Professional Consequences Research Articles

Knowledge and Consequences of Violence Against Health Professionals in Southern Portugal

Background: Violence against health professionals is a global and growing problem, with significant impacts on the quality of care and the mental health of workers. Objectives: To analyze the level of knowledge, reporting practices and consequences of violence against health professionals in the Alentejo region (southern Portugal). Methods: This was an observational, cross-sectional study involving 440 health professionals (doctors and nurses). Data were collected using an online platform and a structured questionnaire created specifically for this study. In the statistical analysis, the data were described as counts and proportions and the X2 test was used considering a significance level of 0.05. Results: This study reveals that violence against health professionals in the southern region of Portugal is a frequent problem (40%), with a higher incidence among nurses (80%). Despite awareness of the existence and functioning of reporting channels, reporting is low (52%). The main causes are related to the health system, professionals and users. The consequences include mental health problems and a reduction in the quality of care provided. Suggested measures to combat violence include improving security, training and punishing aggressors. Conclusions: This study reveals that violence against health professionals in the southern region of Portugal is a frequent, under-reported problem with serious consequences for professionals and the quality of care.

Working on scorched earth: Contemporary risks of higher education leadership critique through autoethnography

ABSTRACT Organisational autoethnographers in higher education weave compelling stories to connect their personal experiences to phenomena, often to illuminate or challenge extant norms in the culture and leadership of universities. While much has been written about the strengths and limitations of this method, there are emerging risks that may be poorly understood. While some autoethnographies in higher education have already led to unfavourable professional consequences, the growing prevalence of non-disparagement clauses in higher education employment contracts and separation agreements, and the surge in civil defamation action in society more broadly, may pose significant risks for researchers in this space. This research article blends autoethnography with consideration of these emerging risks, and while there is a focus on implications for Australian academics, these risks are not unique to this context, holding international relevance. Scholars may need to liaise with university policy makers and legal professionals to develop a best practice model for autoethnography that can enable researchers to be open about their experiences without fear of reprisal. Where overarching codes, models or policies exist that have nationwide buy in, universities may need to be brought to account to engage more sincerely and comprehensively with them.

Social media "SoMe" in neuro-oncology: a review of the literature.

This article examines the current state of social media (SoMe) in neuro-oncology and neurosurgical oncology. The goal of this paper is to provide thorough discourse regarding benefits and disadvantages of being a neurosurgical oncologist on SoMe, while discussing the place SoMe will have in cranial tumor-based practices going forward. The author's performed a rigorous literature review on the topic. Included information was pertinent to the history of SoMe in neurosurgical oncology and its impact on the field of neuro-oncology. Incorporated as well are the benefits of being a neurosurgical oncologist on SoMe, the drawbacks of participation on SoMe platforms, and knowledge that facilitates discussion about the future of SoMe in neurosurgical oncology. SoMe plays an important role in neuro-oncology and neurosurgical oncology. SoMe continues to exponentially grow in the healthcare sphere as more providers utilize SoMe platforms. We report objective negative and positive outcomes of SoMe in neurosurgical oncology and neuro-oncology. Here, we summarize these results and provide dialogue describing the effect SoMe is having on the many different aspects of neurosurgical oncology and neuro-oncology. Although SoMe platforms improve social presence and patient outreach, the use of SoMe can also adversely affect one's career by exposing clinicians to unchecked societal, legal and professional consequences. While using SoMe as a vessel to propagate career initiatives, neurosurgical oncologists should exercise caution with the content they choose to circulate.

Working for a "Flip-Flop" Boss: Strategies for Thriving in an Environment of Constant Change

This article provides strategies for individuals navigating the challenges of working for a boss who exhibits inconsistent leadership through frequent changes in priorities, direction, and decision-making. Key concepts are explored relating to the potential causes of unpredictable management, as well as the professional consequences it can create like unclear direction, low morale, and inefficiency. The article then presents evidence-based techniques shown to foster clarity, effectiveness, and motivation despite fluctuating external conditions. Specific approaches are outlined for maintaining clarity through documentation, communication, and clarification; preserving efficiency by focusing internally on controllables and automating routines; and sustaining one's own motivation through connecting to purpose and relationships. Real-world industry examples bring the concepts to life, equipping readers with actionable strategies for thriving amid erratic leadership.

Healthcare Provider Experiences With Unvaccinated COVID-19 Patients: A Qualitative Study.

In the setting of an active pandemic the impact of public vaccine hesitancy on healthcare workers has not yet been explored. There is currently a paucity of literature that examines how patient resistance to disease prevention in general impacts practitioners. The COVID-19 pandemic created unprecedented healthcare challenges with impacts on healthcare workers' wellbeing. Vaccine hesitancy added complexity to providing care for unvaccinated patients. Our study qualitatively explored experiences of healthcare providers caring for unvaccinated patients with severe COVID-19 infection in the intensive care setting. We used interview-based constructivist grounded theory methodology to explore experiences of healthcare providers with critically ill unvaccinated COVID-19 patients. Healthcare providers who cared for unvaccinated patients with severe COVID-19 respiratory failure following availability of severe acute respiratory syndrome coronavirus 2 vaccines were recruited from seven ICUs located within two large academic centers and one community-based hospital. We interviewed 24 participants, consisting of eight attending physicians, seven registered nurses, six critical care fellows, one respiratory therapist, one physiotherapist, and one social worker between March 2022 and September 2022 (approximately 1.5 yr after the availability of COVID-19 vaccines in Canada). Interviews were recorded, transcribed, de-identified, and coded to identify emerging themes. The final data was analyzed to generate the thematic framework. Reflexivity was employed to reflect upon and discuss individual pre-conceptions and opinions that may impact collection and interpretation of the data. Healthcare providers maintained dedication toward professionalism during provision of care, at the cost of suffering emotional turmoil from the pandemic and COVID-19 vaccine hesitancy. Evolving sources of stress associated with vaccine hesitancy included ongoing high volumes of critically ill patients, resource shortages, and visitation restrictions, which contributed to perceived emotional distress, empathy loss, and professional dissatisfaction. As a result, there were profound personal and professional consequences for healthcare professionals, with perceived impacts on patient care. Our study highlights struggles of healthcare providers in fulfilling professional duties while navigating emotional stressors unique to vaccine hesitancy. System-based interventions should be explored to help providers navigate biases and moral distress, and to foster resilience for the next major healthcare system strain.

Strengthening the Provision of Abortion and Sexual and Reproductive Health Care Post-Dobbs: An Initiative of the Philadelphia Department of Public Health

The U.S. Supreme Court decision on Dobbs v. Jackson Women’s Health has had a disruptive impact on not only the patients who seek reproductive health care, abortion care providers, and abortion care–adjacent organizations, but has also sparked a need for public health departments to take on new roles to support their communities. In the wake of that 2022 decision, the Philadelphia Department of Public Health launched an ongoing initiative to increase support for the provision of abortion and sexual and reproductive health care. The authors describe the effort, which started with a landscape analysis and qualitative interview analysis to understand the needs and concerns of those comprising the abortion care delivery system in Philadelphia. The authors found that the immediate, short-term needs to support the local abortion care delivery network included funding for patients seeking abortion care, plus communication and education to counter misinformation about the legality of abortion in Pennsylvania. Through the initiative’s research efforts, the authors also found that long-term needs included care capacity–building and health systems–strengthening by removing non–evidence-based restrictions on abortion access and care. Another ongoing role for public health systems is to address and avert legislative or regulatory efforts to impose restrictions to Medicaid coverage for abortion services or other impediments that would disrupt the ability or capacity of health care providers to deliver comprehensive reproductive care. Today, public health departments are uniquely suited to address and mitigate the emerging post-Dobbs chilling effect on both patients and clinicians who may fear legal, professional, or personal consequences as they navigate options for appropriate, evidence-based reproductive health care, even in states where abortion remains legal.

Gossypiboma larynx: a rare cause of post-tracheostomy stridor—case report and review of literature

BackgroundGossypiboma, a retained surgical sponge with a foreign body reaction, is an unusual but serious complication seen in open abdominal surgeries. It is exceptionally rare following head and neck surgeries. Here, we present a case of Gossypiboma of the upper airway following tracheostomy.Case presentationA 32-year-old male presented with stridor and difficulty breathing one-month post-tracheostomy after a severe head injury following a road traffic accident. A neck radiograph was unremarkable, and a computed tomography (CT) scan of the neck showed a well-defined homogenous curvilinear membrane extending from the hypopharynx to the upper trachea. Bronchoscopic evaluation of the larynx and upper trachea revealed a retained surgical sponge, which was retrieved. The patient’s breathing improved drastically post intervention.ConclusionGossypiboma may go undetected in radiographs and may also present atypically as a homogenous membrane on a CT scan of the neck. Though rare, retained surgical items can have profound medicolegal and professional consequences on physicians. Hence, a strong clinical suspicion and vigilance for gossypiboma is necessary for patients presenting with respiratory distress post-tracheostomy.

Professionals’ Fidelity-Adaptation Attitudes: Relation to Implementation Determinants and Work-Life Consequences – A Cluster Analysis

Evidence-based interventions have the potential to improve health and well-being, but their effectiveness depends, among other things, on the challenging act of balancing between fidelity and adaptation, referred to as the fidelity-adaptation dilemma. After initial implementation, it is primarily professionals delivering evidence-based interventions to end users that face the dilemma, but research about how professionals relate to and perceive it is limited. This study aims to describe professionals’ attitudes towards the dilemma and investigate the associations between professional attitudes and individual and organisational implementation determinants, individual characteristics, and work-life consequences for the professionals. Using a cross-sectional design, 103 professionals working with an evidence-based parental support programme ABC (All Children in Focus) were surveyed on attitudes towards the fidelity-adaptation dilemma, implementation determinants, and work-life consequences. Data were analysed using two-step cluster analysis. Three profile groups summarize professionals’ attitudes: one preferring fidelity (the adherers, n = 31), one preferring adaptations (the adapters, n = 50), and one with a dual view on fidelity and adaptation (the double-minded, n = 18). The adherers, the ones preferring fidelity, reported higher levels of skills, knowledge, openness, work-related self-efficacy, meaning of work, and possibilities for development, and a lower level of role conflict and unreasonable tasks compared to the adapters. Professionals with a positive attitude towards fidelity reports experiencing more job resources and a lower level of job demands compared to professionals who are more positive towards adaptation. The study shows that the fidelity-adaptation dilemma is at play during the sustainment phase of implementation and suggest that it has consequences for professionals working life.

Workplace violence in hospital emergency departments and consequences for health care professionals and support staff: a cluster analysis

Workplace violence in hospital emergency departments and consequences for health care professionals and support staff: a cluster analysis

Advanced paramedics' restraint decision-making when managing acute behavioural disturbance (ABD) in the UK pre-hospital ambulance setting: A qualitative investigation.

Acute behavioural disturbance (ABD), sometimes called 'excited delirium', is a medical emergency. In the UK, some patients presenting with ABD are managed by advanced paramedics (APs), however little is known about how APs make restraint decisions. The aim of this research is to explore the decisions made by APs when managing restraint in the context of ABD, in the UK pre-hospital ambulance setting. Seven semi-structured interviews were undertaken with APs. All participants were experienced APs with post-registration, post-graduate advanced practice education and qualifications. The resulting data were analysed using reflexive thematic analysis, informed by critical realism. We identified four interconnected themes from the interview data. Firstly, managing complexity and ambiguity in relation to identifying ABD patients and determining appropriate treatment plans. Secondly, feeling vulnerable to professional consequences from patients deteriorating whilst in the care of APs. Thirdly, negotiating with other professionals who have different roles and priorities. Finally, establishing primacy of care in relation to incidents which involve police officers and other professionals. A key influence was the need to characterise incidents as medical, as an enabler to establishing clinical leadership and decision-making control. APs focused on de-escalation techniques and sought to reduce physical restraint, intervening with pharmacological interventions if necessary to achieve this. The social relationships and interactions with patients and other professionals at the scene were key to success. Decisions are a source of anxiety, with fears of professional detriment accompanying poor patient outcomes. Our results indicate that APs would benefit from education and development specifically in relation to making ABD decisions, acknowledging the context of inter-professional relationships and the potential for competing and conflicting priorities. A focus on joint, high-fidelity training with the police may be a helpful intervention.

Predictors of reading comprehension and profiling of poor readers in Croatian: educational and clinical perspectives.

Reading is an important academic skill. Children who exhibit reading difficulties are more likely to experience various negative professional and personal consequences. To successfully identify children with reading problems as early as possible, one must first understand how reading skills can be mastered, as well as the course of reading development in children with typical reading skills from the beginning of their formal reading instruction. Thus, the purpose of this study was to determine the influence of decoding and language comprehension on reading comprehension ability. In addition, this study aimed to determine types of profiles among poor readers and estimate their frequency in the study sample. Based on the Simple View of Reading model, we developed decoding, language comprehension, and reading comprehension tasks. Participants included 100 typical readers (TR) and 95 poor readers (PR) in the second grade in Croatian schools. Phonemic awareness, phonological working memory, and rapid automatized naming tasks were used to test underlying abilities of decoding skills in both groups of participants. As expected, PRs showed significantly lower performance on all variables than TRs. The correlations between decoding, language comprehension and reading comprehension are significant in the PR group. The linear regression analysis showed that language comprehension was a significant predictor of reading comprehension for TRs, while decoding and language comprehension were significant predictors of reading comprehension for PRs. The profiling of reading difficulties revealed five different profiles, the most common of which was a mixed reading difficulty, i.e., difficulties in both decoding and language comprehension. In line with theoretical expectations, success in reading comprehension in TRs at the end of the second grade depends mainly on language comprehension. To achieve this complex cognitive skill, PRs' language comprehension alone is not sufficient, so they still rely on their decoding skills. Among the poor readers, there was a high prevalence of children with decoding problems (i.e., three out of five profiles). Teachers should be able to identify and monitor decoding difficulties in children, since these difficulties are associated with noticeable manifestations, unlike those associated with comprehension difficulties.

Screen time, mute, mixed messages, and panic: An international auto-ethnographic study of knowledge workers during a pandemic.

The coronavirus pandemic provoked worldwide changes to the workplace, leading to rapid changes in lifestyles and working conditions. While organizations and governments struggled to develop regulations and policies, individuals were forced to find ways to manage work and life. During the pandemic and quarantine, a group of knowledge workers from around the world convened virtually and agreed to use qualitative autoethnographic methods to study how the quarantine disrupted their conventional patterns of work and care. In this article, we apply two communication perspectives-uncertainty reduction theory and re-silience-to participant diaries to understand how participants represent internal and external stressors, the efforts diarists employed to overcome those stressors, and their varying success in doing so. Post-hoc application of these communication concepts suggests that the diarists, though privileged in some ways, were not exempt from the social, professional, and emotional consequences of the pandemic and that their efforts to enact resilience were unevenly successful, especially in relation to their use of communications technology. Diarists reported struggling with uncertainty at numerous levels and that uncertainty contributed to individual emotional and cultural distress. Disruptions to work, home, and communities significantly affected wellbeing and ability to cope with challenges. Added to this were the complex and competing roles that diarists felt as they struggled to work from home, parent, and remain engaged.

Effect of Dobbs on the Obstetrics and Gynecology Workforce [ID 2683443

INTRODUCTION: After the Dobbs v. Jackson decision in June 2022, 17 U.S. states have functionally banned abortion. Little research has focused on consequences of these bans for obstetrician–gynecologists in affected states, for whom medically necessary care provision may now carry serious personal and professional consequences. The objective of the Study of Ob-Gyns in Post-Roe America (SOPRA) was to characterize how abortion bans affect obstetrician–gynecologists and identify institution-level practices to support obstetrician–gynecologists in abortion-restrictive policy climates. METHODS: This was a cross-sectional qualitative study of 54 obstetrician–gynecologists from 13 of 14 states that had banned abortion as of March 2023. Data included semistructured interviews conducted from March to August 2023, which were thematically coded and analyzed. Institutional review board approval was obtained. RESULTS: We identified three major domains in which laws affected obstetrician–gynecologists: 1) clinical effects (waiting to provide necessary care until patients became sicker or institutional permission to treat was obtained; inability to counsel on pregnancy options; inability to provide or refer for appropriate care; patient relationships); 2) professional effects (conflicts with colleagues; documentation; fears and perceived consequences of law violation; practicing below the standard of care; moral distress and moral injury; job satisfaction; intention to leave the state); and 3) personal effects (health and well-being). Institutional practices—both helpful and harmful—modified the laws' effects on physicians. CONCLUSION: Findings reveal pervasive effects of state abortion bans on obstetrician–gynecologists, with implications for workforce sustainability, physician health, and patient outcomes. Institutional practices to support and protect obstetrician–gynecologists in restrictive policy environments may help mitigate laws’ effects on attrition and physician well-being.

EXPRESS: No Comments (from You): Understanding the Interpersonal and Professional Consequences of Disabling Social Media Comments

Presumably in an effort to reduce cyberbullying and promote mental health, online influencers often limit viewers’ ability to post comments. In this research, we find that influencers incur significant interpersonal and professional repercussions for doing so. Across a Twitter dataset and six experiments utilizing both consequential and hypothetical dependent measures, we find that consumers form more negative impressions of and are less persuaded by influencers who disable social media comments. These outcomes are driven by the perception that the influencer is less receptive to consumer voice (e.g., consumers’ thoughts, opinions, and suggestions) and, thus, less sincere. However, we find that this effect is mitigated in situations where consumers feel that it is reasonable for influencers to prioritize self-protection.

Characteristics, knowledge, attitude, and practice of pharmacy personnel in supporting tuberculosis treatment: A multicenter cross-sectional study in a high-burden tuberculosis country

BackgroundPositive roles of community pharmacy in tuberculosis (TB) care have been widely reported. However, the actual practice of supporting TB treatment is not optimal yet. ObjectivesWe analyzed the current practice of community pharmacy personnel and its factors in supporting the successful treatment of TB patients in Indonesia, aiming to develop strategies for effective and sustainable TB practice models for the community pharmacy. MethodsWe performed a cross-sectional survey in 3 areas representing Indonesia's eastern, central, and western parts. Development and validation of the questionnaire were conducted to assess 4 domains, that is, characteristics, knowledge, attitudes, and practice of community pharmacy personnel in supporting the successful treatment of TB patients. Data were collected with purposive convenience sampling using online and offline questionnaires. Descriptive analyses were used to summarize factors in each domain, while binary logistic regression was used to analyze the associated factors of the practice. ResultsThirty-five questionnaire items indicated a valid instrument, and the study successfully included 844 participants who comprised pharmacists (n = 473, 56%) and pharmacy assistants (n = 371, 44%). Although most of the knowledge items were correctly answered by more than 60% of the participants, items related to TB signs, risk groups, drug regimens, and medicine uses were still less than 60%. This was in line with exposure to updated TB training in only 51% of the participants (n = 426). Most of the participants had a positive attitude toward their professional role (n = 736, 87%), capability (n = 646, 77%), and consequences (n = 655, 78%) in supporting TB treatment. However, this was not aligned with the actual practice of supporting TB treatment, intensively performed by only 1.3% of participants (n = 11). We identified several factors associated with the practice, that is, a pharmacy assistant background (P < 0.05), short working time (P < 0.05), experience in TB training (P < 0.001), and a positive attitude (P < 0.001). ConclusionThis study highlighted a limited number of community pharmacy personnel intensively practicing as TB treatment supporters in Indonesia. An interventional package considering the identified factors is needed to develop effective and sustainable practices in the real world.

Reality television and the promotion of problematic behavior among cast members: a case study content analysis through the lens of feminist and media framing theories

ABSTRACT A combination of feminist and media framing theories allows for a perspective of the world in which power structures play a role in the construction of identities. In mass media spaces, those who hold power can shape the reality for viewers. This longitudinal case study content analysis of one reality television show, MTV’s The Challenge, reveals an ongoing scenario where producers encourage and devote airtime to sexism, racism, and violence, possibly with the intent to increase viewership, resulting in mixed messages for cast members regarding problematic behaviors. Over time, instances of these problematic behaviors increased, and cast members who engaged in these behaviors were more likely to be re-cast than those who did not. Negative behaviors are sometimes met with consequences, but these are inconsistent. As a result, cast members may be misled about acceptable behaviors and may suffer social, professional, and mental health consequences. Further, the content leaves viewers vulnerable to mixed messages on important issues such as sexism, racism, and violence.

Exploring Trade and Investment Potential Between Indonesia and Slovakia

This study explores the qualitative analysis of the trade and investment potential between Indonesia and Slovakia, two contrasting economies characterized by dynamic differences and untapped economic synergy. Using theories and frameworks from international trade and foreign direct investment, this study aims to give a full picture of the complicated web of economic complementarities, barriers, and policy landscapes that affect the flow of trade and investment between two countries. By conducting a comprehensive examination of existing scholarly works, supplemented by in-depth interviews with experts and focused analysis of specific instances, this study reveals significant areas that are conducive to collaboration as well as the intricate obstacles that hinder commercial transactions. The results underscore the significant impact of legislative frameworks, market entry opportunities, and infrastructure preparedness on the facilitation or impediment of economic participation. Furthermore, the research highlights the necessity of implementing strategic bilateral agreements in order to effectively use the complete range of trade and investment prospects. The conversation expands to include practical consequences for legislators and business professionals, promoting specific measures to reduce obstacles and take advantage of the found economic synergies. This study makes a valuable contribution to the ongoing academic conversation surrounding the improvement of bilateral economic relations by providing a strategic plan for future collaborations between Indonesia and Slovakia.

Understanding Burnout in Surgeons: How to Avoid Burnout?

Although surgeons work in more stressful medical fields, surgeons are generally considered to offer some of the best lifestyles among physicians. Burnout among surgeons is increasing at an alarming rate. The goals of this review are to increase awareness of the symptoms, causes, and consequences of surgeons’ burnout and how to avoid burnout? Surgeons’ burnout is largely attributed to work-related factors and personal -related factors. Burnout has many potential adverse consequences including professional consequences and personal consequences. The recovery from surgeon’s burnout can take months or longer, therefore it’s important to try to avoid it in the first place through preventative strategies.&#x0D; Mugda Med Coll J. 2023; 6(2): 99-106

Suicide in Healthcare Workers: An Umbrella Review of Prevalence, Causes, and Preventive Strategies.

The medical profession faces a critical challenge with the mental health of its practitioners, leading to an alarming increase in suicide rates among healthcare workers (HCW). Factors such as the culture of perfectionism, excessive workloads, and stigma against seeking help exacerbate this issue. This umbrella review synthesizes the existing literature on HCW suicide, exploring the prevalence, causes, and potential preventive strategies. This study conducted a search of the literature from PubMed/Medline, Scopus, Web of Science, Cochrane Library, PsycINFO, and Google Scholar until April 2, 2024. The non-exhaustive search terms used were "doctor suicide," "physician suicide," "medical professional suicide," "suicide in healthcare," "healthcare worker suicide prevention," and "causes of healthcare worker suicide." Hand-searches were also conducted. Of the 487 studies initially identified, a total of 10 systematic reviews/meta-analyses were included. This umbrella review collates findings from 400 primary clinical studies conducted between the years 2004 and 2023. With a focus on mental health factors contributing to suicide in HCW, there are regional and specialty-specific variations in stress prevalence in the populace. Further, anesthesiologists and psychiatrics depicted higher rates of burnout compared to other HCW; causative factors such as seeking perfection and challenging work-life balance were key when assessing suicidal behaviors in these groups. Job demand level was found to correlate directly with suicidal thoughts, specifically among psychiatric ward HCW, where access to drugs and sharp instruments is readily available. In specific contexts, female HCWs showed a standardized mortality ratio (SMR), indicating that the rate of suicide was higher among them as compared to the general female population. Interventions such as cognitive behavioral therapy (CBT) and mindfulness were effective in decreasing depression, psychological distress, and anxiety in several included studies. This umbrella review also identified major obstacles to seeking help, including stigma and the fear of professional consequences. To reduce suicide rates among HCWs, it is the need of the hour to implement evidence-based interventions and create supportive work environments that encourage mutual care for each other's emotional health. Further research is necessary to determine the effectiveness of various measures in preventing suicide among HCW.

Global education reform and the Swedish CPD market: restricted professional learning and the power of ideology

ABSTRACT Against the backdrop of global convergences in education reforms, a growing focus on teacher competences has emerged in European policy discourses about teacher professionalism and professional learning and development that has driven an expanding international and national CPD market involving both state and private operators. Developments in Sweden are an example, and the aim of this article is to identify and explore the discourses on teacher professional learning that seem to proliferate on this newly emerged and expanding market and their connections with and consequences for teacher professionalism. Two sets of data have fed the analysis. These are (a) CPD invoices and (b) interviews with school principals. The analysis indicates that the dominant discourses discursively shape teacher professionalism in relation to ideas about teachers as learners as collegial consumers of knowledge. Policy recommendations about peer learning become a subordinated element of a dominant discourse that prioritises and privileges the agency of knowledge producers, such as consultancies, compared to other actors as intermediaries. Commodification is a new key intermediary process in professional learning for teacher professional development.