Helen Reid

Diagnosing endometriosis in primary care: clinical update

Prompt diagnosis of endometriosis is a clinical imperative for general practice. Women with endometriosis typically face a diagnostic delay of 7–10 years, despite more frequent GP and accident and emergency attendances than women without the disease.1,2 Endometriosis has a relatively high prevalence (up to 10% of women in the general UK population and up to 50% of infertile women) and causes high morbidity in terms of both pain and infertility.2 Despite this, the condition remains poorly recognised in practice, meaning that patients must often navigate misdiagnosis and suboptimal care. While there have been recent significant advances in the evidence regarding pathogenesis and management, this literature is largely directed towards a secondary care audience. We present key issues below from a primary care perspective. Diversity of presenting symptoms, overlap with benign conditions, and a low index of suspicion in both primary and secondary care all contribute to women with endometriosis falling between the cracks. Other contributors include cultural attitudes normalising painful menstruation, a lack of clinician awareness of updated guidelines on distinguishing normal from pathological, and concern over the invasive nature of laparoscopy.1,2 Paradoxically, while women …

Content and discontent: a qualitative exploration of obstacles to elearning engagement in medical students

BackgroundElearning is ubiquitous in healthcare professions education. Its equivalence to ‘traditional’ educational delivery methods is well established. There is a research imperative to clarify when and how to use elearning most effectively to mitigate the potential of it becoming merely a ‘disruptive technology.’ Research has begun to broadly identify challenges encountered by elearning users. In this study, we explore in depth the perceived obstacles to elearning engagement amongst medical students. Sensitising concepts of achievement emotions and the cognitive demands of multi-tasking highlight why students’ deeply emotional responses to elearning may be so important in their learning.MethodsThis study used focus groups as a data collection tool. A purposeful sample of 31 participated. Iterative data gathering and analysis phases employed a constant comparative approach to generate themes firmly grounded in participant experience.ResultsKey themes that emerged from the data included a sense of injustice, passivity and a feeling of being ‘lost at sea’. The actual content of the elearning resource provided important context.ConclusionsThe identified themes have strong emotional foundations. These responses, interpreted through the lens of achievement emotions, have not previously been described. Appreciation of their importance is of benefit to educators involved in curriculum development or delivery.

Safe moving and handling of patients: an interprofessional approach.

A gap in the medical undergraduate curriculum on safe moving and handling of patients was identified, and a project to enhance moving and handling education for undergraduates in various healthcare disciplines was undertaken. A team of nurses, doctors, physiotherapists and e-learning professionals developed a cross-discipline e-learning resource, piloted with medical and nursing students at Queens University Belfast. One outcome of the project was the development of a deeper recognition of the common curriculum across healthcare disciplines.

Let’s not talk about sex: unexpected tensions in teaching women’s health.

As clinical educators, our vocation for medicine is deeply enmeshed with our research and educational practice. In general, we have found this to add credibility and depth to our teaching of medical students. Here, though, we describe our surprise at encountering tension and pushback upon introducing something important from our clinical world to medical education. We reflect on how this situation evolved, how we resolved it, and what we have learned from it, in the hope of informing others who may find themselves in similar positions. Working as experienced female general practitioners (GPs) in the United Kingdom, we have long been aware of challenges around diagnosis and management of women’s health conditions. This area of medicine reflects a cultural normalization of pejorative attitudes towards ‘women’s problems’, leading to well-documented health inequalities [1]. Historically, this has been perpetuated by patriarchal attitudes within society, and subsequently within gynaecology [2–4]. Even within our modern society, certain aspects of female sexual and reproductive health remain open to stigma and even ridicule [5, 6]. Clinically, this translates to ‘hard’ outcomes in terms of delayed diagnoses and significant morbidity [7, 8]. We have observed this in action in our clinical practice, and have explored it within our academic scholarship [9, 10]. As researchers, we are critical scholars in that we seek to question taken for granted assumptions, and are committed to following a social justice agenda. Additionally, this form of advocacy for patients is a central

Considering axiological integrity: a methodological analysis of qualitative evidence syntheses, and its implications for health professions education

Qualitative evidence synthesis (QES) is a suite of methodologies that combine qualitative techniques with the synthesis of qualitative knowledge. They are particularly suited to medical education as these approaches pool findings from original qualitative studies, whilst paying attention to context and theoretical development. Although increasingly sophisticated use is being made of qualitative primary research methodologies in health professions education (HPE) the use of secondary qualitative reviews in HPE remains underdeveloped. This study examined QES methods applied to clinical humanism in healthcare as a way of advancing thinking around the use of QES in HPE in general. A systematic search strategy identified 49 reviews that fulfilled the inclusion criteria. Meta-study was used to develop an analytic summary of methodological characteristics, the role of theory, and the synthetic processes used in QES reviews. Fifteen reviews used a defined methodology, and 17 clearly explained the processes that led from data extraction to synthesis. Eight reviews adopted a specific theoretical perspective. Authors rarely described their reflexive relationship with their data. Epistemological positions tended to be implied rather than explicit. Twenty-five reviews included some form of quality appraisal, although it was often unclear how authors acted on its results. Reviewers under-reported qualitative approaches in their review methodologies, and tended to focus on elements such as systematicity and checklist quality appraisal that were more germane to quantitative evidence synthesis. A core concern was that the axiological (value) dimensions of the source materials were rarely considered let alone accommodated in the synthesis techniques used. QES can be used in HPE research but only with careful attention to maintaining axiological integrity.

Interdisciplinarity defines our identity as medical educators

Medical education is a broad church. As a young interdisciplinary group of educationalists we discuss some aspects of the relevance of interdisciplinarity to medical education, using our own experiences as exemplars.