and overall career advancement. Threat or Opportunity? Pathways of Leader Identity Development Presenter: Catarina R. Fernandes; Harvard U. Presenter: Lakshmi Ramarajan; Harvard U. Presenter: N Andrew Cohen; The George Washington U. Identity Work Within and Beyond the Professions: Toward a Theoretical Integration and Extension Presenter: Douglas A Lepisto; Boston College Presenter: Eliana Crosina; Boston College Presenter: Michael G. Pratt; Boston College Manufacturing Self-Authenticity: A Reflexive Process of Crafting Authenticity at Work Presenter: Beth A. Devine; INSEAD Presenter: Jennifer Louise Petriglieri; INSEAD Approach and Avoidance: How Parental Role Models Influence Professional and Family Identity Work Presenter: Rachel D. Arnett; Harvard U. Presenter: Robin Ely; Harvard U. Presenter: Kathleen L. McGinn; Harvard U.

BackgroundThe prevalence of COVID-19 highlights the shortage of human medical resources, and improving medical students' professional identity is crucial to improving this situation. The sources of confidence in overcoming COVID-19 and medical students' attention to COVID-19 were significant factors affecting their professional identity. However, no study has investigated the mediating role of medical students' attention to COVID-19 in their relationship. This study investigates the relationship between these three factors in three medical university students in Hunan Province.MethodsA cross-sectional survey study that used convenience sampling method was conducted on 2775 medical students from three universities in the Hunan Province of China from March 15 to April 19, 2020. An intermediary model was established to evaluate the role of medical students' attention to COVID-19 in the sources of confidence in overcoming COVID-19 and the improvement of medical students' professional identity.ResultsThe sources of confidence in overcoming COVID-19, medical students' attention to national crisis events, and the improvement of medical students' professional identity was positively associated with each other (β = 0.328 ~ 0.464, P < 0.001). The mediating effect accounted for 23.3% of the total effect and 30.4% of the direct effect. Medical students' attention to COVID-19 partially mediates the relationship between the sources of confidence to overcome COVID-19 and the improvement of medical students' professional identity.ConclusionsThis study found that the sources of confidence in overcoming COVID-19 and medical students' attention to national crisis events have a significant predictive effect on the improvement of medical students' professional identity. Medical students' attention to COVID-19 mediated the relationship between the sources of confidence to overcome COVID-19 and the improvement of medical students' professional identity. The findings have emphasized the theoretical and practical significance of professional identity education for medical students.

BackgroundAlthough interprofessional practice (IPP) offers the potential to enhance rural health services and provide support to rural clinicians, IPP may itself be problematic due to workforce limitations and service fragmentation. Differing socioeconomic and geographic characteristics of rural communities means that the way that IPP occurs in rural contexts will necessarily differ from that occurring in metropolitan contexts. The aim of this study was to investigate the factors contributing to effective IPP in rural contexts, to examine how IPP happens and to identify barriers and enablers.MethodsUsing Realistic Evaluation as a framework, semi-structured interviews were conducted with health professionals in a range of rural healthcare contexts in NSW, Australia. Independent thematic analysis was undertaken by individual research team members, which was then integrated through consensus to achieve a qualitative description of rural IPP practice.ResultsThere was clear evidence of diversity and complexity associated with IPP in the rural settings that was supported by descriptions of collaborative integrated practice. There were instances where IPP doesn’t and could happen. There were a number of characteristics identified that significantly impacted on IPP including the presence of a shared philosophical position and valuing of IPP and recognition of the benefits, funding to support IPP, pivotal roles, proximity and workforce resources.ConclusionsThe nature of IPP in rural contexts is diverse and determined by a number of critical factors. This study goes some of the way towards unravelling the complexity of IPP in rural contexts, highlighting the strong motivating factors that drive IPP. However, it has also identified significant structural and relational barriers related to workload, workforce, entrenched hierarchies and ways of working and service fragmentation. Further research is required to explicate the mechanisms that drive successful IPP across a range of diverse rural contexts in order to inform the implementation of robust flexible strategies that will support sustainable models of rural IPP.

Space, place, and the politics of access: Service provider perspectives on health system responses to sexual- and gender-based violence in rural communities.

Beginning teachers' professional identity work and its support

Introduction Professional Identity Formation represents an ongoing process of negotiation among Professional Identities. Graduate Medical Educators regularly negotiate among multiple PIs (e.g. clinician, teacher, researcher, leader). We set out to understand how Clinician Educators realized that they had “arrived”, which is to say become a core member of their Clinician Educator community, and how, if at all, did the core member identity affect how they presented in their professional lives? Methods We used reflexive thematic analysis with Communities of Practice as a sensitizing construct. Semi-structured interviews were conducted among clinician educators in Graduate Medical Education. Participants were recruited using the snowball method from among faculty who currently hold or previously held positions of leadership within Graduate Medical Education. Results Four themes emerged from our inductive coding: Clinical Educators “Triple Threat”; External Validation of Belonging; Release from Constraint; and Renegotiating Identity Relationships. Conclusion Clinician educators’ experience of “arriving” as core members of Clinician Educator Communities of Practice provides a window into what facilitates a sense of belonging in these communities. Additionally, these findings shed light on how achieving this milestone alters the valence of a range of professional identities as well as claims to the clinician educator identity. This understanding offers a range of tools to encourage active members of a Community of Practice towards full participation as core members. By assuring a sense of belonging within Clinician Educator Communities of Practice, we can release creative and dynamic energy to the benefit of the community and of learners alike.

New Zealand (NZ) faces an ongoing shortage of rural medical professionals. In an effort to increase interest in rural practice, both of the medical schools in NZ offer rural immersion programs as well as rural entry pathways. The aim of this study was to compare the effect of long (>33-week) rural immersion with a short (5-week interprofessional) rural immersion or no rural immersion on the career location intentions of NZ medical students. This observational study used linked data from the Commencing Medical Students Questionnaire (CMSQ) and Exit Questionnaire (EQ), collected between 2011 and 2017 as part of the Medical Schools Outcomes Database project, along with information on whether or not a student undertook a rural immersion program. The main outcome measure was EQ career location intention (Rural (population 100 000)). The explanatory variables were rural immersion (long, short, none), age, ethnicity, background, CMSQ career location intention, gender, specialisation preferences and interest in rural medicine. In addition to univariate analysis, data were used to build a multinomial model to determine relative associations of these variables with the outcome. Full data were available for 1367 NZ medical students (47% of all students during the time period). Of these, 17.4% had undertaken a long or short rural immersion program. In univariate analysis, age was the only variable that did not significantly predict EQ rural intention outcome. In the multivariate model, rural immersion was a significant independent predictor of EQ career location intention. Students taking a long rural immersion were 6.4 and 4.4 times more likely to select a Rural or Regional intention, respectively, than those with no rural immersion. This strong effect on rural intentions was seen regardless of background. CMSQ career location intention, background, ethnicity, rural club membership and preference for general practice were also significant predictors. While short rural immersion did not have an independent effect, this finding should be interpreted with caution given the smaller number of students and the response rate. Long rural immersion is highly beneficial for increasing interest in rural work, increasing the likelihood that medical students will intend to work outside an urban setting. Students who signal an early rural intention are strong candidates for such programs later in their course, regardless of their background. A three-category classification for geographic background and career location intention permitted a more detailed understanding of the interplay among demographic variables and rural immersion in influencing career intentions. Following cohorts into their postgraduate years is needed to ascertain if these career location intentions persist.

This study explores the impact of the coronavirus pandemic on teaching practices and teacher-learner professional relationships in a rural school context, examining the lived experiences of teachers. The teaching practices that rural context teachers used prior to the COVID-19 pandemic and those they employed during the lockdown begun in March 2020 when schools shut down are examined. Framed by the Hargreaves (2001) conceptual framework of emotional geographies, this study illuminates the subjective experiences of teachers in rural geographical contexts. The study adopted a qualitative approach, grounded within interpretive paradigm and using case study research design. Semi-structured interviews and collages were used as data generation method. A total of eight teachers (four from each school) were sampled to participate in the study. The deductive approach was best suited to analyse the data. The findings of study suggest that teachers in rural context schools adopted various teaching practices during the COVID-19 pandemic, primarily embracing online teaching methods and using social platforms to distribute learning materials. However, these adopted practices encountered significant challenges including limited internet connectivity, teachers' insufficient ICT skills, and the overarching digital divide posed formidable obstacles, impeding the sustained effectiveness of these methods. These challenges worsened the existing disparities in access to education between rural and urban areas. The findings also indicate that the impact of teaching practices amidst the COVID-19 pandemic on the professional relationship between teachers and learners in rural context schools revealed predominantly negative outcomes. It came out from the findings that the lack of communication due to contextual factors strained professional relationships significantly. Furthermore, the introduction of a rotation timetable created emotional voids for teachers, hindering their ability to deliver academic content and maintain previous interaction levels with learners. COVID-19 restrictions prevented teachers from offering pastoral care or engaging in non-curricular discussions, diminishing the overall teacher-learner relationship. Disruptions caused by the pandemic hindered teachers' multifaceted roles, impeding their capacity to identify and address individual learner needs. The physical distance enforced by the pandemic limited teachers' ability to detect struggling learners, eroding the efficacy of a prior learner-centered and interactive teaching approach. This led to emotional strain on teachers, underscoring the importance of a deeper connection beyond curriculum delivery. Contrary to assumptions, emotional bonds couldn't compensate for physical distance, impacting the professional relationships between teachers and learners adversely and leaving teachers questioning their teaching purpose amidst this perplexing period.

In recent years, migration it has significantly increased due to political conflicts, economic instability, and environmental crisis. In migrant reception centers, interdisciplinary collaboration is essential. However, professionals face complex challenges, such as systemic barriers, fragmented services, bureaucratic inefficiencies, and a lack of culturally competent training, particularly in rural contexts where resources are limited. Understanding how professionals navigate the complexities of their roles is crucial. The aim of this study is to explore the experiences of a multidisciplinary team involved in the reception of vulnerable migrants in a rural Italian reception center. A qualitative study with semi-structured interviews was conducted in April 2022 with professionals working in an Italian reception center. The interview questions focused on professionals' experiences, the strengths and challenges of their work, potential improvements to the reception process, the needs and requests reported by migrants, and the priority areas to address, recommended interventions. The data were analyzed using Automatic Analysis of Textual Data, allowing for the identification of latent dimensions and thematic clusters. Correspondence analysis basing on professionals working area, Hierarchical Discending Classification and Principal Component Analysis were conducted. The research report adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. The sample consisted of sixteen professionals, divided into three working areas: healthcare, social and organizational. Thematic clusters revealed distinct focuses: socioeducational support emphasized relational and emotional care, healthcare professionals addressed cultural barriers and clinical complexities, and organizational roles concentrated on systemic frameworks and sustainability. Two principal dimensions of care emerged: the cultural dimension of care, which integrates clinical, cultural, and symbolic aspects, and personalized systemic integration planning, highlighting the balance between immediate needs and long-term systemic strategies. The findings underscored the critical importance of interdisciplinary collaboration and culturally sensitive approaches in migrant care. Relational dynamics must be harmonized with systemic planning to address the diverse and evolving needs of beneficiaries. The study also highlights unique challenges in rural contexts, including resource limitations and geographic isolation, which require innovative and context-specific solutions. This study provides context-specific insights that may inform integrated care strategies in similar rural or resource-limited migrant settings. By emphasizing the interplay of cultural, clinical, and systemic dimensions, it offers a framework for improving health outcomes and fostering sustainable integration in both rural and global contexts. Future studies should explore these dynamics across diverse settings to further inform clinical practice, research, and policy development. Not applicable.

This article explores the impact of the working definition of social work practice first articulated almost one half century ago. Its influence on both beginning and advanced levels of practice is considered. This consideration is examined in the contexts of social work education and professional identity. The authors conclude that the working definition has assisted in the development of clear and consistent theory underpinning generalist social work practice. On the other hand, the authors conclude that it has weakened social work's professional identity, thus reducing social work practice effectiveness in the Canadian environment.

BackgroundDespite the emphasis on the uniqueness and educational importance of clinical clerkships in medical education, there is a lack of deep understanding of their educational process and outcomes. Especially due to an inherent trait of clinical clerkships which requires participation in the workplace outside the classroom, it is difficult to fully comprehend their educational potential using traditional learning perspectives such as imbibing outside knowledge. Accordingly, this study aims to explore the experiences of a rotation-based clerkship of medical school students from the perspective of social constructivism of learning, which can empirically examine what and how medical students learn during clinical clerkship in South Korea. By providing an insight into the workings of the clerkship process, this study contributes to a better understanding of how a learning-friendly environment can be cultivated at clinical clerkships.MethodsThe study utilized a basic qualitative study to understand what and how medical students learn during their clinical clerkships. Semi-structured, in-depth individual interviews were conducted with eight sixth-graders who had experienced a two-year clerkship at Ajou University Medical School. Data were analyzed based on Lave and Wenger’s situated learning theory and Wenger’s social theory in learning.ResultsWe found that the medical students had developed different aspects of their professional identities such as values, functionality, career decisions, sociality, and situating during their clinical clerkships. Further, professional identity was formed through a combination of participation and reification—the processes involved in the negotiation of meaning. This combination was facilitated by the students’ first experience and relationships with professors, classmates, and patients. Finally, non-learning occurred in the context of over-participation (learning anxiety and alienation) or over-reification (evaluation and e-portfolio).ConclusionsThis study revealed five sub-professional identities and their formation process from the learners’ perspective, thereby uncovering the unique learning characteristics and advantages of rotated-based clerkship and contributing to a further understanding of how gradual improvements can be made to the traditional clerkship education of medical students.

With high unemployment rates in South Africa, research into agribusiness entrepreneurship has become relevant. Despite their job creation dimension, agribusinesses are essential for realizing food security in both rural and urban contexts. The study aimed to explore the question: How do cultural elements affect small agribusiness entrepreneurship in rural areas? This question was prudent owing to the restrictions to open business that arose from the Covid-19 induced lockdowns and restricted movements. A rural context was the basis for the study taking note that in most rural areas in Africa, agricultural activity forms the backbone of socioeconomic life. The study followed the qualitative research approach based on the case study design of a selected rural community. The actual data collection method was based on two focus group discussions of the cultural elements that affect agribusiness entrepreneurship among members of the rural community. The findings show that culture is a strong determent of success agribusiness entrepreneurship in rural areas. Evidence collected pointed that the history of a community, family backgrounds as well as the external environment influences its culture which then affects agribusiness entrepreneurship in rural environments. These shape the beliefs, values, behaviour and values of a community. The apartheid era instilled psychological inhibitions such as the rejection of self-identities and the belief that self-employment is not possible among Blacks. It emerged that families influence the orientations of respondents especially through tales, stories and shared totems. The study shows that the external environment and its factors such as globalisation, technology and economic development also influence values, beliefs and agri-entrepreneurship behaviour.

Background Access to modern family planning methods is essential for African women to avoid repeated pregnancies, and the subsequent risk of maternal mortality, particularly in rural contexts. This study addressed the gap in access to family planning services for women living in a rural district of northern Tanzania. Objectives In this pilot study, we trained community health workers to educate couples, distribute condoms and oral contraceptives, and refer women and men for more advanced methods of family planning. The purpose of this study was to explore the views of community members, nurses, and policymakers to this project to improve access to modern family planning methods, to understand the barriers and solutions for accessing family planning services in this rural context. Methods Twenty focus group discussions were held separately with women, men, community health workers, nurses and policymakers (total 173 participants) from across the district. The focus group transcripts were subjected to a thematic analysis by the first author through repeated readings focusing on the barriers and solutions to accessing family planning services in Rorya District. Results The barriers to family planning access were most commonly negative male attitudes towards women using family planning methods. The community held myths regarding methods, institutional barriers impeding access and specific family planning method challenges were also problematic. Solutions focused on community health education, provider training, reliable supply of family planning methods in the community, and free access to these methods. Conclusion The community members, nurses and policymakers interviewed about this project agree that community health workers can successfully provide family planning education and basic methods to community members, and refer couples for more advanced methods. Challenges remain to ensure the supply of contraceptive methods is sustainable, and that male partners are engaged and supportive. The four pillars of a successful program in family planning are community-based health education, training of nurses in advanced methods, consistent supply of family planning methods and provision of free supplies to the population.