Achieving 'something that everybody has invested in': perspectives of diverse stakeholders during co-creation of a transition to residency curriculum.

Co-creation of education within the context of student inclusion alongside diverse stakeholders merits exploration. We studied the perspectives of students and teachers from different institutions who participated in co-creating a transition to residency curriculum. We conducted post-hoc in-depth interviews with 16 participants: final-year medical students, undergraduate, and postgraduate medical education stakeholders who were involved in the co-creation sessions. Findings build on the Framework of Stakeholders' Involvement in Co-creation and identify the four key components of co-creation with diverse faculty: immersion in positive feelings of inclusivity and appreciation, exchange of knowledge, engagement in a state of reflection and analysis, and translation of co-creation dialogues into intended outcomes. Despite power dynamics, participants valued open communication, constructive feedback, mutual respect, and effective moderation. The study broadened our understanding of the co-creation process in diverse stakeholder settings. Incorporating key elements in the presence of power relations can enrich co-creation by leveraging wider expertise.

Sailing the boat together: Co-creation of a model for learning during transition.

PURPOSE: Medical students' transition to postgraduate training, given the complexity of new roles and responsibilities, requires the engagement of all involved stakeholders. This study aims to co-create a transition curriculum and determine the value of involving the key stakeholders throughout such transition in its design process. METHODS: We conducted a mixed-methods study involving faculty/leaders (undergraduate/postgraduate), final-year medical students, and chief residents. It commenced with eight co-creation sessions (CCS), qualitative results of which were used to draft a quantitative survey sent to non-participants, followed by two consensus-building CCS with the original participants. We applied thematic analysis for transcripts of all CCS, and mean scores with standard deviations for survey analysis. RESULTS: We identified five themes: adaptation, authenticity, autonomy, connectedness, and continuity, embedded in the foundation of a supportive environment, to constitute a Model of Learning during Transition (MOLT). Inclusion of various stakeholders and optimizing their representation brought rich perspectives to the design process. This was reinforced through active students' participation enabling a final consensus. CONCLUSIONS: Bringing perspectives of key stakeholders in the transition spectrum enriches transition curricula. The proposed MOLT can provide a guide for curriculum designers to optimize the final year of undergraduate medical training in preparing students for postgraduate training with essential competencies to be trained.

Screening for diabetes and impaired glucose metabolism in Qatar: Models' development and validation.

AIM: To establish two scoring models for identifying individuals at risk of developing Impaired Glucose Metabolism (IGM) or Type two Diabetes Mellitus (T2DM) in Qatari. MATERIALS AND METHODS: A sample of 2000 individuals, from Qatar BioBank, was evaluated to determine features predictive of T2DM and IGM. Another sample of 1000 participants was obtained for external validation of the models. Several scoring models screening for T2DM were evaluated and compared to the model proposed by this study. RESULTS: Age, gender, waist-to-hip-ratio, history of hypertension and hyperlipidemia, and levels of educational were statistically associated with the risk of T2DM and constituted the Qatar diabetes mellitus risk score (QDMRISK). Along with, the 6 aforementioned variables, the IGM model showed that BMI was statistically significant. The QDMRISK performed well with area under the curve (AUC) 0.870 and .815 in the development and external validation cohorts, respectively. The QDMRISK showed overall better accuracy and calibration compared to other evaluated scores. The IGM model showed good accuracy and calibration, with AUCs .796 and .774 in the development and external validation cohorts, respectively. CONCLUSIONS: This study developed Qatari-specific diabetes and IGM risk scores to identify high risk individuals and can guide the development of a nationwide primary prevention program.

Assessment of Educational Needs and Design of a Preceptor Development Program for Health Professional Education Programs in Qatar.

INTRODUCTION: Experiential learning is the backbone of many health care professional education programs; however, the quality of learning is profoundly dependent on the skills and experiences of clinical preceptors. This study was conducted at Qatar University Health Cluster (Colleges of Pharmacy, Medicine, and Health Sciences) with the primary objective of identifying the educational needs of preceptors to design and review an educational professional development program. METHODS: This study adopted a mixed-methods approach and was conducted in three stages: (1) assessment of preceptor educational needs, (2) designing of the Practice Educators' Academy program, and (3) revision and refinement of the designed program. The needs' assessment was conducted at all the three colleges through a validated survey and focus groups comprising of preceptors, students, and clinical faculty members. The sample included 209 survey respondents and 11 focus group sessions. RESULTS: The results yielded five key themes and a variety of individual preferences, which were used to design a five-module face-to-face two-day interactive workshop. For the revision of the designed program, the syllabus was shared purposively with selected scholars and experts in the area of health professions education, and their feedback was collected and critically examined. Furthermore, the refinement of the program was performed on the basis of this feedback, resulting in the revised and representative program being ready for piloting. DISCUSSION: A preceptor development program on experiential teaching and learning skills was successfully designed and revised with the needs of the clinical preceptors at its core. Preceptors' skills development can advance health care outcomes by preparing competent health professional graduates.

Reshaping experiential education within Qatar University's Health Programs during the COVID-19 pandemic.

Health professions programs heavily depend on experiential learning to prepare learners for practice within the healthcare system. Learners acquire a significant proportion of patient care skills as they participate in experiential learning activities. As the coronavirus disease 2019 (COVID-19) pandemic disrupts education globally, educators have been challenged to reexamine existing teaching approaches to minimize the impact on experiential educational outcomes. This article describes how educators from the College of Pharmacy and College of Medicine at Qatar University utilized nontraditional teaching methods to ensure the continuation of experiential learning despite the disruption due to the pandemic.

A program evaluation reporting student perceptions of early clinical exposure to primary care at a new medical college in Qatar.

BACKGROUND: Though common practice in Europe, few studies have described the efficacy of early clinical exposure (ECE) in the Middle East. The barriers to clinical learning experienced by these novice medical students have not been reported. This evaluation reports on introducing ECE in primary care, supported by Experiential Review (ER) debriefing sessions. The evaluation explores students' experiences of their acquisition of clinical and non-technical skills, sociocultural issues commonly encountered but underreported and barriers to clinical learning experienced. METHODS: We conducted a cross-sectional study of three student cohorts in 2017-19: All second and third-year students at the new College of Medicine were invited to participate. The primary outcome was students' perceptions of the aims of the Primary Health Centre Placement (PHCP) programme and how it facilitated learning. Secondary outcome measures were students' perceptions of their learning in ER sessions and perceived barriers to learning during PHCPs. Student perceptions of the PHCPs were measured using a Likert scale-based questionnaire. RESULTS: One hundred and fifty-one students participated: 107 in year 2 and 44 in year 3; 72.3% were female. Overall, most students (> 70%) strongly agreed or agreed with the purposes of the PCHPs. Most students (71%) strongly agreed or agreed that the PCHPs allowed them to learn about patient care; 58% to observe doctors as role models and 55% to discuss managing common clinical problems with family physicians. Most students (year 2 = 62.5% and year 3 = 67%) strongly agreed/agreed that they were now confident taking histories and examining patients. Student barriers to clinical learning included: Unclear learning outcomes (48.3%); faculty too busy to teach (41.7%); lacking understanding of clinical medicine (29.1%); shyness (26.5%); and finding talking to patients difficult and embarrassing (25.8%). Over 70% reported that ER enabled them to discuss ethical and professional issues. CONCLUSIONS: Overall, our Middle Eastern students regard ECE as beneficial to their clinical learning. PHCPs and ER sessions together provide useful educational experiences for novice learners. We recommend further exploration of the barriers to learning to explore whether these novice students' perceptions are manifesting underlying cultural sensitivities or acculturation to their new environment.

Clinical presentation and outcomes of peripartum cardiomyopathy in the Middle East: a cohort from seven Arab countries.

AIMS: Published data on the clinical presentation of peripartum cardiomyopathy (PPCM) are very limited particularly from the Middle East. The aim of this study was to examine the clinical presentation, management, and outcomes of patients with PPCM using data from a large multicentre heart failure (HF) registry from the Middle East. METHODS AND RESULTS: From February to November 2012, a total of 5005 consecutive patients with HF were enrolled from 47 hospitals in 7 Middle East countries. From this cohort, patients with PPCM were identified and included in this study. Clinical features, in-hospital, and 12 months outcomes were examined. During the study period, 64 patients with PPCM were enrolled with a mean age of 32.5 ± 5.8 years. Family history was identified in 11 patients (17.2%) and hypertension in 7 patients (10.9%). The predominant presenting symptom was dyspnoea New York Heart Association class IV in 51.6%, class III in 31.3%, and class II in 17.2%. Basal lung crepitations and peripheral oedema were the predominant signs on clinical examination (98.2% and 84.4%, respectively). Most patients received evidence-based HF therapies. Inotropic support and mechanical ventilation were required in 16% and 5% of patients, respectively. There was one in-hospital death (1.6%), and after 1 year of follow-up, nine patients were rehospitalized with HF (15%), and one patient died (1.6%). CONCLUSIONS: A high index of suspicion of PPCM is required to make the diagnosis especially in the presence of family history of HF or cardiomyopathy. Further studies are warranted on the genetic basis of PPCM.

Racing for COVID-19 Vaccine and Cure: Lessons and Tragedies in Human Subject Research.

Pressured by the enormous human and economic costs of the COVID-19 pandemic, certain countries and political figures have advocated the use of drugs and vaccines that did not go through the required regulatory stages of the development. Although the reason for bypassing these stages in a race to produce a treatment and vaccine for the COVID-19 patients could have been caused by good intentions to stop the human suffering from the pandemic, nonetheless, history has taught us that the results of this action could be catastrophic. In this article, we briefly review the lessons and tragedies in the evolution of human subject research regulations emphasizing the need for the proper evaluation of drugs and vaccines for COVID-19.

Bi- and tri-valent T cell engagers deplete tumour-associated macrophages in cancer patient samples.

BACKGROUND: Tumour-associated macrophages (TAMs) are often implicated in cancer progression but can also exert anti-tumour activities. Selective eradication of cancer-promoting (M2-like) TAM subsets is a highly sought-after goal. Here, we have devised a novel strategy to achieve selective TAM depletion, involving the use of T cell engagers to direct endogenous T cell cytotoxicity towards specific M2-like TAMs. To avoid "on-target off-tumour" toxicities, we have explored localising expression of the T cell engagers to the tumour with enadenotucirev (EnAd), an oncolytic adenovirus in Phase I/II clinical trials. METHOD: A panel of bi- and tri-valent T cell engagers (BiTEs/TriTEs) was constructed, recognising CD3ε on T cells and CD206 or folate receptor ß (FRß) on M2-like macrophages. Initial characterisation of BiTE/TriTE activity and specificity was performed with M1- and M2-polarised monocyte-derived macrophages and autologous lymphocytes from healthy human peripheral blood donors. T cell engagers were inserted into the genome of EnAd, and oncolytic activity and BiTE secretion assessed with DLD-1 tumour cells. Clinically-relevant ex vivo models (whole malignant ascites from cancer patients) were employed to assess the efficacies of the free- and virally-encoded T cell engagers. RESULTS: T cells activated by the CD206- and FRß-targeting BiTEs/TriTEs preferentially killed M2- over M1-polarised autologous macrophages, with EC50 values in the nanomolar range. A TriTE with bivalent CD3ε binding - the first of its kind - demonstrated enhanced potency whilst retaining target cell selectivity, whereas a CD28-containing TriTE elicited non-specific T cell activation. In immunosuppressive malignant ascites, both free and EnAd-encoded T cell engagers triggered endogenous T cell activation and IFN-γ production, leading to increased T cell numbers and depletion of CD11b+CD64+ ascites macrophages. Strikingly, surviving macrophages exhibited a general increase in M1 marker expression, suggesting microenvironmental repolarisation towards a pro-inflammatory state. CONCLUSIONS: This study is the first to achieve selective depletion of specific M2-like macrophage subsets, opening the possibility of eradicating cancer-supporting TAMs whilst sparing those with anti-tumour potential. Targeted TAM depletion with T cell engager-armed EnAd offers a powerful therapeutic approach combining direct cancer cell cytotoxicity with reversal of immune suppression.

Seroepidemiology of hepatitis A, hepatitis B and varicella virus in people living with HIV in Ireland.

Epidemiological studies investigating seroprevalence of vaccine preventable infections at both individual and population level are important in guiding screening and vaccination practices. Data on seroprevalence of common vaccine preventable infections in HIV-infected individuals is lacking. We carried out a retrospective cohort study to investigate serological immunity and factors associated with immunity to hepatitis A virus (HAV), hepatitis B virus (HBV) and varicalla virus (VZV) in a cohort of HIV-infected individuals attending a large ambulatory HIV specialist centre in Ireland. Basic demographic data including risk of acquisition of HIV and region of origin was recorded. Between-group prevalence was compared using the Chi2 test and Wilkoxin signed rank test. Univariate variables with p<0.2 were entered into a multivariate logistic regression model. Of 1287 HIV-infected individuals included in this study (median [SD] age 39 [10] years, 68% male, 46% Irish), 75% were hepatitis A IgG positive, 94% were VZV IgG positive, 3% were HBV surface antigen (sAg) positive while 29% were HBV core antibody (cAb) positive. This study identifies a significant proportion of HIV infected who were susceptible to common vaccine preventable infections. These results highlight the importance of proactive screening and immunization of HIV-infected individuals to ensure optimal protect ionagainst vaccine preventable diseases in this at risk patient group.

Are applicants more likely to quit longer assessments? Examining the effect of assessment length on applicant attrition behavior.

Conventional wisdom suggests that assessment length is positively related to the rate at which applicants opt out of the assessment phase. However, restricting assessment length can negatively impact the utility of a selection system by reducing the reliability of its construct scores and constraining coverage of the relevant criterion domain. Given the costly nature of these tradeoffs, is it better for managers to prioritize (a) shortening assessments to reduce applicant attrition rates or (b) ensuring optimal reliability and validity of their assessment scores? In the present study, we use data from 222,772 job-seekers nested within 69 selection systems to challenge the popular notion that selection system length predicts applicant attrition behavior. Specifically, we argue that the majority of applicant attrition occurs very early in the assessment phase and that attrition risk decreases, not increases, as a function of time spent in assessment. Our findings supported these predictions, revealing that the majority of applicants who quit assessments did so within the first 20 min of the assessment phase. Consequently, selection system length did not predict rates of applicant attrition. In fact, when controlling for observed system length and various job characteristics, we found that systems providing more conservative (i.e., longer) estimates of assessment length produced lower overall attrition rates. Collectively, these findings suggest that efforts to curtail applicant attrition by shortening assessment length may be misguided. (PsycINFO Database Record

Understanding the physical and emotional impact of early-stage ADPKD: experiences and perspectives of patients and physicians.

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary renal disorder; however, at the time this research was conducted, no disease-modifying treatment was currently available. Medical texts often describe early-stage disease (Stages 1 and 2) as asymptomatic, but there is evidence from patients of considerable physical and emotional effects. METHODS: In-depth interviews were conducted with 80 ADPKD patients, 72 nephrologists and 85 primary care physicians (PCPs) from nine European countries to explore the experience and impact of early-stage ADPKD. Interviews were transcribed, translated and analysed centrally using thematic analysis. An additional 600 physicians completed standardised online questionnaires to investigate perceptions of symptom severity and management of early-stage ADPKD. RESULTS: Eighty-eight per cent of patients with early-stage disease reported physical symptoms including pain, fatigue, breathlessness, weakness and a general malaise. However, 24% of nephrologists and 16% of PCPs perceived that the patients with early-stage disease did not experience any physical symptoms at all. There was a greater awareness of the emotional impact of disease, but this was still underestimated when compared with patient-reported experiences, which highlighted widespread feelings of loss, uncertainty and fear. Patients and physicians experienced frustration due to the lack of treatment options, especially in the long latent period. For many patients, the inability to affect their disease course whilst living with a diagnosis resulted in feelings of hopelessness, helplessness and depression. Physicians identified a need for improved cooperation between health-care professionals, and increased psychological support for patients. CONCLUSIONS: Early-stage ADPKD can have a significant physical and emotional impact on patients. Whilst some physicians have an awareness of patient experience during early-stage disease, most underestimate the impact of ADPKD. Both patients and physicians are negatively affected by their inability to alter disease progression.

Developing national selection processes for entry into postgraduate specialty training: the case of trauma and orthopedics in the United Kingdom.

A large body of international research has been done investigating best practice selection across many occupational groups, but there is relatively little research on developing selection methodology for entry to postgraduate training. Hitherto, various selection processes have been used, some of which relied heavily on patronage. Developments in Medical Education, including curriculum design, formal work-based place assessment, alongside the introduction of MMC (Modernizing Medical Careers) paved the way for significant change. Trauma and orthopedics in England is the last surgical specialty to adopt National Selection and did so first in 2013. This paper sets out that journey, the implementation of National selection in 2013, what has been learned, and our goals for the future.

Non-adherence to topical treatments for actinic keratosis.

BACKGROUND: There is limited information on the patterns of use, adherence rates, and factors that impact adherence with topical treatments for actinic keratosis (AK). OBJECTIVES: To establish patterns of use and adherence with topical treatments for AK and to identify treatment-related factors that impact on adherence. METHODS: A community-based, cross-sectional study was performed using a standardized questionnaire completed online or via telephone interview. Patients were stratified according to the presence of AK lesions on the scalp and/or other extremities; and presence of scarring resulting from treatment. RESULTS: This study included 305 patients with AK who were currently using a patient-applied topical therapy for AK or had used one within the previous 12 months. In total, 88% (n = 268/305) of patients were either non-adherent, non-persistent or both non-adherent and non-persistent to topical therapy. Duration of treatment was associated with increasing rates of non-adherence (adjusted odds ratio [OR]; for treatment durations greater than 4 weeks, 2.2, P < 0.01): 52% of patients were non-adherent with 3-4 week treatment duration; 69% of patients with 4-8 week treatment duration; and 71% of patients with 6-12 week treatment duration. There were similar increases in non-persistence with increasing treatment duration (adjusted OR; for treatment durations greater than 4 weeks, 2.1, P < 0.05). CONCLUSION: This study found high rates of non-adherence and non-persistence in patients with AK. Duration of treatment was a significant factor contributing to non-adherence and non-persistence to topical treatments. Patient-applied topical therapies that require less frequent application and have shorter treatment duration may be associated with improved adherence rates.

The role of the interpreter/doula in the maternity setting.

Health care organizations often struggle with issues related to communication with patients who have limited English proficiency. Providing quality interpreter services is necessary to comply with regulatory mandates and to provide safe, effective health care. Maternity care presents a unique situation due to the intimate and unpredictable nature of birth. A unique interpreter/doula program in which trained medical interpreters received additional education in labor and postpartum doula skills was tested at a large urban hospital maternity center with a large population of Spanish-speaking patients. Results showed that interpreter/doulas can offer timely, competent care in a variety of maternity situations. They also were cost-effective and associated with increased patient and staff satisfaction.