Doctoral Training Research Articles

Boris N. Kholtsov (1861–1940): outstanding urologist, scientist, and teacher. To the 100th anniversary of the start of employment in the Urological Clinic of the Leningrad State Institute for Advanced Training of Doctors

This article is dedicated to outstanding clinical scientist Professor B.N. Kholtsov (1861–1940). The main stages of his scientific, clinical, and teaching activities and his scientific achievements in the development of novel methods for treating diseases of the urinary and male genital organs are presented. He was the first to propose a two-stage adenomectomy technique, an original method of urethral resection in case of stricture, and developed a surgical treatment method for contracture of the bladder neck. The role of Kholtsov in the training of urologists at the Department of Urology of the Leningrad State Institute for Advanced Training of Doctors, which he headed in 1926–1940, is shown. Kholtsov was a talented clinician, scientist, teacher, and innovator, whose main ideas remains in demand today.

Forensic Doctorate Trainee Views on an Expert by Experience (EbE)-Led Workshop: A Qualitative Exploration of Trainee Reflections

ABSTRACT There is a growing recognition of the value of Expert by Experience (EbE) input into the training of forensic psychologists. This study aimed to gain insight into the experiences of doctoral trainees of an EbE led workshop. Sixteen trainees wrote reflective pieces of work following attending an EbE designed and led workshop. Four main themes were found: What I took from the workshop; Workshop delivery; What will I do differently?; and What needs to change? The findings point to the EbE led workshop having a positive impact on trainee current and future work practices.

How many Trainee Clinical Psychologists (TCPs) in the UK self-report lived mental health experience (LMHE)?

Lived mental health experience’ (LMHE) describes direct impact of a mental health problem and/or being a mental health carer. LMHE among Trainee Clinical Psychologists (TCP) is rarely investigated despite encountering challenges throughout training. The current study aimed to estimate point, period, and lifetime prevalence of LMHE among TCPs. UK-based TCPs (N=301) completed an online survey. Results found 39.9% identified as a mental health carer at some point in life (current for 21.2%; historical for 32.8%) with 38.5% acquiring mental health carer responsibilities before training, and 6.6% since training commenced. Additionally, 44.9% and 45.2% respectively reported experiencing a diagnosed or undiagnosed mental health problem at some point in life (current for 55.8%; historical for 63.6%). Moreover, 86.4% reported a mental health problem prior to training, and 11.2% since training started. TCPs are likely to experience a mental health problem or identify as a mental health carer at some point in their life either before or during their doctoral training. This is the first study to estimate point, period and lifetime prevalence of self-reported lived mental health experience among UK based TCPs. Although just an estimate, dissemination of prevalence rates to DClinPsy course staff and employing trusts may be useful to prompt development of supportive resources and adaptations for TCPS with LMHE. This may also facilitate normalisation of LMHE within this population and combat stigma.

Caring for kids: Australian general practice registrar confidence in delivering paediatric primary care.

The burden of disease for Australian children from non-acute conditions is growing; however, little is known about how well prevocational training experiences prepare trainee doctors. This study examines the confidence of general practice registrars in managing paediatric consultations in primary care and whether confidence varies by prevocational training type. This was a cross-sectional national survey of Australian general practice registrars that measured confidence in managing paediatric primary care presentations. Respondents reported feeling confident (65%) or very confident (8%) in managing paediatrics in primary care, with higher confidence for those more advanced in their training or with greater exposure to paediatrics during prevocational training. Regression models showed registrars were more likely to report higher confidence when managing acute versus non-acute presentations. Although most registrars reported confidence in managing paediatric presentations, confidence levels were notably lower for non-acute conditions and when prevocational training experiences included limited exposure to paediatric patients.

PROJECT OF THE EXEMPLARY EDUCATIONAL PROGRAMME OF THE PRIMARY SPECIALISATION (INTERNSHIP) «FORENSIC MEDICAL EXAMINATION»

The article proposes a project of a 2-year model educational programme of primary specialisation (internship) «Forensic medical examination» for training of forensic doctors in Ukraine. Aim of the work. To provide information about the project of 2-year model educational program of primary specialisation (internship) "Forensic Medicine" for training of forensic doctors in Ukraine. Results. The total duration of internship in specialisation «Forensic medical examination» is 2 years: 22 months, 3960 hours, 132 credits of the European Credit Transfer and Accumulation System, including 1) 6 months of training in the department and related departments (1080 hours, 36 ECTS credits). According to the requirements of the Ministry of Health of Ukraine, the trainee stays at the Department for no more than 3 months during an academic year; 2) 16 months internship at the State specialised institution «Forensic Medical Examination Bureau» (2880 hours, 96 credits of the European Credit Transfer and Accumulation System). Conclusions. The proposed project of a two-year model educational program of the primary specialization (internship) «Forensic medical examination» and the curriculum containing a full volume of systematized theoretical knowledge and a sufficient volume of practical skills, the mastery of which is necessary for the quality education of a doctor-specialist in the specialization «Forensic medical expert».

Effect of the COVID-19 Pandemic on the Training of Surgical Resident Doctors at the University College Hospital, Ibadan, Nigeria

Effect of the COVID-19 Pandemic on the Training of Surgical Resident Doctors at the University College Hospital, Ibadan, Nigeria

Role of Intestinal Ultrasound for IBD Care: A Practical Approach.

Intestinal ultrasound (IUS) has recently become the imaging technique of choice for patients with different types of intestinal inflammation. IUS has a high sensitivity, specificity, positive predictive value, and negative predictive value when diagnosing Crohn's disease or ulcerative colitis. Further, it is now the preferred imaging modality for routine IBD reevaluations because of its non-invasiveness, cost-effectiveness, availability (at least in Europe), and reproducibility in all age groups. However, the clinical success of IUS requires IUS training for doctors and technicians who perform IUS with a standardised description of ultrasound findings of the terminal ileum and entire colon. Complications such as abscess formation, fistulae, and stenosis can be detected by either conventional IUS or contrast-enhanced ultrasound (CEUS). Lately, several disease activity scores have been proposed for Crohn's disease, postoperative Crohn's disease, and ulcerative colitis both in adults (including elderly) and in children. IUS was successfully used in randomised clinical trials in order to measure the treatment response. Therefore, IUS now plays a central role in clinical decision making.

Family Satisfaction of Polytrauma Patients in Intensive Care Unit at a Tertiary Care Center.

Family members play a crucial role in ICU patients' treatment and decision-making, despite the stress and uncertainty they may experience, ensuring high-quality medical care. Providing comfortable spaces with noise-reducing techniques can boost family satisfaction. Further research is needed to support families in intensive care units (ICU). This study aims to evaluate family satisfaction and decision-making in polytrauma patients in the ICU, identify improvement opportunities, and analyze demographic and socioeconomic factors influencing satisfaction. This cross-sectional study was conducted at King George's Medical University, Lucknow, over a period of one year. A total of 66 patients, aged between 20 and 70, their family members, and those who gave written informed consent were included. Exclusion criteria included those who died within 48 hours of ICU admission or did not give consent. Patient characteristics, such as age, sex, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and hospital stay length, were also collected. The family satisfactionin the intensive care unit (FS-ICU) questionnaire, consisting of 24 items with five Likert response options, was used to assess satisfaction levels in ICU care and decision-making. A study of 66 patients which included 78.79% male and 21.21% female. The majority of the patients (66.67%) lived with their family members. The mean ICU stay was 13.03 days, with an APACHEscore of 17.39. The results showed that families were very satisfied with a considerable portion of the ICU stay. The overall satisfaction score was 57.00. Families were less satisfied with the atmosphere in the ICU and involvement in the decision-making process. The satisfaction scores were comparable for both genders, except for the time taken to respond to questions, which was significantly higher for women. Although families were very satisfied with the ICU stay, several areas were identified as having potential for improvement. The present study shows that the quality of treatment and communication during hospitalization is a major factor in the need for follow-up care. This underlines the need for a constant focus on communication skills in the training of nurses and doctors and in their practical training in the ICU. Participation in decision-making, especially by family members of survivors, was identified as an area for improvement. We recommend more research to be conducted in India focusing on family satisfaction with involvement in the decision-making in ICU considering the unique racial, cultural, ethnic, and linguisticdifferences in India.

Does a service provide safe, effective rehabilitation? An evaluation method for providers and purchasers

Background Independent organisations monitor the safety and governance of clinical services but do not assess specialist expertise. Peer review can assess service capability but is resource-intense and infeasible. The problem How can you ensure a service provides safe, effective rehabilitation? You ask them to provide data as evidence that they can be trusted to do so. This article suggests a structured approach to providing data on entrustability. An analogy How is the specialist skill of a doctor in training established? They provide evidence about high-level outcomes (capabilities in practice) related to their speciality. An educational supervisor assesses whether they can be trusted to perform safely and effectively without supervision. The capabilities in practice define their expertise. The solution A service can use seven high-level rehabilitation service capabilities, based on the clinical capabilities associated with medical training, with observable indicative descriptors, to collect evidence of their rehabilitation approach. A service must also select four to eight high-level competencies indicating they can rehabilitate their patient caseload safely and effectively. These competencies also need indicative descriptors as evidence of their performance in the service; 11 examples are given. Capabilities. The seven rehabilitation capabilities are: using the biopsychosocial model, having a multi-professional team, making a person-centred rehabilitation plan, working collaboratively across all boundaries, tailoring treatments to the patient's needs, ensuring staff have specific competencies required for their caseload, and acknowledging and managing uncertainty and complexity. Conclusion. Service providers could use this structured approach to develop and provide users with evidence of their rehabilitation expertise.

Recommendations for Integrating Anti-Racist and Inclusive Pedagogy Strategies into Doctoral Teaching Training in Public Health

Greater use of antiracist and inclusive pedagogy is necessary to address racism in public health education. To effectively prepare the next generation of public health faculty who can support diverse cohorts of students in developing the skills needed to promote health equity, such pedagogies must be integrated into doctoral teaching training. Based on our experiences as co-instructors and student of a doctoral-level course on teaching public health, we offer recommendations for integrating antiracist and inclusive pedagogies into doctoral teaching training. First, integrating student voices, such as letters to academic institutions demanding changes to address institutional racism, can prompt reflection and discussion on how doctoral students’ teaching can contribute to antiracist work. Second, pedagogy courses offer the opportunity to model inclusive teaching strategies that value the participation and perspectives of all students. Third, mentored teaching experiences provide doctoral students opportunities to meaningfully engage in course preparation and delivery, including reflexive consideration of positionality in the context of the course. Fourth, instructors and doctoral students must engage in ongoing and collaborative learning, reflection, discovery, and accountability. We encourage public health programs to assess how antiracist and inclusive pedagogies fit into doctoral teaching training and implement further steps to better prepare future faculty to become antiracist educators.

‘I’m really glad I did do it and that on balance the extra work was worth it’: A COM-B framework of final year trainees experiences of attaining secondary accreditation in Cognitive Behavioural Therapy on a clinical psychology programme in the UK

Clinical Psychology trainees undertaking the specialised Cognitive Behavioural Therapy (CBT) pathway develop robust CBT competencies and gain secondary accreditation with the British Association for Cognitive and Behavioural Psychotherapy upon qualification from doctoral training. This paper outlines final year trainees’ reflections on their experience of undertaking the pathway. A COM-B model of behaviour change was adopted to consider the process of implementation and avenues for development. Overall, trainees reported being pleased to have left the doctorate with well-honed competencies in CBT. The trainees reported varied opportunities to develop skills, a significant increase in their capability, referred to multiple forms of intrinsic and extrinsic motivations and reported commitment to sustainable behaviour change. Issues relating to working with complexity and across the lifespan were highlighted as areas for further consideration.

Impacto de la movilidad académica en la producción científica de los médicos brasileños

In recent years, a significant increase in the exodus of individuals has been observed, motivated by a variety of reasons and circumstances, both in the Brazilian and global context. One of the main driving factors of this migratory flow is the search for higher quality academic training in higher education institutions. In this scenario, this work proposes to analyze data related to the scientific production and academic training of Brazilian doctors, with the objective of understanding the impact of academic mobility on the scientific production of these professionals. To achieve this purpose, information on academic training was extracted from the curricula available on the Lattes Platform. The sample included all CVs that indicated completion of a doctorate, totaling 381,463 records. The results obtained enabled a comprehensive analysis of the academic mobility of Brazilian doctors and its correlation with data related to scientific production. It is hoped that this analysis will contribute to a deeper understanding of the relationship between academic training, mobility and scientific production of Brazilian doctors, providing relevant insights for understanding the challenges and opportunities faced by these professionals in a globalized and highly competitive environment.

Professional Responsibilities of Doctors in Making Visum Et Repertum for Cases of Criminal Acts of Obscenity

The complexity in handling cases of sexual assault highlights the crucial role of Visum et Repertum as vital medical evidence in legal proceedings. This document requires both medical expertise and a profound understanding of law to be effectively utilized in court. Primary challenges include the lack of specialized training for doctors in forensic medicine and external pressures that may compromise professional independence. This research underscores the necessity for clear standards and enhanced competencies to support fair and accurate law enforcement for victims of sexual violence. The aim of this study is to explore the professional responsibilities of doctors in the preparation of Visum et Repertum for cases of sexual assault. Findings indicate that doctors must maintain objectivity and integrity in this forensic medical process, navigating challenges such as external pressures and resource limitations. Effective implementation of professional regulations and standards within medical institutions ensures compliance and the quality of Visum et Repertum as robust legal evidence in court. In this context, improving infrastructure, doctor training, and inter-agency coordination are key to enhancing the effectiveness of forensic medical services in supporting judicial fairness.

Single-case design emphasis in American Psychological Association-accredited school psychology programs.

Single-case design (SCD) is an underutilized research methodology in school psychology literature. Despite its relevance to practitioners and applied intervention researchers alike, the majority of intervention research disseminated in school psychology journals tends to involve group designs, such as the randomized controlled trial. Group designs are useful for answering a wide variety of research questions but may not always be relevant to practitioners seeking procedures that work for their students or researchers seeking for the optimal design to answer their research questions. In comparison, the relative dearth of SCD studies in school psychology literature, in conjunction with common values among the field regarding data-based decision making and the scientist-practitioner model to training, raises questions about the cause of this gap. The present study sought to review doctoral training programs in school psychology and evaluate their relative emphasis on SCD in training. Seventy-six American Psychological Association-accredited school psychology programs were reviewed, and results indicated that roughly two thirds of programs do not emphasize SCD during training. Implications regarding school psychology training and research are discussed and recommendations are provided on future directions for school psychology trainers and researchers. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Learning how to develop a research question throughout the PhD process: training challenges, objectives, and scaffolds drawn from doctoral programs for students and their supervisors

AbstractWith the higher education reform putting forward the professionalization of doctoral students, doctoral education has been strongly focused on generic transferable skills to ensure employability. However, doctoral training should not forget core skills of research and especially the ability to formulate research questions, which are the key to original research and difficult to develop at the same time. Learning how to develop a research question is traditionally seen as a one-to-one learning process and an informal daily transmission between a novice and a senior researcher. The objective of this paper is to offer a framework to design doctoral programs aimed at supporting the process of development of research questions for doctoral candidates guided by their supervisors. We base our proposal on two doctoral training programs designed with a pedagogical strategy based on dialogs with peers, whether they be students, supervisors, or trainers from a diversity of scientific backgrounds. The resulting framework combines three learning challenges faced by doctoral students and their supervisors when developing their research question, as well as training objectives corresponding to what they should learn and that are illustrated by the scaffolds we have used in our training programs. Finally, we discuss the conditions and originality of our pedagogical strategy based on the acquisition of argumentation skills, taking both the subjective dimensions of PhD work and the added value of interactions with a diversity and heterogeneity of peers into account.

Implementing a community rotation to the internship training in Kenya: barriers and enablers

ABSTRACT Community placements among trainee doctors have proven beneficial in understanding community problems, the role of primary care in health, and increasing the likelihood of pursuing a primary care career, albeit with some challenges. In 2020, Kenya started community rotations as part of the mandatory internship programme. This study aimed to describe the experiences among medical interns and their educational supervisors during the rotation from which insights on how to improve the community rotation may be drawn. A qualitative analysis of 13 in-depth interviews carried out among medical interns and their supervisors was undertaken in the first year of the implementation of the community rotation. Factors that enabled a successful rotation were an increased awareness amongst interns about patient health in the context of the community, presence of existing primary care structures, and the use of technology for patient follow-up during the COVID-19 pandemic. Conversely, challenges experienced by participants included insufficient communication prior to implementing the community health rotation, limited community health exposure among medical graduates before the internship, and fear of contracting or spreading COVID-19. The study identified opportunities to improve the community rotation through stakeholder engagement, timely government communication, and strengthening undergraduate medical training in community health competencies.

Navigating Dravet syndrome in Spain: A cross-sectional study of diagnosis, management, and care coordination.

Dravet syndrome (DS) is a rare form of refractory epilepsy that begins in the first year of life. Approximately 85% of patients have a mutation in the SCN1A gene, which encodes a voltage-gated sodium channel. The main objective of the present work was to assess the degree of knowledge of DS among Spanish primary care (PC) professionals, the communication flow between them and the pediatric neurologists (PNs), and the services available and resources offered to patients in Spain when searching for a diagnosis and adequate treatment. Two anonymized online surveys on DS diagnosis and patient management in PC were conducted with Spanish PC pediatricians (PCPs) and caregivers of DS patients in Spain. Most PCPs are aware of genetic epilepsy but lack full knowledge of DS and patient advocacy groups (PAGs). Access to epilepsy treatments varies among regions, with many referrals to hospitals and pediatric neurologists. Diagnosis is often delayed, with misdiagnoses and frequent emergency room (ER) visits. Treatment involves multiple drugs, and sodium channel blockers are used, which are contraindicated in DS treatment. Improved training, resources, and communication are needed for early diagnosis. To improve the care and treatment of DS patients in Spain, early diagnosis is required and, possibly, specific efforts aimed at identifying patients in adulthood, generating socio-sanitary structures that integrate social and health services to provide comprehensive care, taking into account the different features and comorbidities of the disease. Dravet syndrome (DS) is a form of genetic epilepsy that starts within the first year of life. We present a study showing that, while family doctors are aware of genetic epilepsies, many don't have a complete understanding of DS. Unfortunately, getting the right diagnosis can take a long time, leading to unnecessary visits to the emergency room. Patients often need several medications, and sometimes they're given drugs that aren't recommended for DS. The takeaway is that training for doctors, more resources, and improved communication could help creating better healthcare systems and therefore give easier access to the right therapies.

Navigating competing tensions: A qualitative study of experiences and perceptions of leadership among emergency medicine doctors.

Emergency medicine (EM) doctors are often required to manage a diverse set of complex challenges; navigating direct patient care, systemic issues and inter-professional interactions. Leadership is well recognised as crucial in optimising both the delivery and the quality of patient care. There is a clear need to gain greater understanding of the reality of EM leadership through exploring doctors' experience and perception of leadership in EM, yet there is a paucity of research focusing on this area. The objective of the present study was to explore the research question: 'What are the experiences and perceptions of leadership by EM doctors?' This single-site qualitative study was undertaken using semi-structured in-depth individual interviews to collect data. Interviews were audio recorded, transcribed and de-identified. Reflexive thematic analysis was performed by the research team with the aid of DelveTool software. Our sample included nine participants incorporating consultants and registrars. Three major themes were identified: (i) situational tensions, (ii) relational tensions and (iii) leadership style tensions. Each of these was further explored with subthemes discussed separately. Leadership within the ED is complex and multifaceted, with doctors required to navigate many competing tensions. The present study highlighted key areas for future leadership development, including situational awareness, emotional intelligence and a fluid approach to leadership styles. The present study provides an important step towards enhancing the development of targeted leadership training for EM doctors.

Women's participation in health care development in Dagestan in the 1960s: history, problems

Satisfaction of the increased demands of medical institutions for trained doctors and secondary medical workers, ensuring gender equality in this socially significant matter, especially in its Muslim regions are considered to be the most important factors in the effective development of healthcare in modern Russia. This necessitates the analysis and use of the positive experience of previous decades. In this context, the experience of multinational Dagestan in the development of healthcare, including increasing its human resources, is of exceptional scientific, theoretical and practical interest. In this research, for the first time in regional historiography, an attempt is made to analyze the experience of the Republic's authorities in meeting the requests and needs of healthcare institutions in the personnel of medical workers in the gender aspect in the 1960s.The article is based on the principles of scientific objectivity and historicism, descriptive and systematic research methods are used, which allowed us to recreate a full-fledged picture of the topic under study.The analysis of the factual material allowed us to come to a reasonable conclusion that despite the objective difficulties and unresolved issues in the economic and socio-cultural development of Dagestan in the decade under review, there have been significant positive changes in the development of healthcare, including meeting the requests and needs of healthcare institutions for personnel with higher and secondary medical education. During this period, despite the decrease in the proportion of women in the medical staff, they continued to prevail. However, as it is traced in the article, by the end of the analyzed decade, significant difficulties and unresolved issues remained in the Republic in meeting the needs of healthcare institutions for medical personnel and secondary medical workers from among women, primarily Dagestanis, in rural areas.

1179 Navigating the AI Landscape: Surveying the Use of AI Language Tools for Medical Portfolios

Abstract Aim Recent advances in artificial intelligence (AI) driven natural language processing have made it possible to use tools such as ChatGPT to generate pieces of text which are realistic, eloquent, and challenging to distinguish from human-generated content. This work aims to answer the question: could the use of these tools for medical portfolios represent a positive opportunity to enhance learning, or would it detract from the purpose of reflective practice? Method In total, 98 post-graduate doctors from across the UK were surveyed to gather data on their awareness of, previous use of, disclosure of use and experience with these tools for their professional portfolios. Their opinions on the need for future guidance in this area were also explored. Results From 90 respondents who currently maintain a professional portfolio, 18 (20%) had used AI-driven tools in some form to generate content for it and none disclosed this use. Regarding disclosing the use of AI-driven tools, 67.3% advocate for this whereas 32.7% believe disclosure is unnecessary. There was slightly stronger consensus regarding how useful guidance from regulatory bodies on this practice would be, with 73.5% in support of guidance and 26.5% in opposition. Conclusions Clearly, there is an urgent need for larger studies, discussion, and consensus from regulatory bodies so that guidance can be put in place. Without this, maintaining the integrity of CPD will become challenging for both trainee doctors and assessors of medical portfolios.