Elective Experience Research Articles

The Value of Legislative Versus Electoral Experience and Gender in Explaining Candidate List Placement in Closed-List PR

Candidates’ political qualities and personal characteristics reflect what priorities political parties have when they nominate for viable seats. The limited research on the link between candidate characteristics and ranking on closed lists is an important hiatus in understanding legislative recruitment since in closed list PR nomination to top positions on viable lists virtually guarantees election. We address the issue by analyzing longitudinally the determinants of candidate list placement in Romania, an intriguing case given its low proportion of reelected incumbents and women MPs. Our findings indicate that while male candidates are placed higher up on the lists than women, the positive effect of incumbency is larger for female than male incumbents.

Measuring the course of anxiety in women giving birth by caesarean section: a prospective study.

BackgroundWomen undergoing elective caesarean section experience anxiety. However, course, extent and duration of anxiety have not been investigated yet. This study aimed to explore anxiety levels during the course of the day of surgery by employing and comparing subjective as well as objective measures. By examining their correlation it is intended to give methodological support for interventional studies.MethodsThis is a monocentric, prospectively planned study in which 47 women with an indication for primary caesarean section took part. Anxiety levels were evaluated using the State-Trait Anxiety Inventory (STAI-trait and STAI-state), the visual analogue scale for anxiety (VASA) as well as saliva cortisol at three time points on the day of the caesarean section (at admission, at skin closure and 2 h post surgery).ResultsPeak anxiety levels for the STAI-state and VASA were highest at admission and showed significant decreases to skin closure (p < .001). The subjective measures correlated significantly at all time points (p-values < .001). For cortisol levels the peak level of anxiety was shown at skin closure with a significant increase from admission to skin closure and a significant decrease from skin closure to 2 h post operation (p-values < .001). Additionally women with STAI-trait scores above the median showed significantly higher levels at the peaks of anxiety.ConclusionThe study reveals the course of anxiety on the day of the caesarean section. A strong correlation of STAI-state and VASA was demonstrated. Cortisol showed a different course, which fits into its known biological kinetics. Taking into account all measures, anxiety seems to be most bothersome before surgery until skin closure. In a differentiated approach using STAI-trait scores as a discriminator we showed that the group with STAI-trait levels above the median is particularly prone to develop anxiety in the setting of the caesarean section and might therefore mostly be in need of an intervention against anxiety.

Implementing and assessing an elective learning experience in medical missions for PGY-1 pharmacy residents

ObjectiveTo implement and assess an elective learning experience in medical missions for postgraduate year one (PGY-1) pharmacy residents at the Lloyd L. Gregory School of Pharmacy. MethodsOut of a total of six PGY-1 pharmacy residents who pursued the elective medical mission trip learning experience, five completed a survey evaluating the perceived value in spiritual and professional development, the benefit to the population served, as well as the benefit to the resident as a part of the learning experience. ResultsAll participants reported high levels of satisfaction with their mission experience. ConclusionPGY-1 pharmacy residents were very satisfied with the elective learning experience in medical missions. We encourage residency directors and preceptors to incorporate such an elective into their programs.

P103: Emergency medicine as a career choice: what influences medical students throughout their schooling?

Introduction: Practicing emergency medicine (EM) involves rapid decision-making in an acute setting, broad knowledge and a strong ability to multi-task. Some medical students find these characteristics attractive, while others find them a deterrent. Previous studies have indicated the range of characteristics that interest undergraduate students. No studies have followed students to assess how attitudes towards EM careers evolve over their schooling. Methods: An open-ended survey of medical students’ career interests was distributed at five data-collection points over the four years of undergraduate training from 1999-2006 at Memorial University. Guided by principles of grounded theory the qualitative data was coded to identify key themes and sentinel quotes. Semi-structured interviews with academic emergency physicians at Dalhousie University were then conducted to assess the relevance of these findings to postgraduate training (in progress). These transcripts were analyzed in the same manner as the longitudinal surveys. Results: 1281 surveys were completed by 540 students, with 758 comments about EM. The biggest drawbacks of EM included lack of patient follow-up and lack of experience in EM; the biggest benefits included variety of cases and patients, congruence with previous life experiences, and elective experiences. One major theme was the Certificant of the College of Family Physicians (CCFP) EM training, as it meant a shorter residency that was more transferrable to rural settings. Lifestyle was a prominent theme, seen as positive by some and negative by others. Emergency physicians commented on students’ naivety, especially relating to media and the nature of the work early in their training. Conclusion: Medical students’ opinions of EM tend to shift throughout their schooling, in particular, the perception of the work. Medical students’ perceptions differ significantly from that of experienced emergency physicians, highlighting the need for a greater degree of mentoring. Perceptions of lifestyle in EM are highly variable amongst students, acting as both a benefit and a drawback. Medical schools may be able to improve clinical exposure and provide more informed career counselling with respect to emergency medicine. Residency program directors can consider these findings during recruitment and interviewing to determine whether students have a realistic view of the specialty and career trajectory.

What Should Constitute an Acceptable Advanced Pharmacy Practice Experience?

What Should Constitute an Acceptable Advanced Pharmacy Practice Experience?

On being agents of change: A qualitative study of elective experiences of medical students at the Faculty of Health Sciences, University of Cape Town, South Africa

Background. Student electives during the 5th year of the University of Cape Town (UCT) medical curriculum provide a 4-week work experience in the health system. The reflective reports of past students indicate that the electives may significantly shape their developing identities as health professionals and agents of change. Objective. To better understand how 5th-year medical elective students perceive themselves as agents of change to strengthen the elective programme in the Faculty of Health Sciences, UCT. The hypothesis was that the more choice that students are given over their learning, the greater is their sense of agency. Methods. Thirteen 5th-year student volunteers participated in four focus group discussions soon after completing their electives in district, regional or tertiary health facilities in the South African health system. Thematic analysis of the transcripts was performed independently by two of the authors. Results. Key themes were the importance of providing holistic patient-centred care, becoming a competent health professional, working within the health team and advocating for a better health system. The elective experience helped students to be more confident in their abilities and to better understand how to effect change at a clinical and health system level. Conclusion. This study supported the hypothesis that the more choice students have over their learning, the greater is their sense of agency. The electives are appreciated as opportunities to develop clinical skills and competencies and to better understand the role of future doctors within the health team and health system. The value of the UCT elective programme could be enhanced by greater promotion, funding for rural electives, and post-elective peer-to-peer feedback sessions. This study will inform planning for an extended 2016 medical elective programme in the Faculty.

Does sector-specific experience matter? The case of European higher education ministers

This paper looks at the relationship between higher education ministers and the performance of the sector that they govern. Using an original panel dataset with the characteristics of European higher education ministers, we find that having a past experience in the sector leads to a higher level of performance, as measured by ranking data. Making a parallel with the literature about the impact of education on the educated, we discuss potential explanations behind the impact of this on-the-job learning experience. As we find that this characteristic has no impact on the spendings of the sector, we argue that this academic experience makes them more prone to introduce adequate reforms that makes the sector more attractive for top-researchers. Furthermore, we find that this result is driven by ministers with both sector-specific and electoral experience, the latter measured by a successful election at the regional or national level. This tends to show that political credibility should not be overshadowed by the importance of the sector-specific experience of ministers.

Required and Elective Experiences During the 4th Year: An Analysis of ACGME Accredited Psychiatry Residency Program Websites.

The objective of this study was to assess and describe required and elective components of the 4th post-graduate year (PGY4) in psychiatry residency programs. We reviewed the websites of all 193 2014-2015 ACGME accredited psychiatry residency programs for content describing the specific components of the PGY4 year. Nearly all residency programs (99%) had some form of required experiences during the PGY4 year. Ninety-four percent had clinical requirements for PGY4 residents, with longitudinal outpatient clinic being the most common (77%). All programs offered some elective time during PGY4, but the amount of time ranged from 2months to 100%. Virtually all residency programs include some requirements in the 4th year (most commonly didactics and outpatient clinic) in addition to a broad array of elective experiences. Although 3years may suffice for residents to complete ACGME requirements, a variety of factors may motivate programs to include required 4th year curricula. Future studies should explore the rationales for and possible benefits of programmatic requirements throughout 4 versus only 3years of psychiatric training.

McMaster University Internal Medicine International Health Elective: A Survey-Based Study to Understand Achievements and Lessons Learned

The McMaster Internal Medicine International Health Elective (IHE) has been placing senior medical residents (PGY-3) in an elective setting in a teaching hospital in Kampala, Uganda, for the past 7 years. This article discusses a study in which the authors electronically mailed a survey to alumni of this elective to evaluate important aspects of program participation from the residents’ point of view. The factors most commonly cited as being important in the decision to apply to the McMaster IHE were to gain experience practising medicine in a resource-limited setting and to gain exposure to diseases and conditions not commonly encountered in Canada. Most residents (61.5%) planned to have some involvement in global health prior to their elective, and 100% felt the elective experience made them more likely to take part in global health activities in the future. IHEs offer a unique opportunity for residents to explore global health. Residents participating in this survey found the McMaster Internal Medicine IHE to be a successful endeavour.

Searching for Persons with Disabilities in Canadian Provincial Office

This exploratory study examines the electoral experience of persons with disabilities with a particular focus on those that have sought provincial political office in Canada for the last three provincial elections in every province. It also gauges the accessibility of the environment into which they were entering when deciding to seek political office: political parties (recruitment efforts, campaign finance provisions, disability specific language in party constitutions) and the provincial electoral management bodies (campaign financing laws). If the incremental nature of disability policy changes has long been “not good enough” with minimal gains won through long drawn out processes (Levesque and Graefe, 2014), what then is to be made of the gains made to date? For persons with disabilities, this is important given their late enfranchisement (Davidson and Lapp, 2004). In its wake, a small but growing literature has emerged that examines accessibility issues related to the voting experience (Prince, 2004, 2012) while an even smaller literature exists that examines persons with disabilities seeking political office in Canada (e.g., D’Aubin and Stienstra, 2004). The work thus far largely focuses on barriers to inclusion and on federal electoral participation. Missing in this literature is a provincial assessment of persons with disabilities that have sought elected office, as well as the mechanisms used by political parties to encourage potential candidates with disabilities to seek office. The story that emerges is one of largely non-participation which underscores the work needed to attract candidates with disabilities to seek political office to aid in the construction and reconstruction of the Canadian nation.

The influence of international medical electives on career preference for primary care and rural practice.

BackgroundPrevious studies have demonstrated a correlation between medical students who undertake international medical electives (IMEs) in resource poor settings and their reported career preference for primary care in underserved areas such as rural practice. This study examines whether a similar correlation exists in the Australian medical school context.MethodsData was extracted from the Medical Schools Outcomes Database (MSOD) of Australian medical students that completed commencing student and exit questionnaires between 2006 and 2011. Student responses were categorized according to preferred training program and preferred region of practice at commencement. The reported preferences at exit of students completing IMEs in low and middle income countries (LMIC) were compared to those completing electives in high income countries (HIC).ResultsThe effect of elective experience for students expressing a preference for primary care at commencement was non-significant, with 40.32 % of LMIC and 42.11 % of HIC students maintaining a preference for primary care. Similarly there were no significant changes following LMIC electives for students expressing a preference for specialist training at commencement with 11.81 % of LMIC and 10.23 % of HIC students preferring primary care at exit. The effect of elective experience for students expressing a preference for rural practice at commencement was non-significant, with 41.51 % of LMIC and 49.09 % of HIC students preferring rural practice at exit. Similarly there were no significant changes following LMIC electives for students expressing a preference for urban practice at commencement, with 7.84 % of LMIC and 6.70 % of HIC students preferring rural practice at exit.ConclusionsThis study did not demonstrate an association between elective experience in resource poor settings and a preference for primary care or rural practice. This suggests that the previously observed correlation between LMIC electives and interest in primary care in disadvantaged communities is likely dependent on student and elective program characteristics and supports the need for further research and critical examination of elective programs at Australian medical schools.

A scoring model for predicting survival following primary tumour resection in stage IV colorectal cancer patients with unresectable metastasis

Stage IV colorectal cancer patients with unresectable metastasis who undergo elective primary tumour resection experience heterogeneous post-operative survival. We aimed to develop a scoring model for predicting post-operative survival using pre-operative variables to identify patients who are least likely to experience extended survival following the procedure. Survival data were collected from stage IV colorectal cancer patients who had undergone elective primary tumour resection between January 1999 and December 2007. Coefficients of significant covariates from the multivariate Cox regression model were used to compute individual survival scores to classify patients into three prognostic groups. A survival function was derived for each group via Kaplan-Meier estimation. Internal validation was performed. Advanced age (hazard ratio, HR 1.43 (1.16-1.78)); poorly differentiated tumour (HR 2.72 (1.49-5.04)); metastasis to liver (HR 1.76 (1.33-2.33)), lung (HR 1.37 (1.10-1.71)) and bone (HR 2.08 ((1.16-3.71)); carcinomatosis (HR 1.68 (1.30-2.16)); hypoalbuminaemia (HR 1.30 (1.04-1.61) and elevated carcinoembryonic antigen levels (HR 1.89 (1.49-2.39)) significantly shorten post-operative survival. The scoring model separated patients into three prognostic groups with distinct median survival lengths of 4.8, 12.4 and 18.6 months (p < 0.0001). Internal validation revealed a concordance probability estimate of 0.65 and a time-dependent area under receiver operating curve of 0.75 at 6 months. Temporal split-sample validation implied good local generalizability to future patient populations (p < 0.0001). Predicting survival following elective primary tumour resection using pre-operative variables has been demonstrated with the scoring model developed. Model-based survival prognostication can support clinical decisions on elective primary tumour resection eligibility.

Radiology in Medical Education: A Pediatric Radiology Elective as a Template for Other Radiology Courses

PurposeTraditionally, the pediatric radiology elective for medical students and pediatric residents constituted a morning teaching session focused mainly on radiography and fluoroscopy. A more structured elective was desired to broaden the exposure to more imaging modalities, create a more uniform educational experience, and include assessment tools. MethodsIn 2012, an introductory e-mail and formal syllabus, including required reading assignments, were sent to participants before the start date. A rotating weekly schedule was expanded to include cross-sectional imaging (ultrasound, CT, MR) and nuclear medicine. The schedule could accommodate specific goals of the pediatric resident or medical student, as requested. Starting in 2013, an online pre-test and post-test were developed, as well as an online end-of-rotation survey specific to the pediatric radiology elective. Taking the Image Gently pledge was required. A scavenger hunt tool, cue cards, and electronic modules were added. ResultsPre-test and post-test scores, averaged over 2 years, showed improvement in radiology knowledge, with scores increasing by 27% for medical students and 21% for pediatric residents. Surveys at the end of the elective were overwhelmingly positive, with constructive criticism and complimentary comments. ConclusionsWe have successfully created an elective experience in radiology that dedicates time to education while preserving the workflow of radiologists. We have developed tools to provide a customized experience with many self-directed learning opportunities. Our tools and techniques are easily translatable to a general or adult radiology elective.

Free Elections and Political Instability in Lesotho

Since 1993, Lesotho has had six free elections. Five have been followed by episodes of coercive regional diplomacy or military intervention to maintain order or sustain the elected government. Two of these interventions have occurred as Lesotho's electoral system was being transformed from a first-past-the-post dominant party system to a mixed member proportional pattern, and a third intervention is presently underway. This essay contends that the effort to remedy the prior lack of inclusiveness in Parliament has accentuated the fissiparous proclivities within Lesotho's political culture. Following the 2012 and 2015 elections, greater fragmentation among political parties led to hung parliaments and coalition governments with minimal parliamentary majorities. This essay questions whether Staffan Lindberg's conceptual model regarding the link between the consolidation of democracy and the experience of successive free and fair elections can adequately explain Lesotho's trajectory. Remarkably, the transfers of power by Pakalitha Mosisili to Motsoahae Thomas Thabane in 2012, and by Thabane back to Mosisili in 2015, were the first such exchanges between an incumbent government and an opposition party in southern Africa during the post-liberation era. Whether this positive development might be translated into more effective governance and regard for democratic norms will be explored.

The impact of fellowships on surgical resident training in a multispecialty cohort in Australia and New Zealand

Fellowships in surgery are increasing in number, and concerns have been raised regarding their impact on resident training. Although fellows may contribute to resident education and training, they also compete for operative and other experience. This study aimed to quantify the impact of fellowships on resident training in a binational multispecialty cohort. The operative case volumes and primary operator rates of surgery trainees (residents) in Australia and New Zealand were compared between units with and without fellows. Trainees also were surveyed using Likert Scales to assess quality of operative and other experience in units with and without fellows. Data from 911 trainees over 2 terms was analyzed; survey response rate 42%. Of all trainees, 42% worked with fellows. Trainees in units without fellows were involved in more major (P = .03) and minor (P < .0001) cases. Primary operator rates were comparable, but trainees in units without fellows were less often assistants, reported an increased quality of elective operating experience, and reported more favorable completion of learning objectives (all P < .05). These findings were consistent between tertiary and nontertiary hospitals. Thematic analysis showed positive benefits of fellows in teaching, training and mentorship, but negative impacts on case exposure, competition for operating, and clinical experience. Fellows may assist in the teaching and training of residents, but residents working with fellows experience a decreased quantity of operative experience that may impact several aspects of the quality of training. Surgical educators must actively balance the learning needs of fellows and residents.

Reflective Writing: A Potential Tool to Improve Interprofessional Teamwork with Radiologists

Studies show that problems with interprofessional collaboration can result in adverse patient outcomes. These problems are common in the field of radiology, where technology has decreased opportunities for direct communication and collaboration with referring physicians. To our knowledge, critical reflection has not been studied as an intervention to better understand one's own and/or others' roles in the context of an interprofessional team, or more specifically, to improve interprofessional collaboration between radiologists and other physicians. We trialed a reflective journaling assignment in our fourth year medical student general radiology elective. Student journal content was scored by percentage of comments reflecting on elective experiences versus recounting events. Content was categorized as "reflection" using an established measurement tool. Reflective content was evaluated to identify common themes. A total of 31 journals (178 entries and 26,749 words) were analyzed. Reflective content accounted for 43% of overall content and was subdivided into three categories: insight into one's own role and responsibilities as an ordering physician (20%), insight into a radiologist's role and responsibilities (12%), and thoughts on improving interprofessional collaboration with radiologists (11%). Reflective writing allows students to explore their own role and responsibilities in the context of an interprofessional team and may improve interprofessional teamwork with radiologists.

A review of literature on medical students and scholarly research: experiences, attitudes, and outcomes.

The aim of medical student research programs is to develop interest in and competencies related to scholarly research within future physicians. Although schools invest in these programs, there is currently no consensus regarding what benefits they confer. The goal of this review is to characterize students' perceptions of research programs during medical school as well as the outcomes attributed to these programs to provide recommendations for their optimization. In June 2013, the authors reviewed the literature (1950-June 2013) and identified 20 reports that provided original data delineating undergraduate medical students' primarily self-reported experiences with, outcomes related to, and attitudes toward research. Students generally perceive their medical school research experiences to be positive in terms of stimulating research interest and developing scholarly research abilities. The majority of students author at least one article, and first-author publications occur more frequently as formal research experiences lengthen. Elective experiences do not differ from mandatory experiences in terms of student satisfaction or productivity. Several studies uncovered negative student perceptions regarding their research experience, including too little acknowledgment, time, and faculty interaction. Published studies were deficient in characterizing effects on future research engagement in participants. These findings suggest that formal medical student research programs can be optimized by improving the recognition of student effort, promoting student-mentor interaction, and allowing students the option to increase the duration of the research experience. Future studies are needed to determine whether these programs affect research participation and productivity later in participants' careers.

Press and ethnic polarization in post-2001 Afghanistan: the 2014 presidential election experience

This article analyses the contents of three newspapers affiliated with the Tajik-dominated Jamiat and Shura-e-Nezar factions that were deployed during the 2014 presidential election to publicize ethno-political polarization for instrumental ends. The practice of nurturing ethnic identities serves as a microcosm of the broader context in which identity politics, besides coalition-building, rent-seeking, and patrimonial interdependencies, has become a key feature of post-2001 politics. This article focuses on how these factions used these newspapers to polarize ethnic cleavages to win legitimacy for themselves and defamation for their Pashtun-dominated rival factions – Hezb-e-Islami Gulbuddin and the Taliban. It will be years before the ethnic mujahedeen and muhajereen and the new generation reach a mutually binding and working condition that facilitates the country's long-term stability. Reaching this condition is critical because the future of Afghanistan lies in the commitment of its people to form a united community that resolves disputes in the manner of a democratic nation.

Nephrology elective experience during medical residency: a national survey of US nephrology fellowship training program directors

Interest in nephrology careers continues to decline in the United States. The reasons for this declining interest are not fully understood but it is plausible that inadequate exposure to the full spectrum of what a career in nephrology encompasses may be part of the explanation. Inpatient-based nephrology electives have been a common venue for residents to gain exposure to nephrology but little is known regarding the details of such electives and how often they include outpatient experiences. We carried out a national survey of nephrology fellowship training program directors to obtain data on the content of nephrology elective experiences as well as their ideas on how to promote interest in the field. The survey revealed the majority of elective experiences to be either exclusively or heavily inpatient based, with only a small percentage having a substantial outpatient component, particularly in outpatient dialysis or transplantation. Training program directors felt that providing greater outpatient experiences to residents during elective rotations would be an effective means to promote interest in nephrology, along with structured faculty mentoring. Our findings suggest that current approaches to the nephrology elective experience are heavily inpatient-based and might benefit from incorporating much more of the rich spectrum of activities a career in nephrology entails. Hopefully such efforts can create and enhance interest in careers in nephrology and potentially begin a sustained reversal of an unfortunate and serious decline in interest.

115: Don &amp; Elizabeth Hillman International Child Health Grant Awardees: Where are they Now?

In 2003, the Don & Elizabeth Hillman International Child Health Grant was created by the Canadian Pediatric Society (CPS) Global Child & Youth Health Section to promote international health opportunities for residents and fellows. Forty awards were administered ($750 – $1000) from 2003 to 2013, for use towards costs of paediatrics elective in low-middle income countries (LMIC). It is one of the few funding opportunities of its kind available to Canadian paediatric trainees. It is timely to evaluate the impact of providing supportive funds for such experiences and their effects on recipient career paths. This evaluation aimed to describe interest, enablers, and perceived barriers of career activities in global health amongst those who completed a funded international elective during residency, and to examine how these experiences may influence the time dedicated to global health activities including local patient populations. Past Hillman Grant recipients were contacted by email to complete an online survey, which was designed from review of relevant literature, to assess interest, perceived enablers and barriers in global health experiences and career paths. Data were collected and managed using REDCap electronic data capture tools hosted at University of British Columbia. Nineteen out of 40 grant awardees completed the online survey; five are still in residency or fellowship. While for 8/19, receiving the grant influenced their decision to go, the remainder would have done an international residency elective (IRE) regardless but qualitative review indicates that it assisted in lifting ‘burden of cost’ and was appreciated, but not sole influential factor in participating. Nearly half (47%) have pursued further training related to global health (GH), while another 36% are planning to do so in the future. The majority (79%) endorsed that participation in an IRE encouraged future global health involvement, while all respondents felt the experience influenced their attitudes towards health care. Ten (of 14 total) pediatrician respondents indicated that they currently spend time in GH activities (both locally and abroad); respondents are involved with caring for families receiving social assistance (14/19), newcomer health (11/19), First Nations/Inuit/Metis health (10/19), GH education within Canada (14/19), and health education outside Canada (10/19). Enablers to participation in GH activities include: family support (11/19), departmental support (10/19), international electives (9/19) and mentorship (8/19). Most significant barriers to participation in GH activities were: scheduling (16/19) with 68% of these indicating need to use vacation time, financial (15/19), and family obligations (10/19). Recipients of the Hillman grants generally are involved with the care of vulnerable children within and outside Canada, and for many, their international elective experience influenced those career directions.