Richard Meakin

Where students go when they are ill: How medical students access health care

Background  Doctors have high levels of self‐treatment, investigation and referral, but little is known about how medical students seek health care.

Living with and dying from cancer: a humanities special study module

We describe a humanities-based, special studies module (SSM) exploring the impact of cancer on the lives of patients, families and professionals. Literature, film, art and drama provide third year medical undergraduates with vicarious experience of all of these perspectives in a format that has proved highly acceptable to students and tutors. The development, delivery, evaluation and evolution of this humanities-based course are described and we highlight some important elements of course organisation that emerged as being integral to its success.

Current Prevalence Pattern of Hypertension in Nigeria: A Systematic Review

Background The global burden of hypertension and other non-communicable diseases (NCDs) is rapidly increasing, and the African continent seems to be the most affected region in the world. The prevalence of hypertension in Nigeria forms a substantial portion of the total burden in Africa because of the large population of the country currently estimated to be over 170 million. Objective The purpose of this systematic review is to summarise up to date data on the prevalence and distribution of hypertension in Nigeria from prevalence studies. Methods A search of the following databases: PubMed, EMBase and WHO cardiovascular InfoBase from 1968 till date was conducted to identify studies which provide estimates of prevalence of hypertension in Nigeria. Results The search yielded a total of 1748 hits from which 45 relevant studies met the inclusion criteria for the review. The overall crude prevalence of hypertension ranged from 0.1% (95%CI:-0.1 to 0.3) to 17.5% (95% CI: 13.6 to 21.4) in children and 2.1% (95%CI: 1.4 to 2.8) to 47.2% (95%CI: 43.6 to 50.8) in adults depending on the benchmark used for diagnosis of hypertension, the setting in which the study was conducted, sex and ethnic group. The crude prevalence of hypertension ranged from 6.2% (95%CI: 4.0 to 8.4) to 48.9% (95%CI: 42.3 to 55.5) for men and 10% (95%CI: 8.1 to 12) to 47.3% (95%CI: 43 to 51.6%) for women. In most studies, prevalence of hypertension was higher in males than females. In addition, prevalence across urban and rural ranged from 9.5% (95%CI: 13.6 to 21.4) to 51.6% (95%CI: 49.8 to 53.4) and 4.8% (95%CI: 2.9 to 6.7) to 43% (95%CI: 42.1 to 43.9) respectively. Conclusions The prevalence of hypertension is high among the Nigerian population. Appropriate interventions need to be developed and implemented to reduce the preventable burden of hypertension especially at Primary Health Care Centres which is the first point of call for over 55% of the Nigerian population.

Proposal for an academic Association for Medical Humanities

Following an initiative taken by the Nuffield Trust, an ad hoc steering committee consisting of the authors of this paper was convened under the auspices of the Trust in order to bring about the establishment of an academic Association for the Medical Humanities in the United Kingdom and Ireland (see page 63).1 The present paper seeks to do two things: (A) to propose the founding of an academic Association for Medical Humanities, as a representative focus for medical humanities research and teaching in medical schools and universities in the United Kingdom and Ireland; and (B) to propose for discussion a conception of the nature, identity and scope of medical humanities as a field of study. 1. Several universities and associated medical schools in the British Isles have introduced, or are preparing to introduce, the medical humanities as a field of academic teaching and/or research. 2. The medical humanities needs a national, specific, academic association, comparable to those enjoyed by most if not all academic disciplines, to enable those engaged in the field to identify and discuss matters of common interest and to share their experiences regarding teaching and research. 3. The Association for Medical Humanities is proposed as a voluntary academic association to play such a role. 4. The Association for Medical Humanities should facilitate the development of both teaching and research in the medical humanities, by means of regular meetings and conferences where academic, professional and administrative matters can be discussed in person, subsequently to be pursued and disseminated through publications including the Medical Humanities journal (to which …

Undergraduate research in primary care: is it sustainable?

Aim: To describe the research project component of the BSc in Primary Health Care and to discuss the issues faced by students and faculty in attempting to complete a student-led research project. Background: Medical schools increasingly expect medical students to undertake research as part of intercalated BSc’s or in self-selected study modules. This research has historically been laboratory based, ‘piggybacking’ onto existing projects. Projects initiated by students themselves and studies in primary care or community settings are more unusual. Methods: A qualitative study, based on interviews with students and examiners, triangulated with data from the peer review process and personal observations on the running of the course. Setting: A London medical school, running an intercalated BSc in Primary Health Care. Findings: We interviewed 24 of 26 students and two external examiners during the interview period of the study. Students successfully undertook research, from initial question through to publication. Overall, 90 dissertations were completed since 1997, of which half used a qualitative methodology (45/90). Ten projects have subsequently been published; there were also 16 conference presentations and 6 research letters. Themes from the interview data include: the students’ strong sense of project ownership, the difficulties of being a novice researcher, the difficulties posed by the research governance hurdles, the beneficial and for some students adverse impact (stress and coping with unsuccessful projects) and finally, the impact on their careers. Conclusion: Students gain considerably from this learning process, not only by undertaking their own research, but they also gain in terms of acquisition of transferable skills such as critical appraisal and improved self-directedness. Project completion and publication rates suggest that programmes developing undergraduate initiated research projects can be as successful as those for other novice researchers. The student-led project is a fragile endeavour, but currently is sustainable.

Beliefs of Health Care Providers, Lay Health Care Providers and Lay Persons in Nigeria Regarding Hypertension. A Systematic Mixed Studies Review.

Background Hypertension is a major health risk factor for mortality globally, resulting in about 13% of deaths worldwide. In Nigeria, the high burden of hypertension remains an issue for urgent attention. The control of hypertension, among other factors, is strongly determined by personal beliefs about the illness and recommended treatment. Objective The aim of this review is to systematically synthesize available data from all types of studies on beliefs of the Nigerian populace about hypertension Methods We searched the following electronic databases; Medline, EMBase, PsycInfo, AMED from their inception till date for all relevant articles. A modified Kleinman’s explanatory model for hypertension was used as a framework for extraction of data on beliefs about hypertension. Results The search yielded a total of 3,794 hits from which 16 relevant studies (2 qualitative, 11 quantitative and 3 mixed methods studies) met the inclusion criteria for the review. Overall, most health care providers (HCPs) believe that stress is a major cause of hypertension. Furthermore, reported cut-off point for uncomplicated hypertension differed widely among HCPs. Lay Health Care Providers such as Patent Medicine Vendors’ beliefs about hypertension seem to be relatively similar to health care professionals in areas of risk factors for hypertension, course of hypertension and methods of treatment. Among Lay persons, misconception about hypertension was quite high. Although some Nigerians believed that life style habits such as alcohol intake, exercise levels, cigarette smoking were risk factors for developing hypertension, there was discordance between belief and practice of control of risk factors. However, beliefs across numerous ethnic groups and settings (urban/rural) in Nigeria have not been explored. Conclusion In order to achieve control of hypertension in Nigeria, interventions should be informed, among other factors, by adequate knowledge of beliefs regarding hypertension across the numerous ethnic groups in Nigeria, settings (rural/urban), age and sex.

Exploring senior doctors’ beliefs and attitudes regarding mental illness within the medical profession: a qualitative study

Objective To explore the views of senior doctors on mental illness within the medical profession. Background There has been increasing interest on the issue of doctors’ mental health. However, there have been few qualitative studies on senior doctors’ general attitude towards mental illness within the medical profession. Setting Large North London teaching hospital. Participants 13 hospital consultants and senior academic general practitioners. Methods A qualitative study involving semi-structured interviews and reflective work. The outcome measures were the themes derived from the thematic framework approach to analysis. Results Four main themes were identified. (1) ‘Doctors’ attitudes to mental illness’—doctors felt that there remained a significant stigma attached to suffering from a mental illness within the profession. (2) ‘Barriers to seeking help’—doctors felt that there were numerous barriers to seeking help such as negative career implications, being perceived as weak, denial and fear of prejudice. (3) ‘Support’—doctors felt that the use of support depended on certainty concerning confidentiality, which for occupational health was not thought to be guaranteed. Confiding in colleagues was rare except among close friends. Supervision for all doctors was raised. (4) ‘General Medical Council (GMC) involvement’—doctors felt that uneasy referring colleagues to the GMC and the appraisal and revalidation process was thought not to be thorough enough in picking up doctors with a mental illness. Conclusions Owing to the small size of this study, the conclusions are limited; however, if the findings are confirmed by larger studies, they suggest that greater efforts are needed to destigmatise mental illness in the profession and improve support for doctors. Additional research should be carried out into doctors’ views on occupational health services in managing doctors with mental illness, the provision of supervision for all doctors and the effectiveness of the current appraisal and revalidation process at identifying doctors with a mental illness.

Editorial: Medical students and arts and humanities research—fostering creativity, inquisitiveness, and lateral thinking

In the first issue of this journal, Education and Debate asked whether medical humanities would help make better doctors or just happier ones.1 That question begs a number of others, among them: what is a good doctor, what attributes might such a doctor possess, and are there different kinds of good doctors that medical educators should be helping to graduate? Appropriately, the focus of much of the published data on arts and humanities based medical education is on equipping doctors with the skills, knowledge, and attitudes necessary for clinical practice. The emphasis, either explicitly or implicitly, is on the doctor/patient interaction, and on the role of medical humanities in enhancing the quality of that interaction. The ability to appreciate the perspective of all those affected by illness, to reflect on one’s own practice, and to contextualise the lived experience of illness, socially, culturally, and historically are among the objectives ascribed to medical humanities teaching. By contrast, the Education and Debate paper in this issue describes a medical humanities …

Consider fledgling researchers

Undergraduates are tomorrow’s researchers, and we predict that many will be put off by the difficult, onerous, and ultimately demotivating procedures for research approval.1 For students undertaking the clinical intercalated degree in primary health care (iBSc) at UCL2 their dissertation based on original research makes up 37.5% of …

The Humanities in Medicine – Distancing and the distance between us

In the first issue of this journal Greaves and Evans1 characterised the medical humanities as a spectrum with an additive view of the relationship between humanities disciplines and medicine at one end and an integrated view at the other. The first part of the paper by Louis-Courvoisier and Wenger2 represents a good example of the integrated view of medical humanities, addressing as it does a theoretical underpinning for the inclusion of the teaching of history and literature in medical education, the practical value of this teaching for medical students and the tools provided by these disciplines to the teaching of medical students. The second part of the paper deals with the difficulties both actual and potential for teachers in delivering such a programme. The discussion of these areas is based on their own experience but may have much wider currency and provide a detailed reflective account of areas of importance to the place of Medical Humanities in medical …