Parental opinion of consent in neonatal research.

BACKGROUND: Neonatal research, particularly neonatal emergency research is a challenging area, notably in relation to obtaining valid prospective informed consent. The aim of this study is to determine parental perceptions of the consent process involved in performing research in newborn care, to explore methods used to obtain consent and their acceptability to parents. METHODS: A parental questionnaire was developed that examined attitudes towards research and hypothetical research studies, in which the acceptability of various methods of consent was examined (informed, waived, deferred). These research scenarios were of varying time sensitivity and perceived risk level. The study setting was an Irish maternity hospital. RESULTS: There were 600 responses to the questionnaire. In 93% of cases, parents felt that their involvement in the consent process was essential. In emergency situations, 52% felt full prospective informed consent was necessary; however, almost 28% of parents would feel pressure to consent. Most (75%) parents would prefer to be approached to discuss neonatal research studies antenatally, irrespective of study type and 40% of parents felt that neonates involved in research studies received overall better care. Acceptability of deferred consent was greater than waived, and was highest for the more emergency-based scenarios presented. DISCUSSION: Parents feel that they should play a central role in research involving their children. There were differences in the acceptability of various consent methods with strongest agreement for informed consent and lowest agreement for waived consent. Parents were more willing to accede to deferred consent in the cardiopulmonary resuscitation scenario study. These findings provide useful insights to consent strategies in future newborn research studies.

Attitudes towards abortion in graduate and non-graduate entrants to medical school in Ireland.

BACKGROUND: Recent legislation has sought to clarify abortion law in Ireland, allowing abortion where pregnancy endangers a woman's life, including through risk of suicide. Previous studies have shown that medical students' attitudes towards abortion can predict their likelihood to provide abortion care services in the future. AIM: To survey graduate-entry (GEM) and undergraduate-entry (i.e. school-leaver; DEM) medical students in Ireland on their attitudes to abortion, in light of recent changes in legislation. METHODS: Irish medical students completed an 18-item anonymous questionnaire, measuring knowledge and attitudes regarding abortion, and current Irish abortion law. RESULTS: Of 525 respondents (response rate 52.9%), 92% indicated that abortion was justified in specific circumstances. Over 80% stated that abortion was justified in cases of risk to the life of the mother (including risk of suicide) or where the fetus would not survive until term. 58.2% believed abortion was justified in the case of certain fetal developmental and genetic defects. 56.6% expressed a willingness to perform a legal abortion in their future practice. GEM students were more likely than DEM students to support availability of abortion services across each of the clinical scenarios. This effect was largely mediated by differences in religious adherence and continent-of-origin across both cohorts. CONCLUSIONS: The majority of students, regardless of mode of entry, believed abortion was justified where there was a real risk to the life of the mother (including risk of suicide) or in cases of fetal non-viability. The most significant determinant of students' beliefs was religious adherence.

Medical school attrition-beyond the statistics a ten year retrospective study.

BACKGROUND: Medical school attrition is important--securing a place in medical school is difficult and a high attrition rate can affect the academic reputation of a medical school and staff morale. More important, however, are the personal consequences of dropout for the student. The aims of our study were to examine factors associated with attrition over a ten-year period (2001-2011) and to study the personal effects of dropout on individual students. METHODS: The study included quantitative analysis of completed cohorts and qualitative analysis of ten-year data. Data were collected from individual student files, examination and admission records, exit interviews and staff interviews. Statistical analysis was carried out on five successive completed cohorts. Qualitative data from student files was transcribed and independently analysed by three authors. Data was coded and categorized and key themes were identified. RESULTS: Overall attrition rate was 5.7% (45/779) in 6 completed cohorts when students who transferred to other medical courses were excluded. Students from Kuwait and United Arab Emirates had the highest dropout rate (RR = 5.70, 95% Confidence Intervals 2.65 to 12.27;p < 0.0001) compared to Irish and EU students combined. North American students had a higher dropout rate than Irish and EU students; RR = 2.68 (1.09 to 6.58;p = 0.027) but this was not significant when transfers were excluded (RR = 1.32(0.38, 4.62);p = 0.75). Male students were more likely to dropout than females (RR 1.70, .93 to 3.11) but this was not significant (p = 0.079).Absenteeism was documented in 30% of students, academic difficulty in 55.7%, social isolation in 20%, and psychological morbidity in 40% (higher than other studies). Qualitative analysis revealed recurrent themes of isolation, failure, and despair. Student Welfare services were only accessed by one-third of dropout students. CONCLUSIONS: While dropout is often multifactorial, certain red flag signals may alert us to risk of dropout including non-EU origin, academic struggling, absenteeism, social isolation, depression and leave of absence. Psychological morbidity amongst dropout students is high and Student Welfare services should be actively promoted. Absenteeism should prompt early intervention. Behind every dropout statistic lies a personal story. All medical schools have a duty of care to support students who leave the medical programme.