Alienation in the Teaching Hospital: How Physician Non-Greeting Behaviour Impacts Medical Students' Learning and Professional Identity Formation.

Introduction: Clinical workplaces offer unrivalled learning opportunities if students get pedagogic and affective support that enables them to confidently participate and learn from clinical activities. If physicians do not greet new students, the learners are deprived of signals of social respect and inclusion. This study explored how physicians' non-greeting behaviour may impact medical students' participation, learning, and professional identity formation in clinical placements. Methods: We analysed 16 senior Norwegian medical students' accounts of non-greeting behaviours among their physician supervisors in a reflexive thematic analysis of focus group interview data. Results: The main themes were: A) Descriptions of non-greeting. Not being met with conduct signalling rapport, such as eye contact, saying hello, using names, or introducing students at the workplace, was perceived as non-greeting, and occurred across clinical learning contexts. B) Effects on workplace integration. Non-greeting was experienced as a rejection that hurt students' social confidence, created distance from the physician group, and could cause avoidance of certain workplace activities or specific medical specialties. C) Impact on learning. Non-greeting triggered avoidance and passivity, reluctance to ask questions or seek help or feedback, and doubts about their suitability for a medical career. Conclusion: Medical students' accounts of being ignored or treated with disdain by physician superiors upon entering the workplace suggest that unintended depersonalising behaviour is ingrained in medical culture. Interaction rituals like brief eye contact, a nod, a "hello", or use of the student's name, can provide essential affective support that helps medical students thrive and learn in the clinic.

Welfare and Management of Civets in Civet Coffee Tourism Plantations.

Civet coffee is produced with coffee beans that have passed through the digestive tract of civets which are then processed for drinking. Outlets, known as civet coffee tourism plantations are popular tourist attractions in Bali, Indonesia. These outlets keep caged civets for public viewing and sell civet coffee. We assessed civet welfare in 29 civet coffee tourism plantations to assess husbandry factors, the five freedoms and body condition scores. We also assessed civet welfare in eight wildlife markets where civets are sourced for civet coffee tourism and calculated turnover of civets. We found 99 civets in civet coffee tourism plantations and 136 in markets, where. Annually between 400 and 800 civets are sold. Welfare standards do not meet the Indonesian laws and regulations. Diet, hygiene, presence of water and mobility affected body condition scores and no civet met all of the five freedoms. Enforcement of welfare and trade laws is needed to improve civet welfare, and to curb the illegal civet trade. Tourists frequenting civet coffee tourism plantations should be made aware of the low welfare standards to inform their choice about supporting this industry.

Shame in medical clerkship: "You just feel like dirt under someone's shoe".

INTRODUCTION: This study explores how senior medical students' experience and react to shame during clinical placements by asking them to reflect on (1) manifestations of shame experiences, (2) situations and social interactions that give rise to shame, and (3) perceived effects of shame on learning and professional identity development. METHODS: In this interpretive study, the authors recruited 16 senior medical students from two classes at a Norwegian medical school. In three focus group interviews, participants were invited to reflect on their experiences of shame. The data were analyzed using systematic text condensation, producing rich descriptions about students' shame experiences. RESULTS: All participants had a range of shame experiences, with strong emotional, physical, and cognitive reactions. Shame was triggered by a range of clinician behaviours interpreted as disinterest, disrespect, humiliation, or breaches of professionalism. Shame during clinical training caused loss of confidence and motivation, worries about professional competence, lack of engagement in learning, and distancing from shame-associated specialties. No positive effects of shame were reported. DISCUSSION: Shame reactions in medical students were triggered by clinician behaviour that left students feeling unwanted, rejected, or burdensome, and by humiliating teaching situations. Shame had deleterious effects on motivation, learning, and professional identity development. This study has implications for learners, educators, and clinicians, and it may contribute to increased understanding of the importance of supportive learning environments and supervisors' social skills within the context of medical education.

Meeting the mental health needs of today's college student: Reinventing services through Stepped Care 2.0.

A new stepped care model developed in North America reimagines the original United Kingdom model for the modern university campus environment. It integrates a range of established and emerging online mental health programs systematically along dimensions of treatment intensity and associated student autonomy. Program intensity can be either stepped up or down depending on level of client need. Because monitoring is configured to give both provider and client feedback on progress, the model empowers clients to participate actively in care options, decisions, and delivery. Not only is stepped care designed to be more efficient than traditional counseling services, early observations suggest it improves outcomes and access, including the elimination of service waitlists. This paper describes the new model in detail and outlines implementation experiences at 3 North American universities. While the experiences implementing the model have been positive, there is a need for development of technology that would facilitate more thorough evaluation. (PsycINFO Database Record