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This study aimed to describe medical students’ perceptions and experiences with health policy and advocacy training and practice and define motivations and barriers for engagement.
Methods:
This was a mixed-methods study of medical students from May to October 2022. Students were invited to participate in a web-based survey and optional follow-up phone interview. Surveys were analyzed using descriptive statistics. Phone interviews were audio-recorded, transcribed, and de-identified. Interviews were coded inductively using a coding dictionary. Themes were identified using thematic analysis.
Results:
35/580 survey responses (6% response rate) and 15 interviews were completed. 100% rated social factors as related to overall health. 65.7% of participants felt “very confident” or “extremely confident” in identifying social needs but only 11.4% felt “very confident” in addressing these needs. From interviews, six themes were identified: (1) participants recognized that involvement in health policy and/or advocacy is a duty of physicians; (2) participants acknowledged physicians’ voices as well respected; (3) participants were comfortable identifying social determinants of health but felt unprepared to address needs; (4) barriers to future involvement included intimidation, self-doubt, and skepticism of impact; (5) past exposures and awareness of advocacy topics motivated participants to engage in health policy and/or advocacy during medical school; and (6) participants identified areas where the training on these topics excelled and offered recommendations for improvement, including simulation, earlier integration, and teaching on health-related laws and policies.
Conclusions:
This study highlights the importance of involvement in health policy and advocacy among medical students and the need for enhanced education and exposure.
Chapter One sets out to trace Heaney’s early Catholic formation at home, school and parish. It begins in his childhood home of Mossbawn, where a strong devotional piety was a product of what the historian Emmet Larkin called the ‘devotional revolution’ of the nineteenth century. Central to this piety was an emphasis on Marian devotion and the visual and tactile appeal of Catholic sacramental practice. The domestic piety of Mossbawn takes a more formal shape in the learning of the catechism at Anahorish Primary School and in more developed catechesis at St Columb’s College in Derry, where Heaney was a boarder. It was at St Columb’s that Heaney first came across the poetry of Gerard Manley Hopkins, the poet who was to have the greatest influence on his early apprentice work. I trace the influence of Hopkins from Heaney’s early unpublished work to later poems such as ‘Seeing the Sick’ in Electric Light. Heaney’s later introduction to the work of Patrick Kavanagh provided him with the validation of his earliest writing instincts about the local landscape and the centrality of parish as a guarantor of the local.
In recent years, there has been a growth in awareness of the importance of equity and community engagement in clinical and translational research. One key limitation of most training programs is that they focus on change at the individual level. While this is important, such an approach is not sufficient to address systemic inequities built into the norms of clinical and translational research. Therefore, it is necessary to provide training that addresses changing scientific norms and culture to ensure inclusivity and health equity in translational research.
Method:
We developed, implemented, and assessed a training course that addressed how research norms are based on histories and legacies of white supremacy, colonialism, and patriarchy, ultimately leading to unintentional exclusionary and biased practices in research. Additionally, the course provides resources for trainees to build skills in how to redress this issue and improve the quality and impact of clinical and translational research. In 2022 and 2023, the course was offered to cohorts of pre and postdoctoral scholars in clinical and translational research at a premier health research Institution.
Results:
The efficacy and immediate impact of three training modules, based on community engagement, racial diversity in clinical trials, and cancer clusters, were evaluated with data from both participant feedback and assessment from the authors. TL1 scholars indicated increased new knowledge in the field and described potential future actions to integrate community voices in their own research program.
Conclusions:
Results indicate that trainings offered new perspectives and knowledge to the scholars.
In Khartoum the work of managing displacement and organising the future involved extensive educational projects. Residents of all socio-economic and ethnic backgrounds organised adult night schools and taught their own syllabuses of critical political and social education, using self-written alternative history textbooks, in multiple mother tongues or in a common southern Sudanese Arabic. Based on private archives of teaching resources, school records, aid agency archival marginalia, and personal accounts of educative work, this chapter reconstructs this intellectual terrain. It explores the definitions of education among these residents, which included practical and moral knowledge, linguistic creativity, and critical political analysis.
For decades, transnational knowledge circulation in relation to schooling in Ireland has been a neglected area of study among historians. This paper provides new insights through a transnational lens on primary, secondary, and vocational curriculum developments in the first decade following the advent of national independence in the country in 1922. During this period, key policy-makers largely rejected progressive educational ideas circulating internationally and promoted curricula and pedagogy in primary and secondary schools that reflected the new nation’s deeply conservative Catholic nature and nationalist ethos. While initial signs indicated that developments in vocational education might head in a different direction, ultimately, more progressive educational ideas circulating internationally were excluded from that sector as well. At all levels of the education system, the hegemony of the Catholic Church and other contextual factors resulted in traditional and conservative curricula that underpinned policy and practice until the 1960s.
Entrustable professional activities (EPAs) have gained traction in the medical education field as a means of assessing competencies. Essentially, an EPA is a profession-specific task that a trainee is entrusted to conduct unsupervised, once deemed competent by their supervisor through prior evaluations and discussions. The integration of EPAs into postgraduate assessment strategies enhances the delivery of capability-based curricula. It strategically bridges the theoretical–practical divide and addresses existing issues associated with workplace-based assessments (WBPAs). This article aims to (a) provide an overview of EPAs, (b) review the application of EPAs in postgraduate psychiatry so far, exploring their conceptual framework, implementation, qualities and potential benefits and concerns, and (c) propose a theoretical framework for their integration into the UK psychiatry curriculum.
How does the public form preferences on racialized policy issues that are both widely discussed and broadly misunderstood? This has been the question centering around the sudden attacks on academic terms like “critical race theory” (CRT). I argue that the politicization of, and opinion polarization around, critical race theory is evidence of what I call policy branding, where political parties or organizations brand an arbitrary concept that has national salience into a policy issue. Using a series of original survey experiments, this study shows that one of the primary sources of opposition to critical race theory is the literal use of the term. I juxtapose this with evidence that the education policy issue at the core, antiracist teaching, maintained strong public, bipartisan support. This study has implications for the consequences of political elite capture of academic concepts and ideas.
Focusing on journalists’ training between 1960 and 2015, this chapter captures the enduring strength of colonial logic effectuated through nonjournalistic actors, such as the education field. It shows how curricula focused on Western canonical thought reinforce a sense of liminality in a field already perceived as out of touch. It discusses the role of journalism education in inculcating specific normative assumptions about how the fields should work on the continent. It argues that journalism education now, just as at the dawn of independence, is such that the profession is heavily moored on Western understandings of journalistic doxa.
There were about 130 universities in Europe when Goldsmith was born, most founded in the preceding 200 years. Focusing on Trinity College Dublin, Edinburgh University, and the University of Leiden, this chapter uses Goldsmith’s experiences as a means to detail the nature of university education in the mid eighteenth century. The chapter sketches Goldsmith’s time at these three universities and shows that each institution had a distinctive character, defined by its age, religious ethos, governance structures, architecture, and the curriculum it offered. A discussion of Goldsmith’s own thoughts on university education in An Enquiry into the Present State of Polite Learning in Europe (1759) concludes the chapter.
Higher specialist trainees (HSTs) in psychiatry in Ireland were recruited to complete a 21-item online questionnaire anonymously. Questions were designed to establish the research experience of HSTs in various years of training, identify perceived barriers to participation and generate potential strategies to overcome these barriers.
Results
Of 165 HSTs surveyed, 50 (30%) responded. Most respondents (58%) were in the second or third year of HST. Most (72%) were training in general adult psychiatry. Themes that emerged from analysis of the qualitative data were ‘collaborative research culture’, ‘guidance’, ‘choice’ and ‘access to resources’. Participants felt they needed more structured guidance and regular supervision, and expressed a desire for more networking and collaboration.
Clinical implications
The need for a supportive, collaborative research culture within psychiatry was predominant among responses. Structured research programmes and access to resources may facilitate a more positive research culture and should be considered as part of the training curriculum.
There is a need to utilise formal education to ensure and support the effective participation of communities in the disaster risk management process. The negative outcomes of disasters occurring as a result of various disasters in Turkiye show that the society is inadequately prepared. Therefore, the best fight against disasters can be carried out within the scope of formal education activities. In this study, the content and infrastructure of a curriculum for the management of disaster risks at the university level is presented at the conceptual level. Disaster literacy curriculum can contribute to the management of current and future disaster risks. However, there is a need to expand the implementation and measurement of the effectiveness and feasibility of the curriculum as a public health intervention tool. Finally, the support of the national education system needs to be ensured.
This study explores the transformative effects of the Community Plunge, an educational program at the Wake Forest University School of Medicine (WFUSOM), on healthcare delivery, community engagement, and trainee perspectives. It addresses the broader context of health outcomes, where clinical care only accounts for 20%, emphasizing the critical role of social determinants of health (SDOH) and individual behaviors in the remaining 80%.
Methods:
WFUSOM’s Community Plunge, established in 2002, involves a guided tour of the community, discussions with residents, and debriefing sessions. Qualitative interviews with 20 clinicians were conducted to extract key themes and insights.
Results:
The study identified several key outcomes. First, participants gained crucial insights into the community’s history, structural challenges, and prevalent SDOH, enhancing their understanding of the diverse patient populations they serve. Second, the program positively influenced clinician attitudes, fostering empathy, reducing paternalism, and promoting holistic patient care. Third, participants expressed a desire for increased community involvement and reported career trajectory changes toward advocacy and volunteerism. However, challenges such as time constraints were acknowledged.
Conclusions:
The study advocates for collaborative efforts to enhance the program’s impact, including proactive measures to ensure respectful engagement during community tours. It positions the Community Plunge as an innovative, scalable, and transformative strategy for experiential SDOH exposure, crucial for the evolving social consciousness of healthcare learners.
Democrats prize experts in staffing the Executive Branch while Republicans prefer political operatives and media spokespersons. But across the issue spectrum, policies are increasingly complicated and technical, requiring knowledge of many previous rounds of institution-building and policymaking. New social problems require remixing of complex policy tools, often led by research and experts. Addressing climate change and public health, for example, requires professionalized expert workforces and technical analyses. Even seemingly value-based areas of policymaking such as economic development and racial discrimination increasingly require subject-matter experts and formalized training. And the issue of higher education itself has increasingly divided the parties. Chapter 6 documents how each policy area is increasingly dominated by complex proposals from liberals accompanied by conservative suspicion of expert-led governance. Policy knowledge and evaluation capacity have become increasingly tethered to the Democratic Party, with believably nonpartisan expertise now in short supply.
During the 1980s, the AIDS crisis unleashed a torrent of animosity against gays and lesbians. As hatred rose, so too did physical assaults. Most of the perpetrators were teenagers, who did not just torment queer adults – they also directed their anger and hatred at their peers. As a result, a substantial percentage of gay and lesbian youth dropped out of school, abused alcohol and drugs, and attempted suicide. Two types of violence consequently plagued queer life: violence from attackers and self-harm. Some advocates responded by focusing on preventing attacks on the streets. They worked with police to improve their responses and lobbied legislators to enact hate crimes protections, which helped make antiqueer violence visible. Others, typically teachers and parents of queer children, focused on creating support systems in schools, so that gay and lesbian teens would not give up hope for a better future.
Gay and lesbian rights groups had tried to combat violence by legislating against hate and supporting queer students in schools, but these projects did not address the root of the violence – the prejudice and hatred that children learned at an early age. To forestall hate crimes, queer rights advocates consequently turned their attention to educational curricula, lobbying schools to identify same-sex sexuality as a matter of benign difference. These advocates met with intense resistance, which restricted their ability to secure even limited reforms. What ultimately transformed the social and legal landscape were the straight family members of gays and lesbians, who came out in droves in the 1990s. These mothers and fathers drew national attention to the plight of their sons and daughters, helping make violence visible. They also helped the country see that support for families and support for gay and lesbian rights were one and the same.
Supportive educators can aid young people in channelling negative emotions about climate change in healthy, adaptive ways. However, globally only a small minority (13 percent) of young people in school have been asked to consider their feelings about climate change and most teachers lack training and confidence to deliver climate change education. The first portion of this chapter provides an overview of climate change education and explores young people’s climate distress in educational settings, with an emphasis on institutional betrayal. The second portion presents case studies and qualitative data from semi-structured interviews conducted with four leading practitioners whose approaches to climate change education acknowledge and support the mental health implications for young people. Finally, themes identified from thematic analysis of the interviews are presented, and key insights for good practice in climate change education are provided.
Persistence in physician-scientist careers has been suboptimal, particularly among women. There is a gender gap in self-confidence in medicine. We measured the impact of our physician-scientist training programs on trainee’s confidence in professional, personal, and scientific competencies, using a survey measuring self-rated confidence in 36 competencies across two timepoints.
Methods:
Results were analyzed for the full survey and for thematic subscales identified through exploratory factor analysis (EFA). A mixed effects linear model and a difference in differences (DID) design were used to assess the differential impact of the programing by gender and career level.
Results:
Analysis included 100 MD-PhD or MD-only medical student or resident/fellow trainees enrolled between 2020 and 2023. Five subscales were identified through EFA; career sustainability, science productivity, grant management, goal setting, and goal alignment (Cronbach’s alpha 0.85–0.94). Overall, mean scores increased significantly for all five subscales. Women significantly increased their confidence levels in all five areas, whereas men increased only in science productivity and grant management. Mixed effects models showed significant increases over time for women compared to men in career sustainability and goal alignment. Residents and fellows had greater increases than medical students across all subscales.
Conclusion:
Physician-scientist trainees fellows increased their confidence in personal, professional, and scientific skills during training. Training had a greater impact on women than men in building confidence in sustaining careers and aligning their goals with professional and institutional priorities. The magnitude of increased confidence among residents and fellows exceeded that in medical students.
Otolaryngology (ENT) plays a crucial role in healthcare, yet undergraduate education in the United Kingdom has historically not reflected this. This study aimed to assess the delivery of ENT education, focusing on teaching methods, clinical placements, and assessment practices.
Methods
An online questionnaire was distributed to medical students. Data were collected via Qualtrics from 5 August 2023 to 17 October 2023.
Results
Forty medical schools were involved. Thirty-seven schools had compulsory ENT teaching however 20 per cent lack an ENT placement. Clinical placements varied, with an average length of 7.3 days. Assessment of ENT knowledge included Objective, Structures, Clinical Examination stations (90 per cent) and written exams (80 per cent).
Conclusion
The study highlights persistent gaps in ENT education. Deficiencies in clinical exposure and lack of alignment with national guidelines indicate the need for improvement. As the Medical Licensing Assessment approaches, standardising assessments may address disparities but should be accompanied by comprehensive changes in teaching methods and placements.
In response to recommendations for improving the quality and coordination of care delivered by eating disorder services, a whole-team training programme was commissioned by Health Education England in 2020. This paper describes the development and evaluation of the Eating Disorder Services for Adults (EDSA) whole-team training course, delivered to National Health Service adult eating disorder community teams in England. Course participants (n = 561) in the first two EDSA training cohorts (2021 and 2022) were asked to complete questionnaires at intake and after each session, asking about their views on the training.
Results
All course aspects were rated as highly enjoyable, meeting participants’ training needs and fostering reflective practice. Thematic analysis identified themes relating to key innovative features of the course and suggestions for improvements.
Clinical implications
Preliminary evaluation suggests that EDSA is valued by clinicians to enhance their knowledge, skills and ability to improve eating disorder patient care.
The new 2021 UK Foundation Programme Curriculum mandates foundation doctors to acquire mental health competencies. This study aimed to evaluate the effectiveness of psychiatry placements in facilitating competency attainment, foundation doctors’ perceived importance of acquiring these and their preferred teaching methods. Utilising Kirkpatrick's evaluation framework, the study employed a pre–post intervention design assessing the impact of psychiatry placements on 135 foundation doctors across three cohorts from August 2021 to March 2022.
Results
Initially, foundation doctors assigned high importance to mental health competencies. Post-placements, this perceived importance improved slightly, whereas that of clinical skills scenarios slightly decreased. Significant confidence increases were observed in recognising and assessing specific psychiatric disorders. Foundation doctors favoured small seminar groups and on-the-job ad hoc teaching. Qualitative insights underscored the need for context-specific teaching.
Clinical implications
Psychiatry placements enhance foundation doctors’ confidence and perceived importance of mental health competencies as specified by the curriculum. Addressing clinical scenario gaps through context-specific teaching and transferable skills development is essential. Customised teaching approaches, especially small seminars and ad hoc teaching, hold promise for effective mental health training.