"Enough is enough, I don't want any audience": exploring medical students' explanations of consent-related behaviours.

Medical students are often faced with an ethical dilemma within the clinical setting--to learn from as many patients as possible but to learn only with consenting patients. Although studies have examined patients' and students' views about informed consent, none have examined how medical students talk about consent-related behaviours in 'naturalistic' focus group settings. This paper aims to explore medical students' explanations of behaviours relating to patient consent. Thirty-five excerpts across eight focus group discussions were identified using what we call momentum analysis: an identification of where the impetus of the groups' discussions changed noticeably. Ten were related to consent issues, seven of which occurred in focus groups with medical students. Utilising Malle's folk conceptual theory of behavioural explanation (2004. How the mind explains behavior. Folk explanations, meaning, and social interaction. Cambridge Massachusetts: MIT Press) within a narrative framework, we identified seven types of consent-related behaviour across the seven excerpts and 101 explanations for these behaviours by students. We found that students employed less reason explanations but more causal history reason (CHR) and enabling factor explanations than is found in other studies of naturally occurring talk, suggesting that consent-related behaviours were difficult and that our students actively managed others' impressions of them and their behaviours. Although our data is generally supportive of Malle's folk conceptual theory of behavioural explanation we suggest potential developments to this theoretical framework following our analysis with naturally occurring talk. However, further research is needed with larger samples of behavioural explanations to contribute more fully to theoretical development.

"User involvement is a sine qua non, almost, in medical education": learning with rather than just about health and social care service users.

Despite the General Medical Council emphasising the value of service users to medical students' education, there is scant literature about service user involvement in medical education. Although some research has outlined the effectiveness of service users as teachers, none has explored social issues surrounding how medical students learn 'with' rather than just 'about' service users. Incorporating insights from contemporary socio-cultural learning theory, this study examines the views and experiences of 47 stakeholders (comprising 19 service users, 13 medical students and 15 medical educators) concerning service user involvement in medical education. Eight audiotaped focus group discussions were convened and the audiotapes were transcribed. The transcripts and audiotapes were independently analysed by multiple researchers using Framework analysis. Seven content- and five process-orientated themes emerged from the analysis. Content-related themes included the costs and benefits of service user involvement in medical education and process-related themes included the use and function of humour and metaphor. In this paper, we focus primarily on the content-related themes. We discuss these findings in light of the existing service user involvement literature and contemporary socio-cultural learning theory and provide implications for further research and educational practice. We encourage educators to involve service users in medical education but only in a considered way.

"The stroke is eighty nine": understanding unprofessional behaviour through physician-authored prose.

The unprofessional behaviour of medics is explored through their depiction in two physician-authored books-the novel Bodies and the autobiography Bedside stories: confessions of a junior doctor. Using the Integrative Model of Behavioural Prediction, not only the range and nature of professionalism lapses outlined in these books but also the reasons behind such unprofessional behaviours are examined. The books contained examples of lapses in professionalism outlined in research investigating the unprofessional behaviour of medical students, such as communication violations, objectification of patients and causing harm to patients. More interestingly, various reasons behind lapses in professionalism were found. Most examples of unprofessional behaviour were unintentional acts and therefore due to environmental constraints and skill deficits. Seemingly intentional acts were largely influenced by normative beliefs-that is, people feeling pressurised to act unprofessionally. Further research is needed to examine the depiction of lapses in professionalism in a wider range of physician-authored prose.

A silly expression: Consultants' implicit and explicit understanding of Medical Humanities. A qualitative analysis.

The term Medical Humanities has still not been established in the wider medical, educational and academic communities. This qualitative study, conducted across three acute care trusts, is an exploration of whether clinicians were familiar with the term Medical Humanities, and if so, what the term meant to them and whether they considered the associated concepts relevant to medical practice and education. Reactions to the term Medical Humanities were varied: many clinicians had not heard of the term before, some were unsure what it meant, others displayed mistrust or contempt for it. Explicit definitions that were elicited were categorised (inductively) according to three main approaches to the understanding of Medical Humanities: Humanistic-holistic, Humanities-medicine seperate and Intellectual exercise. Findings indicate that the lack of clarity about the term Medical Humanities among experienced healthcare professionals, contrasts with their sophisticated implicit knowledge of key issues frequently associated with Medical Humanities. Thus, while some clinicians could not define Medical Humanities and some definitions separated humanities from medicine, all clinicians implicitly acknowledged the importance of Medical Humanities issues within their clinical and teaching practices during conversations prior to any mention of the term. It appears that clinicians as role models for medical students can inadvertently convey an ambivalent position towards the Medical Humanities that encompass the very values and attitudes they are trying to inculcate, sending out mixed messages to the novices.

Prediction of a Large ASE Effect in Silver Plasmas Produced by a Short-Pulse-Drive Laser.

A Ne-like laser scheme is considered for a pure silver plasma. Level populations and gain coefficients are calculated with an atomic-kinetics model. It is shown that large gain values (GL>100) are achievable in a hot dense quasi-steady-state silver plasma at λ=10.038 nm (2-1 transition) and λ=12.298 nm (0-1 transition). Lasing is also possible at λ=2.75 nm (2s-2p transition). The plasma conditions needed are: electron temperature 3–5& keV and density 5 × 1022 < ne < 1023;cm-3;. These plasma conditions can be created with a high-contrast, high-intensity short-pulse visible light laser driver.

A capillary discharge as a potential x-ray laser driver.

This paper describes a combined theoretical and experimental approach to understanding the capillary spark discharge with specific application to use as a soft x-ray or extreme ultraviolet laser source. Atomic physics calculations have identified several potential laser lines in a collisionally pumped neon-like or nickel-like plasma, and magnetohydrodynamic (MHD) modeling has shown that a capillary discharge device should be capable of producing the correct plasma conditions to achieve a population inversion in some of these lines. An experiment is constructed to evaluate the accuracy of the MHD model and investigate the potential of observing inversion in a neon-like argon or a nickel-like krypton plasma.

Measured response of multilayers to damaging fluxes.

We have measured the response of WC/C multilayers to x-ray fluxes on the order of 200 MW/cm2 using laser-generated plasmas and found that these multilayers will maintain near peak reflectivity for at least 1 ns but are eventually destroyed. A description of the experiments and data analysis methods is given. Transmission electron micrographs of WC/C multilayers before and after irradiation show melting to be the dominant damage mechanism. The results of the experiments will be compared with simulations.

Laser-induced thermal lens effect: a new theoretical model.

A theoretical model for the laser-induced thermal lens effect in weakly absorbing media is derived. The model predicts the intensity variation in the far field of the laser beam in the presence of the lensing medium and takes into account the aberrant nature of the thermal lens. Some experimental results which support the validity of this approach are presented.