Editorial - We are all story-tellers.

Story telling is a human universal. It is as old as language. Creating and relating narratives form an integral part of how physicians understand and communicate about our patients and their diseases. We ask our patients to help us develop their story ('tell me about when all of this first started'), and then we tell their story back to them to facilitate our understanding ('let me just check I understood; this is how things have progressed'). We use individual patients to anchor our learning in medicine; conditions are better recalled when they are attached to a specific people. Thus, we write case vignettes to improve understand when we teach others.

Delivering and evaluating a scalable training model for strengthening family medicine in resource-limited environments: the Gaza experience. A mixed-methods evaluation.

BACKGROUND: Since 2007, Gaza Palestine has been subject to blockade affecting over 1.9 million people. This denies health professionals access to continuing professional development (CPD). In Gaza, family physicians are scarce, and their level of training does not meet the needs of United Nations Relief and Works Agency's (UNRWA) Family Health Team (FHT) model for better population health. AIM: This study sought to develop a postgraduate training programme for Gazan doctors via a Diploma in Family Medicine (FM PG), and evaluate its impact on physicians and patients. DESIGN & SETTING: A mixed-methods evaluation of a postgraduate diploma in Gaza Palestine. METHOD: The programme was delivered over 1 year, to 15 primary care doctors. The impact was evaluated through focus group discussions and patient feedback questionnaire survey comparing FM PG graduate doctors and doctors without the FM PG Diploma. RESULTS: All participating doctors graduated successfully and found the experience extremely positive. Trainees felt that the Diploma helped them take more individualised approach to patients; have a better understanding of psychosocial elements affecting patient health; feel more inclined towards team-working and collaborative approaches to health care; and more insight into non-verbal communication such as active listening and tactile gestures. Statistical analysis of patients' feedback showed significantly improved patient-reported outcomes and satisfaction when treated by course diplomates compared to non-diplomates. CONCLUSION: Where there are limited training opportunities, investment in a structured postgraduate diploma training programme can improve quality of health service delivery. UNRWA's experience in Gaza demonstrates the value of a scalable model in resource-limited settings.

Editorial - Decision-making in acute medicine.

Acute physicians make patient-centred decisions at the start of the patient's hospital journey. Dozens more decisions are made by the individual members of the MDT (and, of course, by the patient) during the in-patient period. Decisions are made at every level of seniority and experience and range widely in scope and impact. The original articles in this issue are connected by a common thread: phenomena that inform and influence the decisions made by acute physicians.

Editorial - Acute Medicine is invested in patient care, and therefore multiple departments.

There is a myth that Acute Physicians only work in Acute Medical Units (AMUs). In fact, they tread a constant path between the AMU, the Emergency Department (ED), ambulatory care, Intensive Care Units (ITUs) and various specialty wards within the hospital. Just as our focus is not tied to a single organ or body system, is it not solely linked to a certain geographical place. As a result, those working in Acute Medicine are invested in the pathways, problems, processes and positive attributes of departments and units outside of the AMU, because they affect our patients.

Editorial - An increasing global footprint.

As those working in Acute Medicine gather at SAMsterDAM2, the spring conference of the Society for Acute Medicine, the growth, reputation and global representation of the specialty continues to grow. Alongside, the traditional strongholds of the UK, Ireland, Netherlands, Denmark and Australia growth in Asia continues with an AMU now established in Pakistan among other countries.

Editorial - Delivering and transforming, but many questions and challenges remain.

Acute Medicine remains a specialty in its infancy and, as such, faces many challenges associated with developing new ways of working. As the Society for Acute Medicine celebrates its 18th birthday the extraordinary role of Acute Medicine in both maintaining and indeed enhancing the care and welfare of patients is increasingly evident. However, scepticism still persists among some colleagues with regards to its effectiveness - a perception heightened by the difficult environment that currently pervades in acute and emergency care in the UK which mirrors the experience of many countries internationally.

Editorial - Assessing, treating and prognosticating from the front door.

In our daily working lives, acute physicians strive to provide the best holistic care to our patients from the moment they arrive in hospital. Experienced healthcare professionals develop a gut feeling (generally recognised as the nagging internal voice of professional experience) about patients who may be more unwell than appearances suggest, or who may deteriorate despite showing signs of physiologically compensating quite well. The papers in this issue challenge us to examine how we prioritise, prognosticate and risk-stratify the patients we treat in acute medicine, how we remain cognisant and skilled in treating patients with more unusual acute medical conditions, and how we allocate resources in the NHS.

What do we know about coaching in medical education? A literature review.

CONTEXT: Coaching has been employed successfully in the competitive sports, professional music, and business and corporate worlds. It is now emerging as a training modality in medical education. OBJECTIVES: This paper reviews the current evidence on coaching strategies for doctors and medical students. METHODS: An applied literature search was conducted in PubMed, MEDLINE and Web of Science. Predetermined definitions of coaching interventions and their evaluations were used to narrow 993 papers down to 21, which were included in the final review. The 21 papers were critiqued with reference to validated scoring metrics. RESULTS: There are many papers discussing the merits of coaching in the world of medicine, but few evaluations of coaching interventions. Existing coaching methodologies can be broadly summarised into three categories: coaching for doctor/student well-being and resilience; coaching for improved non-technical skills, and coaching for technical skills. Identification of suitable papers for inclusion is complicated by theoretical uncertainty regarding coaching: many papers use the term as a synonym for teaching or mentoring. The strongest evidence for coaching lies in the teaching of technical skills. CONCLUSIONS: There is weak- to medium-strength evidence to support coaching as a method of improving doctor well-being and enhancing non-technical skills, although the evidence base is limited as a whole. This review identifies strong evidence to support coaching as a method to improve technical skills. There is great scope for further studies investigating the power of coaching in medical students and doctors.

Recurrent painful ophthalmoplegic neuropathy.

Recurrent painful ophthalmologic neuropathy (RPON), previously termed ophthalmoplegic migraine, is characterised by repeated attacks of one or more ocular cranial nerve palsies with ipsilateral headache. Its cause remains unclear; it is currently thought to be neuropathic in origin, but there is debate in the literature. In documented cases, a third cranial nerve palsy is by far the most common. Here we present a case of RPON involveing the fourth and sixth cranial nervesonly. Thorough investigation, including MR scan of brain and lumbar puncture, found no alternative explanation. This case adds to the debate over whether the cause of RPON is truly neuropathic or migrainous.

Hematospermia as a manifestation of severe hypertension in a young man.

Whilst hematospermia may indicate urological disease, it is a rare manifestation of severe systemic hypertension. We describe the case of a young man with hematospermia associated with a blood pressure of 228/135. Blood pressure treatment led to resolution of his hematospermia. Physicians must be aware of this potential association.

Emergent core values: the student perspective.

BACKGROUND: Certain moral and ethical values are expected of doctors, and these values are usually formed and consolidated at medical school. The efficacy of didactic teaching of values such as compassion and empathy has been disputed. Additionally, it is not clear if the values that students actually develop during undergraduate training are concordant with those outlined by national legislative and governing bodies. METHOD: A total of 24 final-year medical students participated in semi-structured interviews, which explored the values that they recognise in themselves and in their colleagues. The resultant data were thematically analysed to establish core themes. These themes represent the values that students hold in the highest regard. RESULTS: Analysis yielded three overarching themes: personal fortitude, which relates to the nurturing of the inner strength of the trainee; establishment of the ego, which pertains to the developing sense of self as a doctor; and striving for professional maturity, which refers to the cultivation of humane and compassionate care and interpersonal communication. The efficacy of didactic teaching of values such as compassion and empathy has been disputed FINDINGS: The moral values that are constructed in undergraduates centre around maintaining personal well-being, establishing an identity as a medical professional and delivering compassionate care as part of a team. Most values align with those described by professional bodies and educators, but a minority are new findings, and relate to student welfare. Although there are validated assessment tools that measure the trainees' emotional intelligence and adherence to universally approved values, this study delineates the core principles valued by the students themselves. Understanding these principles grants teachers the opportunity to facilitate personal and professional development, and to foster humane and caring values.

Molecular interactions of the γ-clade homeodomain-leucine zipper class I transcription factors during the wheat response to water deficit.

The γ-clade of class I homeodomain-leucine zipper (HD-Zip I) transcription factors (TFs) constitute members which play a role in adapting plant growth to conditions of water deficit. Given the importance of wheat (Triticum aestivum L.) as a global food crop and the impact of water deficit upon grain yield, we focused on functional aspects of wheat drought responsive HD-Zip I TFs. While the wheat γ-clade HD-Zip I TFs share significant sequence similarities with homologous genes from other plants, the clade-specific features in transcriptional response to abiotic stress were detected. We demonstrate that wheat TaHDZipI-3, TaHDZipI-4, and TaHDZipI-5 genes respond differentially to a variety of abiotic stresses, and that proteins encoded by these genes exhibit pronounced differences in oligomerisation, strength of DNA binding, and trans-activation of an artificial promoter. Three-dimensional molecular modelling of the protein-DNA interface was conducted to address the ambiguity at the central nucleotide in the pseudo-palindromic cis-element CAATNATTG that is recognised by all three HD-Zip I proteins. The co-expression of these genes in the same plant tissues together with the ability of HD-Zip I TFs of the γ-clade to hetero-dimerise suggests a role in the regulatory mechanisms of HD-Zip I dependent transcription. Our findings highlight the complexity of TF networks involved in plant responses to water deficit. A better understanding of the molecular complexity at the protein level during crop responses to drought will enable adoption of efficient strategies for production of cereal plants with enhanced drought tolerance.