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Biofeedback and mindfulness in everyday life : practical solutions for improving your health and performance
A mind-body approach to taking control of your physical and emotional health.
Book
Perceptions of medical students towards online teaching during the COVID-19 pandemic: a national cross-sectional survey of 2721 UK medical students
ObjectivesTo investigate perceptions of medical students on the role of online teaching in facilitating medical education during the COVID-19 pandemic.DesignCross-sectional, online national survey.SettingResponses collected online from 4th May 2020 to 11th May 2020 across 40 UK medical schools.ParticipantsMedical students across all years from UK-registered medical schools.Main outcome measuresThe uses, experiences, perceived benefits and barriers of online teaching during the COVID-19 pandemic.Results2721 medical students across 39 medical schools responded. Medical schools adapted to the pandemic in different ways. The changes included the development of new distance-learning platforms on which content was released, remote delivery of lectures using platforms and the use of question banks and other online active recall resources. A significant difference was found between time spent on online platforms before and during COVID-19, with 7.35% students before versus 23.56% students during the pandemic spending >15 hours per week (p<0.05). The greatest perceived benefits of online teaching platforms included their flexibility. Whereas the commonly perceived barriers to using online teaching platforms included family distraction (26.76%) and poor internet connection (21.53%).ConclusionsOnline teaching has enabled the continuation of medical education during these unprecedented times. Moving forward from this pandemic, in order to maximise the benefits of both face-to-face and online teaching and to improve the efficacy of medical education in the future, we suggest medical schools resort to teaching formats such as team-based/problem-based learning. This uses online teaching platforms allowing students to digest information in their own time but also allows students to then constructively discuss this material with peers. It has also been shown to be effective in terms of achieving learning outcomes. Beyond COVID-19, we anticipate further incorporation of online teaching methods within traditional medical education. This may accompany the observed shift in medical practice towards virtual consultations.
Journal Article
Role of active patient involvement in undergraduate medical education: a systematic review
ObjectivesTo identify the scope of active patient involvement in medical education, addressing the current knowledge gaps relating to rationale and motivation for involvement, recruitment and preparation, roles, learning outcomes and key procedural contributors.MethodsThe authors performed a systematic search of the PubMed database of publications between 2003 and 2018. Original studies in which patients take on active roles in the development, delivery or evaluation of undergraduate medical education and written in English were eligible for inclusion. Included studies’ references were searched for additional articles. Quality of papers was assessed using the Mixed Methods Appraisal Tool.Results49 articles were included in the review. Drivers for patient involvement included policy requirements and patients’ own motivations to contribute to society and learning. Patients were engaged in a variety of educational settings in and outside of the hospital. The vast majority of studies describe patients taking on the role of a patient teacher and formative assessor. More recent studies suggest that patients are increasingly involved in course and curriculum development, student selection and summative assessment. The new body of empirical evidence shows the wide range of learning objectives was pursued through patient participation, including competencies as professional, communicator, collaborator, leader and health advocate, but not scholar. Measures to support sustainable patient involvement included longitudinal institutional incorporation, patient recruitment and/or training, resource support and clear commitment by faculty. The importance and advantages of patient involvement were highlighted by students, faculty and patients themselves; however, organisations must continue to consider, monitor and take steps to mitigate any potential harms to patients and students.DiscussionThis systematic review provides new knowledge and practical insights to physicians and faculty on how to incorporate active patient involvement in their institutions and daily practice, and provides suggested action points to patient organisations wishing to engage in medical education.
Journal Article
Brain control : developments in therapy and implications for society
\"With the burden of brain disorders increasing worldwide, there has been a resurgence of interest in techniques to control the brain and thereby improve its function. Yet how realistic are these expectations and what are the ethical implications? This book reviews the main techniques that can enable patients to use their brains for communication and control and doctors to modify brain function. It explains how paralysed patients may be helped through brain reading, how brain stimulation can help to improve Parkinson's disease and certain mental disorders and how patients can be trained to regulate their own brain activity through neurofeedback. Brain Control situates the application of these techniques within ethical and legal debates on the principles of autonomy and fairness, and suggests ethical standards for their future development\"-- Provided by publisher.
Book
Defining clinical empathy: a grounded theory approach from the perspective of healthcare workers and patients in a multicultural setting
ObjectiveTo define clinical empathy from the perspective of healthcare workers and patients from a multicultural setting.DesignGrounded theory approach using focus group discussions.SettingA health cluster in Singapore consisting of an acute hospital, a community hospital, ambulatory care teams, a medical school and a nursing school.Participants69 participants including doctors, nurses, medical students, nursing students, patients and allied health workers.Main outcome measuresA robust definition of clinical empathy.ResultsThe construct of clinical empathy is consistent across doctors, nurses, students, allied health and students. Medical empathy consists of an inner sense of empathy (imaginative, affective and cognitive), empathy behaviour (genuine concern and empathic communication) and a sense of connection (trust and rapport). This construct of clinical empathy is similar to definitions by neuroscientists but challenges a common definition of clinical empathy as a cognitive process with emotional detachment.ConclusionsThis paper has defined clinical empathy as ‘a sense of connection between the healthcare worker and the patient as a result of perspective taking arising from imaginative, affective and cognitive processes, which are expressed through behaviours and good communication skills that convey genuine concern’. A clear and multidimensional definition of clinical empathy will improve future education and research efforts in the application and impact of clinical empathy.
Journal Article
How effective is undergraduate palliative care teaching for medical students? A systematic literature review
Palliative care is central to the role of all clinical doctors. There is variability in the amount and type of teaching about palliative care at undergraduate level. Time allocated for such teaching within the undergraduate medical curricula remains scarce. Given this, the effectiveness of palliative care teaching needs to be known.ObjectivesTo evaluate the effectiveness of palliative care teaching for undergraduate medical students.DesignA systematic review was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Screening, data extraction and quality assessment (mixed methods and Cochrane risk of bias tool) were performed in duplicate.Data sourcesEmbase, MEDLINE, PsycINFO, Web of Science, ClinicalTrials.gov, Cochrane and grey literature in August 2019. Studies evaluating palliative care teaching interventions with medical students were included.Results1446 titles/abstracts and 122 full-text articles were screened. 19 studies were included with 3253 participants. 17 of the varied methods palliative care teaching interventions improved knowledge outcomes. The effect of teaching on clinical practice and patient outcomes was not evaluated in any study.ConclusionsThe majority of palliative care teaching interventions reviewed improved knowledge of medical students. The studies did not show one type of teaching method to be better than others, and thus no ‘best way’ to provide teaching about palliative care was identified. High quality, comparative research is needed to further understand effectiveness of palliative care teaching on patient care/clinical practice/outcomes in the short-term and longer-term.PROSPERO registration numberCRD42018115257.
Journal Article
Is the awarding gap at UK medical schools influenced by ethnicity and medical school attended? A retrospective cohort study
ObjectivesTo better characterise the Awarding Gap (AG) between black, Asian and other minority ethnic (BAME) and white students in UK undergraduate medical education by examining how it affects eight minority ethnicity subgroups (Bangladeshi, black, Chinese, Indian, Pakistani, mixed, other Asian background and other ethnic background) and whether the AG varies by medical school attended.DesignRetrospective cohort study.SettingData extracted from the UK Medical Education Database on students enrolled at 33 UK medical schools in the academic years starting 2012, 2013 and 2014.Participants16 020 ‘Home’ tuition fee status students who sat the University Clinical Aptitude Test on entry to university and obtained a UK Foundation Programme (UKFP) application score on exit.Primary outcome measureUKFP Z-scores on exit from medical school.ResultsThere were significant differences in UKFP Z-scores between ethnicity subgroups. After white students, mixed ethnicity students performed best (coefficient −0.15 standard deviations [SD]) compared with white students, (95% confidence interval [CI] −0.23 to −0.08, p<0.001) and Pakistani students scored lowest (coefficient −0.53 SD, 95% CI −0.60 to −0.46, p<0.001). In pairwise comparisons of scores between all nine individual ethnicity subgroups, 15/36 were statistically significant. The AG varied considerably across medical schools. The largest gap showed the coefficient for BAME was −0.83 SD compared with white students (95% CI −1.18 to −0.49, p<0.001), while the smallest demonstrated no statistically significant difference in performance between BAME and white students (+0.05 SD, 95% CI −0.32 to 0.42, p=0.792).ConclusionsBAME students are significantly disadvantaged by the current UK medical education system. There are clear differences in medical school outcomes between students from different ethnicity subgroups, and the size of the AG also varies by medical school attended. Urgent and effective action must be taken to address the AG and achieve an equal learning environment for our future doctors.
Journal Article
Systematic scoping review on moral distress among physicians
BackgroundConcepts of moral distress (MD) among physicians have evolved and extend beyond the notion of psychological distress caused by being in a situation in which one is constrained from acting on what one knows to be right. With many accounts involving complex personal, professional, legal, ethical and moral issues, we propose a review of current understanding of MD among physicians.MethodsA systematic evidence-based approach guided systematic scoping review is proposed to map the current concepts of MD among physicians published in PubMed, Embase, PsycINFO, Web of Science, SCOPUS, ERIC and Google Scholar databases. Concurrent and independent thematic and direct content analysis (split approach) was conducted on included articles to enhance the reliability and transparency of the process. The themes and categories identified were combined using the jigsaw perspective to create domains that form the framework of the discussion that follows.ResultsA total of 30 156 abstracts were identified, 2473 full-text articles were reviewed and 128 articles were included. The five domains identified were as follows: (1) current concepts, (2) risk factors, (3) impact, (4) tools and (5) interventions.ConclusionsInitial reviews suggest that MD involves conflicts within a physician’s personal beliefs, values and principles (personal constructs) caused by personal, ethical, moral, contextual, professional and sociocultural factors. How these experiences are processed and reflected on and then integrated into the physician’s personal constructs impacts their self-concepts of personhood and identity and can result in MD. The ring theory of personhood facilitates an appreciation of how new experiences create dissonance and resonance within personal constructs. These insights allow the forwarding of a new broader concept of MD and a personalised approach to assessing and treating MD. While further studies are required to test these findings, they offer a personalised means of supporting a physician’s MD and preventing burn-out.
Journal Article