COVID-19 and medical educator perceptions: Sense-making during times of crisis

Background. Although crises are generally considered uncommon, health professions education (HPE) literature gives evidence of repeated and ongoing crises. This has been most recently demonstrated by the global impact of COVID-19. Crisis management literature proposes that such recurrent crises are opportune moments for learning. While there has been much literature published that describes changes made to the format of HPE amid COVID-19, there has been little attention given to the perceptions of medical educators. Medical educators' experiences may serve as a resource to uncover lessons that may have been learnt during this period. Objective. To address the gap in the literature, by analysing the perceptions of medical educators at the University of Cape Town (UCT) during the COVID-19 pandemic of 2020-2021. Methods. A qualitative case-study approach was adopted. Rich data were collected from four medical educators using semi-structured interviews and a focus group discussion, and then analysed using a reflexive thematic approach. Results. The data indicated that educators grappled with a multitude of struggles during the COVID-19 pandemic. These were analysed thematically as: tensions with technology, balancing expectations, and the distribution of support. However, surface-level challenges faced by educators seem to belie a much deeper personal struggle. Conclusion. The data suggest that whe the rany learning occurs and what is learnt are embedded within the process of sense-making. If institutions of higher education aim to adopt proactive responses to crises, then further research ­ as well as support for these sense-making processes during crises ­ should form a critical part of overall institutional preparedness.

Views and Attitudes of Pregnant Women Regarding Late Termination of Pregnancy for Severe Fetal Abnormalities at a Tertiary Hospital in KwaZulu-Natal

Aim. To study the views and attitudes of pregnant women with severe fetal anomalies regarding late termination of pregnancy (LTOP). Methods. Data were collected over a 3-month period using semi-structured interviews of pregnant women with severe fetal anomalies (lethal and non-lethal) detected after 24 weeks' gestation at a single tertiary/quaternary fetal medicine unit in KwaZulu-Natal; South Africa. The interviews were conducted both during pregnancy and within 2 weeks after delivery. The women who underwent LTOP and those who continued with their pregnancies were compared in respect of a variety of demographic and socio-economic characteristics. Results. During the study period; 15 pregnant women with severe fetal anomalies were interviewed. Of these; 5 (33.3) requested termination and 10 (66.6) opted to continue the pregnancy. The women who continued their pregnancies were significantly younger (mean age 25 years; range 20 - 32 years) than those who requested termination (mean age 31 years; range 22 - 35 years) (p0.05). Mean parity was 1 (range 0 - 3) in the patients who continued the pregnancy and 2 (1 - 3) in those who terminated it. The majority of the women were Christians; and there was no significant difference between the groups in their choices. Many women indicated that their partners and immediate family members influenced decision making. All the women said that they were given sufficient time by the hospital staff to make their decision whether to terminate or continue the pregnancy after the options had been explained to them in a non-threatening manner. Before delivery; the common reasons for continuing with the pregnancy included fear of killing an unborn baby; that a baby is God's gift and the baby will be well after it is born; that nature should be allowed to take its course; and that there should be no interference with the pregnancy. The main reasons for opting for LTOP were the cost implications of raising an abnormal baby; that the baby would suffer during his or her life; and being unable to cope with a severely handicapped child. After delivery and seeing the baby; most women felt that they made the correct choice. Conclusion. Despite the small numbers from a single academic institution; this study illustrates that even while pregnant with an anomalous fetus; patients' views and attitudes regarding LTOP for severe fetal anomaly were variable. Younger primigravidas were more likely to continue the pregnancy in the hope that the baby would be born normal. Good support from partner and family after delivery was associated with less regret about the decision that had been made. Larger follow-up studies assessing long-term views and attitudes of women regarding LTOP will be important for comparison with the initial decision-making process and for future prenatal counselling