GP trainees as teachers: a rapid review of the barriers, facilitators and outcomes.

BACKGROUND: There is a workforce crisis in General Practice (GP) within the United Kingdom (UK). High-quality clinical placement experiences in GP influence medical students' interest and likelihood to enter this speciality. GP trainees often express a desire to teach, yet teaching does not feature significantly within their current practice. This study aims to explore outcomes, barriers, and facilitators of GP trainees teaching medical students through a rapid review of published literature. METHODS: MEDLINE, EMBASE, PsychINFO, Web of Science were searched for articles relating to GP trainees teaching. Studies conducted in the UK and Australia, between January 2000 and October 2022 were included. The Medical Education Research Study Quality Index and the Critical Appraisal Skills Programme checklist were used to assess quality. RESULTS: Twenty-seven publications, 11 qualitative, six quantitative, three mixed-methods and seven opinion pieces, were identified. Many studies have methodological limitations. Empirical studies show that there are benefits of near-peer teaching, but these are limited by trainees' capacity and capability to teach, and GPs' confidence in trainees' teaching. The culture within the practice influenced whether trainees were seen solely as learners or also as teachers for students. DISCUSSION: When GP trainees teach there are positive outcomes for medical students and trainees. Teaching was considered an activity that trainees did in 'addition to' rather than 'part' of' their training. Appropriate teaching opportunities, and relevant training, were key to trainees' competence and confidence in teaching. Resources and recognition and a strong teaching culture are needed to support GP trainees to teach.

Social connections and social identity as a basis for learning and support: Experiences of medical students with minoritised and non-minoritised ethnic identities.

BACKGROUND: Social connections between medical students provide a key basis for learning and support. These connections, and associated social identity, may be patterned by ethnicity, and students often perform similarly academically to those they connect with. The mechanisms that underpin the formation of these connections and the role that they play are not fully understood. This study explored how medical students connect with each other, and the potential impact of this on their academic attainment and well-being, with a focus on students with minoritised ethnic identities. METHODS: A mixed methods study combining (1) a survey to establish the number and strength of connections formed by Years 1 and 2 medical students with both minoritised and non-minoritised ethnicities and (2) semi-structured interviews to understand how connections were formed, whether this was shaped by ethnicity and the role of connections in supporting students with their learning and well-being. RESULTS: One hundred fifty-one students (15.5% response rate) completed the survey. Students connected regularly with three to four peers with the goal of supporting learning and 71.9% of students reported a sense of social identification with this group. There was no statistical difference between ethnically minoritised and White students on either of these measures (t = 0.1, p = 0.92, χ2 = 2.9, p = 0.56). Interviews with 19 students found that social connections were shaped by perceptions of their self-identity and the need to find 'equilibrium' by forming relationships with compatible others. The education environment, including its ethnic diversity, impacted on the opportunities to make connections. Students who were ethnically minoritised reported encountering challenges, especially in the clinical environment, and described the burden of these for them. DISCUSSION: Curriculum designers should consider the time and space that is afforded to student interaction during course development, as finding compatible others with whom students can socially connect is important to balancing well-being with academic performance.

The patient voice: More than a tick box exercise?

BACKGROUND: Patient and public involvement (PPI) in healthcare professional education is important, yet publications often provide insufficient detail about the types of involvement patients undertake and the level of autonomy that they have. This study details the factors that promote or hinder PPI within a university healthcare professional education setting and the types of activities members conducted. METHODS: PPI activities were described and mapped against a framework for PPI in healthcare professional education. Semi-structured interviews with PPI group members explored the motivators, enablers and barriers that influence involvement. FINDINGS: The framework highlighted that the PPI group were involved in a range of activities, yet they received limited training for their role and were infrequently involved in planning the activities. When interviewed, PPI members did not consider that these factors were the important promoters or barriers to involvement, instead emphasising five themes: (1) their individual characteristics, (2) factors relating to the university organisation, (3) relationships between themselves, faculty and students, (4) time in their role and (5) evidence of their impact. DISCUSSION AND CONCLUSION: Supporting PPI members whilst working, rather than provision of formal training was considered most empowering for group members. This was mediated through having enough time in their role to develop supportive relationships with faculty, which in turn promoted self-confidence and increased autonomy. This should be considered when making PPI appointments. Small changes in processes during education planning can make it easier for PPI members to bring their own agenda forward and promote equity during education decision making.

Saturated fat replacement in short dough biscuits with HPMC and lecithin stabilised nanoemulsions.

Biscuits contain high proportions of saturated fats, which could lead to an adverse health effect. The objective of this study was to study the functionality of a complex nanoemulsion (CNE), stabilised with hydroxypropyl methylcellulose and lecithin, when used as a saturated fat replacer in short dough biscuits. Four biscuit formulations were studied including a control (butter) and three formulations where 33% of the butter was replaced with either extra virgin olive oil (EVOO), with CNE, or with the individual ingredients of the nanoemulsion added separately (INE). The biscuits were evaluated by texture analysis, microstructural characterisation, and quantitative descriptive analysis by a trained sensory panel. The results showed that incorporation of CNE and INE yielded doughs and biscuits with significantly higher (p < 0.05) hardness and fracture strength values than the control. The doughs made of CNE and INE showed significantly less oil migration during the storage than EVOO formulations, which was confirmed by the confocal images. The trained panel did not find significant differences in crumb density and hardness on the first bite among CNE, INE and the control. In conclusion, nanoemulsions stabilised with hydroxypropyl methylcellulose (HPMC) and lecithin can work as saturated fat replacers in short dough biscuits, providing satisfactory physical characteristics and sensory attributes.

Clinical Teaching Fellows, the new norm?-Experiences of fellows and education faculty.

BACKGROUND: In the United Kingdom, there is an increasing tendency for doctors in the first 2 years after graduation, to step off the training pathway and take up Clinical Teaching Fellow (CTF) positions. We aimed to explore stakeholder experiences of CTF positions to inform future planning and support. METHODS: Individual semi-structured interviews with 10 stakeholders (five CTFs and five education faculty members) from one institution in England were conducted. Interviews explored the participants' views of the CTF position, its benefits and challenges. Inductive thematic analysis was performed. RESULTS: CTFs and education faculty views strongly aligned and three themes were identified. These were (1) developing a career, (2) developing confidence and competence as a clinical teacher and (3) developing a position that works for all. Participants reported that the CTF position allowed time for specialty decision making and curriculum-vitae strengthening and provide CTFs with the opportunity to work autonomously and to establish a better work-life balance by stepping away from training pressures and focusing on other aspects of life. There were differing thoughts on how the position should be structured, although retaining a clinical role with boundaries to constrain competing responsibilities was important. CONCLUSION: A brief hiatus in clinical training, where individuals feel supported to progress personally and professionally and to renew their energy for the next steps of clinical training, seems important. The ideologies of providing the CTFs with autonomy, time to explore options, recharge and form connections with colleagues should be considered when structuring the posts.

Oral retention of thermally denatured whey protein: In vivo measurement and structural observations by CD and NMR.

This study investigated structural changes and the in vivo retention in the oral cavity of heated whey protein concentrate (WPC). Heated WPC was shown to have both a higher retention time in the oral cavity compared to unheated whey protein up to 1 min post swallow, and a concomitant increase in free thiol concentration. Nuclear magnetic resonance and circular dichroism demonstrated structural changes in the secondary and tertiary structures of the WPC upon heating. Structural loss of the ß-barrel was shown to increase during heating, leading to the exposure of hydrophobic regions. The increase in free thiols and hydrophobic regions are two factors which are known to increase mucoadhesive strength and hence increase oral retention of heated whey protein which may subsequently increase the perception of mouthdrying.

Consistent Effects of Whey Protein Fortification on Consumer Perception and Liking of Solid Food Matrices (Cakes and Biscuits) Regardless of Age and Saliva Flow.

Although there are numerous high protein products on the market, they are typically not designed with, or for, older consumers. This is surprising considering that dietary guidelines recognise the need for higher protein intake in later life. Protein fortified products are, however, associated with negative sensory attributes and poor consumer acceptance. This paper investigates the extent of mouthdrying sensations within a high protein solid food matrix, along with the effect of age and saliva flow. Solid models using cakes and biscuits, with or without protein fortification, were investigated. The sensory profile and physical properties were analysed and two volunteer studies (n = 84; n = 70) were carried out using two age groups (18-30; 65+). Volunteers rated individual perception and liking of products, and salivary flow rates (mL/min) were measured. Unstimulated salivary flow rates were significantly lower (p < 0.05) in older adults, although this was not found to influence product perception. Protein fortification of cakes and biscuits significantly increased (p < 0.05) perceived mouthdrying, hardness and "off" flavours, and significantly reduced (p < 0.05) melting rate, moistness and liking compared with the control versions. There is a clear need to address negative sensory attributes associated with protein fortification of cakes and biscuits to ensure product suitability for older adults.

An Investigation of the Influence of Age and Saliva Flow on the Oral Retention of Whey Protein and Its Potential Effect on the Perception and Acceptance of Whey Protein Beverages.

Protein fortified products are regularly recommended to older adults to improve nutritional status and limit sarcopenia. However protein fortification can elicit negative sensory attributes such as mouthdrying. Sensitivity to mouthdrying can increase with age, yet the influence of saliva flow and mucoadhesion remain uncertain. Here, two studies tested different whey protein beverages (WPB); 22 healthy younger volunteers completed a pilot and 84 healthy volunteers from two age groups (18-30; 65+) completed the main study. In both studies salivary flow rates (mL/min) were measured and saliva samples were collected at time intervals post beverage consumption to measure mucoadhesion to the oral cavity, where protein concentration was analysed by Bradford Assay. Volunteers rated perception and acceptability of WPBs in the main study. WPB consumption resulted in significantly increased protein concentration (p < 0.0001) in saliva samples compared with a control whey permeate beverage. Older adults had significantly lower unstimulated saliva flow (p = 0.003) and significantly increased protein concentration (p = 0.02) in saliva samples, compared with younger adults. Heating of WPB significantly (p < 0.05) increased mouthdrying and thickness perception and reduced sweetness compared with unheated WPB. Mucoadhesion is concluded to be a true phenomenon in WPBs and increases with age.

Exploiting open source 3D printer architecture for laboratory robotics to automate high-throughput time-lapse imaging for analytical microbiology.

Growth in open-source hardware designs combined with the low-cost of high performance optoelectronic and robotics components has supported a resurgence of in-house custom lab equipment development. We describe a low cost (below $700), open-source, fully customizable high-throughput imaging system for analytical microbiology applications. The system comprises a Raspberry Pi camera mounted on an aluminium extrusion frame with 3D-printed joints controlled by an Arduino microcontroller running open-source Repetier Host Firmware. The camera position is controlled by simple G-code scripts supplied from a Raspberry Pi singleboard computer and allow customized time-lapse imaging of microdevices over a large imaging area. Open-source OctoPrint software allows remote access and control. This simple yet effective design allows high-throughput microbiology testing in multiple formats including formats for bacterial motility, colony growth, microtitre plates and microfluidic devices termed 'lab-on-a-comb' to screen the effects of different culture media components and antibiotics on bacterial growth. The open-source robot design allows customization of the size of the imaging area; the current design has an imaging area of ~420 × 300mm, which allows 29 'lab-on-a-comb' devices to be imaged which is equivalent 3480 individual 1µl samples. The system can also be modified for fluorescence detection using LED and emission filters embedded on the PiCam for more sensitive detection of bacterial growth using fluorescent dyes.

Evaluation of an innovative, evidence-guided, PBL approach.

AIM: To understand the experiences of students and problem-based learning (PBL) facilitators during an evidence-based curriculum change to a PBL programme within an undergraduate medical course in South West England. METHODS: Four novel PBL cases were designed and implemented, based on educational theory and evidence. Eight focus groups were undertaken with Year-1 and -2 students (n = 18) and PBL facilitators (n = 14) to explore the experiences of participants. Thematic analysis and conceptual abstraction led to insights into the intended and unintended consequences of the change. RESULTS: Participant responses to the change process were influenced by the perceived relevance and value of the change (e.g. benefit to student learning), which was shaped by individual beliefs and preferences (e.g. presumed purpose of PBL, relative value placed on different curriculum topics, and desire for uniform educational experience), and the wider education context (e.g. expectations of assessment). It appears that the three distinct elements must align for the changes to be received positively. We updated our PBL curriculum in response to new evidence DISCUSSION: This study describes how we updated our PBL curriculum in response to new evidence, and demonstrates the importance of communicating the pedagogic rationale behind changes, and meticulous planning, preparation and alignment, even in distant parts of the curriculum. Engaging with existing views and attitudes is an essential requirement for successful curriculum change.

Whey protein mouth drying influenced by thermal denaturation.

Whey proteins are becoming an increasingly popular functional food ingredient. There are, however, sensory properties associated with whey protein beverages that may hinder the consumption of quantities sufficient to gain the desired nutritional benefits. One such property is mouth drying. The influence of protein structure on the mouthfeel properties of milk proteins has been previously reported. This paper investigates the effect of thermal denaturation of whey proteins on physicochemical properties (viscosity, particle size, zeta-potential, pH), and relates this to the observed sensory properties measured by qualitative descriptive analysis and sequential profiling. Mouthcoating, drying and chalky attributes built up over repeated consumption, with higher intensities for samples subjected to longer heating times (p < 0.05). Viscosity, pH, and zeta-potential were found to be similar for all samples, however particle size increased with longer heating times. As the pH of all samples was close to neutral, this implies that neither the precipitation of whey proteins at low pH, nor their acidity, as reported in previous literature, can be the drying mechanisms in this case. The increase in mouth drying with increased heating time suggests that protein denaturation is a contributing factor and a possible mucoadhesive mechanism is discussed.

Assembly-line synthesis of organic molecules with tailored shapes.

Molecular 'assembly lines', in which organic molecules undergo iterative processes such as chain elongation and functional group manipulation, are found in many natural systems, including polyketide biosynthesis. Here we report the creation of such an assembly line using the iterative, reagent-controlled homologation of a boronic ester. This process relies on the reactivity of α-lithioethyl tri-isopropylbenzoate, which inserts into carbon-boron bonds with exceptionally high fidelity and stereocontrol; each chain-extension step generates a new boronic ester, which is immediately ready for further homologation. We used this method to generate organic molecules that contain ten contiguous, stereochemically defined methyl groups. Several stereoisomers were synthesized and shown to adopt different shapes-helical or linear-depending on the stereochemistry of the methyl groups. This work should facilitate the rational design of molecules with predictable shapes, which could have an impact in areas of molecular sciences in which bespoke molecules are required.

Can we reduce eating disorder risk factors in female college athletes? A randomized exploratory investigation of two peer-led interventions.

Female athletes are at least as at risk as other women for eating disorders (EDs) and at risk for the female athlete triad (i.e., inadequate energy availability, menstrual disorders, and osteoporosis). This study investigated whether two evidence-based programs appear promising for future study if modified to address the unique needs of female athletes. Athletes were randomly assigned to athlete-modified dissonance prevention or healthy weight intervention (AM-HWI). ED risk factors were assessed pre/post-treatment, and 6-week and 1-year follow-up. Results (analyzed sample, N=157) indicated that both interventions reduced thin-ideal internalization, dietary restraint, bulimic pathology, shape and weight concern, and negative affect at 6 weeks, and bulimic pathology, shape concern, and negative affect at 1 year. Unexpectedly we observed an increase in students spontaneously seeking medical consultation for the triad. Qualitative results suggested that AM-HWI may be more preferred by athletes.

What biomedical science should be included in undergraduate medical courses and how is this decided?

This review aimed to determine the availability of core curricula for the biomedical sciences in the published literature and the approach taken to determining learning objectives. A systematic review was conducted searching three databases for articles containing the terms 'core curriculum', 'undergraduate' and 'medic*'. Fifty seven papers were read in full, of which 40 listed learning objectives. The authors used a consensus process to categorize the learning objectives according to the level of detail (high / medium / low) and the approach taken (either a top down approach using experts or a bottom up approach using key stakeholders). This paper directs the reader to publications that describe core curricula for the biomedical sciences. The review revealed that topic coverage was patchy and there was a variable level of detail of learning outcomes presented. Documents published by professional bodies tended to provide more detailed learning outcomes than those derived by experts associated with medical schools. Two thirds of the 40 publications used a top down approach and there was a temporal trend towards involving non-expert groups in some stage of the process of defining the learning objectives, regardless of whether a top down or bottom up approach was taken.

Effects of being a peer-leader in an eating disorder prevention program: can we further reduce eating disorder risk factors?

Studies regarding the effect of peer-leadership on peer-leaders in prevention programs remain extremely limited. In this study, 83 undergraduate sorority members, who previously participated in the program, served as peer-leaders for an eating disorder prevention program. Peer-leaders attended 9 hours of training and then led two 2-hour sessions. Leaders showed decreases (beyond participation in earlier studies) in dietary restraint, bulimic pathology, body dissatisfaction, and thin-ideal internalization from pre-training through 7-week follow up. Results from this exploratory study suggest that peer-leaders who participate in a program and subsequently lead it may experience additional benefits compared to participation in the program alone.

Flock health indicators and Campylobacter spp. in commercial housed broilers reared in Great Britain.

This study investigated the relationship between flock health and Campylobacter infection of housed commercial broilers in Great Britain. Thirty ceca were collected at slaughter from batches of broilers from 789 flocks, at either full or partial depopulation, between December 2003 and March 2006 and examined individually for Campylobacter by direct plating onto selective media. Management and health data were collected from each flock and included information on mortality or culling during rearing, the number of birds rejected for infectious or noninfectious causes at slaughter, the proportion of birds with digital dermatitis (also termed hock burn), and other general characteristics of the flock. Campylobacter spp. were isolated from 280 (35%) flocks. The relationship between bird health and welfare and Campylobacter status of flocks was assessed using random-effects logistic regression models, adjusting for region, month, year, and rearing regime. Campylobacter-positive batches of ceca were associated with higher levels of rejection due to infection (odds ratio [OR], 1.5; 95% confidence interval [CI(95%)], 0.98 to 2.30) and digital dermatitis (OR, 2.08; CI(95%), 1.20 to 3.61). Furthermore, higher levels of these conditions were also associated with the highest-level category of within-flock Campylobacter prevalence (70 to 100%). These results could indicate that improving health and welfare may also reduce Campylobacter in broilers.

Effectiveness of peer-led eating disorders prevention: a replication trial.

The aim of this study was to replicate and extend results of a previous trial that investigated the effectiveness of 2 peer-led eating disorders prevention interventions in reducing eating disorder risk factors in undergraduate women (C. B. Becker, L. M. Smith, & A. C. Ciao, 2006). To extend findings from the previous study by allowing for investigation of differential response, the authors randomly assigned a larger sample of both higher and lower risk sorority members (N = 188; age M = 18.64 years, range = 18-21; 20% minority) to either a cognitive dissonance (CD) or a media advocacy (MA) intervention under naturalistic conditions. Interventions were delivered by trained sorority peer leaders and consisted of two 2-hr group sessions. Participants completed questionnaires that assessed eating disorder risk factors at pretreatment, posttreatment, 7-week follow-up, and 8-month follow-up. Results indicate that both interventions reduced thin-ideal internalization, body dissatisfaction, dietary restraint, and bulimic pathology at 8 months, although higher and lower risk participants responded somewhat differently. Both CD and MA generally appeared effective for higher risk participants; only CD, however, appeared to benefit lower risk participants. Results further support the viability of using peer leaders in dissonance-based prevention.