Medical Experience Research Articles

Medical mistrust, discrimination and healthcare experiences in a rural Namibian community

ABSTRACT Substantial evidence indicates that medical mistrust, resulting from experiences with discrimination and marginalisation, is a determinant of health disparities in minority populations. However, this research is largely limited to the US and other industrialised countries. To broaden our understanding of the role of medical mistrust on health-care decision making, we conducted a study on healthcare experiences and perceptions in a rural, underserved indigenous community in northwest Namibia (n = 86). Mixing semi-structured interview questions with the medical mistrust index (MMI), we aim to determine the relevance of the MMI in a non-industrialised population and compare index scores with reports of healthcare experiences. We find that medical mistrust is a salient concept in this community, mapping onto negative healthcare experiences and perceptions of discrimination. Reported healthcare experiences indicate that perceived incompetence, maltreatment and discrimination drive mistrust of medical personnel. However, reporting of recent healthcare experiences are generally positive. Our results indicate that the concept of medical mistrust can be usefully applied to communities in the Global South. These populations, like minority communities in the US, translate experiences of discrimination and marginalisation into medical mistrust. Understanding these processes can help address health disparities and aid in effective public health outreach in underserved populations.

A critical analysis on quality-of-life in women with visible facial disfigurements.

This study aimed to examine whether surgical treatment for a facial disfigurement influenced an individual's quality of life. One-on-one interviews were conducted with the aim of synthesizing participant's medical experiences into common themes. Additionally, participants completed the World Health Organization's Quality of Life Brief Version (WHOQOL-BREF) questionnaire. The WHOQL-BREF is a standardized testing instrument with four domains of 26 questions, meant to analyze participants' overall quality of health, physical health, psychological status, social relationships, and environmental health. Our study revealed that women with visible facial differences experienced a quality of life below the average of the general population. However, in those who reported above-average quality of life, a key theme emerged: active participation in the choice to undergo surgical treatment. Participants who felt this sense of agency in the decision-making process also reported a more positive healthcare experience. They felt more respected by others, indicating a strong connection between personal agency, surgical choices, and overall well-being. These findings reveal that personal agency plays an important role in the decision-making process for patients undergoing surgical treatment for facial differences, as it improves quality of life and has a positive impact on overall healthcare experience and well-being.

Factors Associated with Medical Students' Attitudes About Cost-Conscious Care: A Mixed-Methods Multi-school Study.

Because physician practices contribute to national healthcare expenditures, initiatives aimed at educating physicians about high-value cost-conscious care (HVCCC) are important. Prior studies suggest that the training environment influences physician attitudes and behaviors towards HVCCC. To explore the relationship between medical student experiences and HVCCC attitudes. Quantitative and qualitative analysis of a multi-institutional survey. Medical students from nine US medical schools. A 44-item survey that included the Maastricht HVCCC Attitudes Questionnaire, a validated tool for assessing HVCCC attitudes, was administered electronically. Attitudinal domains of high-value care (HVC), cost incorporation (CI), and perceived drawbacks (PD) were compared using one-way ANOVA among students with a range of exposures. Open text responses inviting participants to reflect on their attitudes were analyzed using classical content analysis. A total of 740 students completed the survey (response rate 15%). Students pursuing a "continuity-oriented" specialty held more favorable attitudes towards HVCCC than those pursuing "technique-oriented" specialties (HVC sub-score = 3.20 vs. 3.06; p = 0.005, CI sub-score = 2.83 vs. 2.74; p < 0.001). Qualitative analyses revealed personal, educational, and professional experiences shape students' HVCCC attitudes, with similar experiences interpreted differently leading to both more and less favorable attitudes. Students pursuing specialties with longitudinal patient contact may be more enthusiastic about practicing high-value care. Life experiences before and during medical school shape these attitudes, and complex interactions between these forces drive student perceptions of HVCCC.

Abstract PO1-10-12: Advancing Gender Equity: A Closer Look at Women's Representation in Leading Breast Cancer Clinical Trials

Abstract Introduction: Clinical trials serve as pivotal sources for evidence-based medicine, wielding substantial influence within the medical and scientific community. In recent years, heightened attention has been directed towards encouraging greater female involvement and advancing their representation across various domains of the medical field. Female oncologists tend to focus more over breast cancer as a subspeciality and focused practice. Consequently, this observational study seeks to assess the present status of gender equity in leading breast cancer clinical trials, with the aim of identifying potential concerns and mitigating future risks of bias. By delving into this analysis, we can shed light on the current landscape and pave the way for improved inclusivity and fairness in breast cancer research. Methodology: To examine the portrayal of female principal investigators (PIs) in breast cancer clinical trials over the past two decades, we conducted a thorough search of breast cancer clinical trials listed on ClinicalTrials.gov. Furthermore, we employed https://gender-api.com to assess the gender of each PI and calculate the experience in the medical field of the PI by subtracting the PI graduation year from the year of conducting the clinical trial. In addition, we gathered pertinent details concerning the PIs and the clinical trials, and subsequently subjected the data to univariate analyses to detect any noteworthy distinctions between male and female PIs. Results: Over the span of the past twenty years, a total of 9,145 cancer clinical trials were conducted, with 1,127 (12.32%) focusing specifically on breast cancer. Through our rigorous efforts, we managed to gather comprehensive information about the principal investigators (PIs) in 788 (69.92%) of these clinical trials. Notably, we discovered that 419 (53.17%) of these trials were led by female investigators. Upon scrutinizing the characteristics of the PIs, we observed several significant distinctions between male and female PIs. Female PIs exhibited a lower median age (57.0 vs. 60.0) and possessed less medical experience (17 vs. 22 years) compared to their male counterparts (P&amp;lt; 0.001). Furthermore, we found a substantial divergence in the funding sources for the clinical trials between the genders. Female-led trials received a lower percentage of industrial funding (13.1% vs. 24.2% for males, P&amp;lt; 0.001) but showcased a significantly higher percentage of university funding (38.7% vs. 28.0% for males, P&amp;lt; 0.001). Most of the clinical trials led by female PIs were categorized as phase 2 trials (82.8% vs. 66.8% for males) and were conducted in single centers (61.2% vs. 52.6% for males), demonstrating a noteworthy statistical difference (P&amp;lt; 0.001) in both cases. However, no statistically significant disparities were found between male and female PIs in terms of termination rates, publication rates, or the type of intervention utilized in the clinical trials. Furthermore, the ratio of females PI wasn’t different throughout the time as the liner regression model estimated effect was -0.009 with P= 0.065. Conclusions: The study shows the great effort done by female researchers, even though they have lower age, experience, and support from the industrial companies and lower opportunity to have bigger multicenter clinical trials, they still manage to have equivalent rate of termination and publication of the clinical trials showing their capability to lead clinical trials and the need to be supported to maintain the gender equity in leading the breast cancer clinical trials. However, female involvement in other cancer sites might be different and needs to be looked at. Citation Format: Abdulrahman Alhajahjeh, Ghayda’ Bader, Basil Abdin, Taima’ Bader, Saji Aweidah, Layla El-Amayreh, Hikmat Abdel-Razeq. Advancing Gender Equity: A Closer Look at Women's Representation in Leading Breast Cancer Clinical Trials [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-10-12.

Exploring Medical Student Experiences With Direct Observation During the Pediatric Clerkship.

Direct observation (DO) enables assessment of vital competencies, such as clinical skills. Despite national requirement that medical students experience DOs during each clerkship, the frequency, length, quality, and context of these DOs are not well established. This study examines the quality, quantity, and characteristics of DOs obtained during pediatrics clerkships across multiple institutions. This multimethod study was performed at 6 U.S.-based institutions from March through October 2022. In the qualitative phase, focus groups and/or semistructured interviews were conducted with third-year medical students at the conclusion of pediatrics clerkships. In the quantitative phase, the authors administered an internally developed instrument after focus group discussions or interviews. Qualitative data were analyzed using thematic analysis, and quantitative data were analyzed using anonymous survey responses. Seventy-three medical students participated in 20 focus groups, and 71 (97.3%) completed the survey. The authors identified 7 themes that were organized into key principles: before, during, and after DO. Most students reported their DOs were conducted primarily by residents (62 [87.3%]) rather than attendings (6 [8.4%]) in inpatient settings. Participants reported daily attending observation of clinical reasoning (38 [53.5%]), communication (39 [54.9%]), and presentation skills (58 [81.7%]). One-third reported they were never observed taking a history by an inpatient attending (23 [32.4%]), and one-quarter reported they were never observed performing a physical exam (18 [25.4%]). This study revealed that students are not being assessed for performing vital clinical skills in the inpatient setting by attendings as frequently as previously believed. When observers set expectations, create a safe learning environment, and follow up with actionable feedback, medical students perceive the experience as valuable; however, the DO experience is currently suboptimal. Therefore, a high-quality, competency-based clinical education for medical students is necessary to directly drive future patient care by way of a competent physician workforce.

ЭКСПЕРТНАЯ ОЦЕНКА КАЧЕСТВА МЕДИЦИНСКОЙ ПОМОЩИ ДЛЯ СНИЖЕНИИ РЕПРОДУКТИВНЫХ ПОТЕРЬ

The paper considers and highlights the modern principles and methods for assessing the quality of the process of providing medical care, as the most complex and least regulated component of the entire multicomponent system for assessing the quality of medical care. To date, two directions have been formed - theoretical and practical - to solve the problem of quality control of the medical care process. One, standardization, is based on previous medical experience - "method of choice", protocols of management. The second is the quality of the medical care process technology. Quality control of the result is carried out "post factum". Purpose: introduction of effective methods for assessing the quality of medical care by trimesters of pregnancy to reduce reproductive losses. Material and methods: statistical, analytical, prognostic, epidemiological analysis. Results and discussion. The results of the analysis of the assessment of the quality of medical care received by a woman during pregnancy, based on a study of medical records, as well as a study of the opinions of pregnant women, are presented. Comparison of the data obtained makes it possible to reveal the correlation dependence of the results of an expert assessment of the quality of medical care on the timing of a woman's registration for pregnancy. Integral registration defects were determined in the collection of anamnesis data from the examined women in the process of dynamic observation of pregnancy at the outpatient stage. The study of the state of the quality of medical care provided to pregnant women, women in childbirth and puerperas, took place in a complex manner, including laboratory diagnostic studies, registration of medical documentation and possible errors in making a clinical diagnosis. It has been proven that errors in diagnosis and treatment, as a rule, negatively affect the patient's condition. The sub-optimal use of resources is reflected in the lack of respect and use of existing standards. In the study groups with the highest risk of providing medical care of inadequate quality, there were violations that are associated with the risk of worsening the condition of a pregnant woman and the development of gestational complications in the future.

A-I-D for Cascades: Designing a theory-informed intervention for addressing prescribing cascades in primary care

Abstract Introduction Prescribing cascades, which occur when a medication is used to treat the side effect of another medication, are important contributors to polypharmacy. There is an absence of studies that evaluate the implementation or impact of existing interventions to address prescribing cascades in practice. Aim To design theory-informed options for interventions to address prescribing cascades within interprofessional primary care teams. Methods The Behaviour Change Wheel (BCW) framework, and its eight steps, were applied to guide intervention development by the research team. Three target behaviours were drafted and prioritised for intervention development based on data collected as part of two qualitative studies exploring why and how cascades occur across practice settings.[1,2] A target behaviour was selected and the COM-B (capability, opportunity, motivation-behaviour) model was then applied to identify the relevant factors for interprofessional primary care teams. The BCW was used to determine the relevant intervention types and policy options for the behaviour. Next, corresponding behaviour change techniques (BCTs) were identified and intervention options drafted. Prioritisation of behaviours and intervention examples were guided by the APEASE criteria (Affordability, Practicability, Effectiveness/cost-effectiveness, Acceptability, Side-effects/safety, Equity). Results The three target behaviours involved supporting: 1) healthcare providers to ask about, investigate and manage cascades (often through deprescribing), 2) the public to ask about prescribing cascades, and 3) the public to share medication histories and experiences with healthcare providers. The team selected the healthcare provider behaviour, called A-I-D (ask, investigate, deprescribe), for intervention development. Psychological capability and physical opportunity were determined to be the most relevant COM-B components, corresponding to education, training, environmental restructuring, and enablement intervention types and the guidelines, communications and marketing, and service provision policy options within the BCW model. Ultimately, 10 intervention options comprised of BCTs were developed by the team, which are ready for further prioritisation by stakeholders. These can be grouped into three categories: provision of educational content or materials for use by clinicians, provision of consultation or training to support clinicians, and knowledge mobilisation strategies. Through the process, the team identified that development of a practice guidance tool, which assists healthcare providers to investigate and manage prescribing cascades, is needed to support further intervention development. Conclusion The BCW framework guided the design of intervention options that will support primary care clinicians practising in interprofessional teams to address prescribing cascades. A limitation of this work is that applying the BCW framework required several judgements by the team, comprised of scientists, pharmacists, and nurses but not a general practitioner physician. Many but not all have practised with primary care interprofessional teams. When identifying interventions for future consultation, it was determined that the development of a practice guidance tool (i.e., which assists with identifying, investigating, and managing prescribing cascades) underpinned all the proposed interventions for addressing prescribing cascades in practice. Further research is needed to determine what primary care clinicians will need in this practice guidance tool and how it will be used in practice, to support its development.

Examining How Black Women Medical Students Rate Their Experiences with Medical School Mistreatment on the Aamc Graduate Questionnaire.

Few researchers have examined how medical student mistreatment varies by race/ethnicity and gender, specifically highlighting Black women's experiences. Moreover, researchers often fail to use theoretical frameworks when examining the experiences of minoritized populations. The purpose of this study was to examine the frequency of mistreatment US Black women medical students experience and how this compared to other students underrepresented in medicine (URiM) using intersectionality as a theoretical framework. We used the Association of American Medical Colleges Graduate Questionnaire (GQ) as the data source for examining descriptive statistics and frequencies. We examined differences between US Black women (N = 2,537) and other URiM students (N = 7,863) with Mann-Whitney U tests. The results from this study highlighted that most Black women medical students did not experience mistreatment, yet a higher proportion of these trainees reported experiencing gendered (χ2(1) = 28.59, p < .01) and racially/ethnically (χ2(1) = 2935.15, p < .01) offensive remarks at higher frequency than their URiM counterparts. We also found US Black women medical students infrequently (27.3%) reported mistreatment from a lack of confidence for advocacy on their behalf, fear of reprisal, and seeing the incident as insignificant. A paucity of research exists on Black women medical students and even less using relevant theoretical frameworks such as intersectionality. Failure to extract Black women's experiences exacerbates alienation, invisibility, and inappropriate attention to their mistreatment.

Impact of medical school experiences on the career choice of neurosurgery: a cross- sectional study from Pakistan

BackgroundPakistan grapples with the issue of an inadequate neurosurgery workforce but the reasons for such a disparity remain uncertain. Previous studies have highlighted how various factors including medical school experiences have an impact on career choice, but no study has delved into the impact of medical school exposure among Pakistani medical students, especially for the field of neurosurgery. This study aims to evaluate the impact of neurosurgery exposure, mentorship, and interest groups on medical students' decision to pursue neurosurgery.MethodsA national cross-sectional survey was conducted in Pakistan, collecting data from medical students, interns, and medical officers over a one-month period. Ethical approval was obtained from the Ethical Review Committee at Aga Khan University, Pakistan. The data was analyzed using SPSS version 26.ResultsOut of 2618 participants, 38.0% were male and 62.0% were female, with an average age of 21.82 years (± 2.65). Among them, only 358 (13.6%) were interested in pursuing neurosurgery as a career, while the remaining 2,260 (86.3%) were not. More females (58.9%) than males (41.1%) expressed interest in pursuing neurosurgery as their intended career. Most medical students interested in pursuing neurosurgery were in the early years of their medical school (1st Year: 19.6%, 2nd Year: 26.0%, 3rd Year: 20.9%). In our study, students from public sector institutions (52.2%) showed more interest in neurosurgery as a career choice compared to those from private sector institutions (44.1%). The main deterrents for choosing neurosurgery were intense training (42.2%), work-life balance (39.9%), limited residency slots (56.7%), medical knowledge (34.1%), and surgical skills (36.6%).ConclusionThis study highlights the need for increased student engagement to inculcate the decision to pursue neurosurgery among medical students in Pakistan. A significant gap is highlighted, with the majority of interested students in early years. Public sector students show higher interest than their private sector counterparts. However, barriers like intense training, limited residency slots, and work-life balance concerns influence career choice. Targeted interventions like mentorship programs are crucial for fostering future neurosurgeons and advancing patient care and research. By addressing the identified disparities in experiences and promoting a supportive educational environment, it is possible to cultivate a future generation of skilled and dedicated neurosurgeons who can contribute to advancements in patient care and research in the field.

Flip the Script: Rebranding ART and enhancing the U=U message in Malawi and Zimbabwe

Background Since 2009, global efforts have made significant strides in identifying and treating People Living with HIV (PLHIV), with the number on Antiretroviral Therapy (ART) surpassing 25 million by 2020. However, challenges persist as a substantial number of individuals enrolled in ART, particularly in countries like Zimbabwe and Malawi, are lost to follow-up, impeding the success of HIV response initiatives. Stigma and limited awareness continue to pose barriers to effective HIV management. Methods The methodology centres on identifying compelling messengers to bridge the gap between medical information and lived experiences in sub-Saharan Africa. Grounded in human-centered and co-design approaches, the initiative engages host country governments, stakeholders, influencers, and the target audience to create a globally resonant brand with country-specific adaptations. Results The "Undetectable = Untransmittable" (U=U) movement, founded in 2016, emphasizes that PLHIV with undetectable viral loads cannot transmit the virus, playing a crucial role in dismantling stigma and enhancing HIV prevention efforts. To address the low awareness of U=U in Malawi and Zimbabwe, the collaborative "Flip the Script" project was launched, involving public and various private sectors. This initiative aims to reshape perceptions around ART, presenting it as a key to a normalized, healthy life rather than a symbol of infection. "Flip the Script" seeks to boost ART initiation and re-initiation, promote effective ART use, and encourage viral load testing and result sharing among PLHIV. It also strives for consistent counseling on the prevention benefits of ART by health providers. Conclusions Ultimately, the initiative aims to increase the percentage of PLHIV achieving and sustaining viral suppression, leading to a reduction in HIV incidence. Its success hinges on effectively communicating the U=U message, challenging stigma, and empowering both PLHIV and health providers in the targeted regions.

Transgender and gender diverse curriculum in medical imaging programs: a case study

BackgroundTransgender and gender diverse (TGD) individuals face barriers, including harassment and discrimination, when accessing healthcare services. Medical imaging procedures require personal information to be shared, such as date of last menstrual cycle and/or pregnancy status; some imaging exams are also invasive or intimate in nature. Terminology is based on binary sex creating an inherently cis-heteronormative environment. TGD patients fear being outed and often feel a need to function as educators and advocates for their care. Incorporation of inclusive healthcare curriculum related to TGD populations is an effective means of educating new health providers and promotes safer and more inclusive spaces in healthcare settings. Educators face barriers which hinder the creation and implementation of TGD content. The purpose of this study was to examine the impacts educators are faced with when creating and delivering TGD content in their medical imaging curriculum.MethodsA case study of medical imaging programs at a Canadian post-secondary institute was undertaken. Data was collected via semi-structured interviews with faculty. Relevant institutional documents such as strategic plans, policies/procedures, websites, and competency profiles were accessed. Framework analysis was used to analyze the data.ResultsThe study found seven themes that influence the development of TGD curriculum as follows: familiarity and comfort with the curriculum and content change process; collaboration with other healthcare programs; teaching expertise; management of course workload and related. duties; connections to the TGD community; knowledge of required TGD content and existing gaps in curriculum; and access to supports.ConclusionsUnderstanding educators’ perspectives can lead to an increased sense of empowerment for them to create and incorporate TGD curriculum in the future. Many post- secondary institutions are incorporating an inclusive lens to educational plans; this research can be used in future curriculum design projects. The goal is improved medical imaging experiences for the TGD population.

Comparative characteristics of early-onset vs. late-onset advanced colorectal cancer: a nationwide study in China

BackgroundThe incidence of early-onset colorectal cancer (EOCRC, diagnosed in patients under the age of 50 years) has been increasing around the world. Here, we aimed to systematically identify distinctive features of EOCRC.MethodsFrom 2020 to 2021, we conducted a nationwide survey in 19 hospitals, collecting data on advanced CRC patients’ demographics, clinical features, disease knowledge, medical experiences, expenditures, and health-related quality of life (HRQOL). We compared these features between EOCRC and late-onset colorectal cancer (LOCRC, ≥ 50 years old) groups and analyzed the association between EOCRC and HRQOL using multivariate linear regression.FindingsIn total, 991 patients with EOCRC and 3581 patients with LOCRC were included. Compared to the LOCRC group, the EOCRC group had higher levels of education, were more informed about the risk factors for CRC, were more likely to have widespread metastases throughout the body, were more inclined to undergo gene testing, and were more likely to opt for targeted therapy, radiotherapy, and chemotherapy. However, HRQOL in the EOCRC group was similar to that of the LOCRC group, and no significant association was observed between EOCRC and HRQOL (beta: -0.753, P value: 0.307).InterpretationIn Chinese patients, EOCRC patients had more aggressive features. Despite undergoing more intensified treatments and gene testing, they had similar HRQOL compared with LOCRC. These findings advocate for a more tailored approach to treatment, especially for young CRC patients with advanced TNM stages and metastasis.

A systematic review of large language models and their implications in medical education.

In the past year, the use of large language models (LLMs) has generated significant interest and excitement because of their potential to revolutionise various fields, including medical education for aspiring physicians. Although medical students undergo a demanding educational process to become competent health care professionals, the emergence of LLMs presents a promising solution to challenges like information overload, time constraints and pressure on clinical educators. However, integrating LLMs into medical education raises critical concerns and challenges for educators, professionals and students. This systematic review aims to explore LLM applications in medical education, specifically their impact on medical students' learning experiences. A systematic search was performed in PubMed, Web of Science and Embase for articles discussing the applications of LLMs in medical education using selected keywords related to LLMs and medical education, from the time of ChatGPT's debut until February 2024. Only articles available in full text or English were reviewed. The credibility of each study was critically appraised by two independent reviewers. The systematic review identified 166 studies, of which 40 were found by review to be relevant to the study. Among the 40 relevant studies, key themes included LLM capabilities, benefits such as personalised learning and challenges regarding content accuracy. Importantly, 42.5% of these studies specifically evaluated LLMs in a novel way, including ChatGPT, in contexts such as medical exams and clinical/biomedical information, highlighting their potential in replicating human-level performance in medical knowledge. The remaining studies broadly discussed the prospective role of LLMs in medical education, reflecting a keen interest in their future potential despite current constraints. The responsible implementation of LLMs in medical education offers a promising opportunity to enhance learning experiences. However, ensuring information accuracy, emphasising skill-building and maintaining ethical safeguards are crucial. Continuous critical evaluation and interdisciplinary collaboration are essential for the appropriate integration of LLMs in medical education.

Identifying Levels of Competency in Aesthetic Medicine: A Questionnaire-Based Study.

In 2022, the US experienced a significant increase in demand for minimally invasive aesthetic procedures, underscoring its rising acceptance amidst an unregulated educational environment for practitioners. The absence of standardized educational pathways and quality control in aesthetic medicine, primarily provided by non-academic institutions, highlights a critical need for establishing educational standards to ensure practitioner competence and patient safety. To identify levels of competency for the aesthetic practitioner and for necessary achievement milestones during the educational path from novice to expert injector. A total of n = 386 international study participants responded to an online questionnaire regarding their experience in aesthetic medicine practice. The questionnaire comprised 58 questions focusing on professional data, the perceived difficulty of injection and risk for the occurrence of adverse events for specific facial regions in soft tissue filler and toxin injections. Regardless of medical specialty and experience level, an average of 3.85 (1.8) years, 786.4 (2,628) filler injections, and 549.9 (1,543) toxin injections was estimated to progress from novice to advanced injector, while an average of 6.10 (3.7) years, 1,842.2 (4,793) filler injections, and 1,308.5 (3,363) injections was estimated to advance from advanced to expert injector. The nose and the perioral region have been ranked as the facial regions most difficult to achieve a perfect aesthetic outcome and with the greatest risk for the occurrence of adverse events for filler and toxin injections, respectively. This study establishes an educational framework in aesthetic medicine by defining the progression from novice to competent and expert injector levels, suggesting 4 years of practice and over 790 filler and 550 neuromodulator injections for competence, and at least 6 years with 1,840 filler and 1,310 neuromodulator injections for expertise. It also identifies critical facial regions for targeted treatments by different expertise levels.

732 An Evidenced Based Approach to Capturing Growth and Change Through the Burn Camp Experience

Abstract Introduction The American Camping Association (ACA) explored “in what ways do children change because of camp experiences” (Thurber et al, 2007). Our burn camp approached this same question about the medical specialty camp experience assessing readiness and change in three key areas of growth: Independence / Leadership, Adventure / Exploration, and Social Skills. Methods The ACA supported the development of the Camper Growth Index (Henderson et al, 2006). For our medical specialty camp, a subset of items was selected for each area based on the strength of factor scores in the original study, relevance to our camp setting, and the growth being documented in counselor reports. Campers ages 8 – 18 and caregivers rated items addressing these areas on a 4 point likert scale from disagree to agree. Sample questions are “I am good at doing things on my own”, “I like to talk to kids I don’t know yet”, and “My child likes to try new activities”. Campers and caregivers received the questionnaires across a 3 year period. Results Pre-Camp ratings from campers and caregivers are consistent across the 3 years (Table 1). When campers were queried on the last day of camp, their adventure / exploration scores trended upwards, however that trend did not continue at 3 months, but independence / leadership trended upwards instead. Caregivers rated all three categories higher at the 3 month post camp assessment. Variation in the responses between individual items suggests discriminant validity and that certain items might be more sensitive to capturing the benefits of the burn camp experience. Conclusions Burn camps are a vital part of the burn rehab and aftercare experience for young burn survivors and their families. Documenting change through burn camp remains an important task. Change in these growth areas supports our targeted and intentional programming. The Camper Growth Index utilized by ACA allows us to assess the camper and caregiver experience of change, while linking the burn camp experience to the larger youth camp community of research. Applicability of Research to Practice We are evaluating the sensitivity of this abbreviated measure within a burn camp setting. Along with other measures of growth and change, we are hoping to document the magic of burn camp.

Nursing students' and faculty's experiences of first medication administration: A phenomenological inquiry

BackgroundLearning medication administration is essential for nursing students, but the first time can be stressful and shape their clinical development. Previous research primarily focused on student knowledge and technical aspects. PurposeThis phenomenological study helped explore the lived experiences of nursing students and faculty during student's first medication administration in the clinical setting to gain a deeper understanding of their thoughts, feelings, and perspectives. MethodSemi-structured interviews were conducted with female student and faculty informants (N = 12). Using a phenomenological study, data were analyzed using van Manen's hermeneutic six-step research activity method. ResultsFive overarching themes were found: administrating medication, (un)preparedness for complexities in the clinical environment, transformative experience, overcoming fears, and reaping the rewards. ConclusionFirst-time medication experiences are greater than an exercise in skill proficiency and may be improved if faculty provides more structured learning experiences and take sufficient time for student preparation in relating medication knowledge to the skill, technology usage, and supporting students' attitudes toward nurse-patient interactions. These are essential aspects of the medication administration learning process as nursing programs shift toward competency-based education. Clinical faculty also need support in their role as educators and to be facilitated to find this time, considering their multiple responsibilities.

A Student Teaching Assistant Program for Diversity, Equity, Inclusion, and Antiracism Curricular Enhancement.

In the United States, physician bias is exhibited early in medical training and contributes to systemic inequities within the field of medicine. A lack of diversity, equity, inclusion, and antiracism (DEI-AR) content within medical curricula drives critical gaps in knowledge and deficiencies when preparing medical students to serve patients of diverse backgrounds. At the Mayo Clinic Alix School of Medicine (MCASOM), student-led curricular reviews between 2017 to 2018 and 2020 to 2021 revealed opportunities to improve DEI-AR content within preclinical courses. Course directors expressed concern of limited expertise and time to enact effective changes. The MCASOM DEI-AR teaching assistant (TA) program aims to curate a collaborative partnership between course directors and compensated student TAs to facilitate course enhancements responsive to the prior preclinical course review while centering standardized DEI-AR best practices. As of January 2024, the program has engaged 14 TAs and partnered with 24 preclinical courses. Postcourse student evaluation responses were collected from 8 courses for 2021 to 2022 (before enhancements) and 2022 to 2023 (after enhancements). Student satisfaction with DEI-AR content is tracked through postcourse evaluations, with preliminary data demonstrating improvement after DEI-AR curricular integration (improvement of mean preenhancement and postenhancement scores of 3.81 to 4.05; t12 = 1.79, P = .21). Qualitative student comments were sorted into general categories of positive, negative, or neutral, showing a 6.25% median increase in positive perception of DEI. Plans for the MCASOM DEI-AR TA program include application of quality improvement strategies to improve program processes and outcomes. Development of a centralized dashboard that integrates course enhancement progress and ongoing feedback from evaluations is anticipated to facilitate this effort. The program additionally aims to develop partnerships with clinical clerkships, which would allow for a more comprehensive enhancement of the overall medical education experience related to DEI-AR.

Pharmacogenetic intervention improves treatment outcomes in Chinese adult men with schizophrenia

To investigate the clinical application value of pharmacogenetic testing in individualized drug therapy for adult male patients with schizophrenia. A total of 186 adult patients with schizophrenia were enrolled and randomised into the pharmacogenetic (PGx) intervention group and the standard care group. In the PGx intervention group, PGx testing was performed, and the medication regimen was adjusted according to the results of the pharmacogenomic analysis. In contrast, in the standard care group, patients were treated according to the physician's medication experience. Differences in the primary indicator of schizophrenia, the Positive and Negative Symptom Scale (PANSS), and the secondary efficacy measures, the Clinical Global Impressions–Severity of Illness scale (CGI-SI) and Clinical Global Impressions–Global Improvement (CGI-GI) scale, were compared between the intervention and standard care groups. At baseline, the PGx intervention group consisted of 109 individuals, while the standard care group had 77 participants. After 12 weeks of treatment, 49 individuals withdrew from the PGx group (a dropout rate of 45.0%), and 34 withdrew from the standard care group (a dropout rate of 44.2%), with no significant difference in dropout rates between the two groups. The PANSS score reduction rate in the PGx intervention group significantly exceeded that of the standard care group during weeks 3, 6, and 12 of follow-up (P < 0.05). At the 12th week, the PGx intervention group achieved a treatment response rate of 81.7%, significantly surpassing the 48.8% of the standard care group (odds ratio of 4.67, 95% confidence interval of 1.96–11.41; P = 0.001). Furthermore, the PGx intervention was significantly more effective than standard care regardless of whether the patient had a first episode or a relapse (P < 0.05). Furthermore, the Global Assessment of Functioning (GAF) scores and the Personal and Social Performance Scale (PSP) score changes in the PGx intervention group were both significantly different from those in the standard care group (P < 0.05). It is noteworthy that the PGx intervention similarly improves the prognostic outcomes for patients with and without a family history of mental disorders.In conclusion, the application of a PGx intervention treatment model based on PGx testing can significantly improve medication efficacy and shorten the time to achieve the effects of medication in schizophrenia.

Culinary Medicine Experiences for Medical Students and Residents in the U.S. and Canada: A Scoping Review

Phenomenon Despite the importance of diet in the prevention and management of many common chronic diseases, nutrition training in medicine is largely inadequate in medical school and residency. The emerging field of culinary medicine offers an experiential nutrition learning approach with the potential to address the need for improved nutrition training of physicians. Exploring this innovative nutrition training strategy, this scoping review describes the nature of culinary medicine experiences for medical students and resident physicians, their impact on the medical trainees, and barriers and facilitators to their implementation. Approach This scoping review used the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) checklist as guides. Eligible publications described the nature, impact, facilitators, and/or barriers of nutrition and food preparation learning experiences for medical students and/or residents. Additional inclusion criteria were location (U.S. or Canada), allopathic or osteopathic, English, human subjects, and publication year (2002 or later). The search strategy included 4 electronic databases. Two reviewers independently screened titles/abstracts and a third reviewer resolved discrepancies. The full-text review consisted of 2 independent reviews with discrepancies resolved by a third reviewer or by consensus if needed, and the research team extracted data from the included articles based on the nature, impact, barriers, and facilitators of culinary medicine experiences for medical trainees. Findings The publication search resulted in 100 publications describing 116 experiences from 70 institutions. Thirty-seven publications described pilot experiences. Elective/extracurricular and medical student experiences were more common than required and resident experiences, respectively. Experiences varied in logistics, instruction, and curricula. Common themes of tailored culinary medicine experiences included community engagement/service-based learning, interprofessional education, attention to social determinants of health, trainee well-being, and cultural considerations. Program evaluations commonly reported the outcome of experiences on participant attitudes, knowledge, skills, confidence, and behaviors. Frequent barriers to implementation included time, faculty, cost/funding, kitchen space, and institutional support while common facilitators of experiences included funding/donations, collaboratives and partnerships, teaching kitchen access, faculty and institutional support, and trainee advocacy. Insights Culinary medicine is an innovative approach to address the need and increased demand for improved nutrition training in medicine. The findings from this review can guide medical education stakeholders interested in developing or modifying culinary medicine experiences. Despite barriers to implementation, culinary medicine experiences can be offered in a variety of ways during undergraduate and graduate medical education and can be creatively designed to fulfill some accreditation standards.

Innovations for an Enriched Fourth-year Medical Student Neurology Experience (P1-7.004)

Innovations for an Enriched Fourth-year Medical Student Neurology Experience (P1-7.004)