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Background Several studies suggest that medical student empathy declines throughout medical school. However, no studies have synthesised the evidence regarding why empathy declines. Objective To conduct a systematic review and thematic synthesis of qualitative studies investigating why student empathy may change throughout medical school. Methods We included any qualitative study that investigated why empathy might change during medical school. We searched the Medline, Scopus, CINAHL, ERIC, and APA PsycInfo databases for relevant studies. All databases were searched from their inception to 18 July 2022. We also searched the reference lists of the included studies and contacted experts to identify additional studies. We used the Joanna Briggs Institute tool to evaluate the risk of bias in the included studies. Overall confidence in our results was assessed using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach. We used thematic methods to synthesise our findings. Results Our searches yielded 2523 records, and 16 studies involving a total of 771 students were eligible for analysis. Most studies ( n  = 11) were from Europe or North America. The descriptive themes and sub-themes were identified for each study. Increased complexity in patients and their diseases, together with the ‘hidden curriculum’ (including a stressful workload, prioritisation of biomedical knowledge, and (sometimes) poor role models), led to student adaptations, such as cynicism and desensitisation. Students’ prior lives and professional experiences appeared to exacerbate the decline in empathy. However, there were bias concerns for most of the included studies. Discussion Many of the included studies included were small, and some did not include demographic participant data. Given the likely benefits of providing empathic care for patients and practitioners, medical education interventions should focus on developing an ‘empathic hidden curriculum’ that mitigates the decline in medical student empathy. Trial registration A protocol for this systematic review was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) on 28 July 2022 (registration number CRD42022347856).

IntroductionOne in 10 patients are harmed in healthcare, more than three million deaths occur annually worldwide due to patient safety incidents, and the economic burden of patient safety incidents accounts for 15% of hospital expenditure. Poor communication between patients and practitioners is a significant contributor to patient safety incidents. This study aims to evaluate the extent to which patient safety is affected by communication and to provide a logic model that illustrates how communication impacts patient safety.Methods and analysisWe will conduct a systematic review of randomised and non-randomised studies, reported in any language, that quantify the effects of practitioner and patient communication on patient safety. We will search MEDLINE, CINAHL, APA PsychINfo, CENTRAL, Scopus and ProQuest theses and dissertations from 2013 to 7 February 2024. We will also hand-search references of included studies. Screening, data extraction and risk of bias assessment will be conducted by two independent reviewers. Risk of bias will be assessed using the Cochrane Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) for non-randomised studies, and the Cochrane Risk of Bias V.2 (RoB2) for randomised controlled trials. If appropriate, results will be pooled with summary estimates and 95% confidence intervals (CIs); otherwise, we will conduct a narrative synthesis. We will organise our findings by healthcare discipline, type of communication and type of patient safety incident. We will produce a logic model to illustrate how communication impacts patient safety.Ethics and disseminationThis systematic review does not require formal ethics approval. Findings will be disseminated through international conferences, news and peer-reviewed journals.PROSPERO registration numberCRD42024507578.

ObjectiveTo conduct an overview of systematic reviews that explore the effectiveness of interventions to enhance medical student well-being.DesignOverview of systematic reviews.Data sourcesThe Cochrane Library of Systematic Reviews, MEDLINE, APA PsychInfo, CINAHL and Scopus were searched from database inception until 31 May 2023 to identify systematic reviews of interventions to enhance medical student well-being. Ancestry searching and citation chasing were also conducted.Data extraction and synthesisThe Assessing the Methodological Quality of Systematic Reviews V.2 tool was used to appraise the quality of the included reviews. A narrative synthesis was conducted, and the evidence of effectiveness for each intervention was rated.Results13 reviews (with 94 independent studies and 17 616 students) were included. The reviews covered individual-level and curriculum-level interventions. Individual interventions included mindfulness (n=12), hypnosis (n=6), mental health programmes (n=7), yoga (n=4), cognitive and behavioural interventions (n=1), mind-sound technology (n=1), music-based interventions (n=1), omega-3 supplementation (n=1), electroacupuncture (n=1) and osteopathic manipulative treatment (n=1). The curriculum-level interventions included pass/fail grading (n=4), problem-based curriculum (n=2) and multicomponent curriculum reform (n=2). Most interventions were not supported by sufficient evidence to establish effectiveness. Eleven reviews were rated as having ‘critically low’ quality, and two reviews were rated as having ‘low’ quality.ConclusionsIndividual-level interventions (mindfulness and mental health programmes) and curriculum-level interventions (pass/fail grading) can improve medical student well-being. These conclusions should be tempered by the low quality of the evidence. Further high-quality research is required to explore additional effective interventions to enhance medical student well-being and the most efficient ways to implement and combine these for maximum benefit.

This article introduces the initiative by library staff and students at the University of Leicester, co-ordinated between 2020 and 2022, that focused on creating a reading list toolkit to support academic staff in diversifying their module reading lists. Developed through collaboration with student volunteers and academic staff, the toolkit provides prompts for academic staff to critically assess and diversify the resources on their reading lists, addressing biases and ensuring representation across dimensions such as race, gender and socio-economic background.

IntroductionEmpathy is a core component of high-quality care yet is expressed and received in different ways depending on the characteristics (including gender, race, socioeconomic status and disability) of both practitioners and patients. However, the evidence exploring how these characteristics or their overlap (‘intersectionality’) influence empathy has not been synthesised.Methods and analysisWe will systematically review and meta-analyse studies exploring the influence of healthcare practitioners and patient characteristics on empathy in healthcare. MEDLINE, EMBASE (via Scopus), Scopus, PsycINFO, CINAHL, CENTRAL Web of Science, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects will be searched from database inception to present. Reference chasing will be used to identify additional studies. Studies that report empathy levels using either (1) the patient-reported Consultation and Relational Empathy Measure or (2) the practitioner or student-reported Jefferson Scale of Empathy. This will include validated versions or translations of both scales.Two reviewers will independently screen titles, abstracts, and full texts and extract data using Rayyan. Discrepancies will be resolved in discussion with a third author if necessary. Two independent authors will evaluate the risk of bias using the Joanna Briggs Institute tools.Continuous data will be analysed based on the mean, SD, sample size and 95% CIs. Sensitivity analyses will be used to explore the potential impact of risk of bias and use of imputed data. We will explore differences between countries, demographic characteristics, disciplines and lengths of time in practice experience, as well as differences over time (comparing more recent with older studies). We will also explore differences between patient-reported and practitioner-reported empathy.We will report our findings following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and flowchart.Ethics and disseminationEthical approval is not required for this review as primary data will not be collected. The review will be disseminated through peer-reviewed publication and presented at conferences.PROSPERO registration numberCRD42024604677.

Space Motion Sickness (SMS) is a syndrome that affects around 70% of astronauts and includes symptoms of nausea, dizziness, fatigue, vertigo, headaches, vomiting, and cold sweating. Consequences range from discomfort to severe sensorimotor and cognitive incapacitation, which might cause potential problems for mission-critical tasks and astronauts and cosmonauts' well-being. Both pharmacological and non-pharmacological countermeasures have been proposed to mitigate SMS. However, their effectiveness has not been systematically evaluated. Here we present the first systematic review of published peer-reviewed research on the effectiveness of pharmacological and non-pharmacological countermeasures to SMS. We performed a double-blind title and abstract screening using the online Rayyan collaboration tool for systematic reviews, followed by a full-text screening. Eventually, only 23 peer-reviewed studies underwent data extraction. Both pharmacological and non-pharmacological countermeasures can help mitigate SMS symptoms. No definitive recommendation can be given regarding the superiority of any particular countermeasure approach. Importantly, there is considerable heterogeneity in the published research methods, lack of a standardized assessment approach, and small sample sizes. To allow for consistent comparisons between SMS countermeasures in the future, standardized testing protocols for spaceflight and ground-based analogs are needed. We believe that the data should be made openly available, given the uniqueness of the environment in which it is collected. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021244131.

IntroductionSeveral studies suggest that medical student empathy declines throughout medical school. However, no studies have systematically investigated why. The objective of our proposed review is to conduct a systematic review and thematic synthesis of qualitative studies investigating the reasons empathy may change throughout medical school.Methods and analysisThis systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We have searched MEDLINE, Scopus, CINAHL, ERIC and APA PsycINFO for relevant studies. We will also search reference lists of included studies and contact experts to identify additional studies. We will include any qualitative study investigating the reasons why empathy changes throughout medical school. We will use the Joanna Briggs Institute tool to evaluate the risk of bias in the included studies. We will use thematic analysis to synthesise our results. For all included studies, we will summarise the main characteristics including the number of participants, medical school year, country and gender. In our discussion, we will summarise the limitations of the evidence (including the risk of bias and inconsistency), and provide a general interpretation of the results and important implications.Ethics and disseminationThis study will not require ethical approval since no original data will be collected. The results of this review will be published through peer-reviewed publications and conference presentations. Additionally, this review will inform changes to the enhanced empathy curriculum at the Leicester Medical School.

Background: Coronary microvascular disease is associated with adverse prognosis in a range of cardiovascular diseases, but its prognostic role in patients with aortic stenosis (AS) is unclear. The aim of this systematic review and meta-analysis is to determine the prognostic role of myocardial perfusion and coronary flow reserve, assessed using non-invasive imaging modalities, in patients with AS. Methods: We conducted a systematic review and meta-analysis of all studies assessing myocardial perfusion reserve (MPR) or coronary flow reserve (CFR) in patients with AS and reporting clinical outcomes, from inception to January 2024. The definition of abnormal MPR/CFR and major adverse cardiovascular events (MACE) was that used in each study. Estimates of effect were calculated from hazard ratios (HRs) and 95% confidence intervals (CIs) using a random-effects model. Results: Four studies comprising 384 participants met the inclusion criteria. Myocardial/coronary blood flow was assessed using Doppler echocardiography (n = 2), PET (n = 1), or cardiac magnetic resonance (n = 1). The median optimal cutoff for MPR/CFR across all studies was 2.01 (range 1.85–2.13), with 109 events. Impaired MPR/CFR was associated with a higher incidence of MACE (HR 3.67, 95% CI: 1.66, 8.09, I2 = 63%) in the overall population. Conclusions: Reduced MPR/CFR is associated with increased risk of MACE in patients with AS, although significant heterogeneity exists in published studies. Further studies are required to establish its role in the risk stratification of asymptomatic patients with AS.

BackgroundCoronary microvascular disease is well recognised in aortic stenosis (AS) and has been shown to be associated with adverse prognosis in a range of cardiovascular diseases. However, the prognostic role of myocardial perfusion reserve (MPR) or coronary flow reserve (CFR) in patients with AS has not been conclusively established.PurposeTo determine the prognostic role of MPR/CFR, assessed using non-invasive imaging modalities, in patients with AS.MethodsA systematic search of the MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE and SCOPUS databases from inception to 09 January 2024 was conducted. Two authors (SA and MH) independently screened titles/abstracts. Studies where an index of CFR/ MPR was measured in patients with AS and clinical outcomes were reported were included (PROSPERO ID 358443). Indices representing the ratio between maximal coronary blood flow and resting coronary blood flow were considered equivalent; these studies were meta-analysed together. The primary outcome was MACE as defined in each study. The definition of abnormal MPR was that used in each study. Estimates of effect were calculated from published hazard ratios (HRs) and 95% confidence intervals using a random-effects model. Risk of bias assessment was performed using Quality in Prognosis Studies (QUIPS) tool.ResultsOf 1417 identified studies from the initial search, 4 studies with a total of 393 subjects met the inclusion criteria. The patient characteristics are summarised in table 1. Two studies (301 patients) included only asymptomatic patients and 3 studies included only patients with moderate and severe AS whereas one also included patients with mild AS. The median follow-up duration was 38.3 months, ranging from 12 to 104 months. Myocardial/ coronary blood flow was assessed using PET, transthoracic or transoesophageal echocardiography or cardiac magnetic resonance. The median optimal cut off for MPR/CFR across all studies was 2.01, ranging from 1.85 to 2.13, to predict MACE. Impaired MPR/CFR was associated with a higher incidence of MACE (HR 2.74, 95% CI: 1.45, 5.18) (figure 1). Significant heterogeneity was present (I2 >50%). The association of MPR with MACE was consistent across disease severity. A sensitivity analysis confirmed a significant association of MPR/CFR with MACE in patients with moderate to severe AS (HR 1.95, 95% CI: 1.34, 2.85).ConclusionReduced MPR/CFR is strongly significantly with increased risk of MACE in patients with AS, although significant heterogeneity exists in published studies. Further studies are required in to establish the role of CFR/MPR in risk stratification of asymptomatic patients with AS.Abstract 7 Table 1Baseline clinical characteristicsMale 233 (55) Age (years) 66.3 ± 11.7 Diabetes 78 (26) Hypertension 163 (69) Coronary artery disease 30 (11) Systolic blood pressure (mmHg) 147 ± 20 AV mean pressure gradient (mmHg) 37.5 ± 11.2 AVAi (cm2/m2) 0.80 ± 0.22 Left ventricular mass (g/m2) 80 ± 26 Weighted follow up (months) 38.3 Values are mean ± SD, n (%)AV, aortic valve; AVAi, aortic valve area indexed to BSAAbstract 7 Figure 1Forest plot showing coronary flow reserve as an indicator of major adverse cardiovascular events. Hazard ratios for individual studies are represented by squares, and 95% confidence intervals (CI) are represented by horizontal lines. Pooled estimates and their 95% confidence intervals are represented by diamonds. Subgroups are by disease presentation. The sizes of the squares and the diamonds are proportional to the weight assigned to the relative effect sizesConflict of InterestNone

This article introduces the initiative by library staff and students at the University of Leicester, coordinated between 2020 and 2022, that focused on creating a reading list toolkit to support academic staff in diversifying their module reading lists. Developed through collaboration with student volunteers and academic staff, the toolkit provides prompts for academic staff to critically assess and diversify the resources on their reading lists, addressing biases and ensuring representation across dimensions such as race, gender and socio-economic background.