Experience Of Doctors Research Articles

The entangled becoming in humanities doctoral education

PurposeInstitutional framings of doctoral education mostly do not recognize the existential dimension of doctoral experience. This paper aims to offer an expanded understanding of experiences of doctoral researchers in the humanities with the concept of entangled becoming. This concept is developed through an existential lens by using Søren Kierkegaard’s philosophy – particularly his emphasis on emotions such as passion, anxiety and despair – and Denise Batchelor’s derived concept of vulnerable voices.Design/methodology/approachThe conceptual framing is used for an empirical study based on ethnographic interviews with 10 doctoral researchers and supplementary observational notes from fieldwork at a university in Denmark. Two of the interview cases were selected to showcase variation across lived experiences and how doctoral researchers voice their entangled becoming.FindingsCommon experiences such as loneliness, insecurity(ies), vulnerability(ies) or passion for one’s research were identified across the interviews. On the other hand, this study shows that each doctoral journey in the humanities envelops a distinct web of entanglements, entailing distinct navigation, that makes each case a unique story and each doctoral voice a specific one.Originality/valueCombining an existential philosophical perspective with a qualitative study, the paper offers an alternative perspective for doctoral education. It connects the humanities doctoral experience to the broader condition of human existence and the sophisticated uniqueness of each researcher’s becoming.

Effect of the duration of temporary disability in dental diseases on the economically active population of the region: On the example of the Republic of Tatarstan

BACKGROUND: Morbidity with a temporary disability is an informative objective criterion for assessing the health status of the working population. The special literature describes data on research activities of temporary disability examination services; however, the issues of clinical and statistical analyses of the duration of temporary disability in dental diseases and factors affecting it at the regional level have not been sufficiently investigated.
 AIM: To determine the average duration of temporary disability for each class of dental morbidity at the regional level through clinical and statistical analyses.
 MATERIALS AND METHODS: Cases of temporary disability established by dental medical organizations of the Republic of Tatarstan for 11 years were analyzed retrospectively. To calculate the intensive indicators, data of working patients who received dental treatment during the study period were assessed. Statistical analysis was performed using IBM SPSS Statistics version 23.
 RESULTS: The average duration of temporary disability for each class of dental morbidity in the Republic of Tatarstan was 7.02±0.09 days. In addition, the duration of temporary disability in each group of dental diseases was influenced by the following factors: type of nosology, sex and age of the patient, and doctor’s experience. The duration was statistically significantly different depending on the nosological group of dental diseases (p 0.001). The average duration of cases was the greatest in patients with developmental abnormalities and injuries of the maxillofacial region, in whom surgical treatment and follow-up were performed on an outpatient basis (12.18±1.26 and 12.16±0.36 days, respectively).
 CONCLUSION: This clinical and statistical study allows us to obtain reliable information about the state of dental morbidity in the economically active population of the Republic of Tatarstan, which is the basis for planning preventive measures, appropriate comprehensive treatment, and rehabilitation of patients.

Diagnosis knowledge constrained network based on first-order logic for syndrome differentiation

Traditional Chinese medicine (TCM) has been recognized worldwide as a valuable asset of human medicine. The procedure of TCM is to treatment based on syndrome differentiation. However, the effect of TCM syndrome differentiation relies heavily on the experience of doctors. The gratifying progress of machine learning research in recent years has brought new ideas for TCM syndrome differentiation. In this paper, we propose a deep network model for TCM syndrome differentiation, which improves network performance by injecting TCM syndrome differentiation knowledge in the form of first-order logic into the deep network. Experimental results show that the accuracy of our proposed model reaches 89%, which is significantly better than the deep learning model MLP and other traditional machine learning models. In addition, we present the collected and formatted TCM syndrome differentiation (TSD) dataset, which contains more than 40,000 TCM clinical records. Moreover, 45 symptoms (“▪”), 322 patterns(“▪”), and more than 500 symptoms are labeled in TSD respectively. To the best of our knowledge, this is the first TCM syndrome differentiation dataset labeling diseases, syndromes and pattern. Such detailed labeling is helpful to explore the relationship between various elements of syndrome differentiation.

Managing the Expectations of Doctoral Students and Their Supervisors: A UK Perspective

The management of expectations in doctoral education relates to the negotiation and agreement of a learning contract denoting actions and initiatives between a student and a supervisor. A learning contract is a set of understandings of what things, actions and initiatives might reasonably be expected from whom, in the course of learning, where there is a natural power imbalance. This is important so that both scholarly and material progress can be made along all points of the doctoral learning experience, i.e., that learning is personalised, professional and productive towards an original contribution of knowledge. It is the evidencing of this continual learning process through research that is deemed to be doctoral at the final examination stage. A doctoral student is a learner on the highest degree pathway that is available at all UK universities. This typically results in a thesis, marking the end point of being supervised whereupon an assessment or examination takes place, which, in UK universities, is called a viva voce (Latin: the living voice). This is a verbal account or defence of the thesis document by the student, made to two or three examiners who comprise the examination team. In the UK, the viva examination is a private event, while elsewhere, for example, across Europe and North America, the examination can be a public event. A student on a doctoral programme usually has a period of registration that is 3 years full-time or 6 years part-time. Other terms that can be used interchangeably around doctoral supervision are candidate (for the student) and candidature, which is their period of registration. Supervisors also have roles denoted as the Director of Studies (DoS) or Principal Investigator (PI). The supervision team is led by a Director of Studies (or PI) who is often the most experienced scholar who teaches, guides and mentors their student’s learning through the research they conduct. There are usually at least two supervisors in a supervision team in the UK, but there can be more as required depending upon the specialisms and topics being researched. Expectations formed by either the student or the supervisor(s) can be about physical resources to embark upon a passage of learning through a doctoral programme, or more typically, the discussion of expectations relates to managing the behaviours of students and supervisors in their respective roles. Managed expectations help to achieve a balance between the intellectual sharing of expertise by the supervisor with the self-directed initiatives for learning, which are taken by the student. The aim of managing expectations is to help a student move from dependence in their learning at the start of their programme to becoming an independent doctoral-level scholar who, once graduated as doctor, can act autonomously to conduct their own research, or even embark upon supervising others’ research in the future.

Exploring the experiences of junior doctors who were shielding during the COVID-19 pandemic: a qualitative study of semi-structured interviews

BackgroundThe term “Shielding” was introduced in the UK during the COVID-19 pandemic to protect approximately 4 million people at highest risk from infection. Shielding was characterised by extreme isolation and applied to those with certain illnesses, disabilities, and during pregnancy. For the estimated 1300 high-risk doctors, shielding meant abrupt departure from the clinical environment. We aimed to understand the impact of shielding on junior doctors (JDs) by interviewing them and their consultants. MethodsThis qualitative study used individual semi-structured interviews and reflexive thematic analysis. Virtual interviews were conducted between Sept 2, and Nov 30, 2022, using an interview guide, including open questions around impacts on training, career, and health. 11 JDs and 2 consultants were recruited via Scotland-wide purposive and snowball sampling. Written informed consent was obtained. 12 of 13 participants were women. Eight JDs were shielding because of health issues, and three because of pregnancy. Participant specialties included primary care, secondary care, and foundation and specialty training. Interview transcripts were coded by the lead author and the second author acted as a critical friend. FindingsDespite making important contributions working from home, most JDs (73%, eight of 11) felt that their work was undervalued during shielding. They felt forgotten, feeling they had to “pester” supervisors to be allocated work. All participants reported inadequate support at Occupational Health and workplace levels, including limited supervision or information about training impacts. Negative attitudes towards JDs were experienced by 82% (nine of 11) of JDs, including being denied reasonable adjustments and threatened with dismissal if not following shielding advice. Consultants described supervisory challenges including not receiving guidance or resources and ongoing issues supporting disabled and pregnant JDs beyond the pandemic. InterpretationThese findings offer novel qualitative insight into the impacts of shielding on JDs in Scotland. Findings indicated that support infrastructure was not fit for purpose. Given the significant number of JDs that take prolonged leave from the clinical environment, and the JDs working with disabilities and during pregnancy, these findings are of ongoing concern. Although the sample size was small and the study was set in a specific region, these findings suggest there is potential to improve support infrastructure and move towards a more inclusive clinical environment that recognises, celebrates, and benefits from the value of a diverse workforce. FundingScottish Medical Education Research Consortium.

The rational dose for MaXingShiGan decoction is crucial for its clinical effectiveness in treating bronchial pneumonia: three randomized, double-blind, dose-parallel controlled clinical studies

The rational dose for MaXingShiGan decoction is crucial for its clinical effectiveness in treating bronchial pneumonia: three randomized, double-blind, dose-parallel controlled clinical studies

Comparison of the diagnostic efficiency between the O-RADS US risk stratification system and doctors’ subjective judgment

BackgroundThis study aimed to compare the diagnostic efficiency of Ovarian-Adnexal Reporting and Data System (O-RADS) and doctors’ subjective judgment in diagnosing the malignancy risk of adnexal masses.MethodsThis was an analysis of 616 adnexal masses between 2017 and 2020. The clinical findings, preoperative ultrasound images, and pathological diagnosis were recorded. Each adnexal mass was evaluated by doctors’ subjective judgment and O-RADS by two senior doctors and two junior doctors. A mass with an O-RADS grade of 1 to 3 was a benign tumor, and a mass with an O-RADS grade of 4–5 was a malignant tumor. All outcomes were compared with the pathological diagnosis.ResultsOf the 616 adnexal masses, 469 (76.1%) were benign, and 147 (23.9%) were malignant. There was no difference between the area under the curve of O-RADS and the subjective judgment for junior doctors (0.83 (95% CI: 0.79–0.87) vs. 0.79 (95% CI: 0.76–0.83), p = 0.0888). The areas under the curve of O-RADS and subjective judgment were equal for senior doctors (0.86 (95% CI: 0.83–0.89) vs. 0.86 (95% CI: 0.83–0.90), p = 0.8904). O-RADS had much higher sensitivity than the subjective judgment in detecting malignant tumors for junior doctors (84.4% vs. 70.1%) and senior doctors (91.2% vs. 81.0%). In the subgroup analysis for detecting the main benign lesions of the mature cystic teratoma and ovarian endometriosic cyst, the junior doctors’ diagnostic accuracy was obviously worse than the senior doctors’ on using O-RADS.ConclusionsO-RADS had excellent performance in predicting malignant adnexal masses. It could compensate for the lack of experience of junior doctors to a certain extent. Better performance in discriminating various benign lesions should be expected with some complement.

Experiences of doctors and nurses offering fertility guidance to young breast cancer patients: A qualitative study

PurposeExisting qualitative studies on young breast cancer patients' fertility have explored patients’ perspectives rather than those of doctors and nurses. With the goal of presenting a scientific basis for the design of high-quality fertility guidance programs, this study examines the advantages and disadvantages of providing fertility guidance, as well as the obstacles perceived by doctors and nurses. MethodsPurposive sampling was used to select 16 doctors and nurses from a Class III Grade A cancer hospital in Hunan Province, China, from March to May 2023. Face-to-face in-depth interviews were conducted. The interview data were analyzed and organized using Colaizzi's seven-step analysis method and NVivo software, respectively. ResultsThree themes and nine sub-themes were extracted from the data: (1) Attitude: maintain patients' fertility hope, respect patients’ fertility wishes; (2) Obstacles: patient factors, family factors, healthcare worker factors; (3) Suggestions: enhance the professional confidence of doctors and nurses, ensure two-way communication between doctors and patients, promote interdisciplinary knowledge sharing, and establish a whole-process fertility guidance model. ConclusionsWhen carrying out fertility guidance for young breast cancer patients, doctors and nurses should fully respect and safeguard the patients’ fertility wishes and hope, continuously strengthen their own knowledge reserve, promote interdisciplinary cooperation and improve their communication abilities, rationally analyze the hindrances, and provide continuous and personalized fertility guidance considering factors related to the patient and their family.

Impact of bedside ultrasound on care in specialist palliative care units: a qualitative study

ObjectivesTo explore the experiences of palliative care doctors regarding the clinical impact of ultrasound in specialist palliative care units (SPCUs).MethodsThe study adopted a qualitative research design using semistructured interviews and...

HPB P14 Setting the Foundation: Empowering Junior Doctors in Complex Specialties through Induction Excellence

Abstract Background The newly qualified junior doctors in the UK face challenges due to limited experience and unfamiliarity with their rotations. We aim to share the experience of establishing a Hepatobiliary and Pancreatic (HPB) surgery specific induction program at University Hospitals of Leicester NHS Trust and assess its impact on doctors' knowledge and experience. Methods A booklet was distributed to new junior doctors and a two-hour structured teaching session was also conducted, with pre- and post-session assessments using multiple-choice questions and a feedback survey. The survey measured understanding of HPB anatomy, interventions, and satisfaction with the teaching methodology. Results Prior to the teaching session, levels 4 and 5 understanding of HPB anatomy were reported by 18.1% of participants. After the teaching session, there was a significant improvement in understanding, with levels 4 and 5 reported by 95% of participants, and only 5% reporting level 3. Similar improvements were observed in other tested categories. Factual knowledge also improved, with a 38% increase in correct responses on basic HPB and surgical knowledge questions. Participants found the session helpful and well-structured, with 60% strongly agreeing and an additional 30% agreeing. The delivery method was deemed appropriate by the majority. Conclusions Specialty-specific induction programs are crucial for providing support and ensuring the development of competent doctors. Efforts should be made to create supportive working environments for junior doctors to alleviate stress and improve their well-being.

Patient safety discourse in a pandemic: a Twitter hashtag analysis study on #PatientSafety.

The digitalization of medicine is becoming a transformative force in modern healthcare systems. This study aims to investigate discussions regarding patient safety, as well as summarize perceived approaches to mitigating risks of adverse events expressed through the #PatientSafety Twitter hashtag during the COVID-19 pandemic. This research is grounded in the analysis of data extracted from Twitter under the hashtag #PatientSafety between December 1, 2019 and February 1, 2023. Symplur Signals, which represents a tool offering a method to monitor tweets containing hashtags registered with the Symplur Healthcare Hashtag Project, was used for analyzing the tweets shared in the study period. For text analytics of the relevant data, we further used the word cloud generator MonkeyLearn, and VOSviewer. The analysis encompasses 358'809 tweets that were shared by 90'079 Twitter users, generating a total of 1'183'384'757 impressions. Physicians contributed to 18.65% of all tweets, followed by other healthcare professionals (14.31%), and health-focused individuals (10.91%). Geographically, more than a third of tweets (60.90%) were published in the United States. Canada and India followed in second and third positions, respectively. Blocks of trending terms of greater interest to the global Twitter community within the hashtag #PatientSafety were determined to be: "Patient," "Practical doctors," and "Health Care Safety Management." The findings demonstrate the engagement of the Twitter community with COVID-19 and problems related to the training, experience of doctors and patients during a pandemic, communication, the vaccine safety and effectiveness, and potential use of off-label drugs. Noteworthy, in the field of pharmacovigilance, Twitter has the possibility of identifying adverse reactions associated with the use of drugs, including vaccines. The issue of medical errors has been also discussed by Twitter users using the hashtag #PatientSafety. It is clear that various stakeholders, including students, medical practitioners, health organizations, pharmaceutical companies, and regulatory bodies, leverage Twitter to rapidly exchange medical information, data on the disease symptoms, and the drug effects. Consequently, there is a need to further integrate Twitter-derived data into the operational routines of healthcare organizations.

Pharmacological treatment of Tourette's syndrome: from the past to the future.

Tourette's syndrome (TS) is a neuropsychiatric disease featuring tics and vocal tics, with a prevalence of approximately 1%, including 75% of the total number of male patients. TS seriously disturbs the patients' career, education, and life and brings a serious and unbearable psychological burden to the patients themselves and their families. At present, there are no specific clinical medications recommended for treating TS. Therefore, it is necessary to select the appropriate medication for symptomatic treatment based on the doctor's personal experience and the patient's symptoms, with the main goal of relieving symptoms, thus improving the patient's social skills and psychological problems. Here we conducted a comprehensive search on PubMed to review and organize the history and current status of the development of drug therapy for TS through a timeline format. We also systematically evaluated the effects of each drug for TS treatment to summarize the current problems and new research directions and to provide some ideas for clinical treatment.

Taboo words in pediatric oncology: Communication experiences of nurses and physicians with dying children and their families

PurposeDespite the numerous benefits of effective communication between patients, families, and healthcare professionals, there are still substantial barriers and communication challenges. This study investigated the experiences of nurses and doctors working in different pediatric hematology-oncology units in Turkey communicating with children and their parents about end-of-life issues. MethodThis qualitative study was conducted with twenty-four physicians and nurses. A descriptive phenomenological approach was used. Data were analyzed using Braun and Clarke’s six-step reflexive thematic analysis. The MAXQDA software was used to facilitate data management. ResultsThe findings revealed three main themes describing end-of-life communication experiences of physicians and nurses: Avoiding communication with a dying child, Everyone knows but nobody talks, and Complicating aspects of the setting. ConclusionsCommunication with dying children and their families is essential. However, multiple barriers remain for healthcare providers to do so. That issue burdens the child and their family more during the end-of-life, which is already a challenging experience to handle. Healthcare professionals need urgent training in communication with the dying children and their families.

Experiences of Australian emergency doctors and nurses using advance care directives in the provision of care at the end of life.

An advance care directive is a legal document outlining the wishes made by a person about treatment options. However, there is increasing evidence that an advance care directive that has previously been documented may not always benefit the current prognosis of the patient. Therefore, the aim of the present study was to explore the experiences of Australian emergency doctors and nurses concerning the use of previously documented advance care directives at the point of care for patients and their families. A qualitative study guided by a phenomenological interpretive approach was employed. Semi-structured interviews were conducted with ED doctors and nurses across Australia. Data were thematically analysed using a seven-stage data analysis framework. An analysis of the interview data resulted in four major themes: (i) Benefits of Advance Care Directives; (ii) Knowledge and Awareness; (iii) Communication; and (iv) Availability of Advance Care Directive Information. From the findings, advance care directives were believed to be beneficial in decision making when patients, families, and ED staff agreed with the decisions made. Advance care directives were often made a long time ago but were useful to start conversations around goals of care and end-of-life care relevant to the patient's current situation. Findings in the present study further reinforced that an advance care directive was beneficial when used alongside goals of care at the point of care in EDs.

Technology, Time And Communication: Exploring Postgraduate Students' Experiences Of Online Supervision During The Pandemic

Doctoral supervision is both a rewarding and challenging experience for supervisors and doctoral students, while effective supervision and research practice is of crucial importance for the developmental process and both students’ and supervisors’ careers. Although several challenges in the research journey are strictly research-focused, supervision is a human activity where intersectional aspects influence actions and activities. Power dynamics are involved in supervisor and research student interactions, many of which link affective with intellectual domains, and many are based on differences, of gender, age, race, or intersectionality. Here, we are mainly concerned with how to tackle challenging issues that grow from gender differences and intersectionality. Within the complex landscape of doctoral supervision, this paper is based on both research and educational development practice, since as authors and practitioners we are engaged with this. We use research, policy, widely available literature, and professional practice to underpin, build and share our developing “gender equality toolkit”. We use case studies to support constructive policies and practices and engage colleagues in reflective and practical development aimed at tackling issues concerning gender and intersectional inequalities in doctoral experiences and supervision.

Tackling Gender Inequality In Doctoral Supervision - An Intersectional Toolkit Involving Hearts, Minds, Policies, And Practices

Doctoral supervision is both a rewarding and challenging experience for supervisors and doctoral students, while effective supervision and research practice is of crucial importance for the developmental process and both students’ and supervisors’ careers. Although several challenges in the research journey are strictly research-focused, supervision is a human activity where intersectional aspects influence actions and activities. Power dynamics are involved in supervisor and research student interactions, many of which link affective with intellectual domains, and many are based on differences, of gender, age, race, or intersectionality. Here, we are mainly concerned with how to tackle challenging issues that grow from gender differences and intersectionality. Within the complex landscape of doctoral supervision, this paper is based on both research and educational development practice, since as authors and practitioners we are engaged with this. We use research, policy, widely available literature, and professional practice to underpin, build and share our developing “gender equality toolkit”. We use case studies to support constructive policies and practices and engage colleagues in reflective and practical development aimed at tackling issues concerning gender and intersectional inequalities in doctoral experiences and supervision.

Supervision, scheduling, satisfaction and shared working: how experiences of junior doctors relate to excess mortality within the NHS

BackgroundWe sought to explore associations between trainee doctor perception and excess patient mortality. MethodsData from two publicly available databases reflecting mortality and components of trainee satisfaction within 81 NHS healthcare institutions between the years 2012 and 2019 were analysed. Pearson's correlation coefficients were calculated. ResultsAll domains of trainee perception were correlated with excess mortality. Clinical supervision out of hours (R=–0.44; p<0.0001), teamwork (R=–0.36; p<0.0001) and clinical supervision at any time (R=–0.35; p<0.0001) were most strongly correlated. Most associations remained consistent year on year. ConclusionTrainee doctor perceptions of clinical supervision, rota design and teamwork within the NHS are consistently correlated with excess patient mortality. Further exploration of these associations could identify opportunities for interventions to reduce excess patient mortality. Given the clinical significance of our findings, organisations should consider rapid implementation of evidence-based interventions where they exist.

Trải nghiệm của người bệnh điều trị nội trú tại Bệnh viện Phổi tỉnh Nam Định năm 2022

This study aimed to describe the patients’ experience among inpatients at Lung hospital in Nam Dinh province, in 2022. Methods: A cross-sectional study was conducted by using the patient experience tool from the American Agency for Health Quality Research (AHQR). Quantitative research was carried out on 230 inpatients at Lung hospital in Nam Dinh province. The study showed that the overall positive patients’ experience among inpatients was 90.0%. In which, the positive patients’ experience of doctors and nurses’ care was the highest proportion (above 90%), the positive patients’ experience was lower than hospital environment (72.2%). Conclusion: To improve the positive patients’ experiences, the healthcare workers need to maintain the explanation and counseling of patients, especially drug information. Moreover, to ensure the convenient environment surrounding hospital (e.g. avoid noising at night) for inpatients when staying at hospitals. Keywords: Patient experience, inpatient, hospital, Lung hospital, Nam Dinh province.

50세 이상 성인학습자의 박사과정 학습 경험, 학습 동기, 학습 실천의 의미

Objectives This study is to identify the meaning of doctoral program learning experience, learning motivation, and learning practice of adult learners aged 50 and older.&#x0D; Methods Individual in-depth interviews were conducted with seven doctoral students aged 50 or older who vol-untarily expressed their willingness to the participation. For thematic analysis, the interview contents were tran-scribed, and three researchers selected meaningful topics through the process of coding, categorization, and classification through continuous elaboration and revision to derive themes, sharing opinions, and coordinating.&#x0D; Results As a result of the analysis, under the three major themes of ‘doctoral course learning experience’, ‘learning motivation’, and ‘meaning of learning Practic’, ‘difficulty of late adult learning’, ‘sense of stability in career’, ‘desire for internal growth' fulfillment’, ‘external growth and development’, ‘recognition of the need for change’, ‘new challenges for dreams’, ‘preparation for the future’, ‘learning to improve the quality of life’, ‘learning to prac-tice good influence’, ‘learning for self-realization’, and ‘learning to continue’ were derived.&#x0D; Conclusions In a rapidly aging society, adult learners who choose doctoral programs at the turn of the age of 50 can feel the stability and satisfaction of their social role needs through the learning process, even though they ex-perience the difficulties of multiple roles of work, family, and learning. Their doctoral course learning practice was most motivated to achieve their personal and social growth in the changing societal context. In other words, they revealed that they not only plan their future lives by cultivating expertise in their field through late learning, but also have the meaning of leading a community life and contributing to society as members of our society.

Клинический случай синдрома Градениго, сложности дифференциальной диагностики

Gradenigo syndrome develops with pathology of the apex of the temporal bone pyramid. This syndrome is characterized by a clinical lesion of the vestibulocochlear nerve in combination with dysfunction of the abducens, trigeminal and facial nerves. The rarity of occurrence of the syndrome, the lack of experience of doctors working with patient with this pathology, the small namber of publications in Russian scientific journals on the diagnosis and treatment of diseases in the area of the apex of the temporal bone lead to the lack of timely diagnosis and adequate treatment of diseases that cause syndrome. The article describes a clinical case of a patient with Gradenigo syndrome, which developed as a result of pathology of the apex of the temporal bone and associated with a neoplasm, which was subsequently determined to be a poorly differentiated carcinoma with squamous cell differentiation of the skull base.