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Background An important element of effective clinical practice is the way physicians think when they encounter a clinical situation, with a significant number of trainee physicians challenged by translating their learning into professional practice in the clinical setting. This research explores the perceptions of educators about how trainee physicians develop their clinical thinking in clinical settings. It considers what educators and their colleagues did to help, as well as the nature of the context in which they worked. Method A qualitative approach was used in this study with in depth interviews carried out with educators as key informants. Rich data derived from 15 interview transcripts were analysed thematically in a rigorous and iterative process. Results Three broad and overlapping themes were identified: working in an educationally minded culture; proximity of the educator to the trainee physician; and trajectory of the trainee physician. The departments in which these educators worked emphasised the importance for the education of trainee physicians. All members of the team were responsible for education of the team, and all members, particularly senior nurses, were able to give feedback upon the trainee physicians’ progress. Educators described working side by side with their trainee physician and frequently being in close proximity to them which means that the educator was both easily accessible and spent more time with their trainee physicians. They described a trajectory of the trainee physicians through the placement with close monitoring and informal assessment throughout. Conclusion Recommendations are made as to how trainee physicians can be supported to develop their clinical thinking. Educators and managers can analyse their own and their department’s practice and select the recommendations relevant to their local circumstances in order to make change. This study adds the educator perspective to a body of literature about the importance of context and supportive learning environments. As such the discussion is applicable to the education of other health professionals.

Mobile devices have become increasingly important to young people who now use them to access a wide variety of health-related information. Research and policy related to the integration of health information and support with this technology do not effectively consider the viewpoint of a younger patient. Views of young people with type 1 diabetes are vital in developing quality services and improving their own health-related quality of life (HRQOL), yet research on their lifestyle and use of Web and mobile technology to support their condition and in non-health-related areas is sparse. To develop insight into young people with type 1 diabetes and their current use of Web and mobile technology and its potential impact on HRQOL. This can be achieved by constructing an in-depth picture of their day-to-day experiences from qualitative interviewing and exploring how they make use of technology in their lives and in relation to their condition and treatment. The goal was then to build something to help them, using the researcher's technical expertise and seeking users' opinions during the design and build, utilizing sociotechnical design principles. Data were collected by semistructured, in-depth qualitative interviews (N=9) of young people with type 1 diabetes aged 18-21. Interviews were transcribed and loaded onto NVivo for theme identification. Data analysis was undertaken during initial interviews (n=4) to locate potential ideas and enhancements for technical development. Latter interviews (n=5) assisted in the iterative sociotechnical design process of the development and provided additional developmental ideas. Six themes were identified providing an understanding of how participants lived with and experienced their condition and how they used technology. Four technological suggestions for improvement were taken forward for prototyping. One prototype was developed as a clinically approved app. A number of ideas for new mobile apps and enhancements to currently existing apps that did not satisfactorily cater to this age group's requirements for use in terms of design and functionality were suggested by interviewees but were not prototyped. This paper outlines the nonprototyped suggestions from interviewees and argues that young people with type 1 diabetes have a key role to play in the design and implementation of new technology to support them and improve HRQOL. It is vital to include and reflect on their suggestions as they have a radically different view of technology than either their parents or practitioners. We need to consider the relationship to technology that young people with type 1 diabetes have, and then reflect on how this might make a difference to them and when it might not be a suitable mechanism to use.

A 32-year-old woman developed severe recurrent hypoglycemia after a medically assisted, first-trimester abortion. She had had type 1 diabetes since 1988, and the pregnancy was her first and planned. The patient's glycemic control had been good, with a preconception A1C of 6.3%. She was on a multiple daily injection insulin regimen and routinely counted carbohydrate. Unfortunately, she had a missed miscarriage at 11 weeks' gestation and opted for medical management. She was given mifepristone 800 μg. After taking mifepristone, the patient noticed that she had numerous episodes of unexplained prolonged hypoglycemia. She had a significant and sudden drop in capillary glucose levels with no obvious trigger and very little warning within about 2 hours after taking mifepristone. Over the next 2-4 days, she continued to have multiple hypoglycemic episodes, mostly attributable to her rapid-acting insulin. However, her glycemic control started to settle down after 5 days, and her blood glucose levels subsequently stabilized in her target range with no hypoglycemia. She was seen in the diabetes clinic after this episode, when she reported the effects of the medical miscarriage treatment on her glycemic control. Her glycemic control has remained stable since, without any further episodes of unexplained hypoglycemia.

Mobile devices have become increasingly important to young people who now use them to access a wide variety of health-related information. The objective of this study is to develop insight into young people with type 1 diabetes and their current use of Web and mobile technology and its potential impact on health-related quality of life (HRQOL). The goal was then to build something to help them, using the researcher's technical expertise and seeking users' opinions during the design and build, utilizing sociotechnical design principles. This paper outlines the nonprototyped suggestions from interviewees and argues that young people with type 1 diabetes have a key role to play in the design and implementation of new technology to support them and improve HRQOL. We need to consider the relationship to technology that young people with type 1 diabetes have, and then reflect on how this might make a difference to them and when it might not be a suitable mechanism to use. Adapted from the source document.

Background An important element of effective clinical practice is the way physicians ‘think’ when they encounter a clinical situation, with a significant number of physicians in training challenged by translating their learning into professional practice in the clinical setting. This research explores the perceptions of educators about how physicians in training develop their clinical thinking in clinical settings. It considers what educators and their colleagues did to help, as well as the nature of the ‘context’ in which they worked. Method A qualitative approach was used in this study with in depth interviews carried out with educators as ‘key informants’. Rich data derived from fifteen interview transcripts were analysed thematically in a rigorous and iterative process. Results Three broad and overlapping themes were identified: working in an educationally minded culture; proximity of the educator to the physician in training; and trajectory of the physician in training. The departments in which these educators worked emphasised the importance on the education of physicians in training. All members of the team were responsible for education of the team, and all members, particularly senior nurses, were able to give feedback upon the physicians’ in training progress. Educators described working side by side with their physician in training and frequently being in close proximity to them, which means that the educator was both easily accessible and spent more time with their physicians in training. They described a trajectory of the physicians in training through the placement with close monitoring and informal assessment throughout. Conclusion Recommendations are made as to how physicians in training can be supported to develop their clinical thinking. Educators and managers can analysis their own and department’s practice and select the recommendations relevant to their local circumstances in order to make change. This study adds the educator perspective to a body of literature about the importance of context and supportive learning environments. As such the discussion is applicable to the education of other health professionals.