A qualitative study of medical students' perceptions of resident feedback.

CONTEXT: Residents play a pivotal role in medical students' clinical education. From a feedback lens, the near-peer relationship between student and resident holds the potential to foster an educational alliance that could influence learning. We undertook the current qualitative study to explore medical students' perceptions of feedback experiences with residents, addressing when, how and why (and conversely when not and why not) resident feedback plays a role in their clinical education. METHODS: Our methodology was qualitative interpretive description, informed by phenomenology. We conducted 24 semi-structured interviews with third and fourth year medical students at one institution. The interviews aimed to foster rich discussion about students' feedback experiences with residents during clinical rotations. Data collection and analysis proceeded iteratively. Initial interviews were independently open-coded by three investigators and then collaboratively refined. Codes were applied to subsequent interviews, and new codes were developed. During the final stages of analysis, we organised our themes by drawing on a sociocultural perspective to examine students' perceptions of relationship-building with residents and when and how this influenced feedback and learning. RESULTS: From the students' perspectives, when residents contributed to building interpersonal relationships with students, this in turn influenced students' receptivity to both encouraging and constructive feedback conversations. In the context of resident-student relationships that were perceived as supportive, resident feedback influenced how students approached learning and working in the clinical environment, as well as students' visions of their future selves. In unsupportive relationships, students were less inclined to engage in feedback with residents and students noted resident behaviours that they wanted to avoid in themselves. CONCLUSION: Residents are uniquely positioned to create a strong educational alliance with students in which feedback conversations can flourish. Focusing educational efforts on resident feedback conversations has the potential to significantly impact the feedback culture of our clinical environments.

Diverse adaptation strategies helped local food producers cope with initial challenges of the Covid-19 pandemic: Lessons from Québec, Canada.

The Covid-19 pandemic has demonstrated the vulnerability of food systems to disturbances. Advocates have promoted short food supply chains as more resilient and adaptable thanks to their embeddedness in local economic and ecological networks. As part of a broader case study on challenges facing farmers in local food supply chains in Québec, Canada, we asked farmers about the pandemic's impacts on food production and marketing in the province, including how food producers coped with these challenges. We sent an online questionnaire to 1,046 farmers who distribute food through direct marketing in Québec, identified through consumer-facing online platforms. We conducted follow-up interviews with 15 of the 133 farmers that completed the questionnaire to gain a better understanding of their pandemic-related challenges and opportunities, as well as their adaptation needs and strategies. We identified four main types of challenges among farmers: workforce shortages, balancing food demand and supply, changes in sales outlets and marketing channels, and other operational and development issues. In turn, six key adaptation strategies helped farmers reorganize their marketing and sales, which we categorize as: redistribution, streamlining, replacement, collaboration, farm adjustment, and outlet adjustment. Most surveyed local farmers felt well-prepared to adapt to the four major challenges that the Covid-19 pandemic forged or escalated, and our findings suggest that they demonstrated remarkable resilience to additional challenges posed by the pandemic. Our study therefore contributes important insights about how flexibility and redundancy among local farmers stabilized the local food system during the onset of a global pandemic.

Coronavirus disease 2019 and the cancellation of face-to-face prostate cancer active surveillance clinic reviews: Does the omission of digital rectal examination alone put patients at risk of missed detection of disease progression?

Objectives:The coronavirus disease 2019 (COVID-19) pandemic has resulted in the cancellation or postponement of face-to-face clinic appointments, meaning patients on active surveillance (AS) for low- or intermediate-risk prostate cancer have been unable to undergo the recommended clinical assessment and digital rectal examination (DRE) during these times. This study aimed to determine whether the omission of DRE during the COVID-19 pandemic has put AS patients at risk by missing early detection of disease progression.Methods:This was a retrospective, regional study looking at the data of 142 men who qualified for placement on the Grampian AS protocol over a six-year span. It paid particular attention to the reasons for progression in those men who moved to active treatment (AT) during this six-year period.Results:The results showed that DRE played no role in triggering the move of these 42 patients onto AT. Nineteen (45%) of these patients moved to AT due to progression on trans-rectal ultrasound biopsy, 10 (24%) due to progression on multi-parametric magnetic resonance imaging, eight (19%) due to a rising prostate-specific antigen and five (12%) due to patient choice.Conclusion:This audit reassures us that those patients who cannot receive a timely DRE during the COVID-19 pandemic are unlikely to be at an increased risk of missing disease progression in our region.Level of evidence:Retrospective cohort study ? level 3.