Postgraduate Practice Research Articles

Trainees' perceptions of course quality in postgraduate General Practice training in Ireland.

Postgraduate General Practice (GP) training is structured around a formal curriculum set out by the training body. It also includes a "hidden curriculum" of experiential workplace learning in a heterogenous learning environment [1]. There is no formal national annual survey of GP trainees and their views in Ireland. The research aim was to evaluate what the trainee population think of their training environment, and to analyse the contributory factors. A mixed methods cross-sectional survey was distributed to all third- and fourth-year GP trainees (N = 404). The Manchester Clinical Placement Index was adapted for the study. The response rate was 30.94% (N = 125). Questions 1 to 7 provided a description of the characteristics of the study population. The remainder of the questions focused on aspects which relate to constituents of the learning environment. The responses were broadly and convincingly positive and supportive of the good work being done in GP training and by trainers in Ireland today across both qualitative and quantitative findings. One notable exception was in the area of feedback where single handed fourth year practices were found to be underperforming. The current research findings were broadly positive and supportive of the good work being done in GP training and by trainers in Ireland today. Further research will be needed to validate the study instrument and to further refine some aspects of its configuration. The implementation of such a survey on a regular basis may have merit as part of the quality assurance process in GP education alongside existing feedback structures [2].

Levelling up or left behind? are GP training opportunities in northern Ireland widening or closing the gap on health inequalities?

Increasing the GP workforce will not necessarily level up healthcare provision: instead increasing GP training numbers could worsen health inequity and inequalities. This is especially true if there are fewer opportunities to learn, train and build confidence in under-served, socioeconomically deprived areas. To investigate the representation of socioeconomic deprivation in postgraduate GP training practices in Northern Ireland (NI). Socioeconomic deprivation indices and scores of GP practices in Northern Ireland were calculated. We compared the socioeconomic deprivation indices and scores of GP postgraduate training practices against general practice in NI by examining the representation of practices whose patients live in areas of blanket deprivation, higher deprivation and higher affluence. Of 319 practices in NI, 171 (54%) were registered as postgraduate training practices with a mean deprivation score of 3.02 (95% CI 2.91-3.12) compared with non-training practices' higher mean deprivation score of 3.2 (95% CI 3.01-3.33), P-value <0.05. The proportion of training practices with blanket deprivation and higher levels of deprivation was underrepresented, with the current postgraduate GP training practices having more affluent populations. Postgraduate training practices had a statistically significant lower deprivation score and did not fully reflect the socioeconomic make-up of wider NI general practice. The results, however, are more favourable than in other areas of the UK and better than undergraduate teaching opportunities in general practice. Health inequalities will worsen if the representation of general practice training in areas of greater social economic deprivation is not increased.

Study on the effect of Huayu Changshen Formula combined with ideological and political psychological intervention on students with anxiety disorder

BackgroundWith the increasing academic pressure on students, students have become a large group of anxiety patients. Some studies have shown that Huayu Changshen Formula can relieve the stagnation of liver qi in patients, and has high application value in the clinical treatment of anxiety disorders. In order to improve its treatment effect on students with anxiety disorder, the study proposed a combined treatment method of Huayu Changshen Formula and ideological and political psychological intervention to improve the diagnosis and treatment level of students with anxiety disorder.Subjects and MethodsA total of 86 students with anxiety disorders from February 2020 to November 2020 were retrospectively analyzed. All patients were randomly divided into the experimental group and the control group. The patients in the experimental group were treated with the combination of Huayu Changshen Formula and ideological and political psychological intervention, and the patients in the control group were treated with paroxetine. The treatment lasted for 10 weeks. Before and after the treatment, Hamilton Anxiety Scale (HAHA) was used for scoring to understand the anxiety level of patients. The symptom scale of liver qi stagnation syndrome was used to score the patient’s condition. All data were analyzed by SPSS24.0 software.ResultsBefore treatment, there was no significant difference in HAHA score and Traditional Chinese Medica (TCM) symptom score between the two groups; After treatment, the HAHA scores of the patients in the experimental group and the control group decreased to about 7.88 and 12.39 respectively, and the TCM symptom scores of the patients in the experimental group decreased by about 4.86 points compared with the control group. The difference between the two groups of patients was statistically significant (P &lt; 0.05). The observation of the overall efficacy of the two groups of patients showed that the recovery rate of the experimental group patients reached 28.78%, which was 24% higher than that of the control group. The overall efficacy difference between the two groups was statistically significant (P &lt; 0.05).ConclusionsThe combined treatment of Huayu Changshen Formula and ideological and political psychological intervention has improved the overall treatment level of anxiety disorder, and its therapeutic effect is far better than that of paroxetine, which can significantly improve students’ anxiety disorder, and can be popularized in the clinical treatment of anxiety disorder.Table 1.Changes in patients’ HAHA score and TCM symptom score before and after the treatmentProjectHAHATCM symptomBefore treatmentAfter treatmentBefore treatmentAfter treatmentExperimental group21.57±1.257.88±0.1413.68±1.172.86±1.48Control group20.69±2.1413.29±2.6914.55±0.097.72±3.09t3.554.212.152.48P0.1350.0010.1430.001AcknowledgementThe research is supported by: Jiangsu Postgraduate Research and Practice Innovation Program: Marx’s Thought of Civil Society and Its Contemporary Value (No. KYCX22_1694).

Transfusion camp: A retrospective study of self-reported impact on postgraduate trainee transfusion practice.

The optimal method of postgraduate transfusion medicine (TM) education remains understudied. One novel approach is Transfusion Camp, a longitudinal 5-day program that delivers TM education to Canadian and international trainees. The purpose of this study was to determine the self-reported impact of Transfusion Camp on trainee clinical practice. A retrospective analysis of anonymous survey evaluations from Transfusion Camp trainees over three academic years (2018-2021) was conducted. Trainees were asked, "Have you applied any of your learning from Transfusion Camp into your clinical practice?". Through an iterative process, responses were categorized into topics according to program learning objectives. The primary outcome was the rate of self-reported impact of Transfusion Camp on clinical practice. Secondary outcomes were to determine impact based on specialty and postgraduate year (PGY). Survey response rate was 22%-32% over three academic years. Of 757 survey responses, 68% of respondents indicated that Transfusion Camp had an impact on their practice, increasing to 83% on day 5. The most frequent areas of impact included transfusion indications (45%) and transfusion risk management (27%). Impact increased as PGY increased with 75% of PGY-4+ trainees reporting impact. In multivariable analysis, the impact of specialty and PGY varied depending on the objective. The majority of trainees report applying learnings from Transfusion Camp to their clinical practice with variations based on PGY and specialty. These findings support Transfusion Camp as an effective means of TM education and help identify high-yield areas and gaps for future curriculum planning.

Teledentistry in pediatric dentistry: Postgraduate dental students' knowledge, practice, and attitudes.

This study aimed to investigate postgraduate pediatric dental students' knowledge, practice, and attitudes toward teledentistry and identify potential applications of this technology in pediatric dentistry. An online questionnaire was sent to all students through Google Forms. The questionnaire included questions about socio-demographic information, knowledge, practice, and attitudes regarding teledentistry and the use of teledentistry during coronavirus disease 2019. Before the coronavirus disease 2019 pandemic, only 8.2% of students knew teledentistry. However, this increased to 45% after the pandemic, with differences depending on the student's clinical experience. Teledentistry was reported as useful for medicine taking, follow-up consultations, and diagnosing soft tissue problems. Integrating teledentistry topics into the dental curriculum can increase awareness and adoption of this technology in pediatric dentistry. Dental students need to be aware of its potential applications.

Practice Impact of a Dedicated LGBTQ+ Clinical Exposure During Residency.

An increased focus on lesbian, gay, bisexual, transgender, queer (LGBTQ+) care in graduate medical education is needed to address health disparities in this patient population. This study assessed practice confidence and practice intentions of residents who rotated through an LGBTQ+ clinic during their residency. Residents completed three to eight half-day sessions in a dedicated LGBTQ+ clinic focusing on primary care, pre-exposure prophylaxis (PrEP), and gender-affirming care from 2019 to 2022. Prior to this clinical experience, they were provided background reading materials, care guidelines, and clinical cases. Residents were electronically surveyed at two time points after completing this clinical experience to retrospectively assess their pre-and postcurricular confidence. Seventeen out of 18 (94%) residents who completed the curricular experience responded to the initial survey, which showed statistically significant differences between reported pre- and postcurricular confidence in providing primary care, PrEP, and gender affirmation care. Eight-eight percent of residents reported that they planned to or have already incorporated this care into their practice. In a follow-up survey 1 year later, 15 out of 18 (83%) responded, reporting consistent skills confidence. Seventy-one percent of participants reported currently providing LGBTQ+ care. We noted no statistical difference between the initial postconfidence survey and the follow-up survey. This study demonstrated positive associations between a focused curricular experience in LGBTQ+ care and both confidence providing LGBTQ+ care and planned and actual postgraduation practice patterns.

Reflections on Online EFL Teaching during COVID-19: A Case Study of Yunnan University in China

The paper is a case study on a whole-term online English teaching practice of non-English major postgraduates from March to July 2020 at Yunnan University in China. By attempting to probe into the strategies employed in the three phases of pre-teaching, while-teaching, and post-teaching respectively, reflections upon the mega-scale online English teaching for 30 classes of approximately 1200 students are analyzed by qualitative research in the forms of online interviews and class video observation. The research aims to summarize useful strategies and key factors teachers need to attach importance to in technology-assisted English language teaching with mixed applications and approaches to meet an urgent need in practical situations. Th e practice can be an example of the effective “localization” of college English teaching in China. It also shows that effectiveness-oriented online teaching can be feasible and useful in shaping and enriching the new normal of foreign language teaching in post COVID-19 era.

Evaluation of knowledge, attitude and practice towards drug-drug interactions among postgraduates in tertiary care hospital, Kurnool

Background: Drug-drug interactions (DDIs) are changes in a drug’s effects due to concurrent use of another drug. Clinically significant interactions lead to undesired adverse effects, therapeutic failure, toxicity or may even cause death of the patients. The Aim is to evaluate the Knowledge, Attitude and Practice of Postgraduates regarding DDIs and implementation of educational program may enhance patient’s safety.Methods: A cross-sectional study was conducted among postgraduates in all clinical departments of Government general hospital, Kurnool in the month of October 2021. Pre-validated questionnaire was used to assess the KAP. It contains demographic data, knowledge and practice questions related to DDIs and attitude towards the preferable sources of drug interaction information. Data analysis was done by using SPSS version 26.Results: Out of 220 questionnaires distributed, 126 postgraduates submitted with complete answers(n=126). Overall response rate is 57%. By using the Bloom’s cut-off points, most of the respondents (43.5%) had low level of knowledge towards DDIs. Even respondents with high knowledge level (19%) are not practicing the drug interaction screening during the admission of patients. Majority of PGs with low level knowledge agreed to ask doctors than pharmacist about DDIs and prefer to search for DDIs using reference book than online mode as the source of drug information.Conclusions: In my study, most of the respondents had insufficient knowledge to prevent life threatening DDI’s. So, there is a need to increase medical educational program regarding the importance of screening and assessing of DDI’s before prescribing medicines.

The effect of specific learning difficulties on general practice written and clinical assessments.

Substantial numbers of medical students and doctors have specific learning difficulties (SpLDs) and failure to accommodate their needs can disadvantage them academically. Evidence about how SpLDs affect performance during postgraduate general practice (GP) specialty training across the different licencing assessments is lacking. We aimed to investigate the performance of doctors with SpLDs across the range of licencing assessments. We adopted the social model of disability as a conceptual framework arguing that problems of disability are societal and that barriers that restrict life choices for people with disabilities need to be addressed. We used a longitudinal design linking Multi-Specialty Assessment (MSRA) records from 2016 and 2017 with their Applied Knowledge Test (AKT), Clinical Skills Assessment (CSA), Recorded Consultation Assessment (RCA) and Workplace Based Assessment (WPBA) outcomes up to 2021. Multivariable logistic regression models accounting for prior attainment and demographics were used to determine the SpLD doctors' likelihood of passing licencing assessments. The sample included 2070 doctors, with 214 (10.34%) declaring a SpLD. Candidates declaring a SpLD were significantly less likely to pass the CSA (OR 0.43, 95% CI 0.26, 0.71, p = 0.001) but not the AKT (OR 0.96, 95% CI 0.44, 2.09, p = 0.913) or RCA (OR 0.81, 95% CI 0.35, 1.85, p = 0.615). Importantly, they were significantly more likely to have difficulties with WPBA (OR 0.28, 95% CI 0.20, 0.40, p < 0.001). When looking at licencing tests subdomains, doctors with SpLD performed significantly less well on the CSA Interpersonal Skills (B = -0.70, 95% CI -1.2, -0.19, p = 0.007) and the RCA Clinical Management Skills (B = -1.68, 95% CI -3.24, -0.13, p = 0.034). Candidates with SpLDs encounter difficulties in multiple domains of the licencing tests and during their training. More adjustments tailored to their needs should be put in place for the applied clinical skills tests and during their training.

Transferability of Mental Health Simulation Skills to Practice: A Nursing Post-Graduate Follow-Up Study.

The purpose of the current descriptive qualitative follow-up study was to explore perceptions of post-graduate nurses regarding transferability of student-learned mental health simulation knowledge and skills to actual acute care practice settings. The study used a survey design of eight questions on SurveyMonkey® and there were 11 participants. Questions were specific to knowledge and skills learned as students in three mental health simulation labs and whether they transferred to post-graduate acute care practice settings. Thematic analysis identified the following main themes: Learned Effective De-Escalation Techniques, Felt More Prepared With Psychiatric Assessments, and Feeling Empathy for Patients Hearing Voices. Subthemes were Being Therapeutic With Patients and More Confident in Psychiatric Emergencies. Post-graduate nurses described being able to transfer use of student-learned mental health simulation knowledge and skills to acute care practice settings. [Journal of Psychosocial Nursing and Mental Health Services, 61(7), 39-45.].

Cohort study assessing the predictive value of a research year vs additional degree in dermatology.

Taking a gap year to obtain an additional degree or for research is becoming increasingly popular among medical students pursuing dermatology to bolster residency application competitiveness. The purpose of this study was to determine whether doing so influences future academic achievement and career trajectory. A list of dermatologists who achieved board certification in 2010 was obtained from the American Board of Dermatology. Information regarding additional post-graduate degrees, research years, fellowship specialization, practice setting, publication number, and H-index were obtained using publicly available data. Additional degrees were associated with higher research productivity, higher H-index, and practicing at teaching hospitals while taking a research year was only associated with a higher H-index. This data can be used to further inform medical students wishing to achieve high levels of research productivity and careers at teaching institutions and residency programs wishing to recruit such applicants.

Knowledge, Attitude and Practice of Dental Interns and Postgraduates towards Managing Medical Emergencies in Dental Chair

Knowledge, Attitude and Practice of Dental Interns and Postgraduates towards Managing Medical Emergencies in Dental Chair

Multi-level classroom learning prepares nurses for future collaboration in palliative care: an educational initiative.

Palliative care (PC) education should be an important part of both the graduate and undergraduate nursing curriculum. Nursing's philosophy of holistic care, which aims to improve the quality of life of patients and families, aligns with the primary objective of PC, positioning nurses to take the lead in expanding and improving PC delivery to all patients with a life-threatening diagnosis. The best way to facilitate this level of care is when staff nurses and advanced practice nurses work collaboratively. To establish a new standard for nursing education that emphasises intradisciplinary care. To fill the gap in PC education for nursing students, a dedicated elective PC class was developed for undergraduate and graduate students at a large midwestern University in the United States. Through an interactive approach to learning, both groups were able to experience and more fully understand how they would work collaboratively with each other to provide high-quality PC. Intradisciplinary PC education is an opportunity for students to learn the precepts of PC in an environment that will mirror their post-graduation practice environment.

Educational Research Ethics Committees as Space for Situated Learning in Higher Education

This paper contributes a different perspective to the debates regarding the role of research ethics committees (RECs) in educational and social sciences research. It identifies limited explicit engagements from such debates about how academics who serve in RECs can learn from these committees towards academic growth and development in and beyond being ethical researchers. We (the authors) follow a duoethnographic method to reflect on our experiences of learning from one committee in a South African university. We argue that, notwithstanding the identified shortcomings in some of the REC committees, they can also be spaces for situated learning. Based on our experience, we identify several ways in which these committees can be resourceful. (1) They can empower the less experienced members through observation and interaction with the experienced. (2) They provide opportunities for the transfer of “knowledge power” to beyond the committee for quality research and postgraduate supervision practices. (3) They can be a solution to the limited research supervision capacity in some institutions. The paper also extends the understanding of the situated learning theory as we add ‘visitors’ as an element of the community of practice.

Factors affecting students’ intentions toward green entrepreneurship in COVID-19 pandemic times: A case study of Egyptian universities

The impact of government assistance, entrepreneurial self-efficacy, conceptual development support, and educational development support on green entrepreneurial aspirations through university curriculum during the COVID-19 epidemic is explored in this research. It is the first of its kind in Egypt and is based on a sample population of 502 undergraduate students from various faculties at five Egyptian universities (two public, two private, and one institution with international cooperation). It employs structural equation modelling via SmartPLS. This study can assist other Egyptian universities in creating strategic plans for environmental initiatives and ensuring that students are given the necessary skills to succeed. The study aims to evaluate the impact of conceptual development support offered by universities in terms of fostering interest and presenting novel ideas to students to start a new project, government support provided in terms of laws and programs to encourage entrepreneurship, development of university curriculum to promote entrepreneurial self-efficacy through regular courses, postgraduate practices, and networking with entrepreneurs. Academics, especially those in universities in Egypt or other Arab or African nations, as well as policymakers, can gain from this research's potential to build new standards to support green entrepreneurship and sustainable economies.

National Chronic Disease Management Programmes in Irish General Practice-Preparedness and Challenges.

Information on the readiness of Irish general practice to participate in structured chronic disease management (CDM) care is limited. This study explores the logistic, staffing, and organizational preparedness of Irish general practice to do so, stratified by their size, location, and training status; implementation challenges were also explored. An anonymous, paper-based random survey was performed. A chi-square test was applied to compare practices by location (urban/rural), post-graduate training status (with/without), and numbers of GMS patient (≥1500/>1500 patients) and prevalence ratio and Poisson regression analysis to examine the relationship of staffing with key variables. Overall, 125/243 practices participated, 22% were rural, 56.6% were post-graduate training practices, and 53.9% had ≥1500 GMS patients. The rural, non-training practices and those with <1500 GMS patients had substantially lower staffing levels. The average number of GPs was significantly less in rural practices; however, the difference was insignificant for nurses. Salary costs for practice nurses in all practices and staff IT training and clinical equipment in smaller practices were important barriers. Most practices reported ‘inadequate’ waiting times for access to almost all referral and paramedical services. The study recommends addressing the staffing, funding, and training challenges within Irish general practice to effectively implement a structured CDM program.

Resident Autonomy and Performance Independence in Surgical Training Are Time- and Skill-Dependent

IntroductionAppropriate faculty supervision and conditional independence of residents during training are required for autonomous and independent postgraduate practice. However, there is a growing concern that competence for transition to independent practice is not universally met. We hypothesize that surgery residents play a significant and active role in achieving their own independent status. MethodsOver seven academic years (July 2014 through June 2021), 46 surgeons supervised and intraoperatively assessed the performance of 51 residents using validated Objective Structured Assessment of Technical Skill (OSATS) and Zwisch Operative Autonomy (ROA) assessments. Resident readiness to perform procedures independently (RRI) was graded as yes, no, or not applicable. Data were analyzed using descriptive statistics with categorical variables reported as frequencies and percentages. ResultsA total of 1657 elective procedures were performed by residents supervised by faculty. Association between RRI and postgraduate year (PGY), OSATS scores, ROA, resident and faculty gender, and case complexity was analyzed. Results indicated positive correlation between RRI and summative OSATS score (r = 0.510, P < 0.001), PGY (r = 0.535, P < 0.001) and ROA (r = 0.473, P < 0.001). Percentage of overall RRI increased from 7% at PGY1 to 87.4% at PGY5. Meaningful autonomy ratings increased from 23.6% at PGY1 to 92.5% at PGY5. Variations in ratings was observed when considering case category and complexity. ConclusionsRRI increases with years of training with variation when considering the specialty/The Accreditation Council for Graduate Medical Education procedure category and the complexity of cases. Specialty fellowships are a viable option to address the gap in The Accreditation Council for Graduate Medical Education categories when residency alone cannot reach appropriate independence. Residents’ technical skills play a crucial role in evaluating RRI and granting operative autonomy.

Identifying threshold concepts in postgraduate general practice training: a focus group, qualitative study

ObjectiveTo identify threshold concepts (TCs) for physicians undergoing postgraduate medical education (PGME) in general practice.DesignAn explorative, qualitative study with 65 min focus group interviews and thematic analysis was used. Participants...

Understanding concepts of generalism and specialism amongst medical students at a research-intensive London medical school

BackgroundMany prominent UK medical organisations have identified a need for more generalist clinicians to address the complex requirements of an aging society. We sought to clarify attitudes towards “Specialists” and “Generalists” amongst medical students and junior doctors at Imperial College School of Medicine.MethodsA survey exploring medical students’ beliefs was followed up by qualitative analysis of focus groups of medical students and Imperial-graduate foundation year doctors.ResultsFirst year medical students associated specialists with academia and higher income, and generalists with ease of training and job availability. Senior (Years 5/6) medical students associated specialists even more firmly with broader influence and academic work, whilst generalists were assigned lower prestige but the same workload as specialists. The medical student focus group discussed concepts of Generalism pertaining only to Primary Care. In contrast, the foundation year doctor focus group revealed that Generalism was now seen to include some hospital care, and the perception that generalists sat lower in a knowledge hierarchy had been challenged.ConclusionPerceptions that Generalism is associated with lower prestige in the medical profession are already present at the very start of medical school and seem to be reinforced during undergraduate training. In early postgraduate clinical practice, the perceived knowledge and prestige hierarchy lessens. These findings can help inform curriculum redesign and the promotion of Generalism as a rewarding career aspiration.

Breast Self-examination Practice among Medical Postgraduate Female Students of Southern Odisha: A Cross-sectional Study

Introduction: Breast cancer is on the rise among females in India. Breast Self-Examination (BSE) is an easy to learn, self monitoring screening modality which can be done in utmost privacy. A proportionate increase in incidence of breast cancer is now reported among urban educated females. Even doctors neglect their own health and are the at-risk population for Non Communicable Diseases (NCDs). Aim: To assess the knowledge, attitude and practice of postgraduates on BSE. Materials and Methods: This was a cross-sectional study conducted between August 2021 to October 2021 at M.K.C.G. Medical College, Berhampur, Odisha, India. Study population included 100 female postgraduate students. A predesigned structured questionnaire was prepared by thorough review of literature and was validated by experts. Data was collected on knowledge, attitude and practice of BSE from the study participants using Google form. Scoring was done and correlation was found out between the parameters. Chi-square test and the Fisher Exact Test was used for statistical analysis. Results: About 82 respondents completed the form. About 66 (80.48%) were in age group of 25-29 years, 7 (8.53%) had family history of breast cancer, 8 (9.75%) had discovered abnormality while practicing BSE. The median scores in knowledge of breast cancer and BSE was 36 and 17 respectively. The median scores of attitude and practice were 42 and 13 each. Spearman’s rank correlation between knowledge and attitude was positively correlated (r=0.324, p=0.003), attitude and practice was positively correlated (r=0.317, p=0.004) and knowledge and practice was not correlated (r=0.173, p=0.120). No significant difference in practice was found for participants with family history of breast cancer (p=0.353) and personal history of breast abnormality (p=0.672) and those who had no history. However a significant association was found between knowledge on frequency of BSE and monthly practice of BSE (p=0.003). Conclusion: In this study 50% of the participants did not know about the age of starting BSE as 20 years. All the steps were not followed by those who performed BSE. The most common reason for not practicing BSE was lack of time. Knowledgepractice gaps exist among the future professionals.