PATHA's vision for transgender healthcare under the current health reforms.

AIM: The Aotearoa New Zealand healthcare system does not adequately meet the needs of transgender people. Due to healthcare reforms and increases in funding and awareness of transgender health, the Ministry of Health has met with the Professional Association for Transgender Health Aotearoa (PATHA) to discuss ways to improve the healthcare system. We developed a vision for a transgender healthcare document to enable a process for our members to collaborate and to increase transparency about what advice PATHA has provided to the Ministry. METHOD: Feedback from PATHA's committees was incorporated into a draft document, which was then sent to all PATHA members for further feedback and collaboration. RESULTS: PATHA proposes improvements to transgender healthcare that are centred around a new transgender health resourcing hub, which should operate according to a Te Tiriti o Waitangi framework, provide national coordination of a distributed model of care, provide resourcing (including education) for primary care and actively work to increase provision and equity of gender-affirming surgeries. In order to be effective, the new resourcing hub would utilise peer health navigators, provide education and professional development, promote healing-focussed care and incorporate transgender community leadership and accountability. CONCLUSIONS: These improvements would allow for the best practices from existing regional programmes to be implemented throughout the healthcare system. The proposed changes align with the goals of the healthcare reforms to make healthcare for transgender people more equitable, accessible and cohesive.

Comparing the influence of 'describing findings to the examiner' or 'examining as in usual practice' on the students' performance and assessors' judgements during physical examination skills assessment.

This article was migrated. The article was marked as recommended. BACKGROUND: Within assessment of physical examination skills, two approaches are common: "Describing Findings" (students comment throughout); and examining as "Usual Practice" (students only report findings at the end). Despite numerous potential influences on both students' performances and assessors' judgements, no prior studies have investigated the influence of either approach on assessments. METHODS: Two group, randomised, crossover design. Within a 2-station simulated physical examination OSCE, we manipulated whether students "described findings" or examined as "usual practice", collecting 1/. performance scores; 2/. Students'/examiners' cognitive load ratings; ratings of the 3/. fluency and 4/. completeness of students' presentations and 5/. Students' task-finishing, comparing all 5 end-points across conditions. RESULTS: Neither students' performance scores nor examiners' cognitive load were influenced by experimental condition. Students reported higher cognitive load (7/9) when "describing findings" than "usual practice" (6/9, p=0.002), and were less likely to finish (4 vs 12, p=0.007). Presentation completeness was higher for "describing findings" (mean=2.40, (95CIs=2.05-2.74)) than "usual practice" (mean=1.92 (1.65-2.18),p=0.016), whilst fluency ratings showed a similar trend. CONCLUSIONS: The decision to "Describe Findings" or examine as "Usual Practice" does not appear neutral, potentially influencing students' efficiency, recall and (by inference) learning. Institutions should explicitly select one option based on assessment goals.

Improving the content of feedback.

BACKGROUND: Feedback, although an important element of skills teaching, is not well regarded by students. This lack of regard may be perpetuated by the differing expectations of tutors and learners, by the weakness of the process and by the apparent irrelevance of its content to learners. We contend that the content of feedback is critical, and has previously been neglected. CONTEXT: We describe a concept for a tutor support tool (a glossary of strategies for improvement) that any group responsible for skills development within an institution can develop in-house and disseminate to improve the content of the feedback given to its learners. INNOVATION: All institutions have skills assessment criteria that represent what students are expected to achieve. Conversely, they can also identify the likely range of deficiencies in students' skills, which can therefore be used as a template for identifying a core set of strategies for improvement. The strategies can be quickly developed by a group of experienced tutors, and then shared with all tutors and students. By monitoring the feedback provided to learners, potential new strategies or revisions of existing strategies can be identified. If these new strategies are considered useful they can be included in updates. In this way the collective wisdom of the school's tutors can be captured and shared. IMPLICATIONS: We suggest that this approach has the potential to increase congruence between the taught and assessed curriculum. If it is shared with students it may reduce the gap between the hidden and published curriculum. We encourage others to experiment with this approach.

The haemangioblast generates haematopoietic cells through a haemogenic endothelium stage.

It has been proposed that during embryonic development haematopoietic cells arise from a mesodermal progenitor with both endothelial and haematopoietic potential called the haemangioblast. A conflicting theory instead associates the first haematopoietic cells with a phenotypically differentiated endothelial cell that has haematopoietic potential (that is, a haemogenic endothelium). Support for the haemangioblast concept was initially provided by the identification during mouse embryonic stem cell differentiation of a clonal precursor, the blast colony-forming cell (BL-CFC), which gives rise to blast colonies with both endothelial and haematopoietic components. Although recent studies have now provided evidence for the presence of this bipotential precursor in vivo, the precise mechanism for generation of haematopoietic cells from the haemangioblast still remains completely unknown. Here we demonstrate that the haemangioblast generates haematopoietic cells through the formation of a haemogenic endothelium intermediate, providing the first direct link between these two precursor populations. The cell population containing the haemogenic endothelium is transiently generated during BL-CFC development. This cell population is also present in gastrulating mouse embryos and generates haematopoietic cells on further culture. At the molecular level, we demonstrate that the transcription factor Tal1 (also known as Scl; ref. 10) is indispensable for the establishment of this haemogenic endothelium population whereas the core binding factor Runx1 (also known as AML1; ref. 11) is critical for generation of definitive haematopoietic cells from haemogenic endothelium. Together our results merge the two a priori conflicting theories on the origin of haematopoietic development into a single linear developmental process.