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Why did you do this work?Paediatrics is becoming a less popular career choice. While the number of medical student places continues to increase, those choosing to specialise in paediatrics after graduation has steadily declined between 2016 to 2022.1–3 Coupled with the increased demand on paediatric services, the Royal College of Paediatrics and Child Health have acknowledged that these issues ‘threaten the safety of our children’s health’.4 In response to this, we designed a mixed methods study with the following objectives:To explore fifth- and sixth-year UCL medical students’ views on current career advice received during undergraduate trainingTo investigate whether the clinical placement had altered medical students’ decision to apply to paediatrics after foundation trainingTo identify educational approaches to meet the needs of medical students considering a career in paediatrics.What did you do?We invited 40 UCL students to complete an online survey following their paediatric clinical placement between December 2023 and May 2024. 28 students responded (response rate 70%). This comprised of Likert scale and white space questions to gather both quantitative and qualitative data.We then hosted a focus group of 12 fifth- and sixth-year medical students. A systematic, non-probabilistic sampling method was used to identify those who had completed their paediatric clinical placement and were considering a career in paediatrics. Anonymised transcripts were analysed using an inductive thematic approach.What did you find?The initial survey found that 12 students (42.9%) were likely or very likely to apply to paediatrics with 22 students (78.6%) reporting that their clinical placement had a positive impact when considering a career in paediatrics. Both positive and negative impacts of the clinical placement were explored in the qualitative survey data.The main themes from our focus group discussion (FGD) were –Frustration around the current career advice availableWanting to understand the application process and how to gain relevant experienceA desire to hear more honest, personal experiences from paediatriciansA request for a mentoring or networking scheme for undergraduate medical studentsWhat does it mean?Our results show that there is a significant opportunity to engage students in meaningful career conversations at the end of their paediatric clinical placements. Following these results, we co-produced an infographic alongside a fifth-year medical student which focused on the areas of need identified in the FGD. This will be disseminated to all UCL medical students following their paediatric placement.We have since added a careers session to our teaching schedule. This focuses on the personal journeys of our junior doctors, honest accounts of being a paediatrician and an open Q&A forum.ReferencesBindal T, Wall D, Goodyear HM. Medical students’ views on selecting paediatrics as a career choice. European Journal of Pediatrics 2011;170(9):1193–9.Kahvo M, Whelan R, Vallabhaneni P. Why choose paediatrics? A scoping review of factors affecting the choice of paediatrics as a career. European Journal of Pediatrics 2023;182(1):9–23.Mallett P, Thompson A, Bourke T. Addressing recruitment and retention in paediatrics: a pipeline to a brighter future. Archives of Disease in Childhood – Education and Practice, 2022;107:57–63.Royal College of Paediatrics & Child Health. (2018). Workforce briefing- winter 2018. Available at: https://www.rcpch.ac. uk/resources/workforce-briefing-winter-2018 [Accessed 30 December 2023].

This article reports on a qualitative study which explored online student engagement experiences in a higher education institution. There are very few studies providing in-depth perspectives on the engagement experiences of online students. The project adopted a case study approach, following 24 online students over one academic year. The setting for the study was an undergraduate online Humanities programme at Dublin City University. The research question for the study was: What themes are central to online student engagement experiences? Data was collected from participant-generated learning portfolios and semi-structured interviews and analysed following a data-led thematic approach. The five central themes that make up the study’s findings highlight key issues of students’ sense of community, their support networks, balancing study with life, confidence, and their learning approaches. The findings of this study indicate that successful online student engagement was influenced by a number of psychosocial factors such as peer community, an engaging online teacher, and confidence and by structural factors such as lifeload and course design. One limitation of the study is that it is a relatively small, qualitative study, its findings provide insights into how online degrees can support online students to achieve successful and engaging learning experiences.

BackgroundThe NHS Friends and Family Test (FFT) is routinely used to gather around 1.2 million pieces of feedback each month. This information is utilised to transform services in ways that matter most to patients. In 2015 there was a large drive to gain paediatric service user feedback. Despite this, a child friendly FFT is not available within large proportion of paediatric settings.AimThis study aimed to provide a platform for children and young people to feedback on the services they use and to report this information back to the regional flexible bronchoscopy service providers, facilitating praise and suggestions for improvement.MethodologyFeedback regarding patient and parent/carer experience of the regional flexible bronchoscopy service was collected via an online questionnaire, with the main question based upon the NHS FFT. The online questionnaire was accessed via a website designed for this study. Adaptations to make the study suitable for paediatric implementation included using ‘Monkey’ - a cartoon character with varying facial expressions. For example, ‘Monkey’ was linked to a Likert scale, facilitating children to independently respond to questions. Information sheets containing details of the study were handed to parents/carers on the day of their child’s procedure. Posters in recovery and business cards to take home displaying the website URL were used to boost response rate. Satisfaction rates were calculated based on patient and parent/carer response to the adapted FFT. Answers to qualitative questions were manually analysed in a thematic approach to identify recurring themes.Results22 questionnaires were completed by parents, with 13 patient sections being completed, over 8 months. Parental and patient satisfaction rates were high, at 100% and 92% respectively. Attentive, informative and friendly staff were the main justifications for their positive feedback. Suggestions for improvement were limited, with no dominant themes being detected.ConclusionThere were overwhelmingly high satisfaction rates from both the parent and patient perspective, with minimal suggestion for improvements. To strengthen conclusions further data needs collecting. The acceptability by both patients and parents/carers means the resources created in this study have potential to be used across multiple departments and multiple paediatric centers.

The overarching project of the conceptual and empirical contributions in this special issue is to redraw boundaries for language teacher cognition research. Our aim in this final article is to complement the foregoing collection of articles by conceptualizing ontologically and methodologically past and current trajectories in language teacher cognition research and synthesizing various themes that arise across this body of work. To that end, we begin by first making the case for the construct under examination and posing some key questions: What is the nature of the mind that we are examining in language teacher cognition research? How have conceptualizations of that mind changed over the period that language teacher cognition research has emerged as a field of empirical study? We then consider how the mind in language teacher cognition research has been studied ontologically, and the conceptual advances that have characterized such research. We conclude by examining how studies in this collection reflect our account of these changes over time.

Background: Following the COVID-19 pandemic, the world's socio-economic structure must adjust to operate within the new normal for each country for its citizens to survive. Many jobs are now operating online, which has changed regular workers into \"digital workers\". The abrupt shift in the nature of work has caused pandemic-related stress among workers and raises the question - can these digital workers thrive during the pandemic? The study aims to evaluate pandemic-related stress faced by digital workers and their resilience and ability to thrive during the pandemic.  Methods: A qualitative research methodology in the form of a thematic approach was used to gauge digital workers' pandemic-related stressors and resilience strategies during the COVID-19 pandemic. 15 digital workers from various backgrounds were interviewed using a semi-structured questionnaire.  Results: Five themes were identified as the pandemic-related stressors among digital workers. These include anxiety about COVID-19 infections, mental exhaustion, physical exhaustion, feeling insecure and uncertain about financial concerns. The resilience factors include an active approach towards problem-solving, a positive outlook even during suffering, staying focused on responsibility for others, managing  one's well-being and a strong reliance on faith.  Conclusions: The outcomes of the study were derived from the culmination of a qualitative approach that comprehended the feelings, ideas, and experiences of digital workers. Therefore, there is a need to conduct a quantitative analysis in order to test the hypotheses and assumptions of the study.

Objective25% of children in hospital experience harmful medication related problems (MRPs).1 Recent research has shown that medicines management in practice is highly complex.2 3 We report the parent experiences of medication safety for children in English hospitals.MethodAn ethnographic study was conducted in three paediatric units in the North of England. 230 hours of non-participant observation and 19 semi-structured interviews with healthcare professionals and parents were undertaken. Data were analysed using an inductive thematic approach. A family forum of five parents helped interpret the data, facilitated by the lead researcher.ResultsGenerally care was viewed as safe with regards acute medication, but for those patients with routine medication needs four themes emerged in the analysis:Advocacy and AutonomyParents ‘reached in’ to support professionals in their tasks. However, this was in tension with organisational expectations. Professionals would assume responsibility for medication at the point of prescription. Parents would continue to administer medicines to their children until then. This could be some time after admission, and created a chaotic medicines landscape. Medicines were often selected on the basis of organisational preference rather than personal requirements resulting in non-adherence.The parent as an information sourceWhere there was a knowledge gap, parents were invited to support the medication process including monitoring. Notwithstanding this, parental medication information was often validated against inaccurate medical records.Competency and patient-centred careParents were asked to administer medicines; competency was generally assumed. Without parents medicines would not be given ‘on time.’ They also provided an additional check on administration. Notwithstanding this informal role, where parents disagreed with professionals, or expressed concerns about their child’s medicines they were dismissed as ‘hard work.’Communication barriersParents were primarily discouraged from participation in medication processes because organisations could not assure communications of changes in medicines. Where parents were involved in medication errors they were often viewed as a causative factor.ConclusionThis study places the parent voice at the heart of patient safety research. Though no adverse medication events were observed, there is evidence that parents are an important source of resilience in medicines safety. The systems for medication safety in hospital are impossible to deliver without parental involvement.Parents want to be part of the system, rather than passive observers. Research is needed to define the role that parents can contribute, to explore barriers to more parent involvement, and how we can maintain safety for all stakeholders.ReferencesSutherland A, Phipps DL, Tomlin S, Ashcroft DM. Mapping the prevalence and nature of drug related problems among hospitalised children in the United Kingdom: A systematic review. BMC Pediatr.; 2019;19:486.Hawkins SF, Morse JM. Untenable expectations: nurses’ work in the context of medication administration, error, and the organization. Glob Qual Nurs Res. 2022;9:1–17.Sutherland A, Phipps DL, Gill A, Wolffsohn K, Morris S, Ashcroft DM. A work domain analysis of medicines management for hospitalised children. In: Balfe N, Golightly D, editors. Ergon Hum Factors. Birmingham, UK: CIEHF; 2022.

ObjectivesFollowing on from a qualitative evidence synthesis,1 and forming the second phase of the INSCHOOL project, this unique large scale qualitative study aims to understand the secondary school experiences of young people with long-term health conditions. This study will inform the development of a new assessment to identify unmet needs within this population for screening and evaluation purposes across education, health and research settings.MethodsThis study adopted a cross-sectional participant-led qualitative design. Young people, 11–18 years old, were invited via outpatient clinics to participate in virtual interviews, focus groups, or an alternative written activity. Recruitment covered 11 long term health conditions selected for diversity of known risk factors such as visibility, severity and predictability: oncology, neuromuscular, cystic fibrosis, colorectal surgery, diabetes, chronic pain, asthma, allergies, rheumatology, dermatology, and haematology. Data collection was participant driven and facilitated by a preparation activity provided beforehand. Transcripts and written tasks were analysed using a needs-based thematic approach,2, supported by participatory analysis meetings with patient advisors who have been involved since the inception of the project.ResultsSixty-five young people participated in the study. There was good representation across age, gender and ethnicity. Many described distressing and challenging experiences related to managing secondary school life in the context of their health conditions. Analysis of the transcripts was conducted in parallel with data collection and has resulted in identification of six fundamental needs this group have in relation to their school lives:Need to manage my condition safely at schoolNeed for a flexible education pathwayNeed to feel seen, acknowledged and listened to at the right times in the right wayNeed to feel included in and supported by the school communityNeed to build towards my futureNeed to develop an approach to adapting to school life with a health conditionConclusionsParticipant accounts reflected basic needs that were often not being met within school. The emphasis that is placed on attendance and attainment within schools means that the more holistic needs of this group are often overlooked. Professionals supporting this group should ensure they are not solely focussing on attendance and attainment, but are assessing and meeting the broader needs of these young people within school. There are significantly greater similarities across conditions than there are differences, suggesting cross-condition working should be the aim of future interventions, policies, resources and support.ReferencesSpencer BK, Wright J, Flemming K, Cottrell D, Pini S. School lives of adolescent school students living with chronic physical health conditions: a qualitative evidence synthesis. Archives of Disease in Childhood 2022 Dec 2.McKenna SP, Doward LC. The needs-based approach to quality of life assessment. Value in Health 2004;7, Suppl. 1(0):S1–S3.

Asset-based approaches to health promotion have become increasingly popular as a way to tackle health inequalities by empowering people in more disadvantaged communities to use local resources and increase control over health and its determinants. However, questions remain about how they work in practice. This article presents the findings from a systematic scoping review of the empirical literature on asset-based approaches in communities. The aim was to identify the key elements of asset-based approaches, and how they are operationalised in interventions aimed at promoting health and reducing inequalities in local communities. Four databases were searched (Medline, PsycINFO, CINAHL, ASSIA) and papers were included if they described interventions explicitly adopting an asset-based approach but excluded if limited to asset identification. Thirty articles were included in the review. Data were extracted on the type of assets that the intervention built upon, how assets were mobilised, the expected outcomes and evaluation methods. A framework is presented that synthesises the key characteristics of asset-based interventions to promote health in communities. Three main approaches to mobilising assets were identified in the literature: (A) connecting assets, (B) raising awareness of assets and (C) enabling assets to thrive. It is argued that asset-based approaches to health promotion take a wide variety of forms, making it difficult to anticipate outcomes and to evaluate interventions. The framework presented here can be used to better understand the processes through which asset-based approaches work in practice to promote health and reduce inequalities.

To delineate the prevalence of smartphone addiction among nursing students. Further, to identify associated harms and underlying risk factors based on established theoretical models. Smartphones have become indispensable tools for students. However, excessive use can lead to smartphone addiction, causing physiological, psychological and social harm. Nursing students represent a unique population whose smartphone use may differ from other disciplines due to clinical training demands. A scoping review was conducted following the Arksey and O'Malley framework. Seven databases were systematically searched from inception to August 2023. Inclusion criteria encompassed original research on smartphone addiction, harms and risks among nursing students. Data were extracted and thematically synthesized. Studies (n=39) met inclusion criteria, representing 15 countries. Rates of smartphone addiction among nursing students ranged from 19% to 72%, averaging 40–50%. Incorporated into Engel's biopsychosocial models, the harm is emphasized across individual inclinations, emotional aspects, cognitive processes and executive functions. Physiological harms include sleep disruption, vision concerns,other physiological concerns. psychologically, addiction correlated with increased anxiety and depression,decline in self-esteem, learning and attention and other psychological concerns. socially, it encompasses harms such as interpersonal relationships challenges, career development and decline in social abilities. The I-PACE model identifies various risk factors for smartphone addiction among nursing students, including personal factors such as interpersonal relationship anxiety and perceived academic pressure, affective factors like high stress and learning burnout, cognitive factors such as the need for online social interaction and low perception of social support, as well as executive factors like extended usage duration, poor self-control and usage before sleep. Smartphone addiction among nursing students presents tangible harms. A proposed theoretical model integrating established frameworks provides avenues to better comprehend addiction genesis and potential intervention strategies. Given addiction's multi-factorial nature, future research investigating harm mitigation through optimizing predisposing, precipitating and perpetuating factors is warranted.

BackgroundProlonged jaundice is common and in the majority of cases is benign and self-resolves. The prolonged jaundice screen aims to rule out serious causes of prolonged jaundice, such as biliary atresia. In our prolonged jaundice clinic (PJC) we test for FBC, blood film, G6PD, TFTs, LFTs, split bilirubin and urine MC&S. Babies are often being brought back for repeat tests due to insufficient bloods or incidental findings. The process is time consuming, resource consuming and anecdotally resulted in poor patient satisfaction.AimWe aimed to reduce the number of investigations and potentially unnecessary repeat tests being carried out in the PJC.MethodA retrospective review was conducted of babies seen in the PJC over 13 months. We collected data on investigation results, repeat tests (and reasons for these) and what pathologies were ultimately picked up.Results212 patients were seen in the PJC in the study period. 14% had a bilirubin result greater than 200 mmol/l. 1 baby had a conjugated bilirubin above 25 mmol or greater than 10% of total bilirubin. Despite this, 68 babies (32%) had at least one repeat test carried out, with some having multiple repeats. A total of 156 repeat tests were carried out. Out of the 212 babies seen 6 babies (2.8%) with pathology were detected: 1 autoimmune neutropenia, 3 G6PD deficiency, 1 intra-hepatic jaundice and 1 e-coli UTI requiring treatment with oral antibiotics only.ConclusionThere was a wide variation in how results were interpreted and hence the reasons for repeating/not repeating tests. A large number of babies did not have high bilirubin results but were having repeat tests done for either insufficient bloods or incidental findings in other parts of the screen. Plan: We have written a new guideline and proposed a 2 tier investigation pathway with all babies having ‘tier 1’ investigations (FBC and split bilirubin) when initially seen in PJC, but only those with abnormalities in this initial screen going on to have ‘tier 2’ investigations (repeat tier 1 investigations in addition to reticulocytes, film, group and DAT, LFTs and urine MC&S).