John L. Anderson

Communication and informed consent in phase 1 trials: a review of the literature from January 2005 to July 2009

Objective and methodsA review conducted in 2005 identified many of the communication difficulties experienced by patients and doctors when discussing phase 1 (P1) oncology trials. The current paper is an update of the area and focuses on studies that measure patient comprehension of information given during the P1 trial discussion and ways to enhance understanding. A literature search was performed for relevant articles published between January 2005 and July 1st 2009.ResultsOnly 12/109 studies met the criteria for inclusion in the review. One study recorded the actual trial discussion and compared patients’ understanding with what the clinician had communicated. The others used interview techniques and surveys to elicit patients’ understanding of P1 trials, motivations for considering trials and expectations of benefit. Two examined interventions to aid patient understanding.ConclusionExplaining potential participation in a P1 trial with a patient with cancer is not an easy task: the doctor must ensure that the patient has an accurate understanding of their condition and that standard treatments have now been exhausted. This must be followed by admission of the probable lack of any therapeutic benefit from the P1 drug together with the possibility that there might be unwanted side effects, many of which are unknown. These are all challenging subjects. New educational initiatives informed through research conducted with patients and health care professionals are currently being developed and clearly much needed.

A UK-wide survey of follow-up practices for patients with high-grade glioma treated with radical intent

RATIONALE AND OBJECTIVE High-grade glioma profoundly affects patients and their families. The best ongoing care for patients completing radical treatment is uncertain. To address this issue a UK-wide audit surveying the follow-up practices of multidisciplinary cancer teams was conducted. METHOD An online survey package was used with a paper version available. RESULTS Of 102 clinicians approached 86 replied, a response rate of 84%. Three-monthly outpatient department appointments led by an oncologist and a specialist nurse were the norm, but more controversially, some centres conduct joint clinics with the whole neurosurgical/oncology team present or available. Nurse-led telephone follow-up in place of hospital visits is uncommon. Regular scanning is conducted despite the clinical benefits being contentious. Access to a range of allied services providing supportive care is considered, but the actual levels of need and the efficiency with which they are delivered require further investigation. CONCLUSIONS The picture of UK follow-up practices revealed by this survey demonstrates that research is now needed to determine what preferences patients and families have for follow-up and their satisfaction with these.

Using Appreciative Inquiry to develop, implement and evaluate a multi-organisation ‘Cultivating Compassion’ programme for health professionals and support staff:

The ‘Cultivating Compassion’ project was developed in response to a research and innovation call relating to compassion training for National Health Service staff in the South East of England. The project aims included the following: the use of Appreciative Inquiry to develop, implement and evaluate a sustainable and evidence-based programme of compassion awareness training through engaging with a diverse group of health professionals and support staff; an evaluation of a ‘train the trainers’ approach; and an evaluation of ‘compassion lead’ roles and a multi-modal compassion toolkit. The project team included academics from two universities and one medical school, NHS staff from three separate organisations and service users. The participants recruited to the study included doctors, nurses, receptionists, chaplains and others working in close contact with service users from within four NHS organisations in the South East of England. The main findings from the project using thematic analysis from participant focus groups and interviews identified project enablers and inhibitors, the value of project resources, and shifts in perspectives. Project conclusions highlighted the importance of effective senior-level support and organisational leadership in cultivating compassion within a healthcare organisation and the importance of the integration of compassion-promoting resources within existing staff development initiatives.

Patients' and staff's experiences of multidisciplinary follow-up for high-grade glioma after radical radiotherapy

Meeting the complex needs of patients with high-grade glioma requires multidisciplinary input. How best to provide care after initial treatment ends is contentious. This study explored the experiences of patients and staff at one UK centre where regular multidisciplinary clinics and brain scanning is provided. In-depth interviews conducted with 10 patients and six staff were transcribed and analysed qualitatively. Patients reported: supportive, individualised care with familiar staff; good communication; that regular scanning was reassuring. Staff believed that team follow-up facilitated immediate decision-making and referral, and reduced visits. They felt that patients value seeing their scans. Patients and staff described positive and negative experiences of multidisciplinary follow-up. There is need to investigate the impact of different approaches to ongoing care.

Twelve tips for teaching medical students with dyslexia

Abstract Dyslexia is a common learning difficulty. As a result of SS’ own experiences as a medical student with dyslexia, we have been researching and teaching on this topic for the past two years. Here, we present twelve tips for teaching medical students with dyslexia. These are gathered from our personal experiences and research, discussions with other educators, and wider literature on the topic. This article aims to shed some light on dyslexia, and also to make practical suggestions. Teaching students with dyslexia should not be a daunting experience. Small changes to existing methods, at minor effort, can make a difference – for example, adding pastel colors to slide backgrounds or avoiding Serif fonts. These tips can help educators gain more insight into dyslexia and incorporate small, beneficial adaptations into their teaching.

'Don't be scared': Demystifying statistics in postgraduate medical education

Statistics can be a frightening concept for students enrolling in postgraduate medical courses. Research has shown that students have anxiety towards statistics instruction.1–3 Reviewing and interpreting statistics are important skills that future physicians and other medical professionals must acquire in order to adhere to evidence-based practice guidelines. In order to demystify medical statistics internationally, we evaluated and compared the statistics curriculum at the University of Texas Southwestern (UTSW) Medical Center’s Family Medicine Residency in Dallas, Texas and Brighton & Sussex Medical School’s (BSMS) Division of Medical Education in Brighton, England. Four objectives of this study were to: 1) measure changes in preand post-knowledge and anxiety of statistics in BSMS Research Methods & Critical Appraisal (MDM10) and Essential Statistics for Research (MDM 66) modules; 2) measure changes in preand post-knowledge and anxiety of basic statistics in a UTSW Family Medicine Residency didactic class block; 3) compare differences in statistics anxiety and knowledge gained between different learning settings; and 4) obtain student and resident feedback. We developed three statistics training courses and tailored them to meet curriculum needs. Data were collected from March to May 2012 from postgraduate students at BSMS and from December 2013 to January 2014 at UTSW. Students in MDM10 (n=12) completed a pre-knowledge and anxiety test prior to the statistics lecture on Day 4. Students rated their perceptions of knowledge on a 5-point Likert scale (1=strongly disagree to 5=strongly agree). At the end of the module, students completed a post-test to determine knowledge gained and satisfaction. Students enrolled in MDM66 (n=11) completed a pre-test rating their perceptions of advanced statistics knowledge on the same 5-point Likert scale on the first day of their module. At the end of the week, students completed a post-test to determine knowledge gained and they provided feedback on course satisfaction. Family Medicine physician residents at UTSW (n=23) reported their perceptions of basic statistics and SPSS knowledge and anxiety before and after attending a 2-hour didactic and computer lab session. Mean changes in self-reported knowledge were measured using Wilcoxon-signed rank tests calculated for each cohort. Significant differences between statistics courses were determined using a Kruskal-Wallis test. The study was exempted from ethics review board approval because it was not deemed human subjects research. We found that MDM10 students and UTSW residents were most anxious about their ability to plan a study using statistics means (2.83 and 2.70, respectively) and interpret/explain results of their statistical analysis means (2.83 and 2.61, respectively). Medical learners showed a significant improvement in knowledge of basic statistics in MDM10 (P=0.041), MDM66 (P=0.027) and UTSW Residency (P<0.01) courses. There were no significant differences in statistics knowledge or anxiety by geographic location or course. Students reported that the instruction was well-paced and examples were helpful but wanted more examples for each statistical test. Residents reported that the training was very helpful, they liked using data from an actual on-going study and desired training earlier in their residency. We found that students and residents had a slight to moderate level of anxiety towards learning statistics. Medical learners in all three courses showed significant improvement in perceived statistical knowledge, with the greatest improvement among UTSW Family Medicine residents. Situational, dispositional and environmental factors can all play a role in statistics anxiety.4 Several tools have been developed to measure these learning barriers. However, there remains a gap in the literature which future studies can explore examining whether these factors play a role in postgraduate medicine. Our study can be replicated in other medical education settings to find ways to improve the statistics curriculum and reduce statistical anxiety among medical learners. We plan to enhance our curricula in order to address the knowledge and skills barriers and ‘demystify’ statistics for medical learners once and for all.

Dyspraxia in clinical education: a review

The stereotype of the student with dyspraxia as ‘clumsy and disorganised’ may cause clinical teachers to be concerned about the students performance in a clinical environment; however, if it is understood that dyspraxic students possess many strengths, as well as weaknesses, it may be that some stereotypical myths will be dispelled and more effective support offered to them. This review considers research surrounding the experiences of students and health professionals with dyspraxia within higher education (HE), alongside the personal experiences of EW, in order to inform the development of clinical teachers with respect to their support for learners with dyspraxia.

Phenomenological research in medical education: an overview of its philosophy, approaches, and conduct

Within this research methods case study, we discuss the case of an interpretive phenomenological study. We outline the methodology, the research process, and the challenges encountered. The project on which this is based explored the experiences of eight U.K. junior doctors with dyslexia. We use this real-life example of interpretive phenomenology to humanize it as a research process. We also highlight its use within a wider research project, concerning the experiences of medical students and junior doctors with dyslexia. Phenomenology is a qualitative methodology, which concerns itself with the study of lived experiences. There are two core and contrasting schools of phenomenology. They are “interpretive” and “descriptive.” Within descriptive phenomenological studies, the researcher is required to “bracket out” their prejudices and pre-conceived ideas before conducting the study. This is not the case within interpretive phenomenology, which instead embraces these in the design and analysis of the study. In this sense, it is well suited to insider-researchers. Seb, as an insider-researcher (a medical student with dyslexia), was therefore well placed to adopt an interpretive phenomenological approach for this study. As an experienced phenomenologist, John was also well placed to supervise it. The research process was emotionally demanding for Seb. However, his insider status helped to establish a sense of camaraderie with participants. He was also able to develop a truly empathic understanding of their experiences. In this sense, the interpretive elements applied through his insider status were used to the benefit of the study.

Autoethnography in action: a research methods case study on the use of a collaborative autoethnography to explore the culture of studying medicine with dyslexia

Within this Research Methods Case Study, we discuss the case of a collaborative autoethnography. We highlight the design process, the methods used, and the challenges encountered. The case takes the example of “Seb”—a UK medical student with dyslexia. We use his story as a real example of autoethnography, to humanize it as a research process. We also highlight its use as a supplementary piece of research to a wider, phenomenological study into the experiences of medical students with dyslexia. Through the use of an autobiographical account and an unstructured, in-depth interview, we were able to gather a wide set of data on Seb’s lived experiences as a medical student with dyslexia. Subsequently, the transcript and written account were both thematically analyzed and used to generate the narrative of the published article. Using a collaborate approach, the developing manuscript was refined over multiple drafts, with input from Alec—a leading authority on autoethnography. This was repeated until all three authors were happy that it was ready to submit for publication. The process of undertaking the autoethnographic study was emotionally taxing for Seb, and left him feeling incredibly vulnerable at times. It highlighted the importance of the relationship between a supervisor and supervisee when undertaking such a personal, emotive research project. These points are discussed and further contextualized within the main text of this case study.

The experiences of medical students with dyslexia: an interpretive phenomenological study

This article explores the experiences of U.K. medical students with dyslexia, using an interpretive phenomenological approach. This project began with a review of the literature, highlighting a void of qualitative research. We then conducted a collaborative autoethnography. This paper forms the next stage in this series of research. We aimed to elicit meaning and understanding from the lived experiences of our participants. Eight U.K. junior doctors with dyslexia were interviewed over the telephone in an in-depth, unstructured manner. Audio recordings were transcribed verbatim and thematically analysed with the aid of a template analysis. Experiences of helplessness and hopelessness were common. These may be a result of a fear of stigmatization and personal feelings of inadequacy. They may also be fuelled by the incidents of bullying and belittling from other medical students that were reported. An important meta-theme was of fear and lack of understanding. A lack of pastoral support was also reported. Their experiences of medical school assessments are also reported. More may need to be done to educate teachers and clinical supervisors on dyslexia.