Women's experiences of the diagnostic journey in uterine adenomyosis: a scoping review protocol.

INTRODUCTION: Uterine adenomyosis is a benign gynaecological disease that causes physical and psychological problems, impacting on relationships. It is poorly understood and consequently may be diagnosed late. This protocol describes the process of conducting a systematic scoping review to retrieve and describe literature examining the daily experience and impact of living with uterine adenomyosis. It will explore the journey to diagnosis (and perceptions of what this process is like); identify the main concepts currently used in the literature and highlight gaps in knowledge for future research in relevant populations. METHODS AND ANALYSIS: Using the Joanna Briggs Institute methodology, the population-concept-context approach is used to form clear review questions. A three-phase search strategy will locate published and unpublished evidence from multiple sources. All articles reporting on the personal experiences of women diagnosed with uterine adenomyosis will be considered. Findings from qualitative, quantitative and mixed-method study designs from all settings will be included, not limited by geography but restricted to English. Documents will be screened by the primary researcher, supported by university supervisors. Search outputs will be presented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow diagram. No formal quality appraisal will be conducted. Review findings will be descriptively collated and reported consistent with the Scoping Review Extension of the PRISMA checklist. Patient and public involvement engagement reflected a positive response for the project that this protocol supports. ETHICS AND DISSEMINATION: As primary data will not be collected, formal ethical approval is not required. Prepared as part of a professional doctorate thesis, the findings of this study will be disseminated via peer-reviewed publications, conference presentations, support groups and social media networks.

Oncology residents' experiences of decision-making in a clinical learning environment: a phenomenological study.

Oncology residents routinely engage in ethically complex decision-making discussions with patients, while observing and interacting with their teaching consultant. If clinical competency in oncology decision-making guidance is to be taught deliberately and effectively, it is necessary to understand resident experiences in this context to develop appropriate educational and faculty development initiatives. Four junior and two senior postgraduate oncology residents participated in semi-structured interviews during October and November 2021 which explored their experiences of real-world decision-making scenarios. Van Manen's phenomenology of practice was used in an interpretivist research paradigm. Transcripts were analysed to articulate essential experiential themes, and composite vocative narratives were created. Three essential themes were identified: (1) residents often endorsed different decision-making approaches than supervising consultants, (2) residents experienced inner conflict, and (3) residents struggled to find their own approach to decision-making. Residents experienced being torn between a perceived obligation to defer to consultant directives, and a desire for increasing ownership of decision-making while not feeling empowered to discuss their opinions with the consultants. Residents described their experiences around ethical position awareness during decision-making in a clinical teaching context as challenging, with experiences suggesting moral distress combined with inadequate psychological safety to address ethical conflicts and unresolved questions of decision ownership with supervisors. These results suggest the need for enhanced dialogue and more research to reduce resident distress during oncology decision-making. Future research should be aimed at discovering novel ways in which residents and consultants could interact in a unique clinical learning context including graduated autonomy, a hierarchical gradient, ethical positions, physician values, and sharing of responsibility.

Twelve tips for using Pattern Matching in data analysis for qualitative medical education research.

Pattern Matching (PM) is a data analysis method used in qualitative research. This article outlines a step-by-step approach to using PM to analyse qualitative data through the example of the author's experience in its use for a master in medical education dissertation. The recommended twelve tips, outlined as steps to be used sequentially in the PM process are: (1) Assess if PM is a suitable technique for you and your research, (2) Consider alternatives, (3) Decide to proceed with PM, (4) Perform literature review, (5) Reflect about your experiences, (6) Define Propositions, (7) Collect your data, (8) Code data, (9) Match data to propositions, (10) Celebrate congruency, (11) Explain discrepancies and, (12) Discuss relevance and utility of findings in your context. PM, when rigorously applied, can increase the internal validity and transferability of qualitative research in medical education. A clear data analysis protocol enhances reliability and dependability of any research.

Teaching, reflecting, and learning: The value of an intercalated medical education programme.

Objectives: Teaching programmes within medicine focus primarily on pathways of a shorter length with little regard to teaching lasting longer than a month. This study is different from other studies as it examines the benefits of a nine month-long medical education degree programme and its impact beyond graduation. This study set out to explore the impact of a medical education intercalated degree programme for its graduates and their careers.Methods: A small scale, exploratory qualitative case study was conducted with 10 graduates of an intercalated degree programme.Results: The findings highlight the longer term value of an intercalated degree programme with particular emphasis on academic and personal skills; research and teaching skills; independence and confidence; its impact on future practice and the notion that 'student as teacher' programmes are a valuable asset to medical education as a whole. Participants advocated more teaching opportunities as a core longitudinal teaching component in preparation for the teaching responsibilities in their working lives.Conclusions: The programme enables the development of a range of academic and personal skills, with particular emphasis on research and teaching skills, independence and confidence.

Medical students' perceptions and confidence in their ability to apply nutrition principles in clinical practice.

This article was migrated. The article was marked as recommended. Background:Due to the rising rates of malnutrition, which can adversely affect health, doctors must be competent in addressing nutrition concerns in practice. This study explored medical students' perceptions and confidence in applying nutrition principles in practice: nutrition assessment, patient counselling, and interventions. Methods: A small scale exploratory case study was conducted using semi-structured interviews with eight undergraduate medical students. An inductive thematic analysis was carried out. Documentary analysis was completed using policy and Medical School curriculum documents to review nutrition-related text in terms of the learning outcomes for nutrition education. Results: The findings highlight aspects which influenced students' nutrition practice for patient assessment and intervention: students' experience of nutrition both in education and practice, roles, importance of nutrition, concerns regarding application, barriers, and nutrition theme teaching. Documentary analysis results showed that the General Medical Council (GMC) and Dundee Medical School curriculum addressed higher level learning outcomes but students felt they were not achieving them. Conclusions:This study identifies factors which contribute to students' confidence in applying nutrition principles in practice with particular emphasis on nutrition curriculum and managing nutrition concerns in practice. It offers suggestion for curriculum review and development.

Dundee's Longitudinal Integrated Clerkship: drivers, implementation and early evaluation.

Dundee University School of Medicine established a pilot for a 40 week long comprehensive Longitudinal Integrated Clerkship (LIC) in 2016. Ten places for year 4 students are available which are shared between two regions of Scotland which are largely rural areas by UK definitions. This paper describes the drivers for the pilot, its implementation and early evaluation. For the evaluation, data were collected using focus groups and semi-structured interviews from the first cohort of seven students, four health service employed staff (two with leadership roles and two with regional student facing roles), 21 General Practitioner tutors, and from reflective audio-diaries kept by all students. Analysis was thematic, the themes being identified from the data. Summative assessment data were collated. Students reported positive learning experiences though access to secondary care learning linked to their patients was sometimes problematic. GP tutors were positive and enthusiastic about the programme and could see the potential benefits on recruitment to GP careers. Pre-existing workload pressures were a challenge. Summative assessment results were encouraging. The Dundee LIC is successful in delivering Dundee's year 4 curriculum. Ongoing development has been focused on improving awareness of the programme in secondary care services.

Identifying key areas for active interprofessional learning partnerships: A facilitated dialogue.

Student and service user involvement is recognised as an important factor in creating interprofessional education (IPE) opportunities. We used a team-based learning approach to bring together undergraduate health professional students, early career professionals (ECPs), public partners, volunteers, and carers to explore learning partnerships. Influenced by evaluative inquiry, this qualitative study used a free text response to allow participants to give their own opinion. A total of 153 participants (50 public partners and 103 students and professionals representing 11 healthcare professions) took part. Participants were divided into mixed groups of six (n = 25) and asked to identify areas where students, professionals, and public could work together to improve health professional education. Each group documented their discussions by summarising agreed areas and next steps. Responses were collected and transcribed for inductive content analysis. Seven key themes (areas for joint working) were identified: communication, public as partners, standards of conduct, IPE, quality improvement, education, and learning environments. The team-based learning format enabled undergraduate and postgraduate health professionals to achieve consensus with public partners on areas for IPE and collaboration. Some of our results may be context-specific but the approach is generalisable to other areas.

Taking the learning beyond the individual: how reflection informs change in practice.

OBJECTIVE: The purpose of this research was to explore the value of reflection and its application to practice through the implementation of educational modules within a new Diabetes Care and Education Master Degree Programme in Kuwait, and to realise how this teaching intervention informs changes in practice. METHODS: A small exploratory case study was conducted within the Dasman Diabetes Institute, Kuwait. A qualitative approach using focus group interviews was carried out with seventeen participants all of whom are studying on the Diabetes Care and Education Master Degree Programme in Kuwait. An inductive approach to thematic analysis, which focused on examining themes within data, was performed. RESULTS: The results indicate that participants value the opportunity to study through organised, structured and assessed reflection. The learning provides useful information and support to the participant by highlighting the role which reflection plays to enhance personal and professional development, the value of educational theory, continuing professional development, collaboration and enhancing patient education and practice. CONCLUSIONS: The significance of reflection is often seen in the literature as an important aspect of professional competence. This research has highlighted the value of reflection as a key component within a new educational programme.

Students' perceptions and experiences of a new "Teaching in Medicine" BMSc intercalated degree programme.

OBJECTIVES: Most doctors are involved in teaching to a greater or lesser degree and as such are required to keep their skills and knowledge up to date. Education for medical students has been moving up the political and professional agenda (GMC 2009, 2013). Currently, few Medical Schools offer a medical education intercalated degree programme. This study sets out to explore the students' experiences of a BMSc Teaching in Medicine Intercalated degree programme, offered by the School of Medicine Dundee, to help inform the value of an educational programme within an undergraduate medical curriculum. METHODS: A small scale, exploratory case study was conducted with students who have completed the BMSc Teaching in Medicine Intercalated degree programme. A qualitative approach using three focus group interviews and questionnaire was carried out with 13 students within one University. RESULTS: The results show the value of the programme and the merit of experiential learning gained throughout the programme. Students enhanced their learning through collaboration and opportunities gained within and out with the Medical School gaining a better appreciation of the roles and responsibilities of staff roles and academic clinicians. CONCLUSION: The findings highlight the value of an intercalated teaching degree within a MBChB programme, its application and relevance to future practice and career development, for continuing personal and professional development and lifelong learning.

Placing the patient at the core of teaching.

BACKGROUND: In the revised undergraduate medical programme at the University of Dundee, medical students visit a patient with a chronic illness in the patient's own home. Students' learn about the patient's experience of their chronic illness/disease over time. It is known as 'the patient journey'. The concept of 'the patient journey' emerged from Tomorrow's Doctors (2003) in light of the need to increase community-based education. DESCRIPTION: The evaluation was carried out using a focus group. Students indicated that community-based education can show them real life in a home context; early contact with a patient enabled them to have a better understanding of patient-centred medicine; meeting a patient early brings reality and continuity to their careers and a clearer understanding of the patient's condition. CONCLUSIONS: Further work may clarify the specific long-term values of the patient visit and how it may support teaching and learning within the first three years of the curriculum.

Accuracy of mandatory surgeon recording of unplanned return to theatre.

BACKGROUND: Unplanned return to theatre (URTT) is a common performance indicator in surgery. The aim of this study is to determine the accuracy of recording URTT in orthopaedic surgery, and whether it is improved when recorded by the operating surgeon. METHODS: All orthopaedic URTT at St. George Hospital (Kogarah, Australia), as recorded by nursing staff, from 1 January 2001 to 31 December 2001 were reviewed. The results were compared to a similar review for the period from 1 June 2002 to 31 May 2003, when data was entered by the operating surgeon. RESULTS: In 2001, the true URTT rate was 68 out of a total of 2250 cases. Only 39 of these were recorded as URTT (sensitivity = 57%). Of the 2182 remaining cases, 34 were incorrectly reported as URTT (specificity = 98.4%). In the period June 2002-May 2003, the true URTT rate was 25 out of 2119 cases. Of these, 22 were correctly recorded (sensitivity = 88%). Of the 2094 remaining cases, 16 were incorrectly recorded as URTT (specificity = 99.2%). The differences in sensitivity and specificity between the two periods were statistically significant. CONCLUSIONS: Unplanned return to theatre cases need to be reviewed individually to assess clinical significance. Mandatory surgeon reporting significantly increases the accuracy of data.