Charles G. Taylor

An interactive 1‐h educational programme for junior doctors, increases their confidence and improves inpatient diabetes care

Diabet. Med. 29, 1574–1578 (2012)

Exploring the transition of undergraduate medical students into a clinical clerkship using organizational socialization theory.

BackgroundTransitions in medical education are emotionally and socially dynamic; this may affect learning. Students transitioning from preclinical to clinical training may experience negative consequences. Less is understood about students’ experiences during transitions within clinical training and influential factors.MethodsThe authors used organizational socialization theory to explore a transition within the clinical years. Final-year medical students experienced a nine-week internal medicine clerkship; willing students participated. Students (n = 101; 97 %) completed a questionnaire with open-ended questions at the beginning and end of the clerkship and participated in six consecutive focus groups, until data saturation occurred (n = 37). Data were thematically analyzed.ResultsSocialization was challenging. Many students experienced difficulty developing relationships with team members. Students with a positive attitude experienced a smoother transition. Many students were uncertain of their roles, concerned about the workload and desired guidance to meet clerkship demands. This transition resulted in varied outcomes from enjoyment, increased confidence and student development through to disinterest.ConclusionTransitions within clinical training are complex. Faculty should focus on adequate socialization in a new clerkship as this may facilitate a smoother transition. This may necessitate orientations, staff training, and formal student support. Further research is needed on the impact of these recommendations on learning and well-being.

The extensive inpatient burden of diabetes and diabetes-related foot disease in Barbados

In this study, we evaluated the burden and quality of adult inpatient diabetes care in Barbados. Inpatients were reviewed over 2 days to identify those with diabetes. Data were collected and analysed from identified patients, their notes and management charts using an audit methodology developed in the UK. Inpatient diabetes prevelance was found to be 42.5% (111 of 261 beds audited). Insulin-treated type 2 diabetes affected 41.8% of the patients. Diabetic foot disease accounted for 30% of admissions and 89% of diabetes-related admissions. Of the patients admitted without diabetic foot disease, 13.9% had their feet examined and 2.8% developed foot lesions during their stay. Medication errors were experienced by 41.4% of patients. We recorded the prevalence of inpatient diabetes in the English medical literature (42.5%) and this was significantly driven by diabetic foot disease. Care needs were complex and areas of potential improvement were identified.

Student perceptions of clerkship handbooks

When students transition into new clerkships, it can be useful to provide them with information to assist them in their adjustment to the new social environment. Handbooks could support students by providing information, particularly during clerkship orientation. The authors explored aspects of existing handbooks that students found useful, and sought additional desirable content.

Barbados Insulin Matters (BIM) study: Perceptions on insulin initiation by primary care doctors in the Caribbean island of Barbados

AIMS With regards to insulin initiation in Barbados we explored primary care doctor (PCD) perception, healthcare system factors and predictors of PCD reluctance to initiate insulin. METHODS PCDs completed a questionnaire based on the theory of planned behaviour (TPB) and a reluctance to initiate insulin scale. Using linear regression, we explored the association between TPB domains and the reluctance to initiate insulin scale. RESULTS Of 161 PCDs, 70% responded (75 private and 37 public sector). The majority felt initiating insulin was uncomplicated (68%) and there was benefit if used before complications developed (68%), but would not use it until absolutely necessary (58%). More private than public sector PCDs (p<0.05) thought that the healthcare system allowed enough flexibility of time for education (68 vs 38%) and initiating insulin was easy (63 vs 35%), but less thought system changes would help initiating insulin (42 vs 70%). Reasons for reluctance to initiate insulin included patient nonadherence (83%) and reluctance (63%). Only the attitudes and belief domain of the TPB was associated with the reluctance to initiate insulin scale (p<0.001). CONCLUSIONS Interventions focusing on PCD attitudes and beliefs and restructuring services inclusive of the use of diabetes specialist nurses are required.

Towards an inpatient diabetes curriculum: medical student-generated aims, objectives and methods for ward-based learning of non-critical, non-perioperative inpatient diabetes care.

To create a summative document containing aims, objectives and methods that can be used for the training of healthcare professionals in inpatient diabetes care.

A checklist that enhances the provision of education during insulin initiation simulation: a randomized controlled trial.

The study tested the hypothesis that doctors using an insulin information checklist during simulated insulin initiation would impart more information regarding insulin use.

How we implemented a classroom-based educational intervention for ward-based diabetes care

Abstract Background: Junior doctors require training to adequately manage the increasing numbers of adult, hospitalized patients with diabetes whom they encounter. Aims: Junior doctors experiencing the intervention acquire knowledge and skills that improve their management of inpatients with diabetes. Methods: We designed and administered, a one-hour, classroom-based, educational intervention to 242 juniors doctors. This resulted in a 49% reduction in insulin prescription errors and an increase in their confidence in the delivery of care. A number of key steps were taken to develop the intervention. First, aims, objectives, methods and assessment were carefully aligned with learning objectives at the appropriate level of Blooms Taxonomy. Clarity was enhanced through the structuring of the introduction, body and conclusion. Clinically authentic active learning methods were used to increase engagement and provide an opportunity for junior doctors to reflect and make connections with their own clinical practice. Additionally, refinement was integrated into the process of administration. Results: Qualitative analysis from 205 trainees (85%) revealed that trainees liked a number of design features, their ability to be interactive, and immediacy behaviors of facilitators. Conclusion: Classroom-based training can impact clinically delivered care. Achieving this goal requires well-thought-out content design and evaluation.

The Barbados Insulin Matters (BIM) study: Barriers to insulin therapy among a population-based sample of people with type 2 diabetes in the Caribbean island of Barbados

Highlights • People on insulin had a more favourable attitude towards it than those not using it.• Most believed that insulin use would improve glycaemic control (78%) and health (58%).• Many people with diabetes felt that insulin use meant a worsening of diabetes (68%).• Most people with diabetes believed insulin use would worry family members (63%).• Multiple factors need to be addressed to reduce psychological insulin resistance.

This thing called life

AbstractAcademic pursuits are inseparable from the medium within which they take place — life. The lives of medical trainees can present many challenges that are independent of academic demands. Poor psychological health has been found to develop in medical trainees. Can medical educators minimize this decline in well-being? Positive education — learning skills for traditional academia and to foster happiness — has been shown to improve students’ well-being. This piece considers the application of ‘positive education’ to medical training. By using this approach, we may optimize the lives of our trainees, potentially enhance learning and improve their academic and personal outcomes.