COVID-19 Vaccine Hesitancy: A Content Analysis of Nigerian YouTube Videos.

Vaccination is key to developing herd immunity against COVID-19; however, the attitude of Nigerians towards being vaccinated stalled at the 70% vaccination target. This study engages Theory of Planned Behaviour to analyse the tone of Nigerian YouTube headlines/titles, and the tone of YouTube users' comments to examine the causes of COVID-19 vaccine hesitancy. YouTube videos uploaded between March 2021 and December 2022 were analysed using a content analytic approach. Results show 53.5% of the videos had a positive tone, while 40.5% were negative, and 6% neutral. Second, findings indicate most of the Nigerian YouTube users' comments were neutral (62.6%), while 32.4%, were negative, and 5% were positive. From the antivaccine themes, analysis shows the people's lack of trust in the government on vaccines (15.7%) and the presence of vaccine conspiracy theories mostly related to expressions of religion and biotechnology (46.08%) were the main causes of COVID-19 vaccine hesitancy in Nigeria. The study presents implications for theory and recommends ways for governments to develop better vaccination communication strategies.

The Gendered Work/Role of Program Directors in International Graduate Medical Education.

Healthcare organizations offer numerous clinical and academic leadership pathways for physicians, among which the position of program director (PD) is considered to be a prominent educational leadership role. As PDs are instrumental in the recruitment and training of the next generations of physicians, PD gender distribution can affect the present and future of a medical specialty. This study offers a dialectical perspective in understanding how international PDs negotiate gendered understanding of their work/role by using the framework of Relational Dialectics Theory 2.0. Thirty-three interviews of PDs from Qatar, Singapore, and the United Arab Emirates were conducted and, using contrapuntal analysis, the competing discourses of meanings of gender in the PD work/role were examined. Competing discourses where structural, cultural, and professional meanings of gender were interrogated revealed inherent multiple meanings of how gender is understood in PD work/roles. In making sense of these meanings of gender, PDs express dilemmas of traditional gender binaries of masculine/feminine work/role meanings to explain the term in different ways in their everyday organizational and cultural struggles. The findings have implications for PD recruitment and retention in teaching hospitals.

"I Find It Quite a Privilege to Be Involved in Their Lives": A Multinational Qualitative Study of Program Directors' Perspectives on Their Relationships with Residents.

PHENOMENON: Program director (PD)-resident relationships are important in shaping resident experiences and educational outcomes. Yet, there is limited literature on the development or meaning of these relationships, particularly from the PD perspective. Through qualitative interviews, we explore how PDs navigate their role to develop and maintain relationships with their trainees, and elucidate how these relationships impact the PDs personally and professionally. APPROACH: Qualitative study using individual semi-structured interviews of former and current PDs (n = 33) from multiple specialties and hospitals in accredited residency programs in Qatar, Singapore, and the United Arab Emirates. We used attachment theory and narrative analysis to investigate how PDs perceive and describe relationship building with their residents amidst tensions of familiarizing themselves with their new role. FINDINGS: PD-resident relationships are complex and multidimensional, shifting over time, changing patterns and evolving to respond to different contexts. PDs initially negotiate their own roles, while navigating their relationships with residents and other stakeholders to create their professional identities. PDs develop professional alliances, defining for the resident the profession and its expectations. As residents negotiate the various challenges of their training, the role of the PD emerges into one of providing emotional support and advocacy. The support and attachment are often enduring and extend beyond the period of residency training. INSIGHTS: Our study examines the experiences of program directors as they negotiate complex educator-learner relationships. The PDs described roles that extended beyond their job description. Although all interviewees reported that the PD position was challenging, they focused on the rewarding aspects of the job and how their relationships helped sustain them through the difficulties. Through their reflections, the PDs described the personal satisfaction and benefits of their interactions with the residents, and how the engagement contributed to personal and professional success.

International Residency Program Directors on Implementing Educational Transformation: A Qualitative Study of Their Experiences and Strategies for Overcoming Challenges.

BACKGROUND: Residency program directors (PDs) need to navigate diverse roles and responsibilities as clinical teachers, administrators, and drivers of educational improvement. Little is known about the experience of PDs leading transformation of international residency programs. OBJECTIVE: We explored the lived experiences of international residency PDs and developed an understanding of how PDs manage educational program transformation. METHODS: Using a phenomenological approach, semi-structured interviews were conducted with current and former PDs involved in the transformation to competency-based medical education in the first international settings to be accredited by the Accreditation Council for Graduate Medical Education-International (ACGME-I). Thirty-three interviews with PDs from Qatar, Singapore, and the United Arab Emirates were conducted from September 2018 to July 2019, audio-recorded, and transcribed. Data were independently coded by 2 researchers. A thematic analysis was conducted and patterns that reflected coping and managing educational reform were identified. RESULTS: PDs described distinctive patterns of navigating the educational transformation. Five themes emerged: PDs (1) embraced continuous learning and self-development; (2) managed change in the context of their local settings; (3) anticipated problems and built support networks to effectively problem-solve; (4) maintained relationships with stakeholders for meaningful and constructive interactions; and (5) focused on intrinsic qualities that helped them navigate challenges. CONCLUSIONS: International PDs were presented with significant challenges in implementing educational transformation but coped successfully through distinctive patterns and methods.

Program Director Retention and Attrition Rates in International Graduate Medical Education.

BACKGROUND: Program directors (PDs) are integral to the education of the next generation of physicians. Yet, administrative burdens, substantial patient care responsibilities, and lack of protected time for teaching may contribute to work-life imbalance and physician burnout, leading to high rates of attrition. Data on international residency program leadership turnover are lacking. OBJECTIVE: This study aimed to quantify PD turnover in Accreditation Council for Graduate Medical Education-International (ACGME-I) accredited programs in Singapore, United Arab Emirates (UAE), and Qatar, and to compare to US PD attrition rates. METHODS: Data on PD turnover in international programs was extracted from the ACGME-I Accreditation Data System for academic years 2010-2011 through 2018-2019 for Singapore and 2013-2014 through 2018-2019 for UAE and Qatar. Rates of PD turnover were calculated by country and by ACGME-I medical-, surgical-, and hospital-based specialty groupings and compared using χ2 test. Annual US PD turnover data was extracted from the ACGME's Data Resource Book. RESULTS: Seventy programs met inclusion criteria. International PD attrition was high, with 56 programs (80%) changing PDs since program inception, and 16 programs (29%) having 2 or more PD turnovers. There was no significant difference between PD turnover rates in hospital (83%), medical (79%), or surgical (78%) specialties. International PD attrition rates varied from 7% to 20% annually and were comparable to PD turnover in US programs (range 12%-15%). CONCLUSIONS: High PD turnover rates in newly accredited international residency programs were noted, although annual attrition rates were comparable to US residency programs.