Discrete Themes Research Articles

CREATING A LEVEL PLAYING FIELD: ADDRESSING GENDER BIAS IN UNDERGRADUATE MEDICAL STUDENT ASSESSMENTS

Objectives: To identify the mechanisms to reduce gender bias during assessments in undergraduate medical education. Material and Methods: A qualitative study with a phenomenological study design was conducted at a Public and Private Med- ical College in Peshawar, Pakistan, from July 2020 to October 2020. In this qualitative study, four gender-specific focal group interviews with undergraduate medical students and 10 individual interviews with senior faculty members were conducted by using a pre-tested & validated semi-structured interview guide. The interviews were recorded and transcribed verbatim. The thematic analysis of the data was done where codes were developed and organized into distinct categories giving rise to discrete themes. Data triangulation was done to increase the credibility and authenticity of the study. Results: Out of 24 students and 10 faculty members, half of the participants were females who shared their perceptions about mechanisms to counteract gender bias in medical education. The analysis revealed 24 codes that were labeled and organized into 10 categories. The 4 themes deducted from these categories were Anti-Bias Training, Surveillance of Exam- ination, Psychological Evaluation of Students & Faculty, and Transparency & Accountability. Conclusion: Gender bias can substantially affect medical students’ capacity to learn and succeed in their careers, is a well-es- tablished fact. Thus, to reduce gender bias in medical education, medical schools must take more excellent initiatives and promote anti-bias awareness sessions & workshops, post-examination feedback & reporting systems, and strict surveillance & accountability. Similarly, psychological evaluation of teachers & students, structured examination patterns, and promoting a panel of assessors for high stake exams are other strategies to counteract this issue in undergraduate medical education. Keywords: Assessment, Gender bias, Reduce, Undergraduate Medical Education

Patients' Perspectives on Life and Recovery 1 Year After COVID-19 Hospitalization.

Many patients hospitalized for COVID-19 experience prolonged symptoms months after discharge. Little is known abou t patients' personal experiences recovering from COVID-19 in the United States (US), where medically underserved populations are at particular risk of adverse outcomes. Toexplore patients' perspectives on the impact of COVID-19 hospitalization and barriers to and facilitators of recovery 1year after hospital discharge in a predominantly Black American study population with high neighborhood-level socioeconomic disadvantage. Qualitative study utilizing individual, semi-structured interviews. Adult patients hospitalized for COVID-19 approximately 1year after discharge home who were engaged in a COVID-19 longitudinal cohort study. The interview guide was developed and piloted by a multidisciplinary team. Interviews were audio-recorded and transcribed. Data were coded and organized into discrete themes using qualitative content analysis with constant comparison techniques. Of 24 participants, 17 (71%) self-identified as Black, and 13 (54%) resided in neighborhoods with the most severe neighborhood-level socioeconomic disadvantage. One year after discharge, participants described persistent deficits in physical, cognitive, or psychological health that impacted their current lives. Repercussions included financial suffering and a loss of identity. Participants reported that clinicians often focused on physical health over cognitive and psychological health, an emphasis that posed a barrier to recovering holistically. Facilitators of recovery included robust financial or social support systems and personal agency in health maintenance. Spirituality and gratitude were common coping mechanisms. Persistent health deficits after COVID-19 resulted in downstream consequences in participants' lives. Though participants received adequate care to address physical needs, many described persistent unmet cognitive and psychological needs. A more comprehensive understanding of barriers and facilitators for COVID-19 recovery, contextualized by specific healthcare and socioeconomic needs related to socioeconomic disadvantage, is needed to better inform intervention delivery to patients that experience long-term sequelae of COVID-19 hospitalization.

A Qualitative Assessment of the Treatment Needs of Women with Concurrent Eating and Substance Use Disorders in a Residential Setting

Objectives: Eating and substance use disorders (SUD) are generally treated separately, leaving eating disorders (ED) overlooked within substance use treatment. The frequent co-occurrence of SUD and ED is well documented. Despite their many similarities and frequent co-occurrence, these two disorder types continue to be largely treated separately–either sequentially, with the most severe disorder addressed first, or concurrently but in separate programs. Our study, therefore, responds to this lacuna of data on patient and provider treatment needs for integrated ED and SUD treatment, centering the perspectives of women with lived experience of ED and SUD to support the development of therapeutic groups for women in treatment programs. Methods: This study was designed as a needs and assets assessment to determine the needs and priorities of women with concurrent ED and SUD for developing group programs. Participants for the needs assessment included both staff members (n = 10) and women receiving treatment (n = 10) who were recruited from a 90-day residential treatment program for women with SUD in British Columbia, Canada. Interviews and focus groups conducted with participants were audio-recorded and transcribed verbatim. Data were thematically analyzed and coded using Dedoose software. Results: Six key themes emerged from the qualitative data and were organized into sections with sub themes. An overarching premise from both staff and program participants was the need for concurrent therapeutic programming, nutritional support, and medical monitoring. The six discrete themes that were elicited included the similarities between ED and SUD, gaps in treatment, community support, family involvement, program participant treatment suggestions, staff treatment suggestions, and family involvement. Conclusions: Throughout this qualitative study, the need for screening and assessment of both disorders along with integrated treatment was stressed by participants, both program participants and staff alike. These findings complement current literature and suggest that pursuing concurrent treatment design may be helpful in addressing unmet program participant needs and could provide a more holistic framework for recovery.

Reflections on the Workings of General Synod

This article is based on a paper delivered to the Ecclesiastical Law Society's day conference in 2022. It is a reflection on the workings of General Synod from the perspective of an author who has been a member of Synod for around 36 years. The article examines three discrete themes: (i) the problem of authority in the Church of England, (ii) the shortcomings of Synodical government, and (iii) the urgency of mission. It examines these themes by considering, among other things, the Church of England's response to a number of contemporary issues: its response to the COVID-19 pandemic, proposed reform of its governance structures, its ability to respond to issues concerning sexuality and racial justice, and the proposals for reforming the Mission and Pastoral Measure 2011, as set out in GS 2222.

The Cambridge Companion to Democracy in America

Review of the book The Cambridge Companion to Democracy in America by Richard Boyd (editor). Richard Boyd has assembled a team of seventeen specialists with a heavy bent towards political science. The volume comprises sixteen chapters divided into four parts: a first one that deals with sources and contexts to Tocqueville’s masterwork; another that examines the book’s reception and applications around the world; a third part that analyses discrete themes and formal aspects of the work itself; and a final section that brings Democracy in America to bear on contemporary challenges.

Provider Perceptions on Bereavement Following Newborn Death: A Qualitative Study from Ethiopia and Ghana

The objective of this study was to explore how clinicians in low- and middle-income countries engage and support parents following newborn death. Qualitative interviews of 40 neonatal clinicians with diverse training were conducted in Addis Ababa, Ethiopia, and Kumasi, Ghana. Transcribed interviews were analyzed and coded through the constant comparative method. Three discrete themes around bereavement communication emerged. (1) Concern for the degree of grief experienced by mothers and apprehension to further contribute to it. This led to modified communication to shield her from emotional trauma. (2) Acknowledgment of cultural factors impacting neonatal loss. Clinicians reported that loss of a newborn is viewed differently than loss of an older child and is associated with a diminished degree of public grief; however, despite cultural expectations dictating private grief, interview subjects noted that mothers do suffer emotional pain when a newborn dies. (3) Barriers impeding communication and psychosocial support for families, often relating to language differences and resource limitations. Neonatal mortality remains the leading global cause of mortality under age 5, with the majority of these deaths occurring in low- and middle-income countries, yet scant literature exists on approaches to communication around end-of-life and bereavement care for neonates in these settings. We found that medical providers in Ghana and Ethiopia described structural and cultural challenges that they navigate following the death of a newborn when communicating and supporting bereaved parents.

GENDER BIAS DURING ASSESSMENTS IN UNDERGRADUATE MEDICAL EDUCATION: A QUALITATIVE STUDY

Objective: To explore the perceptions of students and faculty about gender bias during assessments in undergraduate medical education. Material and Method: The study was conducted at a Public and Private Medical College in Peshawar, Khyber Pakhtunkhwa Pakistan, from June 2020 to October 2020. It was a qualitative study with a phenomenological approach in which, 4 focal group interviews with undergraduate medical students and 10 individual interviews with faculty members were undertaken by using a validated semi-structured interview guide. The interviews were recorded and transcribed verbatim. The thematic analysis of the data was done where codes were developed and arranged in different categories giving rise to discrete themes. Data triangulation from students and faculty results was done for convergence and correspondence to increase the credibility and authenticity of the study. Results: Out of 24 students and 10 faculty members, half of the participants were females who shared their perceptions about gender bias in medical education. The analysis revealed 30 codes that were labeled and collated into 9 categories. The themes deducted from these categories were Lack of awareness, discriminatory attitude, the societal projection of the phenomenon, and the gendered climate in medical education. Conclusion: Most of the students are not aware of the concept of gender bias. The study emphasizes that bias is a natural phenomenon but society and culture multiply the effect of this phenomenon. Most of the participants do believe that the assessment environment is made more comfortable and positive for female students. The study also revealed that gendered cultures of learning and assessment still exist in Gynaecology/Obstetrics and General Surgery departments. Keywords: Gender bias, Assessment, Undergraduate Medical Education

The COVID-19 pandemic: Narratives of front-line nurses from Wuhan, China.

This study aimed to explore the experiences of nurses in Wuhan Hospital as front‐line workers during the COVID‐19 pandemic. A descriptive qualitative study of such nurses was conducted from a tertiary hospital in Wuhan. Semi‐structured individual interviews were undertaken with 8 registered nurses who were front‐line health workers in one of the COVID‐19 wards and 3 nursing managers from the response team. Five discrete themes were identified from the narratives of nurses' experiences during the COVID‐19 outbreak in Wuhan: “content of fundamental care,” “teamwork,” “reciprocity,” “nurses’ own worries,” and “lifelong learning and insights.” Nurses in the front line of care during the COVID‐19 pandemic can contribute important information from their hands‐on experience for providing a holistic response to an infectious outbreak like COVID‐19. The concerns nurses raised at both personal and professional levels have implications for nursing education and clinical practice settings, particularly in the time of a pandemic when nurses' well‐being requires attention, and at the same time for considering organizational factors that enable nurses to provide care to patients with confidence. Hospital policies and nursing management need to be ready and adhere to flexible work planning systems and approaches during a pandemic.

Perspectives\xa0on Resuscitation Decisions at the Margin of Viability among Specialist Newborn Care Providers in Ghana and\xa0Ethiopia: A Qualitative Analysis

BackgroundIn high income countries, guidelines exist recommending gestational age thresholds for offering and obligating neonatal resuscitation for extremely preterm infants. In low- and middle- income countries, this approach may be impractical due to limited/inconsistent resource availability and challenges in gestational dating. Scant literature exists on how clinicians in these settings conceptualize viability or make resuscitation decisions for premature infants.MethodsQualitative interviews of interprofessional neonatal clinicians were conducted in Kumasi, Ghana, at Komfo Anokye Teaching Hospital and Suntreso Government Hospital, and in Addis Ababa, Ethiopia, at St. Paul’s Hospital Millennium Medical College. Transcribed interviews were coded through the constant comparative method.ResultsThree discrete major themes were identified. The principal theme was a respect for all life, regardless of the likelihood for survival. This sense of duty arose from a duty to God, a duty to the patient, and a duty intrinsic to one’s role as a medical provider. The duty to resuscitate was balanced by the second major theme, an acceptance of futility for many premature infants. Lack of resources, inappropriate staffing, and historically high local neonatal mortality rates were often described. The third theme was a desire to meet global standards of newborn care, including having resources to adopt the 22–25-week thresholds used in high income countries and being able to consistently provide life-saving measures to premature infants.ConclusionsNeonatal clinicians in Ghana and Ethiopia described respect for all life and desire to meet global standards of newborn care, balanced with an awareness of futility based on local resource limitations. In both countries, clinicians highlighted how wide variations in regional survival outcomes limited their ability to rely on structured resuscitation guidelines based on gestational age and/or birthweight.

A Qualitative Study of Characteristics of an Effective Health Coach: Personal, Professional, and Program Based

Health coaching continues to grow in popularity as an effective intervention to empower and engage patients and their caregivers. However, little is known about what characteristics contribute to the success of health coaches in implementing evidence-based interventions. This study examines the characteristics that contribute to effective health coaches. Semi-structured interviews were conducted with health coaches and an interdisciplinary research team of an ongoing study examining a virtual health coaching intervention. Interviewees identified three discrete themes of characteristics that contribute to the success of health coaches: personal (e.g. compassion), professional (e.g. transferability of soft skills) and program based (e.g. training regimen). We conclude that it is not just innate personality attributes that make a health coach effective in their role, but training and program design intended to support health coaches are also important in implementing interventions.

An Active Learning Framework for Ecological Intelligence: Using Activities of Multiple Intelligences to Achieve Ecological Awareness

The current paper aimed to identify the relation between ecological intelligence (EI) and the types of multiple intelligences (MI); and pointed out how ecological awareness could be raised through activities of MI. Data was gathered from the freshman students (N = 68) who studied at the Department of Primary Education. Four measures were used in this case study: interviews, multiple intelligence inventory (MII), ecological intelligence scale (EIS), and students' 5-min notes. Correlation analysis was used to find the relationship between the students’ ecological intelligence and the types of MI. The responses to interview questions were coded into discrete themes. Findings indicated that the intelligence type which had the most correlation with the sub-dimensions of EIS was InterP. Moreover, moderate relations were determined between the sub-dimensions of EIS and the types of MI which were Bodily/Kinesthetic (BK) and Visual/Spatial (VS). Although the students had difficulties in activities such as drama and role-playing for BK intelligence, they enjoyed, and had better motivation to learn collaboratively during the activities through visual tools. Ecological intelligence relates to various types of MI. Based on this assertion the activities of MI should be integrated in-class environmental activities for students to acquire ecological awareness and sensitivity.

Easier, but not easy: Testing a grounded theory of breastfeeding experiences among women with larger birthweight infants

Objective Grounded Theory has previously been used to explore breastfeeding practices amongst average birthweight infants and these working hypotheses can be ‘tested’ in new contexts. A pre-existing Grounded Theory was applied to the context of women who gave birth to larger birthweight infants (≥4,000 g) to understand whether perceptions and practices of infant feeding were distinct. Design A nested qualitative study analysed data from N = 10 women with a larger birthweight infant (≥4,000 g). Face-to-face, semi-structured interviews were audio-recorded and transcribed verbatim. Grounded Theory methodology was used to analyse data. Results A pre-existing Grounded Theory of breastfeeding experiences derived from women with average birthweight infants did not hold true among women with larger birthweight infants. An alternative Grounded Theory was therefore proposed comprised of three discrete themes: Infant Ability to Breastfeed; Attenuating Maternal Concerns; and Reality of Breastfeeding. Conclusions Larger infant birthweight is potentially a protective factor against breastfeeding latch and lactation difficulties. It is associated with alleviating maternal concerns, helping to reduce disparities between expectations of breastfeeding and reality, but does not alleviate the demands breastfeeding places on women. Healthcare professionals help to attenuate women’s concerns, however the support needs for women with larger birthweight infants may not differ from existing care recommendations.

Entrustable Professional Activities and Entrustment Decision Making: A Development and Research Agenda for the Next Decade.

To establish a research and development agenda for Entrustable Professional Activities (EPAs) for the coming decade, the authors, all active in this area of investigation, reviewed recent research papers, seeking recommendations for future research. They pooled their knowledge and experience to identify 3 levels of potential research and development: the micro level of learning and teaching; the meso level of institutions, programs, and specialty domains; and the macro level of regional, national, and international dynamics. Within these levels, the authors categorized their recommendations for research and development. The authors identified 14 discrete themes, each including multiple questions or issues for potential exploration, that range from foundational and conceptual to practical. Much research to date has focused on a variety of issues regarding development and early implementation of EPAs. Future research should focus on large-scale implementation of EPAs to support competency-based medical education (CBME) and on its consequences at the 3 levels. In addition, emerging from the implementation phase, the authors call for rigorous studies focusing on conceptual issues. These issues include the nature of entrustment decisions and their relationship with education and learner progress and the use of EPAs across boundaries of training phases, disciplines and professions, including continuing professional development. International studies evaluating the value of EPAs across countries are another important consideration. Future studies should also remain alert for unintended consequences of the use of EPAs. EPAs were conceptualized to support CBME in its endeavor to improve outcomes of education and patient care, prompting creation of this agenda.

Developments in Privacy and Data Ownership in Mobile Health Technologies, 2016-2019.

Summary Objectives : To survey international regulatory frameworks that serve to protect privacy of personal data as a human right as well as to review the literature regarding privacy protections and data ownership in mobile health (mHealth) technologies between January 1, 2016 and June 1, 2019 in order to identify common themes. Methods : We performed a review of relevant literature available in English published between January 1, 2016 and June 1, 2019 from databases including PubMed, Google Scholar, and Web of Science, as well as relevant legislative background material. Articles out of scope (as detailed below) were eliminated. We categorized the remaining pool of articles and discrete themes were identified, specifically: concerns around data transmission and storage, including data ownership and the ability to re-identify previously de-identified data; issues with user consent (including the availability of appropriate privacy policies) and access control; and the changing culture and variable global attitudes toward privacy of health data. Results : Recent literature demonstrates that the security of mHealth data storage and transmission remains of wide concern, and aggregated data that were previously considered “de-identified” have now been demonstrated to be re-identifiable. Consumer-informed consent may be lacking with regard to mHealth applications due to the absence of a privacy policy and/or to text that is too complex and lengthy for most users to comprehend. The literature surveyed emphasizes improved access control strategies. This survey also illustrates a wide variety of global user perceptions regarding health data privacy. Conclusion : The international regulatory framework that serves to protect privacy of personal data as a human right is diverse. Given the challenges legislators face to keep up with rapidly advancing technology, we introduce the concept of a “healthcare fiduciary” to serve the best interest of data subjects in the current environment.

Reflections of Hospice Staff Members About Educating Hospice Family Caregivers Through Telenovela.

Hospice family caregivers are seeking additional information related to patient care, pain and symptom management, and self-care. This study interviewed hospice staff about the potential dissemination of bilingual telenovelas to address these caregiver needs. Qualitative structured phone interviews were conducted with 22 hospice professionals from 17 different hospice organizations in 3 different Midwest states. The interviews were conducted from October to December 2019. Hospice staff volunteers were recruited from conferences, then individual interviews were audio-recorded, transcribed, and thematic analysis was conducted to gain an in-depth understanding of how to best implement telenovela video education into hospice care. Most participants were hospice nurses (36%) located primarily in Missouri (91%), with a mean of 9 years of experience. Three discrete themes emerged, the educational resources currently provided to patient/families, perceptions of the usefulness of telenovelas for education, and practical suggestions regarding the dissemination of telenovelas. The development of 4 telenovela videos covering different topics is described. Hospice staff responded favorably to the concept of telenovelas and identified important keys for dissemination.

Factors impacting on retention, success and equitable participation in clinical academic careers: a scoping review and meta-thematic synthesis

ObjectivesTo examine and synthesise current evidence on the factors that affect recruitment, retention, participation and progression within the clinical academic pathway, focusing on equitable participation across protected characteristics including gender,...

FALLS IN MID-LIFE: A SCOPING LITERATURE REVIEW

The implications of falls of middle-aged adults (40-64 years) on falling in late life (65+) have not received much attention. The patterns of falling over the lifespan require more research. The purpose of this scoping literature review was to answer: What is known about falls occurring in mid-life? and How falls in mid-life relate to falling over the adult lifespan? A six-stage scoping literature review framework by Levac et al. (2010) was followed. A total of 5,136 titles were identified in CINAHL, EMBASE and MEDLINE using MeSH terms for accidental fall, middle-aged and longitudinal studies. Inclusion/exclusion criteria narrowed the search to 30 full-text research articles and nine gray literature sources that were charted. Literature on falls in mid-life produced five discrete themes: two distinct populations of fallers, prevalence rates, fall-related injuries, causes of falls, and risk factors for falling. The two groups of fallers were the general population (falls prevalence 8.7-35.8%) and the special population of mid-life adults living with chronic health conditions (falls prevalence 26% for diabetes and 32.3% intellectual disabilities). Middle-aged adults had a higher proportion of injurious falls (11.5-30%) compared to older adults and extrinsic risk factors were the most frequent causes of falling (83.3%). For special populations, the risk of falls was frequently attributed to intrinsic factors. In conclusion, falls in mid-life require further exploration to establish patterns over the adult lifespan, determine influence of chronic diseases, establish clear fall incidences and risk factors, and determine if current falls prevention interventions are appropriate for mid-life adults.

Engaging under- and/or never-engaged populations in health services: A systematic review

Patient engagement is a mechanism used to facilitate person-centred care, however, has not been realized in all patient populations. Often, many marginalized populations still remain under- and/or never-engaged. The purpose of this systematic review was to: 1) identify methods or interventions that have been used to engage under- and/or never-engaged populations in health services and 2) identify outcomes that are associated with engaging under- and/or never-engaged populations in health services. A comprehensive search using the Ovid MEDLINE, EMBASE and CINAHL databases was conducted to examine literature between January 2002 and January 2015. Twenty-nine studies met the inclusion criteria. Data was extracted from these studies and findings are synthesized based on discrete themes that map to the research objectives. The majority of studies were quantitative, repeated-measures designs and concentrated in the United States. Hispanic and Latino/a populations were most frequently included in these studies. The main methods of recruitment included: 1) referral from a healthcare provider, 2) patient self-referral after seeing advertisements on mass media or targeted media, 3) directly approached by researcher in-person or telephone, and 4) administrative databases. Interventions occurred primarily at the individual-level, however some system-level interventions were identified. Five main outcomes resulted from the interventions, including: 1) behavioural change, 2) physiological, 3) psychosocial, 4) system and 5) process. Finally, culture-specific components were embedded in the interventions, both as surface and deep structures. This study provides future direction for patient engagement related projects, as it relates to under-and never-engaged population in healthcare.

What’s in a Name? A Synthesis of “Allyship” Elements from Academic and Activist Literature

Within men’s activism to address gender inequities and prevent gender-based violence, and social justice movements more broadly, questions about the usefulness and limitations of the term ‘allyship’ have surfaced. Moreover, studies demonstrate that social justice activists with privilege often perpetuate inequalities, perhaps despite their best intentions. To explicate the current understanding of allyship and to apply it to male activism, this paper synthesized the primary elements of allyship as defined by 40 activist and academic sources. Eight unique and discrete themes surfaced: constant action of the “everyday ally”; prioritizing a structural analysis of oppression and privilege; non-self absorbed and accountable self-reflection; amplify marginalized voices; welcome criticism and be accountable; listen+shut up+read, ally is not a self-adhesive label; and allyship: unlikely or undesirable?. While surfacing as discrete concepts, the themes inter-relatedness and interdependence appeared equally crucial. The implications of this synthesis for allyship discourse and scholarship are offered. This synthesis provides conceptual and practical insights that can be applied to men’s gender equity promotion and gender-based violence prevention work.

Testing geovisualisations for effective environmental engineering decision-making

Testing geovisualisations for effective environmental engineering decision-making