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The coronavirus disease 2019 (COVID-19) pandemic poses a challenge to the physical and mental well-being of doctors worldwide. Countries around the world introduced severe social restrictions, and significant changes to health service provision in the first wave of the pandemic to suppress the spread of the virus and prioritize healthcare for those who contracted it. This study interviewed 48 hospital doctors who worked in Ireland during the first wave of the pandemic and investigated their conceptualizations of their own well-being during that time (March–May 2020). Doctors were interviewed via Zoom™ or telephone. Interview transcripts were analyzed using structured thematic analysis. Five composite narratives are presented which have been crafted to illustrate themes and experiences emerging from the data. This study found that despite the risks of contracting COVID-19, many doctors saw some improvements to their physical well-being in the first wave of the pandemic. However, most also experienced a decline in their mental well-being due to anxiety, emotional exhaustion, guilt, isolation and poor support. These findings shed light on doctor well-being during COVID-19, and the ways in which they have been affected by the pandemic, both professionally and personally. The paper concludes by highlighting how doctors’ work life and well-being can be better supported during and after the COVID-19 pandemic.

Background Opioid use in pregnancy and the postpartum period in the United States has continued to rise. There are significant barriers to accessing evidence-based treatment and appropriate wrap-around services for pregnant and postpartum individuals and their families. These challenges sit at the intersection of multiple incongruent and fragmented systems, including criminal justice, child welfare, childcare, health insurance, and physical and behavioral health treatment. To support and improve outcomes for this population, with their unique medical and social complexities, we seek to understand how individuals access Medication for Opioid Use (MOUD), barriers to MOUD treatment, and how the policy environment supports or hinders care delivery and recovery. Methods To understand this, we use in-depth interviews with interest-holders from across a mid-Atlantic state with a county-administered system, including prenatal care providers, county-level administrators, treatment programs, and pregnant and parenting people. From these interviews, we develop composite narratives that merge and share findings through the lens of four separate perspectives: an obstetrician, a director of a treatment organization, a local government official, and a parenting person who experiences opioid use disorder. We map these narratives onto the World Health Organization’s Commission on Social Determinants of Health to illustrate the mechanisms for achieving positive health outcomes and demonstrate opportunities for policy engagement. Results The narratives highlight the social and structural determinants of health and illustrate the policy barriers that prevent pregnant and postpartum people with opioid use disorder from accessing care. We highlight policies that govern criminal justice and substance control, child welfare, and childcare systems, as well as policies related to health insurance and treatment center operations. Conclusions This paper articulates how substance use care for pregnant and postpartum people and their families is distinctly different from substance use disorder care for other populations. Efforts to improve outcomes for this population must consider the policy environment, stigma, and the structural determinants of health.

Digital technologies play an increasing role in intimate couple relationships, prompting new approaches to better understand the contemporary digital relationship landscape. This article uses feminist new materialist assemblage thinking to explore the functioning and processes of a relationship support app, Paired. Deploying diffractive analysis, it presents three composite narratives that explore the temporality of couple relationships, relationship work and situated practices of coupledom. Composite narratives retain the emotional truth of original accounts through combined participant voices, enabling attention to be focused on the user–relationship–app assemblage. Findings suggest that routinised app notifications prompt meaningful everyday relationship maintenance behaviours. Human–technology intra-actions thus generate positive relationship health and wellbeing behaviours which may have lasting benefits. This article’s contributions are therefore largely methodological and conceptual, with analysis of supplementary primary interview data (n=20) derived from a mixed-methods evaluation, including brief longitudinal surveys over three months (n=440) and a detailed survey (n=745).

This article examined the complex experiences of Chinese women international students as they navigated multiple tensions related to their gender identity while studying abroad. Using composite narrative inquiries, the study compiled five stories based on interviews with 14 Chinese women who have studied in the U.S. The findings highlighted how exposure to various educational and social contexts shaped these women's understanding of womanhood and gender oppression. Additionally, the study revealed how these experiences influenced their decision-making processes and their determination to create a better place for themselves, other women, and future generations. This study enhances the existing literature on international students' experiences and provides a nuanced understanding of how global processes intersect with individuals on the level of identity and self-formation. (HRK / Abstract übernommen).

Narrative research approaches provide the opportunity for constructing a detailed understanding of lived experiences relevant to medical education, in areas such as illness narratives, explorations of doctor-patient relationships, and the development of professional identities in students and educators. The benefits of the depth of data gathered in narrative research are, however, counterbalanced by possible weaknesses relating to a focus on individual cases and the risk of identification of participants where subjects are sensitive or unique. To address these concerns, researchers from a variety of social science disciplines, carrying out research employing a range of methodological approaches, have begun to use ‘composite narratives’ in which the commonalities in the experiences of research participants are combined to create joint narrative or narratives which illustrate participants’ shared experiences. Composite narratives have been used both as a component of the methodological approach and as a method of presenting the results of research in a variety of methodologies. This A Qualitative Space paper explores the role, strengths, and weaknesses of narrative research, before outlining the ways in which composite narrative has been defined within existing research. Distinctions between the various approaches to creating composite narratives are discussed, highlighting the differences in the types of data utilised, and the approaches taken to data analysis and presentation. A key distinction is identified between the use of composite narratives as part of an integrated methodology and as an approach to the presentation of data. Finally, issues relating to trustworthiness, reflexivity, and implications for researchers are considered.

Composite narratives are derived from a synthesis of research findings and present key themes in a storied format. The story incorporates the researcher’s critical reflections and data interpretation. This method uses individual voices to illustrate themes and experiences while protecting the anonymity of participants. The aim of this paper is to provide a worked example of a composite narrative and explore its utility for presenting qualitative findings at interdisciplinary health research conferences. Conference presentations are crucial to a researcher’s professional development and research dissemination. The short time allotted to such presentations can make it difficult to share the context and richness of qualitative data adequately. A storied approach may offer a more relatable format that effectively engages not only researchers but consumers, practitioners, and policymakers. The composite narrative method provides an engrossing, context-rich, and anonymous method for privileging participant voices including those from marginalised groups. The composite narrative presented in this paper draws from a qualitative descriptive study of chronically ill older people’s social connections. This paper seeks to contribute to the discourse by providing a worked example of the process undertaken to create the conference presentation and outlining key considerations in the formation of a composite narrative, the process of development and the benefits and risks of this approach. We propose that this method humanises research findings and emotionally resonates with interdisciplinary audiences. While composite narratives have been used in manuscript presentation, the application of this method to oral presentation of qualitative findings has not been widely discussed in the health research literature. As such, this paper provides a valuable contribution to the field. Bringing qualitative data to life through a storied approach, particularly in time-limited conference presentations, may increase research impact and dissemination.

Background Assessment of comprehensive consultations in medicine, i.e. a complete history, physical examination, and differential diagnosis, is regarded as authentic tests of clinical competence; however, they have been shown to have low reliability and validity due to variability in the real patients used and subjective examiner grading. In the ASSIMILATE EXCELLENCE study, our aim was to assess the effect(s) of expert tuition with hybrid simulation using a simulated patient wearing a novel auscultation vest, i.e. a hybrid simulated patient, and repeated peer grading using scoring checklists on student learning, performance, and acumen in comprehensive consultations of patients with valvular heart disease. Methods ASSIMILATE EXCELLENCE was a randomized waitlist-controlled trial with blinded outcome assessment undertaken between February 2021 and November 2021. Students at the Royal College of Surgeons in Ireland in either the second or third year of the four-year graduate-entry medical degree programme were randomized to a hybrid simulation training or waitlist control group and undertook three consultation assessments of three different clinical presentations of valvular heart disease (cases: C1–C3) using hybrid simulation. Our primary outcome was the difference in total score between and within groups across time; a secondary outcome was any change in inter-rater reliability across time. Students self-reported their proficiency and confidence in comprehensive consultations using a pre- and post-study survey. Results Included were 68 students (age 27.6 ± 0.1 years; 74% women). Overall, total score was 39.6% (35.6, 44.9) in C1 and increased to 63.6% (56.7, 66.7) in C3 ( P < .001). On intergroup analysis, a significant difference was observed between groups in C2 only (54.2 ± 7.1% vs . 45.6 ± 9.2%; P < .001), a finding that was mainly driven by a difference in physical examination score. On intragroup analysis, significant improvement in total score across time between cases was also observed. Intraclass correlation coefficients for each pair of assessors were excellent (0.885–0.996 [0.806, 0.998]) in all cases. Following participation, students’ confidence in comprehensive consultation assessments improved, and they felt more prepared for their future careers. Conclusions Hybrid simulation-based training improves competence and confidence in medical students undertaking comprehensive consultation assessment of cardiac patients. In addition, weighted scoring checklists improve grading consistency, learning through peer assessment, and feedback. Trial registration ClinicalTrials.gov Identifier: NCT05895799

Higher education has a dual responsibility, both to the academy and to society at large, to effectively confront racism on campus. And yet, in the United States and perhaps elsewhere, it fails to effectively confront racism as the result of systemic flaws, expressed as organizational intransigence, even as new “supportive and protective” structures are created. Thus, the central question raised by the anonymized, composite narrative case study at the core of this paper is as follows: To what extent, if any, do the familiar organizational structures of higher education, encompassing both leadership and management processes, reinforce or resist racism on campus? Consistent with other social science researchers, the authors believe that richly contextualized narrative cases help to bridge the world of ideas and conjecture and actual situations. We used an iterative process spanning three months for drawing our case, involving a back-and-forth communication of actual experiences involving campus racism. The resulting composite narrative provides a richly contextualized situation drawn from real life, while still preserving anonymity. We regarded this later aspect as crucial for making possible the close examination of an ethically challenging situation that might otherwise remain invisible due to sensitive information. Our analysis focused on campus responsiveness to the challenge of racism within a mechanistic organization, rooted in structuralism, versus an organic organization, rooted in post-structuralism. Four aspects of a more organic university design are identified as key to bringing about meaningful, ethically sound change within the academy: deep, reflective listening; a more horizontal, consensus-based leadership structure that empowers professionals at various ranks; freedom within a framework; and a broadly shared, continually reinforced focus on overarching principles, goals, and ideals.

Purpose The purpose of this paper is to explore, through the composite character of Jaheem, a 16-year-old unaccompanied male from sub Saharan Africa seeking asylum in Ireland (UMSA), the different ways in which football, experienced as a global physical pursuit, a lingua franca and an important site of participation and belonging, can facilitate the development of the therapeutic relationship and the building of coping skills in creative psychotherapy. Design/methodology/approach The composite narrative approach draws on notes taken by the author immediately after the psychotherapy sessions of seven UMSA between 2016 and 2019, for whom football became part of the therapy process. The experiences captured in the notes were combined and are re-presented and explored through the composite character of Jaheem. Findings Drawing on the different facets of football was a key factor in developing the therapeutic relationship. This progressed naturally into using player images to identify and explore the expression of difficult feelings, using football talk as a lingua franca and exploring experiences through football as a metaphor for life. Research limitations/implications The risk of Jaheem not being representative of the seven UMSA was mitigated by the psychotherapist’s expertise in this context which informed her judgement of what to include in a meaningful and representative composite. Originality/value Using the rarely used composite narrative approach to capture the potential of engaging with the football theme in a therapeutic setting with UMSA males.

University student-athletes’ contributions in the form of volunteering, community engagement, and civic engagement have been the subject of recent research; however, no studies have specifically examined the factors that facilitate or serve as barriers to contribution in this population. As such, the purpose of this study is to explore the facilitators and barriers relating to university student-athletes’ contributions. Individual semi-structured interviews were conducted with eight university student-athletes (two males, six females) between 18 and 21 years of age (M = 19.25) from two Canadian universities. The analysis led to the identification of two qualitatively distinct profiles regarding how facilitators and barriers to contributions were experienced: (a) the first-year student-athletes and (b) the sustained contributors. Although the participants in each profile identified teammates, coaches, and athletics department staff as facilitators to contribution, they differed in their interpretation of how these individuals facilitated contributions. First-year student-athletes were more reliant than sustained contributors on having facilitators create contribution opportunities. The profiles also differed in regards to how time constraints were overcome. First-year student-athletes utilized less complex, individual time-management strategies, while sustained contributors collaboratively made use of more advanced time-management strategies to optimize their time.