Medical Experience Research Articles

“If I knew you were a travesti, I wouldn't have touched you”:Iatrogenic violence and trans necropolitics in Turkey

Since 2007, the number of HIV diagnoses in Turkey has increased more than 600% and the AIDS-related deaths have more than doubled. Despite trans community being severely impacted by the growing epidemic, there exists a conspicuous absence of epidemiological data regarding the HIV burden of trans people. This paper examines the medical experiences of HIV-positive trans women who engage in sex work and the harmful violence they encounter at the hands of health providers. The paper emphasizes the urgent need for comprehensive interventions to address the intersecting issues of HIV risk, structural violence, and discrimination faced by HIV-positive trans sex workers, one of the most marginalized communities worldwide. To interpret better how transphobia and HIVphobia become deeply entangled in Turkish medical settings, the paper draws from the concepts of iatrogenesis, necropolitics, and immunity. By bringing together these conceptual tools with long-term ethnographic data and in-depth interviews, this paper demonstrates that trans women are treated by healthcare providers as though they are always-already infectious. The paper contends that aggressive immunitarian boundaries, erected between healthcare personnel and individuals deemed "contagious others," are central to doctors' denial of medical care and reluctance to touch, examine, or even admit trans patients, particularly when they are HIV-positive.

Utility of tele-guidance for point-of-care ultrasound: a single center prospective diagnostic study.

Point-of-care-ultrasound (POCUS) improves diagnostic accuracy and expedites lifesaving procedures. Remote areas disproportionately underuse ultrasound (US) due to a dearth of US trained professionals, imaging tools, and lack of quality assurance. Handheld US probes have been approved for diagnostic imaging but there have been limited studies examining their tele-guidance features. This study investigates whether physician tele-guidance improved ultrasound image acquisition by untrained scanners. To determine the effectiveness of tele-guidance for ultrasound image acquisition, 30 participants (15 in each study arm: experimental and control) with no ultrasound or medical experience gathered images of the heart, right kidney, and gallbladder of a standardized patient using a handheld ultrasound probe (Butterfly iQ +). All participants watched a standardized ultrasound tutorial video and were randomized into the control or experimental group. A physician assisted the experimental group using ultrasound probe's tele-guidance feature while the control group received no assistance. Time to image acquisition was recorded for both groups, and the images were graded by 3 blinded radiologists using the RACE tool to determine image and diagnostic quality. There was evidence that mean imaging time was greater in the control group for the heart, right kidney, and gallbladder (p < 0.0001, all; Cohen's DL: 2.0, 1.7, 3.0, respectively). Similarly, there was evidence that the predicted mean image quality for the heart, right kidney, and gallbladder was higher for the experimental group compared to the control group (3.46 versus 1.86, 4.49 versus 1.58, and 3.93 versus 1.5, respectively; p < 0.0001, all). There was also evidence that the diagnostic quality of images had a statistically higher predicted probability of meaningful interpretation for the experimental group for pericardial fluid, intraperitoneal fluid, and acute cholecystitis (p = 0.003, p < 0.0001, p < 0.0001, respectively). Tele-guidance improves time to image acquisition and clinical applicability of ultrasound images obtained by untrained scanners.

Incidence of dislocation and associated risk factors in patients with a femoral neck fracture operated with an uncemented hemiarthroplasty

BackgroundSeveral factors might be associated with risk of dislocating following uncemented hemiarthroplasty (HA) due to femoral neck fracture (FNF). Current evidence is limited with great variance in reported incidence of dislocation (1–15%). Aim of this study was to identify the cumulative incidence of first-time dislocation following HA and to identify the associated risk factors.MethodWe performed a retrospective cohort study of patients receiving an HA (BFX Biomet stem, posterior approach) at Copenhagen University Hospital, Bispebjerg, in 2010–2016. Patients were followed until death or end of study (dec 2018). Dislocation was identified by code extraction from the Danish National Patient Registry.Variables included in the multivariate model were defined pre-analysis to include: age, sex and variables with a p-value < 0.1 in univariate analysis. A regression model was fitted for 90 days dislocation as the assumption of proportional hazard rate (HR) was not met here after.ResultsWe identified 772 stems (some patients occurred with both right and left hip) and 58 stems suffered 90 dislocations during the observation period, resulting in a 7% (CI 5–9) incidence of dislocation 90 days after index surgery. 55 of the 58 stems (95%) experienced the first dislocation within 90 days after surgery.Only absence of dementia was identified as an independent protective factor in the cause-specific model (HR 0.46 (CI 0.23–0.89)) resulting in a 2.4-fold cumulative risk of experiencing a dislocation in case of dementia. Several other variables such as age, sex, various medical conditions, surgery delay and surgical experience were eliminated as statistical risk factors.We found a decrease in survival probability for patients who experienced a dislocation during follow-up.ConclusionsThe incidence of first-time dislocation of HA (BFX Biomet stem, posterior approach) in patients with a hip fracture is found to be 7% 90 days after surgery. Due to the non-existing attribution bias, we claim it to be the true incidence. Dementia was among several variables identified as the only risk factor for dislocation.In perspective, we may consider treating patients with dementia by other methods than HA e.g., HA with cement or with a more constrained solution. Also, a surgical approach that reduce the risk of dislocation should be considered.

Repurposing phone booths into COVID-19 sampling stations: medical operator experiences

This study investigated the repurposing of phone booths into COVID-19 sampling stations and assessed medical operator experiences in twelve healthcare facilities in Thailand. Amidst the pandemic, these facilities became sampling stations as an emergency measure to enhance medical staff protection. The stations, repurposed from decommissioned phone booths, aimed to reduce COVID-19 infection risks among healthcare workers and patients. After 13 to 16 months of use, a review collected user satisfaction information from each facility. Results indicated high user satisfaction in addressing protection concerns and increasing swab testing participation. This study discusses station design, operational characteristics, and social benefits, emphasizing their adaptability in resource-limited settings. Findings underscore the potential for repurposing infrastructure in public health emergencies and suggest avenues for future research in sustainable healthcare solutions.

Pharmacy residency training program increases residents' confidence in inpatient medical emergency response.

The benefits of pharmacists' involvement in medical emergencies are well established, but optimal methods of training pharmacists for emergency response are unknown. The primary objective of this report is to describe the design and evaluation of a pharmacy resident medical emergency response training (PR-MERT) program for preparing trainees to respond to hospital medical emergencies, including cardiac arrest and rapid sequence intubation (RSI). The PR-MERT program was a year-long longitudinal experience designed to prepare postgraduate year 1 pharmacy residents for medical emergency response. During the first month, the residents completed an orientation session that encompassed several lectures, certification by the American Heart Association in basic life support and advanced cardiovascular life support, standardized simulation scenarios, and mock medical emergencies. The trainees continued to utilize these skills and clinical knowledge through a longitudinal didactic lecture series, resident case conferences, and practice-based application by responding to real-life medical emergencies. Residents were assessed and coached throughout the program by clinical pharmacy preceptors and a "code coach" with extensive medical emergency response experience. After the year-long training, residents completed an anonymous survey assessing self-confidence and the structure of the program. The results showed improved confidence in medication selection and dosing, as well as anticipating the needs of the team and speaking up in cardiac arrest and RSI situations. Residents were satisfied with the training offered and structure of the program. The development of a PR-MERT program at an academic medical center was successful in achieving longitudinal learning objectives and improving residents' confidence in responding to medical emergencies. The implementation of a similar medical emergency training curriculum in inpatient pharmacy residency programs may be beneficial.

The Covid-19 Pandemic Restrictions and Its Impact on Surgical Treatment of Male Infertility Due To Spermatic Cord Varices – A Single Academic Medical Center Experience

The Covid-19 Pandemic Restrictions and Its Impact on Surgical Treatment of Male Infertility Due To Spermatic Cord Varices – A Single Academic Medical Center Experience

Customized Mobile App for Residents Rotating Through Pediatric Critical Care Unit.

Physicians often use mobile apps for patient care, but few apps are dedicated to pediatric critical care medicine (PCCM). This study developed a mobile app specifically for Pediatric Critical Care Unit (PICU) residents to aid their onboarding process and aimed to assess whether it could enhance their confidence and comfort levels. From March 2020 to April 2021, 90 residents participated and completed pre- and post-rotation quizzes with 20 questions each. Quiz score differences between the control and app groups were analyzed using t-tests. A survey was also administered at the end of the rotation to compare comfort level and confidence in PCCM knowledge pre- and post-rotation. Enrollment included 50 residents in the control group and 40 in the app group. The participation rate was 100%, but not all participants completed both quizzes and survey. The app group showed a significantly greater improvement in quiz scores from pre- to post-rotation compared to the control group (increase of 0.23 questions vs 1.67, p = 0.045). However, the two groups had no significant differences in confidence in PCCM knowledge (p = 0.246) or comfort levels (p = 0.776) in the PICU. This study found no significant difference in confidence levels between the App and control groups at the end of the PICU rotation. However, the App group outperformed the control group in knowledge assessments. Frequent use of the app likely reinforced essential concepts and facilitated adaptation to the PICU service. Overall, the app's positive impact on knowledge and adaptation indicates it is a valuable tool for enhancing medical residents' educational experiences in busy clinical environments.

Historical background and current situation of pharmacy education in Mongolia.

In Mongolia, the medical education system with a long history has developed with its characteristics since ancient times. Modern medical education, including pharmacy education, began to grow in 1921. Before modern pharmaceutical science developed in Mongolia, pharmacy and pharmacy education were part of Traditional Mongolian Medicine and education. Medical knowledge and experience were transferred from generation to generation through simple teaching. From the sixteenth century, Manba Datsan was established in religious temples to teach Mongolian medicine through discipleship. Modern pharmacy education in Mongolia began in 1926 with the course training of pharmacy technicians, and pharmacist training started in 1961. Pharmacy technician training with a 3-year and pharmacist training with 5-year programs oriented on patient-centered pharmaceutical care are implemented in Mongolia. Pharmacy technicians can also study towards a B. degree in Pharmacy with an additional 3 years of training. As of 2023, seven state-owned and private higher education institutions offer pharmacy education and the number of institutions and students of pharmacy is expected to increase. The pharmacy education policy and the license examination type may be reformable, and the curricula should be regularly updated in line with international trends.

Exploring user interaction patterns in an online physician interactive community based on exponential random graph models

The online physician interactive community (OPIC) is a platform designed for medical workers to discuss medical issues. Physician users can create content in OPIC by posting and replying to posts to discuss the solutions of medical problems with other users. The OPIC plays an important role in bringing together physicians from different medical specialties and disseminating medical experience. However, most OPIC users are not very active in replying to posts, which makes it difficult to fulfill users’ needs for medical information exchange and the development of OPIC is difficult. Current research has given little attention to the communication of physician users in the OPIC. It is necessary to examine how reposting links are established between users in OPIC. This study builds a user interaction network based on the perspective of social network analysis using user repost data from a well-known OPIC in China. Then, an exponential random graph model (ERGM) was applied to quantitatively analyze this user interaction network. Some reposting patterns among OPIC users were discovered. There is significant reciprocity in OPIC of reposting interactions between users. Users with homogeneous characteristics in terms of professional status, community honor status, and geographic location were more likely to interact with each other. In addition, users who added a profile, had a higher level of social effort, and generated more neutral content were more likely to receive responses from others. This study reveals the interaction patterns between physician users in OPIC, which enriches the related research within the OPIC domain and helps to improve communication between users in OPIC.

An Assessment of the COVID-19 Pandemic’s Impact on US Physicians’ Acceptance of Telemedicine: An Exploratory Study

Prior to the COVID-19, various issues in ethics, laws, regulations and security risks limited physicians in their ability to deliver medical care via telemedicine. However, in 2020, telemedicine quickly became mainstream when the US government issued a waiver granting the use of telemedicine to reduce COVID-19 transmission. This study examined the US physicians’ acceptance of telemedicine after its sudden wide-scale implementation. The authors developed a survey based on the Unified Theory of Acceptance and Use of Technology to assess the US physicians’ intentions and attitudes toward the use of telemedicine in the delivery of medical care. This survey was distributed between March and June in 2021 across several voluntary online physician groups. The survey was validated using factor analysis. The 110 participants who completed this study were all active physicians practising telemedicine in the USA. The majority of the participants were female (93%), between 34 and 59 years of age (93%), had at least 10 years of medical experience (84%) and practised in a city (92%). The behavioural intention to use telemedicine was influenced by performance expectancy ( β = 0.34, p&lt;.001), social influence ( β = 0.34, p&lt;.001), facilitating conditions ( β = 0.14, p&lt;.05) and attitude towards telemedicine use ( β = 0.36, p&lt;.001). Attitude towards telemedicine use was influenced by performance expectancy ( β = 0.60, p&lt;.001), effort expectancy ( β = 0.16, p&lt;.05) and social influence ( β = 0.16, p&lt;.05). In addition, telemedicine experience moderated the influence of performance expectancy on behavioural intention negatively ( β =−0.39, p&lt;.001) and moderated the influence of facilitating conditions on behavioural intention positively( β = 0.27, p&lt;.001). This study found that the physicians’ performance expectancy of and attitude towards telemedicine use were significant predictors of physicians’ acceptance. Social influence from colleagues and administrators also played an essential role in impacting physicians’ acceptance of telemedicine. Physicians’ effort expectancy merely affected their attitude towards telemedicine use. Facilitating conditions—such as the inability to perform physical exams, labs, etc.—only influenced the physicians’ intention to use telemedicine. Finally, the survey data suggested that as physicians gained telemedicine experience, their performance expectancy predicted lower behavioural intention than counterparts with less experience.

Exploring the use of a digital anatomy learning platform in a second-year medical student cohort.

Digital anatomy learning platforms hold potential academic benefits, yet there is currently no universally accepted pedagogical framework guiding their utilization. This study applied the lens of Laurillard's conversational framework to explore second-year medical students' experiences with a digital anatomy learning platform at a South African university. An explanatory sequential mixed methods design was employed. Phase 1 used whole population (N = 280) sampling to survey students' usage of, and access to, the digital anatomy learning platform. The survey response rate was 29%, with 47% of respondents reporting usage of the platform. Internet and device limitations were minimal, with 74% and 87% respectively reporting no hindrance. While 39% found Primal Pictures easy to use and helpful to their learning, a disconnect emerged between perceived value and actual usage, with only 5% of participants exhibiting high usage. Phase 2 used purposive sampling (n = 13) based on students' usage of digital anatomy learning platforms. Two focus groups and two individual interviews explored students' use of the learning platform. Qualitative data were both deductively and inductively analyzed. Two themes were identified: types of learning and influencers of learning. Findings from the deductive analysis indicated that students engaged mainly in acquisition-based learning. Inductive analysis showed students encountered various factors that influenced their learning behavior. Affective domain development emerged as a key factor in students' engagement with their anatomy studies and the digital learning platform, suggesting a potential gap in the conversational framework. Digital anatomy learning platforms may strengthen approaches to learning anatomy if implemented systematically, together with pre-training.

Maternal and Child Health Exhibition in the early days of the People's Republic of China

In the early days of the People's Republic of China, Maternal and Child Health Exhibitions were widely held in urban and rural areas across the country. The vivid image and wide coverage of the Exhibition have directly promoted the popularization of a new and more progressive delivery methods in urban and rural areas across the country. While effectively protecting the health of mothers and children, the people's political power is closely linked to "progress".The purpose, organizer and content of the Maternal and Child Health Exhibition are related to the policies of new methods of midwifery, painless delivery, and birth control in the early days of People's Republic of China.It also partly carried the mission of learning from the Soviet Union to "learn from the advanced medical experience", therefore the content in the first ten years was slightly different.

A pilot study to assess medical students' perception of their osteopathic manipulative therapy (OMT) education

ObjectiveThe aim of this pilot study was to determine which factors (both positive and negative) of a medical students' OMT training influenced their perception of OMT and their intent to use it in the future. MethodsA computer-based survey was distributed to medical students (years 1–4) at two different campuses of an Osteopathic Medical School based in the United States. Multiple factors affecting students' perception of OMT were assessed, including experiences prior to medical school or during their pre-clinical years, virtual/in-person learning, OMT club, OMT clerkship, and OMT fellowship. Students were also asked about their confidence in using OMT, overall perception of OMT, and future intent to use OMT. ResultsFactors that appeared to positively influence medical students' perception of OMT were in-person hands-on training (76 %), prior medical school experiences (31 %), OMT club activities (19 %), and OMT fellowship (9 %). Those that appeared to negatively influence their perception were virtual learning (47 %) and pre-clinical lecture hours (46 %). Medical students' overall perception of OMT diminished when comparing first-year to third- and fourth-year students. Selecting an osteopathic school for OMT training also had a positive influence on a students' perception of OMT. Students who were satisfied and confident in their training reported a higher likelihood of using OMT in the future. ConclusionsStudents' attitude toward OMT and their reported likelihood of future use of OMT were improved by hands-on/in-person learning, clinical OMT opportunities, and OMT experiences prior to medical school. Greater attention must be focused on these forms of OMT education.

From master’s thesis to research publication: a mixed-methods study of medical student publishing and experiences with the publishing process

BackgroundMedical student master’s theses are often carried out as research projects, and some are published as research papers in journals. We investigated the percentage of master’s theses conducted by 5th -year students at the Medical Degree Program at Lund University, Sweden, that subsequently served as the basis for research publications. In addition, we explored both student and supervisor experiences with the publishing process.MethodsA cohort of four semesters of student data covering the period from 2019 to 2020 (n = 446) was searched in PubMed, Embase and the Web of Science to assess whether they had been published as research papers. Surveys were sent to students (n = 121) and supervisors (n = 77) to explore their experiences with the publishing process.ResultsWe found that 33% (149 of 446) of the students in the 2019–2020 cohort subsequently published their theses, and 50% of these students were listed as first authors. Most students published original research. Students (n = 21) and supervisors (n = 44) reported that the publishing process was time-consuming and that students needed multilevel support from supervisors to achieve successful publication. The publishing process was reported by 79% of the students to have led to additional learning. Most of the papers (126 of 149, 85%) had a clinical or patient-oriented focus.ConclusionA high percentage of the student publications in which students are listed as first authors require engagement from both students and supervisors. Supervisors play an essential role in supporting students in a successful publication process. Most of the published papers were either clinical or patient-oriented research.

Tolerance for Ambiguity: Correlations With Medical and Physical Therapy Student Traits and Experiences Within the Learning Environment.

Health care professions trainees and clinicians who perceive ambiguous situations as sources of threat (low tolerance for ambiguity [TFA]) experience greater risk for mental health disorders and professional burnout. Physical therapists likely encounter substantial ambiguity because of the biopsychosocial nature of their main therapeutic strategies. The purpose of this study was to identify student traits and experiences within the learning environment that differentiate students with high and low TFA for medicine and physical therapy (PT), and to identify areas of interprofessional overlap and distinction. Graduation Questionnaire survey data from graduating PT (n = 2,727) and medical students (n = 33,159) from the 2019-2020 and 2020-2021 academic years were sorted according to student TFA score, and respondents in the highest and lowest TFA quartiles were retained for analysis. Difference-in-differences analysis was used to reduce the number of potential explanatory factors to a parimonious subset that was put into linear regression models. Inferential statistics were applied to all significant factors identified from the linear regression models. For both professions, higher TFA was generally associated with more positive ratings of the learning environment (student-faculty interactions, faculty professionalism, satisfaction with career choice), lower experiences of exhaustion and disengagement (the 2 axes of academic burnout), and higher scores for the empathy domain of perspective taking. Uniquely for medical students, low TFA was associated with lower empathy scores and a lower degree of interest in working with underserved individuals. Findings suggest that for both professions, high TFA corresponded with better ratings of the educational experience and with traits that are advantageous for patient-centered practice and occupational resilience. Interventions to cultivate TFA among health care trainees may be an important way to meet the growing demand for humanistic health care professionals who are prepared to meet society's complex needs.

The Delivery Model of Perceived Medical Service Quality Based on Donabedian's Framework.

The implementation of the National Health Insurance has transformed the medical care landscape in Taiwan, rendering perceived medical service quality (PMSQ) and patient satisfaction significant focal points in medical care management. Past studies mostly focused on the technical aspects of medical care services, while overlooking the patients' perception of services and the delivery process of PMSQ in the medical care experience. This study integrated the theoretical framework of the Donabedian SPO model and the SERVQUAL questionnaire. The survey was conducted among the outpatients of three types of medical institutions in northern Taiwan: academic medical centers, metropolitan hospitals, and local community hospitals. A total of 400 questionnaires were collected, and 315 valid questionnaires remained after eliminating the incomplete ones. This study established a PMSQ delivery model to explore patients' perceptions of medical service quality. It was found that the variable, Assurance, could deliver the PMSQ and enhance the Medical outcome (MO), while improving the variable, Tangible, in medical institutions could not significantly enhance the MO. These findings emphasize the importance of healthcare institutions prioritizing the professional background, demeanor of their healthcare staff, treatment methods, and processes over tangible elements.

Genesis of a fact: Friedreich ataxia as a recessive disorder

Fleck and Kuhn suggested that scientific “facts” are constructed by a professional community instead of being discovered. This is examined using recessive inheritance for Friedreich Ataxia (FA). Sibling recurrences were known early on, but, for well over half a century, it was described as hereditary, which meant transmitted from generation to generation. Several factors were involved. First, FA is extremely variable, and overlaps with other disorders, making it seem like part of a spectrum, instead of a distinct unit trait suited to Mendelian analysis. Second, a medical system for inheritance based on a hereditary force for constancy with effects throughout life had overlapping doctrines central to analyses: Blastophoria (toxic damage to inheritance), Degeneration, Neuropathic Inheritance, and Polymorphism (several forms with one cause). Different factors could weaken the force, predisposing to a wide range of problems in the next generation, making it hereditary. Manifestations depended on interactions with other factors, and could vary widely, but the nervous system was especially vulnerable. These concepts were incompatible with the Mendelian inheritance of a specific, stable gene linked to a unique phenotype. Changes in medical experience let physicians deconstruct older “facts” about FA, making it a recessive at long last

Emergency medical technicians' experience of managing patients' pain during hospital transport: A qualitative study

This study aimed to explore and elucidate the experiences of emergency medical technicians concerning the pain management of patients during hospital transfers. By delving into their feelings, thoughts, and attitudes, the study sought to provide valuable insights to address the challenges faced in this critical aspect of patient care. In this qualitative study, targeted sampling was employed to recruit 10 emergency medical technicians as participants. Data were gathered through interviews and subsequently transcribed onto paper. The collected information was then subjected to analysis using the conventional content analysis method. The analysis of the collected data and the resulting findings revealed the presence of several barriers, including limited options for pain management, concerns about drug side effects, fear of potential repercussions, and the lack of readily available medical support for emergency medical technicians. The study's findings highlight the multitude of barriers and challenges in managing patients' pain, underscoring the paramount importance of pain relief as a critical issue. This significance becomes even more apparent in underserved and remote regions with limited treatment resources, where emergency medical technicians must prioritize this matter as a vital concern.

Training, experience, and perceptions of chest tube insertion by higher speciality trainees: implications for training, patient safety, and service delivery

BackgroundSeldinger Chest Tube Insertion (CTI) is a high acuity low occurrence procedure and remains a core capability for UK physician higher speciality trainee’s (HST). A multitude of factors have emerged which may affect the opportunity of generalists to perform CTI. In view of which, this paper sought to establish the current experiences, attitudes, training, and knowledge of medical HST performing Seldinger CTI in acute care hospitals in the Peninsula deanery.MethodsA Scoping review was performed to establish the UK medical HST experience of adult seldinger CTI. Synonymous terms for CTI training were searched across Cochrane, ERIC, Pubmed and British education index databases. Following which, a regional survey was constructed and completed by HST and pleural consultants from five hospitals within the Peninsula deanery between April–July 2022. Data collected included participants demographics, attitudes, training, experience, and clinical knowledge. Outcomes were collated and comparisons made across groups using SPSS. A p-value of < 0.05 was defined as significant.ResultsThe scoping review returned six papers. Salient findings included low self-reported procedural confidence levels, poor interventional selection for patient cases, inadequate site selection for CTI and 1 paper reported only 25% of respondents able to achieve 5–10 CTI annually. However, all papers were limited by including grades other than HST in their responses.The regional survey was completed by 87 HST (12 respiratory, 63 non-respiratory medical HST and 12 intensivists/anaesthetists HST). An additional seven questionnaires were completed by pleural consultants. Respiratory HSTs performed significantly more Seldinger CTI than general and ICM/anaesthetic registrars (p < 0.05). The percentage of HST able to achieve a self-imposed annual CTI number were 81.8, 12.9 and 41.7% respectively. Self-reported transthoracic ultrasound competence was 100, 8 and 58% respectively (p < 0.001). The approach to clinical management significantly differed with national guidance with pleural consultants showing an agreement of 89%, respiratory HST 75%, general HST 52% and ICM/anaesthetic HST 54% (p = 0.002).ConclusionCompared to respiratory trainees, non-respiratory trainees perform lower numbers of Seldinger CTI, with lower confidence levels, limited knowledge, and a reduced perceived relevance of the skill set. This represents a significant training and service challenge, with notable patient safety implications.

Medical student experiences of equality, diversity, and inclusion: content analysis of student feedback using Bronfenbrenner’s ecological systems theory

BackgroundIssues relating to equality, diversity, and inclusion (EDI) significantly impact on medical student achievement and wellbeing. Interventions have been introduced at curricular and organisational levels, yet progress in addressing these issues remains limited. Timely evaluation is needed to assess effectiveness of interventions, and to explore issues and interactions in learning environments impacting on student experience. We introduced an anonymous question concerning students’ experiences of EDI into routine online student feedback questionnaires, to scope the nature of ongoing issues and develop greater understanding of students’ experiences in our programme environment. Ecological systems theory, which conceptualizes learning as a function of complex social interactions, determined by characteristics of individual learners and their environment, provides a framework for understanding.MethodsFree-text responses regarding experiences of EDI gathered over 20 months from all programme years (n = 760) were pooled for analysis, providing a holistic overview of experiences in the learning environment. A counting exercise identified broad categories reported by students. Content analysis of the qualitative dataset was undertaken. Bronfenbrenner’s ecological systems theory was applied as a framework to demonstrate interdependencies between respondents’ experiences and environments, and associated impacts.ResultsThree hundred and seventy-six responses were received relating to wide-ranging EDI issues, most frequently gender or ethnicity. Responses mapped onto all areas of the ecological systems model, with frequent links between subsystems, indicating considerable complexity and interdependencies. Interpersonal interactions and associated impacts like exclusion were frequently discussed. Differential experiences of EDI-related issues in medical school compared to clinical settings were reported. Impacts of institutional leadership and wider societal norms were considered by respondents. Respondents discussed their need for awareness of EDI with reference to future professional practice.ConclusionsImplementation of a regular free-text evaluation question allowed data-gathering across cohorts and throughout several stages of the curriculum, illuminating student experience. Connections established demonstrated intersectionality, and how environment and other factors interact, impacting on student experiences. Students experience EDI-related issues on multiple levels within the educational environment, with consequent impacts on learning. Any successful approach towards tackling issues and promoting equity of opportunity for all requires multi-level actions and widespread culture change. Students can offer fresh and distinct perspectives regarding change needed, to complement and diversify perspectives provided by staff and organisational leadership. Student voice should be enabled to shape change.