Experienced Colleagues Research Articles

Medical death certification by forensic physicians in the Netherlands: Validity and interdoctorvariation

The aim of the study was to assess interdoctorvariation and validity in death certification by forensic physicians using 19 written scenarios. The scenarios described typical cases from forensic-medical practice. Physicians were asked to determine the manner of death (natural/unnatural) and to provide an ICD-10 code for the cause of death. In contrast to most studies on this topic, the measure of agreement among physicians was chance-corrected and a standard was used to assess the correctness of the assigned cause and manner of death. Forty-seven physicians participated in the survey. The study demonstrated that forensic physicians varied widely in their conclusions. With respect to manner of death, adequate agreement (defined as kappa>0.70) was achieved in six scenarios (32% of all scenarios). Concerning the underlying cause of death, adequate agreement was reached in three cases (16% of all scenarios). Furthermore, predictors for the correctness of manner and cause of death were studied using logistic regression. Years of experience as a forensic physician significantly predicted the correctness of cause of death (p < 0.05). Other predictors remained insignificant. With regard to manner of death, none of the studied predictors proved to be significant. To conclude, there appears to be a lack of consistency among forensic physicians regarding death certification. The ICD-10 coding of causes of death applied by forensic physicians is questionable. Less experienced physicians need supervision by more experienced colleagues when making judgments concerning the cause of death. Altogether, there is an urgent need to work out consensus-based guidelines for forensic physicians on how to certify deaths.

A concept analysis of undergraduate nursing students speaking up for patient safety in the patient care environment.

An analysis of the concept of nursing students speaking up for patient safety in the workplace. 'Speaking up' is assertive communication in clinical situations that requires action through questions or statements of opinion or information with appropriate persistence and is linked to patient safety. Previously, the concept of speaking up has focused on the registered or experienced practitioners, there is minimal discussion relating to student nurses. Analysis of the elements of students speaking up will identify the key elements that will give understanding to their position and experiences. A concept analysis. Literature included publications between 1970-2015 from, MEDLINE, CINHAL, PUBMED and SCOPUS. Search terms included patient safety AND speaking up; AND pre-registration/undergraduate nursing students, patient advocate, error reporting, organizational silence, whistleblowing and clinical placement/practicum. The Walker and Avant concept analysis model was modified and used to examine the literature. Nursing students speaking up behaviour is influenced by individual and contextual factors that differ from those influencing more experienced colleagues. Motivators and barriers to voicing concerns include moral and ethical beliefs, willingness and confidence to speak up in the workplace. Students' subordinate and often vulnerable position creates additional tensions and challenges that impact their decisions and actions. This concept analysis provides a clear definition of 'speaking up' in relation to nursing students. The analysis will facilitate understanding and operationalization of the concept applied to learning and teaching, practice and research.

Treatment Methods for Patients with Dupuytren's Disease in Switzerland

The objective of this study was to investigate what treatment options are currently used in Switzerland for Dupuytren's disease. Furthermore, regional preferences and treatment differences based on surgeon experience were analysed. In this survey, an electronic questionnaire was sent to all members of the Swiss Society for Hand Surgery. Participants were asked to indicate their current treatment methods for Dupuytren's disease. In addition, 8 standard patient cases were presented to identify the preferred treatment option. Furthermore, sociodemographic data of the participants were gathered. In total, 70 questionnaires were completed, corresponding to a response rate of 34%. Fasciectomy is performed by 94% of participants, while 59% inject collagenase in certain cases, 40% perform open fasciotomy, and 24% carry out percutaneous needle aponeurotomy if the indication is given. 20% of responders offer one of these techniques, 50% offer 2, 23% offer 3, and 7% offer all 4 treatment techniques. In the case of isolated metacarpophalangeal joint contracture, 51% of participants inject collagenase, whereas fasciectomy is preferred for the treatment of proximal interphalangeal joint contractures or in cases of recurrence. In German-speaking Switzerland, the treatment strategy has changed towards applying collagenase injections in the past 5 years. In this part of the country, 83% of surgeons now use more collagenase than 5 years ago, whereas only 33% of surgeons in French-speaking Switzerland have changed their treatment strategy in favour of collagenase injections (p=0.027). Surgeons with less than 10 years of experience apply more collagenase than their more experienced colleagues (79 vs. 54%, p=0.131). In Switzerland, fasciectomy is the preferred option for treating patients with Dupuytren's disease. In recent years, however, collagenase injection has become more and more popular. More research is needed to define guidelines for the treatment of patients with Dupuytren's disease considering the effectiveness of the different treatment options and regional preferences.

Emotional Intelligence and Self-efficacy of Iranian Teachers: A Research Study on University Degree and Teaching Experience

This study evaluates the level of emotional intelligence, self-efficacy to investigate whether a relationship exists between these two attributes or not, also, the role of years of teaching experience and teachers’ university degrees in their emotional intelligence. To this end, 70 teachers were asked to complete The Assessing Emotions Scale Questionnaire (Salovey and Mayer, 1990) and Teacher Sense of Efficacy Scale (TSES) (Tschannen-Moran &amp; Woolfolk Hoy, 2001), regardless of their English teaching experience. The aim of this study was to represent the importance of emotional intelligence, self-efficacy and in teachers for having an effective teaching. The results indicated a significant relationship between teachers’ EI and their self-efficacy. Moreover, the findings showed that there was a significant relationship between teachers’ EI with their years of teaching experience, in a way that more experienced teachers can benefit their low experienced colleagues with their emotional experiences. Meanwhile, no significant difference was found between teachers’ EI in terms of different university degrees. The research results also proved a positive relationship between EI and self-efficacy.

Yes, We Have an Inflation of Reviews: But of the Wrong Kind!

I read with interest Ingo Schubert's short article on the inflationary number and value of review papers (Front. Plant Sci. 7:88. doi: 10.3389/fpls.2016.00088). I wholeheartedly agree with Schubert that far too many reviews are getting published. Many are what I call “catalog” reviews, and any good Ph.D student worth his salt can, with the help of PubMed, make a compilation of the recent (last 5 years) literature on a particular topic within days. Reviews of this kind seldom draw attention to areas of conflict, rarely provide insight into technical difficulties, and often fail to point to challenges for future research. Publishing reviews is an established strategy through which journals can increase their IFs and thereby enlarging the circle of readership. The irony is that the reviews published by the increasing number of third rate journals are of the catalog type and therefore don't get cited. In agreement with Ingo Schubert I would therefore appeal to younger scientists not to succumb to the temptation of writing this kind of review for that class of journal. They are of questionable value and hardly boost one's reputation. Believe that critical reviews are the only type of review article that should be asked for and be delivered. What are the prequisites for the preparation of a critical review? The authors need to be accredited leaders in the field (unfortunately, this is by no means always the case), they should make the effort to read and evaluate the original papers they cite rather than simply cite what was previously cited by others. Above all, they need to accomodate the reader's desire to be directed to controversies, but also to take a standpoint on them. These may seem banal criteria, but they remain frequently unfulfilled. The essence of a good review is not so much as to highlight individual papers but to critically evaluate all the relevant papers on a particular subject. Would like to draw attention to an alternative to a high profile review to focus interest on controversial topical issues. Essentially this is an open debate with the conflicting parties putting their case in writing for the scientific public to judge for themselves whose arguments are the more convincing. I have tried this out twice, in both cases with an extremely positive feedback from reviewers/editors. My first attempt, over 20 years ago, was to put the spotlight on the auxin binding protein (ABP; Hertel, 1995; Venis, 1995). At that time I had become involved in ABP research by being asked by Mike Venis to apply a silver-immmunogold enhanced epipolarzation technique to visualize ABP at the surface of maize coleoptile protoplasts (Diekmann et al., 1995). From the referees reports to this paper I realized just how volatile the situation with ABP was. Since I also knew one of the major opponents to ABP research (Rainer Hertel) quite well, I thought it would be a rewarding experience for the plant community to have the two major opponents in the ABP field engage in an intellectual duel. Not being an ABP-researcher myself it is difficult for me in retrospect to judge how effective this exercise in scientific pugilism was in generating more interest, but it is interesting to note that, after many years of relative stagnation, interest in ABP research has recently flared up (Grones and Friml, 2015). More recently, I managed to persuade three experienced colleagues to voice their opinions on vesicles vs. tubes as a means of transport between the endoplasmic reticulum and the Golgi apparatus (Robinson et al., 2015). This controversy had been going on for years with a number of one-sided reviews in the literature. Again I thought it was time for a public debate on this issue. Based on the comments that I have received, this is undoubtedly the best way to focus attention on a hot topic. But, in the sense that it reveals how established researchers approach and try to solve problems, such articles are of immeasurable didactical value to young scientists. To get such ventures going requires that senior scientists in a particular area take the initiative and volunteer to act as coordinators. This not only involves persuading competitors to “put on the gloves,” but, as I did for the vesicles vs. tubules “fight” to be prepared to set the stage by writing an introduction which draws attention to the conflict under consideration. Ideally, and to promulgate further discussion, journals should also open a discussion forum in a following issue for comments. I encourage others to follow my example and explore further this kind of scientific debate as a worthwhile alternative to conventional reviews.

Teaching with technology in higher education: understanding conceptual change and development in practice

ABSTRACTResearch indicates that teachers’ conceptions of and approaches to teaching with technology are central for the successful imple-mentation of educational technologies in higher education. This study advances this premise. We present a 10-year longitudinal study examining teachers’ conceptions of and approaches to teaching and learning with technology. Nine teachers on an online Bachelor of Science in Pharmacy and a Master of Pharmacy programme at a Swedish university were studied using a phenomenographic approach. Results showed clear differences between novice and experienced teachers. Although novice teachers initially held more teacher-focused conceptions, they demonstrated greater and more rapid change than experienced colleagues. Experienced teachers tended to exhibit little to no change in conceptions. Supporting conceptual change should, therefore, be a central component of professional development activities if a more effective use of educational technology is to be achieved.

Discussing the Notion of Decent Work: Senses of Working for a Group of Brazilian Workers without College Education.

Despite recent stability and socioeconomic development, Brazil’s history is marked by social inequality, informality, precarious work, and psychosocial vulnerability, with little opportunity for decent and meaningful work, as recommended by the International Labour Office (ILO), for people in the country. Nevertheless, based on a social constructionist view, the hypothesis can be raised that there is no substantive definition of decent work, but rather a psychosocial one, constructed based on the discourse, narratives, and practices produced through the relational processes which grant sense and meaning to work. Therefore, the examination of narratives and discourses is an important methodological strategy to understand the socio-occupational reality of Brazil. Thus, this study aims to understand the senses attributed to working through content analysis of the narratives produced by a set of 20 urban workers and contrast them with the ILO definition of decent work, in an effort to analyze the relationships, similarities, and differences between an established collective social discourse and the interviewees’ singular narratives. The main results point out that the participants look for working with fair wages, social protection, safety, and personal development opportunities, as the ILO recommends. The main difference is that these characteristics do not derive from the State’s actions, as in the employment and formal qualification model, but come from informal sources, such as family and community relationship networks. The informal relationship networks produce job opportunities as well as social protection; qualification takes place through practical learning from more experienced colleagues; the opportunity to be able to keep working (employed or working informally) leads to success and safety; and the possibility to make choices and have control over one’s life translates into personal and occupational development. In conclusion, the participants searched for working according to the principles recommended by the ILO. Nevertheless, in contexts of vulnerability and with restricted support from the State, these principles are constructed in the community and not offered by the public power, which generates distinguished forms of decent work.

‘My mentor was a wonderful support’

We talk to NQTs to find out how more experienced colleagues made all the difference to them in their first year and set them on the right professional track.

Head teachers’ Supervision of Curriculum Implementation: Implications on Provision of Quality Secondary Education in Kenya

This study sought to find out how the head teachers’ supervision of curriculum implementation influences provision of quality education in Kisumu East Sub-County Secondary schools, Kenya. The study population consisted of 13 public and 4 private secondary schools in Kisumu East Sub-County. The total population of the study was 1114. Out of these 924 were Form Four candidates, 174 teachers and 17 head teachers. The study used a sample size of 382 consisting of 308 Form Four candidates, 58 teachers selected using simple random sampling. A total of 16 head teachers were selected using purposive sampling technique. The instrument validity was ascertained by use of a four-point scale rating by experienced colleagues to ascertain the relevance of the questions while instrument reliability was ascertained using Split-Half Technique. Piloting was done in 4 schools in the neighboring Kisumu Central Sub-County to ascertain Face validity of the instruments. The research design employed in the study was descriptive survey. Questionnaires, interviews and document analysis were used to obtain data. Quantitative data analysis was done using descriptive and inferential statistics with the aid of SPSS version 21 and co-relational techniques. Qualitative data from interviews were analyzed using Thematic Analysis. The findings of the study indicated that there was a strong relationship between head teacher supervision, curriculum implementation and provision of quality education in Kisumu East Sub-County. Challenges faced by head teachers included teacher and student truancy, teacher resistance to supervision exercise, financial constraints hampering quality education provision, interschool transfers and high student dropout rate among others. The study recommended that the head teachers, as internal Quality Assurance Officers at the school level should attend supervision training sessions offered by Kenya Educational Management Institute.

How to overcome hurdles in opiate substitution treatment? A qualitative study with general practitioners in Belgium

Background: Opiate substitution treatment (OST) is the administration of opioids (methadone or buprenorphine) under medical supervision for opiate addiction. Several studies indicate a large unmet need for OST in general practice in Antwerp, Belgium. Some hurdles remain before GPs engage in OST prescribing.Objectives: Formulate recommendations to increase engagement of GPs in OST, applicable to Belgium and beyond.Methods: In 2009, an exploratory qualitative research was performed using focus group discussions and interviews with GPs. During data collection and analysis, purposive sampling, open and axial coding was applied. The script was composed around the advantages, disadvantages and conditions of engaging in OST in general practice.Results: We conducted six focus groups and two interviews, with GPs experienced in prescribing OST (n = 13), inexperienced GPs (n = 13), and physicians from addiction centres (n = 5). Overall, GPs did not seem very willing to prescribe OST for opiate users. A lack of knowledge about OST and misbehaving patients creates anxiety and makes the GPs reluctant to learn more about OST. The GPs refer to a lack of collaboration with the addiction centres and a need of support (from either addiction centres or experienced GP-colleagues for advice). Important conditions for OST are acceptance of only stable opiate users and more support in emergencies.Conclusion: Increasing GPs’ knowledge about OST and improving collaboration with addiction centres are essential to increase the uptake of OST in general practice. Special attention could be paid to the role of more experienced colleagues who can act as advising physicians for inexperienced GPs.

Complications in Hip Arthroscopy.

Recent developments in hip arthroscopic techniques and technology have made it possible in many cases to avoid open surgical dislocation for treating a variety of pathology in the hip. Although early reports suggest favourable results' using hip arthroscopy and it has been shown to be a relatively safe procedure, complications do exist and can sometimes lead to significant morbidity. This is a review article. The aim of this manuscript is to present the most frequent and/or serious complications that could occur at or following hip arthroscopy and some guidelines to avoid these complications. Most complications of hip arthroscopy are minor or transient but serious complications can occur as well. A lot of complication e.g. acetabular labral puncture go unreported. Appropriate education and training, precise and meticulous surgical technique with correct instrumentation, the right indication in the right patient and adherence to advice from mentors and experienced colleagues are all essential factors for a successful outcome. Level of evidence: V.

Psychiatrists' responsibilities with regards to patients' fitness to drive.

Byline: Mehboob. Yaqub, Shajahan. Ismail, Sally. Babiker, T. Sathyanarayana Rao Driving has become a near universal and essential part of human life. Many of those who are no longer able to drive have a significant impact on their lives in the form of loss of independence, compromise with work, personal interests, and activities.[sup][1] Driving is a complex skill. It is dependent on several cognitive aspects and executive functioning of a human brain (i.e., information processing, attention, concentration, memory, impulse control, judgment, anticipation, problem-solving, and hazard perception).[sup][2] Many psychiatric disorders lead to impairment in the level of cognitive and executive functioning required for safe driving.[sup][3] Moreover, psychotropic medications can also cause disruption in perception, information processing, and overall psychomotor activity.[sup][4],[5] Driving is impaired not only as a direct effect of mental illnesses but also medications have a significant role. Cost of traffic accidents attributable to impairment by medication in Europe is estimated to be about 6.3 billion euros every year.[sup][6] De Las Cuevas and Sanz studied 208 patients in Spain seen in psychiatric outpatient clinics with stable psychiatric conditions and reported that nearly 80% of the patients had cognitive scores which would not allow obtaining or renewal of a driving license. None of the driving patients notified to the relevant authorities about their psychiatric conditions and only 10% recognized that their ability to drive was somehow damaged.[sup][7] Driving, Risk to Public Safety, and Mental Health Services Risk to public safety from road traffic accidents (RTAs) cannot be denied. RTAs do involve patients with mental illnesses but are usually reported in a sensational way, with potential to swing public opinion against those mentally ill and the mental health services caring for them [Figure 1].{Figure 1} In England and Wales, legislation to govern the general issues related to driving licenses exists in the form of Road Traffic Act 1988.[sup][8] The Driver and Vehicle Licensing Agency (DVLA) has provided a detailed guidance for medical practitioners, and mental disorders are addressed under the same set of guidelines. General Medical Council (GMC), UK has published the following advice for medical practitioners in this regard,[sup][9] which is as follows: *DVLA is legally responsible for deciding if a person is medically unfit to drive. This means they need to know if a driving license holder has a condition or is undergoing treatment that may now, or in the future, affect their safety as a driver *Doctors should seek the advice of an experienced colleague or the DVLA's medical adviser if they are not sure whether a patient may be unfit to drive. Doctors should keep under review any decision that they are fit, particularly if the patient's condition or treatments change. The DVLA's publication for medical practitioners, at a glance guide to the current medical standards of fitness to drive,[sup][10] includes information about a variety of disorders and conditions that can impair a patient's fitness to drive *The driver is legally responsible for informing the DVLA about such a condition or treatment *If a patient has such a condition, doctors should explain to the patient that the condition may affect their ability to drive and they have a legal duty to inform the DVLA about their condition *If the patient is incapable of understanding this advice, for example, because of dementia, doctors should inform the DVLA immediately *GMC further advises that the confidentiality should be breached if patients continue to drive. The Clinical Audit and Clinical Setting Considering the current guidelines for the medical practitioners, a complete clinical audit cycle was carried out to see whether the mental health practitioners were assessing their patients' fitness to drive and addressing the issue as guided by the relevant agencies and legislation. …

Creating learning communities for undergraduate students participating in research

The undergraduate research experience program is a funding program offered by the Qatar National Research Fund. The purpose of the program is to provide hands-on research experience for undergraduate students in order to increase their capacity for future research activities. However, leading a team of unexperienced researchers can be challenging. Minimal literature exists of how to overcome these challenges and provide a positive learning experience for novice researchers. The purpose of this paper is to: 1) describe a ‘situated learning’ framework, and teaching methods and approaches that may be helpful for future researchers to actively engage students in the research learning process; 2) describe our own experiences with creating a professional community of research using a team approach; and, 3) offer some practical strategies for scaffolding students to gain research skills through working in close proximity to more experienced colleagues. Helpful situated learning strategies included active engagement of students throughout the project, setting meaningful activities, meeting regularly as a team, scaffolding student learning, setting both individual and group work, assigning specific roles, engaging students in dissemination activities, sharing responsibility, and fading control of project activities to the students as their competency increased. Using a structured mentoring strategy resulted in students being actively engaged in all stages of the project. This approach helped to overcome many challenges of working with novice researchers. It was also rewarding to observe the growth of young researchers through the experiences that they gained in working as members of a research community of practice.

Dificultades laborales de profesores en escuelas secundarias

Selected results from a study designed to characterize the difficulties teachers face when starting their careers are presented in this article. The analysis is organized around the following questions: What difficulties do new, inexperienced teachers face in the classroom? How do they cope with those difficulties and what type of response do they offer? The study was exploratory and qualitative in nature. The sample was comprised of thirty male and female teachers who work at high schools in Resistencia, Chaco (Argentina). Two semi-structured questionnaires were used. The most significant findings show these teachers cope with problematic situations, fun damentally within the framework of multiple informal learning processes generated in exchanges with experienced colleagues and in their own successful experiences in the high school context.

OBSTETRICS AND GYNECOLOGY PRACTICE AND PROFESSIONAL COUNSELING FOR MEDICAL STUDENTS GRANT

This year, from July to November, the Obstetrics and Gynecology Department from “Bucur” Maternity “Saint John” Hospital, Bucharest conducted the POSDRU grant “Obstetrics and Gynecology Practice and Professional Counseling for Medical Students”. The project had the financial support of both the European Social Fund and the Sectorial Operational Program for Human Resources Development 2007-2013, priority axis 2.The main objective of the Grant was to support students from University of Medicine and Pharmacy “Carol Davila” Bucharest in the transition and integration from study to real professional life. More than 160 students of the 2nd to 5th year of university were included in the project. Each student had the opportunity attend the practice for a period of 3 weeks, 6 hours per day, similar to a normal working day of a doctor.The core of the activity was real, medical practice. The students had the occasion to practice gynecological and surgical everyday gestures such as knots and sutures, to attend in the operating room during gynecological interventions or caesarian sections, but also to be involved in attending vaginal deliveries or performing obstetrics ultrasound by themselves. During that period the students spent 2 weeks of activity in “Bucur” Maternity and one week in the Medical Simulating Center “LifeSiM”. In this specialized center they had the opportunity to practice laparoscopy, hysteroscopy, knots and sutures, basic life support maneuvers and vaginal birth assistance on medical models.The originality of the program was that the physicians who trained the students had no universitary activity in their current life. They were enthusiast young specialists or residents in obstetrics . In this way the students felt closeer to their instructors and integrated easyly in the hospital life. Being trainers, the physicians experienced that challenge and had good result in teaching the students that was an aspect observed from final students feed-back.Why was the project so important? Our practice program is unique because it is the first one who developed such activity in obstetric filed in a simulating center. Moreover, we offered also professional carrier counseling to the students and the most emotional involvement that we could. We considered each student as a less experienced colleague and we tried to explain everything the best we could. The bound created during the program with some of them lead to volunteering for some of them who continued to come in our hospital.

Investigating Omani Science Teachers’ Attitudes Towards Teaching Science: the Role of Gender and Teaching Experiences

A 30-item questionnaire was designed to determine Omani science teachers’ attitudes toward teaching science and whether or not these attitudes differ according to gender and teaching experiences of teachers. The questionnaire items were divided into 3 domains: classroom preparation, managing hands-on science, and development appropriateness. The questionnaire was administered to 139 randomly selected science teachers who teach science in grades 5–10. The sample consisted of 72 male teachers and 67 female teachers, 57 teachers with teaching experience between 1 and 5 years and 82 teachers with teaching experience of 6 and more years. The sample was selected from 7 schools in 1 Educational Governorate in the Sultanate of Oman. The questionnaire reliability was calculated by an internal consistency method, using Cronbach’s alpha, which gave the value of 0.73 for all the items. The findings indicated that science teachers’ attitudes toward teaching science were positive. Furthermore, the results showed that there were statically significant differences in teachers’ attitudes due to gender in favor of the female teachers and in teaching experience in favor of teachers with long experience. The study proposed some recommendations to improve the science teachers’ attitude, especially male teachers towards science teaching. Paying more attention to in-service professional development programs, encouraging new teachers to attend some classes to observe experienced colleagues, and finally rewarding teachers morally, socially, and financially are some of these recommendations.

How to do? Russian entrepreneurs on business (based on the results of 2014 survey): resources, difficulties and recommendations for beginners

In this article, we finish publishing the results of the survey of Russian small and medium entrepreneurs that was conducted in 2014. The first part of the study, that contains the description of the method, literature review, and the respondents’ answers to the first four questions of the questionnaire, was published in No. 15 (volume 16) of Russian Journal of Entrepreneurship (Rossiyskoe predprinimatelstvo) dated August 2015. The second part published in the next issue of the journal includes the analysis of answers to questions concerning happiness in business, CSR (Corporate Social Responsibility) of the small and medium business, business ethics and innovations. Here we give the analysis of small and medium businessmen’s answers to the questions concerning the relationships of business and the state in Russia. Moreover, during the survey valuable data for development of the resource-oriented business approach were collected. The study allowed revealing the main difficulties of doing business in Russia. Also the hypothesis that the most popular advice for beginners from their more experienced colleagues is not to open their business in Russia was disproved.

Peer Review in Transplantation.

Peer Review in Transplantation.

Addressing the challenges of conducting research with end-of-life populations in the acute care setting

End-of-life (EOL) conversations are difficult for patients, families, and nurses. The purpose of this article is to describe the challenges encountered and strategies implemented during a research study designed to elicit information about the congruence among patients' stated preferences at EOL with perceptions of their caregivers and nurses using the Preferences About Dying and Death (PADD) instrument in an acute care setting. With the proper study inclusion criteria, education and support from more confident, experienced colleagues, nurses can be coached to identify appropriate participants for EOL research. Researchers should plan regularly scheduled debriefing sessions with interviewers to provide emotional support and encouragement to minimize distress. A scripted approach to introduce EOL research topics can ease clinicians' discomfort while allowing patients the opportunity to have open, honest dialogues about their care preferences. By proactively implementing strategies, researchers can enhance the integration of EOL research into the acute care setting.

Clinician's Commentary on Farrell et al.(1).

Clinically based anatomy is a foundational science for musculoskeletal (MSK) physiotherapists. Best practices are based on informed treatment strategies that rely heavily on an extensive and up-to-date knowledge of MSK anatomy. The results of this novel study by Farrell and colleagues,1 which investigated the use of clinical anatomy resources by outpatient physiotherapists, are important in identifying the extent of self-directed learning that is taking place in this area after graduation. The finding that more experienced physiotherapists used resources significantly less frequently than their less experienced colleagues can be interpreted in many ways. Perhaps more experienced physiotherapists do not see a need for further clinical anatomy education and view anatomy as a “textbook science,” to be studied from textbooks rather than from the research literature. On the opposite end of the spectrum, it may be that current clinical literature, including relevant basic science studies, is relatively inaccessible as a result of high subscription rates. Open-access papers are readily available, but obtaining articles from many specialty-specific journals requires access to a library that subscribes to these journals or purchasing or renting articles from the publisher. This can be costly, as students' library privileges are terminated on graduation. Canada, unlike Australia (where Farrell and colleagues practise), does not have a “statewide health department online resource portal,” which may further limit the number of physiotherapists who can access online library resources. Encouraging students to become lifelong learners is an important goal of professional programmes. Farrell and colleagues state that “clinical reasoning demands a thorough understanding of the appropriate clinical subject matter,” but the results of their study suggest that gaining deeper insight into pathology-specific MSK anatomy may not be a high priority for some practitioners. Clinical anatomy is a living and evolving science, and all practitioners should therefore strive to keep abreast of the current literature, with a view to integrating the findings into their clinical practice. Textbooks are useful references, but the research literature provides the key to advance evidence-based practice. I congratulate the authors on their excellent study exploring physiotherapists' behaviour and attitudes toward clinical anatomy. Their findings support the development of better resources with greater accessibility to the physical therapy community, enabling lifelong learning and the integration of research findings into clinical practice.