Ethnicity-related stereotypes and their impacts on medical students: A critical narrative review of health professions education literature.

BACKGROUND: Stereotypes are oversimplified beliefs about groups of people. Social psychology concepts and theories describing ethnicity-related stereotypes are well reported in non-medical educational settings. In contrast, the full impact of stereotyping on medical students, and the extent to which they were represented in health professions education (HPE) is less well-described. Using the lens of social psychological theory, this review aimed to describe ethnicity-related stereotypes about medical students portrayed in HPE literature and the impacts of those stereotypes. METHODS: A critical narrative approach was undertaken. Social psychology concepts and theories were used as a framework through which to review the impacts of ethnicity-related stereotypes on medical students as described in HPE literature. A database search of Ovid MEDLINE, JSTOR, Project Muse, and PsychINFO was conducted to identify both theoretical and empirical articles relating to this topic in the HPE literature. Data was synthesised using thematic analysis, giving particular care to appraise the evidence from perspectives in social psychology. FINDINGS: In HPE, the experiences and impact of stereotyping on learners from minority ethnic groups was explained by social psychology concepts such as stereotype threat, stereotype reactance, attributional ambiguity, self-fulfilling prophecy, stereotype boost, stereotype lift, and stereotype masking. Stereotype boost and stereotype lift were particularly described among students who identified as White, whereas stereotype threat was described more commonly among students from minority ethnics groups. The impact of stereotyping is not just on assessment, but may be across all teaching and learning activities at medical school. INTERPRETATION: Social psychology concepts and theories can be used to describe the experience and impact of ethnicity-related stereotypes in HPE. Educators can better support learners from minority ethnic groups by self-reflecting over assumptions about individuals from minority ethnic groups, as well as minimise the impact of stereotyping and bias to create more inclusive learning environments.

Evaluation of Intraoperative Triamcinolone Injection or Primary Lobe Tacking (Pexing) Sutures for Preventing Pincushioning in Bilobed Transposition Flaps.

BACKGROUND: Bilobed transposition flaps are prone to pincushioning (trapdooring), whereby contraction of the flap over the wound bed may produce an unsatisfactory functional and aesthetic outcome. There are several proposed methods to prevent this, but there is currently no clear consensus on the ideal technique. OBJECTIVE: To compare primary lobe pexing sutures versus intraoperative triamcinolone (TAC) injection as methods to prevent pincushioning in bilobed transposition flaps. MATERIAL AND METHODS: A retrospective chart review of bilobed flap reconstructions identified from the Mohs micrographic surgery database at a single tertiary center in New Zealand. RESULTS: Three hundred forty-two patients met the inclusion criteria: 37 received pexing sutures, 42 intraoperative TAC, and 263 no additional intervention. The most defect common location was the nasal tip (43.6%), followed by the ala (20.8%). Ninety-three participants (27.2%) developed pincushioning at a median 35 days postoperatively. Participants receiving no intervention had a 30.8% pincushioning rate. The TAC group had a 23.8% pincushioning rate (p = .358), and the pexing group had a 5.5% pincushioning rate (p = .001). CONCLUSION: Participants receiving primary lobe pexing sutures had a statistically significantly lower rate of pincushioning than those receiving no intervention. Intraoperative TAC injections appeared to have little impact on pincushioning.

Assessing the accuracy of computed tomography in detecting bony invasion and thickness of squamous cell carcinoma of the scalp.

OBJECTIVES: The aim of this study was to ascertain the accuracy of computed tomography (CT) in assessing the presence of bony involvement and thickness of squamous cell carcinoma (SCC) of the scalp. METHODS: A single-centre retrospective chart review was carried out. Inclusion criteria were scalp SCC, CT between January 2008 and 2018, and the availability of a reference test. Reference tests were either histology, surgical notes or clinical notes. Tabular assessment of accuracy was performed and Student's t-test, Mann-Whitney U test and Fisher exact test were used in univariable analysis. Accuracy of thickness measurement was calculated using the limits of agreement method, and linear regression was used to examine trend. RESULTS: Thirty-nine patients were included. Most patients were male (74.4%), white (97.4%), not immunosuppressed (66.6%) and had poorly differentiated tumours (33.3%). The most common tumour sites were the vertex (28.2%) and temporal region (23.1%). Sensitivity of CT in detecting presence or absence of bony invasion of scalp SCC was 76.9% (95% CI 46.2-94.9%) and specificity was 96.2% (95% CI 80.4-99.9%). Overall accuracy was 89.7% (95% CI 75.8-97.1%), positive predictive value was 90.1% (95% CI 58.7-99.8%) and negative predictive value was 89.3% (95% CI 71.8-97.7%). No significant differences were found comparing patients with an accurate or inaccurate CT scan. Thickness on CT was found to be consistent with histological thickness at the 95% confidence level. CONCLUSIONS: CT is accurate at assessing the presence of bony involvement and thickness of scalp SCC. This study was limited somewhat by small sample size.