Consultation Process Research Articles

Using case-based learning supported by role-playing situational teaching method in endocrine physiology education.

Embedding clinically relevant learning experience in basic science subjects is desired for the preclinical phase of undergraduate medical education. The present study aimed to modify case-based learning (CBL) with a role-playing situational teaching method and assess the student feedback and learning effect. One hundred seventy-six sophomore students majoring in clinical medicine from Harbin Medical University were randomly divided into two groups: the control group (n = 90), who received traditional hybrid teaching, and the experimental group (n = 86), who received the role-playing situational teaching. Students in the experimental group were given a 1-wk preclass preparation to dramatize a hyperthyroidism scenario through online autonomous learning of thyroid physiology and performed the patient's consultation process in class, followed by a student presentation about key points of lecture content and a question-driven discussion. A posttest and questionnaire survey were conducted after class. The test scores of the two groups had no statistical differences, whereas the rate of excellence (high scores) of the experimental group was significantly higher than that of the control group. Furthermore, the record of online self-directed learning engagements was significantly improved in the experimental group. In the questionnaire, >70% of the students showed positive attitudes toward the role-playing situational teaching method and were willing to participate in other chapters of the physiology course. Such results show that CBL supported by a role-playing situational teaching method encourages active learning and improves the application of basic knowledge of physiology, which can be incorporated in the preclinical curricula to bridge the gap between theory and practice.NEW & NOTEWORTHY Formal application through structured role-play is often overlooked in physiology education. In traditional case-based learning (CBL), clinical cases are the subject and unfocused discussion often occurs. The present study aimed to modify CBL with a role-playing situational teaching method and assess the student feedback and learning effect. The results show that the new teaching model encourages active learning and improves the application of basic knowledge of physiology.

Accountability for maternal and newborn health: Why measuring and monitoring broader social, political, and health system determinants matters.

This article offers four key lessons learned from a set of seven studies undertaken as part of the collection entitled, "Improving Maternal Health Measurement to Support Efforts toward Ending Preventable Maternal Mortality". These papers were aimed at validating ten of the Ending Preventable Maternal Mortality initiative indicators that capture information on distal causes of maternal mortality. These ten indicators were selected through an inclusive consultative process, and the research designs adhere to global recommendations on conducting indicator validation studies. The findings of these papers are timely and relevant given growing recognition of the role of macro-level social, political, and economic factors in maternal and newborn survival. The four key lessons include: 1) Strengthen efforts to capture maternal and newborn health policies to enable global progress assessments while reducing multiple requests to countries for similar data; 2) Monitor indicator "bundles" to understand degree of policy implementation, inconsistencies between laws and practices, and responsiveness of policies to individual and community needs; 3) Promote regular monitoring of a holistic set of human resource metrics to understand how to effectively strengthen the maternal and newborn health workforce; and 4) Develop and disseminate clear guidance for countries on how to assess health system as well as broader social and political determinants of maternal and newborn health. These lessons are consistent with the Kirkland principles of focus, relevance, innovation, equity, global leadership, and country ownership. They stress the value of indicator sets to understand complex phenomenon related to maternal and newborn health, including small groupings of complementary indicators for measuring policy implementation and health workforce issues. They also stress the fundamental ethos that maternal and newborn health indicators should only be tracked if they can drive actions at global, regional, national, or sub-national levels that improve lives.

Stakeholder responses to mandating environmental, social and governance reporting in Hong Kong

We examine stakeholders’ comment letters regarding the Hong Kong Exchange’s (HKEX) 2015 Consultation Paper, which proposed mandating ESG reporting in Hong Kong. We test for significant differences in responses between stakeholder groups and whether the HKEX’s decision was consistent with stakeholders’ preferences in the consultation process. Examining comment letters submitted by six lobbying groups—preparers, investors, the accounting profession, NGOs, other institutions and individuals—we analyze survey responses using textual analysis software and statistical tests. We find that users and the accounting profession participated more than preparers. We also find that preparers and users took different positions on mandating ESG reporting when lobbying the HKEX, whereas preparers and the accounting profession advocated similar positions. Moreover, we find a significant association between stakeholder groups’ preferences and the HKEX’s decision on most proposed changes.

Internal medicine consults within the emergency department: A workflow intervention to match workforce with workload

Background. Emergency departments (ED) are increasingly overcrowded, exacerbated by patients awaiting consultations and inpatient beds. Internal Medicine (IM) is the most consulted specialty service from the ED. Patients experience long delays after being consulted to Internal Medicine (IM). Objective. Decrease these delays by improving the IM consult process. Methods. A three stage process was designed. First: Analysis of the IM consult workflow over a 27-day period to identify the longest delays. Then implement a data-driven intervention. Second: Quantitatively assess the intervention by comparing three-month periods Pre-Intervention (Time A) with Post-Intervention (Time B). Third: Qualitatively assess the intervention by surveying residents. Results. The first stage included 398 consults. The longest delays were awaiting bed availability post admission order completion (mean 19.5 hours) and awaiting the initial junior resident assessment (mean 3.6 hours). This assessment delay significantly increased during busy shifts. The intervention involved the addition of an extra IM resident during the busiest four hours of the day. The second stage compared 1162 patients from Time A with 1263 patients from Time B. There was no significant change in assessment times post-intervention. However, there was an 8% increase in consult volume in Time B as compared to Time A. The third stage captured 100% of the 23 senior residents. Overall, residents reported the change as beneficial to themselves and the patients. Conclusions. For patients consulted to IM in the ED, inpatient bed availability contributed to the largest delay to leave the ED. Increasing IM resident staffing during peak hours did not decrease time to complete consults. However, increased IM resident staffing was perceived as beneficial to both residents and patients.

Evidence-informed stakeholder consultations to promote rights-based approaches for children with disabilities.

To strengthen the translation of evidence to actionable policy, stakeholder engagement is necessary to synthesize, prioritize and contextualize the academic research content into accessible language. In this manuscript we describe a multi-level evidence-based stakeholder consultation process and related outcomes proposed to promote awareness of and foster cross-sectorial collaborations towards human rights-based approaches for children with disabilities. Mixed-methods participatory action research done in three steps: (1) A literature review of peer-reviewed evidence on rights-based approaches in childhood disabilities; (2) Consultation with researchers in diverse fields, grassroot organizations, caregivers, and youth with disabilities; (3) A constructive dialogue with decision makers at federal and provincial levels in Canada to discuss consultations results. Stakeholders value human rights approaches that can have a direct impact on practical aspects of their daily living. Organizations give high importance to adopting rights-based approaches to measure policy outcomes, while parents value service provision and youth emphasize accessibility. The implementation of rights-based approaches in childhood disabilities can support policy, services, and daily lives of children with disabilities and the ecosystems around them. It can also guide research priorities, and create a common language to foster collaborations across sectors and interested parties.

Imperialism and social movement unionism in South African responses to the Just Transition

In November 2021, South Africa signed the first international Just Energy Transition Partnership (JETP). This unlocked 8.5 billion USD in donor funding (primarily loans) to decarbonise its economy. The processes and substance of this decarbonisation have been criticised by unions and by civil society. This article traces the stakeholder consultation process through which civil society encouraged marginal improvements while broadly legitimising the JETP, and it details the causes and implications of South African unions’ decreased engagement with the Just Transition. The article argues that the specifics of civil society’s engagement with multistakeholder consultations, and organised labour’s disengagement, work towards legitimising a donor- and market-led transition. In partially explaining why a powerful civil society and the labour movement have not demanded more radical change, the article highlights tensions between the ‘professional class’ that dominates responses to climate change and a workers’ movement where political power is deeply tied to identarian mobilisation.

Experiences in developing empirical harvest strategies for the Indonesian tropical tuna fisheries

Harvest strategies, also referred to as management procedures, are foundational to evidence-based fisheries decision making. Together with closed-loop simulation testing, termed Management Strategy Evaluation, of potential harvest strategies, they are considered to be best practice. However, the use of these approaches is still mostly limited to a small minority of high-value, data-rich stocks in developed economies. The Indonesian tropical tuna fisheries provide a rare real-world experience where formal empirical harvest strategies were being developed for data-limited fisheries within a developing economy as an operational management tool. The Harvest Strategy Framework is a departure from a previously open-access fishery for tropical tuna in Indonesian archipelagic waters. It outlines the necessary actions to operationalize the harvest strategy, including fisheries monitoring, harvest control rules, associated management measures to meet the management objectives, and immediate actions to reduce the levels of catch as a precautionary measure until the harvest strategy is fully implemented. It was developed over a 9-year national consultative process, commencing in 2014 and culminating in the official adoption of the framework in June 2023. This paper outlines key processes and challenges encountered in stakeholder engagement and technical capacity development within the intricate governance context of Indonesia. We argue that the engagement processes have cemented a future direction towards sustainable and best practice fisheries management in Indonesia and the effective co-production process has potential to show the way for other fisheries in coastal developing states who face similar challenges in managing their national and internationally shared stocks.

People of the sun: Local resistance and solar energy (in)justice in southern Portugal

This paper explores a public controversy surrounding a large solar power plant planned for the village of Cercal, in Alentejo, southern Portugal, mobilizing energy justice literature to shed light on the contradictions and injustices (re)produced by hegemonic energy transitions. Drawing on qualitative data from interviews, fieldwork and document analysis, this controversy is unpacked through three main tenets of energy justice: distributional, procedural and recognition, contributing to current research on solar energy justice.Our empirical findings indicate that the local population and environmental movements are concerned that Cercal might become a “green sacrifice zone” for the sake of the hegemonic energy transition. Procedural injustices were of particular concern, with interviewees claiming that the public consultation process failed to involve the local community, indicating that the State and corporate actors do not recognize residents as legitimate stakeholders, disregarding protest and active discord as legitimate forms of political participation.This original case study, unfolding in a country currently experiencing a significant lithium mining controversy, is a flagship example of how top-down and corporate energy transitions are major drivers of energy injustices, enforcing green grabbing and the enactment of green sacrifice zones under the aegis of carbon reductionism. In order to address these contradictions, a radical shift in the socioeconomic and political dynamics underlying the hegemonic energy transition is urgently needed, alongside the meaningful involvement of local communities in decision-making processes directly affecting their territories and livelihoods.

Bringing clarity and transparency to the consultative process underpinning the implementation of an ethics framework for AI-based healthcare applications: a qualitative study

AbstractArtificial intelligence (AI) has been applied in healthcare to address various aspects of the COVID-19 crisis including early detection, diagnosis and treatment, and population monitoring. Despite the urgency to develop AI solutions for COVID-19 problems, considering the ethical implications of those solutions remains critical. Implementing ethics frameworks in AI-based healthcare applications is a wicked issue that calls for an inclusive, and transparent participatory process. In this qualitative study, we set up a participatory process to explore assumptions and expectations about ethical issues associated with development of a COVID-19 monitoring AI-based app from a diverse group of stakeholders including patients, physicians, and technology developers. We also sought to understand the influence the consultative process had on the participants’ understanding of the issues. Eighteen participants were presented with a fictitious AI-based app whose features included individual self-monitoring of potential infection, physicians’ remote monitoring of symptoms for patients diagnosed with COVID-19 and tracking of infection clusters by health agencies. We found that implementing an ethics framework is systemic by nature, and that ethics principles and stakeholders need to be considered in relation to one another. We also found that the AI app introduced a novel channel for knowledge between the stakeholders. Mapping the flow of knowledge has the potential to illuminate ethical issues in a holistic way.

Conceptual framework and responding approach of treatment burden of type 2 diabetes mellitus: A video recording-based qualitative analysis

BackgroundPatients with type 2 diabetes mellitus (T2DM) frequently face a considerable treatment burden. Research on the specific treatment burden associated with T2DM is still in its early stages both in China and worldwide. ObjectiveBased on video recordings of clinical diagnostic and therapeutic scenarios, this study aims to summarize the conceptual framework of treatment burden related to T2DM among patients in China Mainland and explore proactive coping strategies of general practitioners (GPs). MethodsThe researchers conducted a retrospective qualitative analysis using video records that filmed during 2018-2019 from general practice training clinics of a standardized training base in Guangdong Province of China. This analysis was integrated with the existing conceptual framework of treatment burden, employing qualitative research methods such as observational record forms, field notes, coding extraction and thematic analysis. ResultsFrom 25 video records, 49 instances of doctor-patient communication related to the treatment burden of T2DM were selected and analyzed. All six themes from the original conceptual framework were explored. Additionally, the researchers identified two additional thematic items (medical information burden and drug-induced hypoglycemia). The finding led to the development of a modified conceptual framework for the treatment burden of T2DM, encompassing seven observable dimensions: financial burden, medication burden, medical management burden, lifestyle change burden, healthcare system burden, time/travel burden, and medical information burden. Each sub-theme's definition was expanded accordingly. The consultation process analysis indicated that trained GPs can actively respond to treatment burdens (medication burden, medical information burden, time/travel burden, lifestyle change burden) using skills such as patient education, enhanced communication, shared decision-making and motivational interviewing. ConclusionThe study constructs a modified conceptual framework for the treatment burden of T2DM. By integrating the identification of conceptual dimensions in clinical diagnosis and treatment, it explores how Chinese GPs can use doctor-patient communication skills to proactively address specific treatment burdens of T2DM patients.

Article: Agenda Setting and Decision Making under the OECD/G20 IF and the WTO – Developing Countries and Reform

This article is the outcome of the call for papers on the topic ‘Democratic Legitimacy Of Decision Making Process in Tax’ The OECD/G20 IF and the WTO have increasingly been subject to calls for reform in recent years. Imbalanced power asymmetries in agenda setting and deficiencies in decision making mechanisms have contributed to the existential crisis under the WTO and to legitimacy challenges under the international tax rulemaking body by developing countries. This article examines similarities and differences in structural and procedural legal frameworks and political considerations that facilitate the rulemaking processes and compares the lessons that have been learned. The article finds that both institutions have [historically] fallen short of incorporate agenda items of interest aligned to national needs in developing countries, resulting in gradually declining perceptions of legitimacy and exclusionary processes dominated by closed groups of developed countries. As a result, developing countries under the WTO have used decision-making processes to ‘opt-out’ as an exercise of country preferences thereby resulting in gridlocks caused by the exclusionary nature of the agenda. The informal fluid structure of the OECD/G20 IF has facilitated critical global breakthroughs in Base Erosion and Profit Shifting (BEPS) related issues, its exigent nature, however, has conversely resulted in challenges. These have been charachterized by opaque arbitrary procedures on the acceptance and rejection of proposals creates input-legitimacy concerns; timelines that impinge on democratic consultative processes; and the absence of alternative approaches to ‘opt-out’, limiting policy options for developing countries. The article further finds that special and differential treatment (S&DT) provides developing countries with much needed policy discretion to address international trade and tax related issues of interest. This may potentially counteract agenda-setting and decision-making deficiencies in both institutions and offset pre-existing onerous commitments imposed by the single-undertaking principle and BEPS minimum standards. S&DT is not without its challenges and controversies, though deficiencies in the relevancy of measures, lack of enforceability, and disagreements over eligibility highlight current weaknesses. The article explores a number of reforms and proposals. Inclusive-Framework, WTO, agenda-setting, decision-making, rulemaking, S&DT, preferential-treatment, developing, UN, consensus.

Identifying priorities for Australian disability research using Q methodology

BackgroundGlobally, there are over an estimated one billion people with disability. Research priorities with a focus on diagnosis and treatment of conditions or policy and service initiatives, traditionally decided by researchers, may not align with priorities of those with lived experience of disability. ObjectiveTo explore and inform disability research for Australia, including perspectives of people with disability. MethodsAs part of a research program, we used Q methodology to explore “what should guide the Australian research agenda?” People with disability, their families, community organizations and researchers were purposively recruited and sorted 25 statements, developed iteratively using data collated from systematic research mapping and a prior consultation process. The sorting grid ranged from −4 to +4, according to “Which topics should guide disability research the least to the most?” Factor analysis revealed four distinct but interrelated participant viewpoints. Results52 participants (65 % female, aged 18–65+ years, 37 % people living with disability), sorted the statements. Viewpoint 1 – design and delivery of services across the lifespan. Viewpoint 2 – understanding the diverse experience of those with disability. Viewpoint 3 – designing systems to address impacts of disability for the individual, their families and society. Viewpoint 4 – addressing mental health for those with disability no matter where they live. ConclusionThese viewpoints focused on design and delivery of services to address the impacts of disabling environments and attitudes on individuals living with impairments, their families and society. The four viewpoints provide a framework for future disability research in consultation with those with lived experience.

Evaluating 3D Simulation Accuracy for Breast Augmentation Outcomes: A Volumetric and Surface Contour Analysis in Chinese Patients.

The use of three-dimensional imaging in breast augmentation with silicone implants has revolutionized the surgery planning process by providing detailed visualizations of expected post-surgical outcomes. This technology enhances the decision-making process, enabling patients to choose their implants with greater confidence and ultimately leading to higher satisfaction with the postoperative outcome. This study aims to assess the accuracy of 3D imaging simulations using the Canfield Vectra XT 3D system in predicting breast augmentation outcomes in Chinese patients, focusing on volume, surface contour, breast anterior-posterior (AP) Projection, and breast internal angle. Our study analyzed female patients who received breast augmentation, documenting their preoperative and three-month postoperative conditions with 3D Vectra XT system images. Exclusions were made for patients undergoing concurrent breast surgeries or those with tuberous or ptotic breasts, due to limitations of the imaging system. Implants used were either round textured or anatomically shaped cohesive silicone gel, inserted subpectorally through trans-axillary or inframammary incisions, based on personalized evaluations. A detailed comparison between preoperative simulations and actual postoperative outcomes was conducted, focusing on volume, surface contour, AP projection, and internal angle variations. Statistical significance was determined through paired T tests, P < 0.05. In the analysis of preoperative simulations for determining postoperative outcomes in breast surgery, our study involving 42 Chinese patients, a total of 84 breasts, was conducted. The results indicated a mean volumetric discrepancy of 21.5 ± 10.3 (SD) cubic centimeters between the simulated and actual postoperative outcomes, achieving an accuracy rate of 91.9%. The root mean square deviation for the breast surface geometry was calculated to be 4.5 ± 1.1 (SD) millimeters (mm), demonstrating a low variance between the predicted and observed outcomes. The investigation found no significant variations across any specific areas of the breast surface, highlighting the uniform accuracy of the simulations across the entire breast. Additionally, the mean differences in Anterior-Posterior (AP) projection and internal angle were determined to be 8.82 ± 5.64 mm and 0.48 ± 1.91 (SD) degrees, respectively. These findings collectively attest to the efficacy of preoperative simulations in accurately predicting the postoperative physical appearance of breasts, thereby providing a valuable tool for surgical planning and improving the consultation process for patients. The Canfield Vectra XT 3D system has proven to be remarkably accurate in predicting the volumetric outcomes of breast augmentation surgery, with an accuracy rate exceeding 91.9%. It stands as a valuable tool for surgeons and patients alike, enhancing the preoperative planning process by offering a realistic preview of surgical results. This advancement not only facilitates a deeper understanding and setting of realistic expectations for patients but also strengthens the communication between patients and surgeons, ultimately leading to higher satisfaction rates with the surgical outcomes. It also emphasizes the significance of detailed documentation and consent processes in protecting against legal repercussions. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Selection of a Topic of a Research Proposal of Emerging Academic Writers in a Blended Linked EAP Course: An Interactional Ethnographic Perspective

AbstractRecent years have witnessed the ethnographic turn in academic writing research and the multimodal turn in classroom discourse studies. Most research proposal genre studies have only provided generic guidelines, and most EAP intervention studies have only provided pre‐ and post‐intervention learning outcomes but have not examined actual in‐depth classroom teaching and after‐class consultative processes of proposal development. This paper fills these gaps by following the view of genre as contextualized social practices and adopting interactional ethnography (IE) logic‐of‐inquiry to analyze video‐recorded linked EAP classroom interactions and WeChat‐mediated individual consultations focusing on postgraduate students' topic selection. IE‐guided reasoning and analysis may make the invisible research topic developmental processes transparent by utilizing IE analytic tools to visualize these dynamic and complex processes, identify cultural patterns of academic literacy practices, and (re)theorize educational phenomena. The IE approach may complement the well‐established three approaches to student writing (i.e., study skills, academic socialization, academic literacies) as the fourth approach for its deep theorizing, micro‐ethnographic discourse‐based analysis, and video‐enabled IE‐guided analytic tools. This study may make a methodological contribution to the EAP field through the IE as an epistemology with analytical tools and propose a tri‐level four‐step IE analytic model for teacher‐researchers' self‐reflexive professional development.

Objectivity vs affect: how competing forms of legitimacy can polarize public debate in data-driven public consultation

ABSTRACT How do data and objectivity become politicized? How do processes intended to include citizen voices instead push them into social media that intensify negative expression? This paper examines the possibility and limits of ‘agonistic data practices’ (Crooks & Currie, 2021) examining how data-driven consultation practices create competing forms of legitimacy for quantifiable knowledge and affective lived experience. Drawing on a two-year study of a private Facebook group self-presenting as a supportive space for working-class people critical of the development of ‘low-traffic neighbourhoods’ (LTNs), the paper reveals how the dynamics of ‘affective polarization’ associated the use of data with elite and exclusionary politics. Participants addressed this by framing their online contributions as ‘vernacular data’ and also by associating numerical data with exclusion and inequality. Over time the strong statements of feeling began to support content of a conspiratorial nature, reflected at the social level of discourse in the broader media environment where stories of strong feeling gain legitimacy in right-wing sources. The paper concludes that ideologies of dataism and practices of datafication may create conditions for political extremism to develop when the potential conditions of ‘agonistic data practices’ are not met, and that consultation processes must avoid overly valorizing data and calculable knowledge if they wish to retain democratic accountability.

Revelation as Scientific in its Method

This paper is an exploration of Shoghi Effendi’s statement that Bahá’u’lláh’s Revelation is “scientifi c in its method,” starting from the various ways that scientific methods are implemented and including perspectives from the philosophy of science. We examine the role of diversity in achieving scientific objectivity and escape from bias, and consider how the Bahá’í process of action, reflection, consultation, and study is consistent with modern understandings of the scientific method. Because this form of learning in action can be used by everybody, and because ethical, moral, and spiritual practices are part of its way of doing things, it provides a powerful extension of science and its methods that is available to everyone and allows ready integration of spiritual values into the process.

Family Therapy as an Intervention for Adults With Aphasia and Other Communication Disabilities After Acquired Brain Injury: A Scoping Review

Acquired brain injury (ABI) affects the whole family unit, significantly shifting family roles and relationships, with communication disabilities associated with ABI further compounding these difficulties. Family therapy is offered in situations where family roles have been disrupted, but research on the application of family therapy to families affected by ABI has not been synthesized. This study systematically maps the research on the use of family therapy in people with ABI, identifying to what extent people with communication disabilities (PWCD) are included in the evidence base. A scoping review of primary research was conducted through a systematic search of five multidisciplinary academic databases. A consultation process, involving a person with aphasia, ran alongside the entire research process. Twenty-four studies were included in the final review with four categories of interventions identified. Twelve studies excluded PWCD, 10 potentially doing so due to the communication demands of the study. Twelve studies included PWCD, five of which included speech and language therapists to support the delivery of family therapy. A small evidence base exists for the use of family therapy within an ABI population. However, PWCD are frequently excluded from this research due to the communication demands of the study designs. More research is needed to guide appropriate intervention for PWCD.

Abstract P292: Lessons Learned From the Implementation of a Peer-to-Peer Cardiology Consultation Program in Federally Qualified Health Centers

Introduction: Conventional access to specialist care for cardiovascular disease can be expensive, geographically limited, and unavailable to communities that need it most. Health consultations that include cardiovascular considerations can improve life expectancy without extra costs. The Doctors With Heart (DWH) is an initiative from the American Heart Association (AHA) initially developed to decrease gaps in care by using telemedicine as a vehicle for cardiovascular consultations between volunteer cardiologists and primary care providers at Federally Qualified Health Centers (Health Centers). Despite efforts to on-board and train Health Centers on the consultation process and benefits to patient care, consultation utilization remained low. Objective: Identify opportunities to enhance DWH to increase consultation utilization by understanding the need for and barriers to conducting consultations among Health Centers already participating in DWH. Methods: An AHA Program Evaluator and the DWH Program Director co-conducted interviews and focus groups with 31 health care professionals from five Health Centers in the Midwest participating in DWH. Thematic analysis revealed key themes across evaluation objectives. Results: Interviewees had mixed feelings about the need for consultations which was largely driven by the barriers they perceived to conducting them. Many interviewees felt consultations could be an effective way to expedite care for patients who need specialty cardiovascular care. They could also help patients with complex but manageable co-morbidities since the patient can receive cardiovascular care within the primary care setting. However, a few providers felt they already had sufficient access to cardiovascular care for their patients. Interviewees identified three key barriers to conducting consultations: time and administrative burden for providers and staff, providers forgetting the consultations exist, and provider hesitations and concerns. During Health Center on-boarding, DWH should work with Health Centers to integrate consultations into existing clinic workflows, identify a program champion at each site, train multiple clinic staff about the program, and secure buy-in from providers. After Health Center on-boarding, DWH and Health Center program champions should find ways to regularly remind providers about the program and determine whether non-provider staff can help providers identify potential consultation cases. Conclusion: While there was an identified need for cardiology consultations among many Health Centers, more support from DWH and Health Center staff and leadership is needed to establish the program within the clinic setting and ensure on-going consultation utilization. DWH can implement strategies to facilitate consultations during Health Center on-boarding and program implementation.

Crowdsourcing a diagnosis? Exploring the accuracy of the size and type of group diagnosis: an experimental study

BackgroundThe consultation process, where a clinician seeks an opinion from another clinician, is foundational in medicine. However, the effectiveness of group diagnosis has not been studied.ObjectiveTo compare individual diagnosis to...

Health from the Grassroots, Listening to Mob

Abstract&#x0D; Background: There is opportunity for Universities to actively engage with Aboriginal communities to participate, conduct, and ideally lead, responsible research that attends to community priorities and issues. The Health from the Grassroots (Grassroots) project seeks to address an ongoing mismatch between university-defined priorities and community-defined priorities in rural [***]. Grassroots, led by Aboriginal staff of the [***], is a community engagement project aimed at engaging Aboriginal communities in conversations to inform research priorities. This paper describes the project vision, implementation, and lessons learned in the first years.&#x0D; &#x0D; Approach: The Grassroots project was a true representation of collaborative research led by and for Aboriginal people. We designed and conducted a local survey and yarning sessions with community members and used this information to design a “rich picture” to report findings and engage in further conversation with communities about evolving health and research priorities.&#x0D; We identified strengths and challenges faced by communities and health services in the region. The Aboriginal research team centred community in decision-making for project design and direction.&#x0D; Lessons Learned: Challenges encountered included limited resources and devoted time for the research team as this project occurred alongside staffs’ substantive positions. Community members were highly engaged in the consultation process and the rich picture continues to be used to further conversations about research action.&#x0D; Conclusions: Deep-rooted relationships and identities as members of the Community in which we live, and work enabled meaningful consultation to inform research action. Research priorities identified through the Grassroots project have been integrated into the ongoing work of the [***].