Professionalism education should reflect reality: findings from three health professions

How prepared are newly qualified allied health professionals for practice in the UK? A systematic review

OBJECTIVES

It is important that allied health professionals (AHPs) are prepared for clinical practice from the very start of their working lives to provide quality care for patients, for their personal well-being and for retention of the workforce. The aim of this study was to understand how well newly qualified AHPs were prepared for practice in the UK.

DESIGN

Systematic review.

DATA SOURCES

Embase, MEDLINE, CINAHL, ERIC and BEI were searched from 2012 to 2024. Grey literature searching and citation chasing were also conducted.

ELIGIBILITY CRITERIA

We included primary studies reporting the preparedness for practice of UK graduates across 15 professions; all study types; participants included graduates who were up to 2 years postgraduation, their supervisors, trainers, practice educators and employers; and all outcome measures.

DATA EXTRACTION AND SYNTHESIS

A standardised data extraction form was used. Studies were quality assessed using the Quality Appraisal for Diverse Studies tool. 10% of articles were independently double-screened, extracted and quality assessed; 90% was completed by one researcher.

RESULTS

14 reports were included (9 qualitative, 3 mixed-method and 2 quantitative). Six papers focused on radiographers, three on a mixture of professions, two on paramedics, and one each on physiotherapists, clinical psychologists and orthotists. An important finding of the review is the paucity and low-medium quality of research on the topic. The narrative synthesis tentatively suggests that graduates are adequately prepared for practice with different professions having different strengths and weaknesses. Common areas of underpreparedness across the professions were responsibility and decision-making, leadership and research. Graduates were generally well prepared in terms of their knowledge base.

CONCLUSION

High-quality in-depth research is urgently needed across AHPs to elucidate the specific roles, their nuances and the areas of underpreparedness. Further work is also needed to understand the transition into early clinical practice, ongoing learning opportunities through work, and the supervision and support structures in place.

PROSPERO REGISTRATION NUMBER

CRD42022382065.

Teaching Strategies for Professional Identity Education in Pharmacy: A Scoping Review

OBJECTIVES

To characterize which strategies of professional identity formation and professionalism are being used in Pharmacy.

FINDINGS

We gathered 5004 articles from 5 databases with the descriptors "pharmacy" "professionalism," "professional identity" and their synonyms. The professional identity is a set of values and behaviors common among professionals. Professionalism is the moral compass of these values, used as a strategy to own social authenticity. After excluding duplicate texts, analyzing titles, abstracts, and full articles, 17 studies met the inclusion criteria and presented strategies for the formation of professional identity and professionalism in pharmacy students. We did not find studies with pharmacists. The quality of reports was assessed using 2 instruments recommended by the literature. All studies were conducted from 2007 onwards, and the United States is the country with the most publications. The identified strategies consisted of extracurricular activities, thematic courses, lectures, and counseling sessions and did not follow standards of theoretical reference, method, execution, duration, and effectiveness of evaluation.

SUMMARY

The interest of Pharmacy about professional identity and professionalism has grown substantially in recent years. Teaching strategies are essential alternatives to improve professionalism, reinforce its importance, and acknowledge its heterogeneity and differences. For that, they must be in line with the aims of the profession in society. This review highlights the need to develop standardized and reproducible teaching strategies to guarantee the effectiveness of students' professional socialization during graduation, as well as to instruct professionals to deal with the changes in the profession, increasing the influence of Pharmacy in society.

Exploring paramedic professional identity

The notion of a paramedic (as a title protected in law) has recently entered its third decade, but the history of the paramedic is considerably older than that. Who are we as a profession? What does it mean to be a paramedic? What makes us who we are? These intriguing and yet seldom asked philosophical questions are at the heart of this article, which is intended to provoke discussion and serve as a foundation for further inquiry into questions of identity and philosophy in paramedicine. Literature pertaining to paramedic professional identity was explored and contextualised within current paramedic practice. Although the overall picture is complex, four key areas for discussion emerged: the history of the paramedic profession; role diversity; the influence of ambulance work; and the education and training of paramedics. The influence of ambulance work permeates all areas, suggesting that it is central to the development of paramedic professional identity. This discussion article is an exploration of the unique contexts and experiences that are associated with the process of being and becoming for paramedics.

Perceptions of undergraduate allied health students of the clinical learning environment and clinical educators’ attributes at the University of Ghana

Background. Clinical education is a vital aspect of the education of health sciences students and consists of two components, i.e. the clinical learning environment and supervision.Objectives. To determine the undergraduate allied health sciences students’ perceptions regarding clinical educators’ attributes and the clinical learning environment. Methods. This cross-sectional study included 169 undergraduate students, randomly recruited from various allied health professions programmes of the University of Ghana. The McGill clinical teacher evaluation tool and the clinical learning environment inventory were used to determine students’ perceptions of clinical educators’ attributes and the clinical learning environment, respectively. The Kruskal-Wallis test and independent t-tests were used to test for relationships between students’ level and programme of study and their perceptions. The level of significance was set at 95%. Results. Of the 169 participants, there were 99 (58.6%) male students, 79 (46.7%) third-year students and 82 (48.5%) medical laboratory science students. Only 16 (9.5%) participants indicated visits by lecturers during clinical rotations. The third-year students had a statistically significant perception of their clinical learning environment (p=0.000), while the differences between perceptions of clinical learning environment among the various programmes were also statistically significant (p=0.028), but not for clinical educators’ attributes (p=0.261). Conclusion. Allied health sciences students have positive perceptions of their clinical learning environment and clinical educators’ attributes. More frequent visits by lecturers to students during clinical rotations may ensure that student innovation is achieved in accordance with their classroom tuition.

Developing an Instrument to Evaluate Undergraduate Healthcare Students' Professionalism

Professionalism is a multidimensional quality acquired over time. Undergraduate years lay a foundation for the development of professionalism. Tools monitoring the students' professional development are needed. Our tool development followed three phases: 1) identifying meaningful criteria for professionalism adapted to the education level, 2) developing an evaluation instrument in a process maximising construct validity, 3) testing the evaluation instrument in an interprofessional study. The evaluation instrument proved to be applicable in the field and it meets validity standards. Some differences between professions were found and discussed. Professionality starts to develop during the education, and early monitoring is important to support students' optimal development. The evaluation instrument supports both self- and expert evaluation of healthcare students' professional development.

The impact of the COVID-19 pandemic on the research activity and working experience of clinical academics, with a focus on gender and ethnicity: a qualitative study in the UK

OBJECTIVE

To investigate the impact of the COVID-19 pandemic on the research activity and working experience of clinical academics, with a focus on gender and ethnicity.

DESIGN

Qualitative study based on interviews and audio/written diary data.

SETTING

UK study within clinical academia.

PARTICIPANTS

Purposive sample of 82 clinical academics working in medicine and dentistry across all career stages ranging from academic clinical fellows and doctoral candidates to professors.

METHODS

Qualitative semistructured interviews (n=68) and audio diary data (n=30; including 16 participants who were also interviewed) collected over an 8-month period (January-September 2020), thematically analysed.

RESULTS

20 of 30 (66.6%) audio diary contributors and 40 of 68 (58.8%) interview participants were female. Of the participants who disclosed ethnicity, 5 of 29 (17.2%) audio diary contributors and 19/66 (28.8%) interview participants identified as Black, Asian or another minority (BAME). Four major themes were identified in relation to the initial impact of COVID-19 on clinical academics: opportunities, barriers, personal characteristics and social identity, and fears and uncertainty. COVID-19 presented opportunities for new avenues of research. Barriers included access to resources to conduct research and the increasing teaching demands. One of the most prominent subthemes within 'personal characteristics' was that of the perceived negative impact of the pandemic on the work of female clinical academics. This was attributed to inequalities experienced in relation to childcare provision and research capacity. Participants described differential experiences based upon their gender and ethnicity, noting intersectional identities.

CONCLUSIONS

While there have been some positives afforded to clinical academics, particularly for new avenues of research, COVID-19 has negatively impacted workload, future career intentions and mental health. BAME academics were particularly fearful due to the differential impact on health. Our study elucidates the direct and systemic discrimination that creates barriers to women's career trajectories in clinical academia. A flexible, strategic response that supports clinical academics in resuming their training and research is required. Interventions are needed to mitigate the potential lasting impact on capacity from the pandemic, and the potential for the loss of women from this valuable workforce.

Conceptualising professionalism in dietetics: an Australasian qualitative study

BACKGROUND

Professionalism is a vital aspect of healthcare and multidisciplinary teamwork. While there is substantive professionalism literature in medicine and an expanding healthcare professions literature, there is a significant gap in understanding professionalism in dietetics. There are very few research papers in the dietetics literature on this issue compared with other health professions. Given the multidisciplinary nature of healthcare, it is important to understand what professionalism means within each profession to develop shared understandings across healthcare teams.

OBJECTIVE

The study aim was to explore how dietetics professionalism is conceptualised by dietetic practitioners/preceptors, faculty and new graduates.

DESIGN

A constructionist exploratory qualitative interview study was conducted.

PARTICIPANTS/SETTING

One hundred participants (dietetic graduates, faculty and practitioners/preceptors), associated with 17 universities across Australia and New Zealand and from diverse geographical and work settings, participated in 27 group and 24 individual interviews from March 2018 to June 2019.

ANALYSIS PERFORMED

Thematic framework analysis was used to examine participants' understandings of professionalism.

RESULTS

Twenty-three dimensions of dietetics professionalism were identified, with the most common being communication and including four novel dimensions of professionalism (generational, emotion management, cultural capability and advocacy) not previously described in other professions. Professionalism as emotion management and generational adds new insights to the professionalism literature, expanding understandings of this vital aspect of healthcare. While high levels of consistency in professionalism understandings existed across the three stakeholder groups, some interesting differences were found. The profession of dietetics shares similarities with other professions in the ways professionalism is conceptualised.

CONCLUSIONS

Using these dimensions of professionalism as a framework for teaching and learning about professionalism will help in clarifying expectations and expand shared understandings about professionalism for dietitians, other health professions and across multidisciplinary teams.

The personal dimension of allied health professional identity: A scoping review in health sciences literature / Die persönliche Dimension der beruflichen Identität von Gesundheitsfachkräften: ein Scoping-Review in der gesundheitswissenschaftlichen Literatur

Introduction

With a shift in healthcare from diagnosis-centered to human- and interprofessional-centered work, allied health professionals (AHPs) may encounter dilemmas in daily work because of discrepancies between values of learned professional protocols and their personal values, the latter being a component of the personal dimension. The personal dimension can be defined as a set of personal components that have a substantial impact on professional identity. In this study, we aim to improve the understanding of the role played by the personal dimension, by answering the following research question: What is known about the personal dimension of the professional identity of AHPs in (allied) health literature?

Methods

In the scoping review, databases, CINAHL, ERIC, Medline, PubMed, and PsychINFO were searched for studies focusing on what is regarded as ‘the personal dimension of professional identity’ of AHPs in the health literature; 81 out of 815 articles were included and analyzed in this scoping review. A varying degree of attention for the personal dimension within the various allied health professions was observed.

Result

After analysis, we introduce the concept of four aspects in the personal dimension of AHPs. We explain how these aspects overlap to some degree and feed into each other. The first aspect encompasses characteristics like gender, age, nationality, and ethnicity. The second aspect consists of the life experiences of the professional. The third involves character traits related to resilience and virtues. The fourth aspect, worldview, is formed by the first three aspects and consists of the core beliefs and values of AHPs, paired with personal norms.

Discussion

These four aspects are visualized in a conceptual model that aims to make AHPs more aware of their own personal dimension, as well as the personal dimension of their colleagues intra- and interprofessionally. It is recommended that more research be carried out to examine how the personal dimension affects allied health practice.

What is Professionalism in Occupational Therapy? A Concept Analysis: Qu'est-ce que le professionnalisme en ergothérapie? Analyse de ce concept

BACKGROUND.

Professionalism has been given different definitions over time. These are, commonly theoretical and difficult to operationalize.

PURPOSE.

This study aimed to provide an operational definition of the concept of professionalism in occupational therapy.

METHOD.

Based on a concept analysis design, a meta-narrative review was conducted to extract information from 30 occupational therapy manuscripts.

FINDINGS.

Professionalism is a complex competence defined by the manifestation of distinct attitudes and behaviours that support excellence in the occupational therapy practice. In addition, professionalism is forged and evolves according to personal and environmental characteristics. The manifestation of professionalism can lead to positive consequences for occupational therapists, clients, and the discipline, notably contributing to a positive and strong professional identity. Moreover, professionalism is also subject to cultural influences, which leads to variations in its development, manifestations, and consequences.

IMPLICATIONS.

This study offers a contemporary operational definition of professionalism and levers to promote its development and maintenance.

Team member expectations of trainee communicator and collaborator competencies - so shines a good deed in a weary world?

BACKGROUND

Workplace-based assessment may be further optimized by drawing upon the perspectives of multiple assessors, including those outside the trainee's discipline. Interprofessional competencies like communication and collaboration are often considered suitable for team input.

AIM

We sought to characterize multidisciplinary expectations of communicator and collaborator competency roles.

METHODS

We adopted a constructivist grounded theory approach to explore perspectives of multidisciplinary team members on a clinical teaching unit. In semi-structured interviews, participants described expectations for competent collaboration and communication of trainees outside their own discipline. Data were analyzed to identify recurring themes, underlying concepts and their interactions using constant comparison.

RESULTS

Three main underlying perspectives influenced interprofessional characterization of competent communication and collaboration: (1) general expectations of best practice; (2) specific expectations of supportive practice; and (3) perceived commitment to teaching practice. However, participants seemingly judged trainees outside their discipline according to how competencies were exercised to advance their own professional patient care decision-making, with minimal attention to the trainee's specific skillset demonstrated.

CONCLUSION

While team members expressed commitment to supporting interprofessional competency development of trainees outside their discipline, service-oriented judgement of performance loomed large. The potential impact on the credibility of multidisciplinary sources for workplace-based assessment requires consideration.

Nursing Students' Perceptions of Menstrual Distress during Clinical Practice: A Q-Methodology Study

This study aimed to explore the cluster patterns of female nursing students’ perceptions of the effects of menstrual distress during clinical practice. This study adopted the Q-methodology study design. We recruited female nursing students from a college in northern Taiwan. Forty-seven Q-statements were constructed to explore participants’ experiences of the impact of menstrual distress on clinical learning. In total, 58 participants subjectively ranked Q-statements concerning menstrual distress experiences during clinical practice and were classified. After Q-sorting, the subjective ranking process PQ Method (version 2.35, Schmolck, Emmendingen, Germany) was employed for factor analysis. Four patterns of shared perspectives, accounting for 46.6% of the total variance, were identified: (a) influencing clinical learning and making good use of painkillers; (b) responsible attitudes and diversified relief of discomfort; (c) seeking peer support and effect on mood; (d) negative impact on learning ability and conservative self-care. Clinical practice is a major component of nursing education; menstrual distress affects female nursing students’ clinical learning and performance. The exploration of clustering different nursing students’ perceptions may facilitate customized strategies to enable more appropriate assistance.

'Whispers and shadows': A critical review of the professional identity literature with respect to minority physicians

OBJECTIVES

Professional identity formation (PIF) is a growing area of research in medical education. However, it is unclear whether the present research base is suitable for understanding PIF in physicians considered to be under-represented in medicine (URM). This meta-ethnography examined the qualitative PIF literature from 2012 to 2019 to assess its capacity to shine light on the experiences of minoritised physicians.

METHODS

Data were gathered using a search of six well-known medical education journals for the term 'professional identit*' in titles, keywords, abstracts and subheadings, delineated with the date range of 2012-2019. All non-relevant abstracts were removed and papers were then further reduced to those that focused only on learners' experiences. This left 67 articles in the final dataset, which were analysed using a collaborative approach among a team of researchers. The team members used their professional expertise as qualitative researchers and personal experiences as minoritised individuals to synthesise and interpret the PIF literature.

RESULTS

Four conceptual categories were identified as impacting PIF: Individual versus Sociocultural Influences; the Formal versus the Hidden Curriculum; Institutional versus Societal Values; and Negotiation of Identity versus Dissonance in Identity. However, a major gap was identified; only one study explored experiences of PIF in URM physicians and there was an almost complete absence of critical stances used to study PIF. Combined, these findings suggest that PIF research is building on existing theories without questioning their validity with reference to minoritised physicians.

CONCLUSIONS

From a post-colonial perspective, the fact that race and ethnicity have been largely absent, invisible or considered irrelevant within PIF research is problematic. A new line of inquiry is needed, one that uses alternative frameworks, such as critical theory, to account for the ways in which power and domination influence PIF for URM physicians in order to foreground how larger sociohistorical issues influence and shape the identities of minoritised physicians.

Great expectations: views and perceptions of professionalism amongst mental health services staff, patients and carers

BACKGROUND

Numerous studies have explored the concept of 'professionalism' in medicine, yet little attention has been paid to the concept in a mental health services context.

AIMS

This study sought to determine how the lived experience of patients, carers and healthcare professionals in mental health services align with medically defined, generic, professionalism standards.

METHOD

Interviews and focus groups were conducted with patients, carers, nurses, occupational therapists, psychiatrists and psychologists. A framework analysis approach was used to analyse the data, based on the 'Improving Selection to the Foundation Programmes' Professional Attributes Framework.

RESULTS

Fifty-six individuals participated. Data aligned to all nine attributes of the Professional Attributes Framework, however the expectations within each attribute varied from that originally cited. A tenth attribute was devised during the process of analysis; Working with Carers. This attribute acknowledges the need to liaise with, and support carers in mental health services. Situational examples included both online and offline behaviours and the topic of 'black humour' emerged.

CONCLUSIONS

Compared to a conventional medical definition of professionalism, additional themes and differing emphases were observed for mental health and learning disability services. These findings should be used to inform the teaching and evaluation of professionalism, especially for staff pursuing mental health service careers.

Professional identity: A concept analysis

The purpose of this study is to give clarity to the concept of professional identity, drawing from health-related fields to help provide a common language and understanding for research and practice. Professional identity, professionalism, professional socialization, and other related terms are often used without a clear definition or with conflicting definitions. This can lead to misunderstandings and assumptions that complicate research and confuse educators and professionals in guiding novice members. Concept analysis. Initially, 737 articles were identified by searching CINAHL, PubMed Central, Google Scholar, Academic Search Complete, PsyINFO, and SocINDEX for the period 2000 to 2019. Finally, 68 studies met the inclusion criteria, 60 of which are discussed in this concept analysis. This concept analysis uses the method described by Walker and Avant. This concept analysis clarifies the definition of professional identity, using literature from health and related professions, as containing the attributes: skills and functions; knowledge values and ethics; personal identity; group identity; and the influence of the context of care. A more clear definition of professional identity will help researchers to have more precision in their analyses and provide mentors and educators with a clear goal.

Professional decision-making in medicine: Development of a new measure and preliminary evidence of validity

Introduction

This study developed a new Professional Decision-Making in Medicine Measure that assesses the use of effective decision-making strategies: seek help, manage emotions, recognize consequences and rules, and test assumptions and motives. The aim was to develop a content valid measure and obtain initial evidence for construct validity so that the measure could be used in future research or educational assessment.

Methods

Clinical scenario-based items were developed based on a review of the literature and interviews with physicians. For each item, respondents are tasked with selecting two responses (out of six plausible options) that they would choose in that situation. Three of the six options reflect a decision-making strategy; these responses are scored as correct. Data were collected from a sample of 318 fourth-year medical students in the United States. They completed a 16-item version of the measure (Form A) and measures of social desirability, moral disengagement, and professionalism attitudes. Professionalism ratings from clerkships were also obtained. A sub-group (n = 63) completed a second 16-item measure (Form B) to pilot test the instrument, as two test forms are useful for pre-posttest designs.

Results

Scores on the new measure indicated that, on average, participants answered 75% of items correctly. Evidence for construct validity included the lack of correlation between scores on the measure and socially desirable responding, negative correlation with moral disengagement, and modest to low correlations with professionalism attitudes. A positive correlation was observed with a clerkship rating focused on professionalism in peer interactions.

Conclusions

These findings demonstrate modest proficiency in the use of decision-making strategies among fourth-year medical students. Additional research using the Professional Decision-Making Measure should explore scores among physicians in various career stages, and the causes and correlates of scores. Educators could utilize the measure to assess courses that teach decision-making strategies.

Defining professionalism for mental health services: a rapid systematic review

Background: Efforts have been made to define professionalism across the professions, yet little attention has been paid to the concept in mental health services, where patients' needs differ to that in other healthcare specialties. Aims: To derive a definition of professionalism for mental health services using the existing literature. Method: A rapid, systematic review was conducted to identify empirical and non-empirical records that described professionalism in a mental health service context from 2006 to 2017. Studies were synthesised narratively using thematic analysis. Results: Seventy records were included in the review. Professionalism was described on two levels; at a societal level, a dynamic social contract between professions and society, and; at an individual level, having intrapersonal, interpersonal, and working professionalism. Utilising emerging themes, an operationalised definition of professionalism, suitable for a mental health service context was derived. Conclusions: Within mental health services, emphasis is placed on the interpersonal aspects of practice such as communication skills, maintaining boundaries and humanity. Themes relating to the vulnerability of patients and the challenge of supporting autonomy and choice whilst maintaining safety and acting in a client's best interest are also evident. 'Practical wisdom' and a flexible approach to working are needed to manage these challenging situations.

Orienting to Medicine: Scripting Professionalism, Hierarchy, and Social Difference at the Start of Medical School

Nascent medical students' first view into medical school orients them toward what is considered important in medicine. Based on ethnography conducted over 18 months at a New England medical school, this article explores themes which emerged during a first-year student orientation and examines how these scripts resurface across a four-year curriculum, revealing dynamics of enculturation into an institution and the broader profession. We analyze orientation activities as discursive and embodied fields which serve "practical" purposes of making new social geographies familiar, but which also frame institutional values surrounding "soft" aspects of medicine: professionalism; dynamics of hierarchy and vulnerability; and social difference. By examining orientation and connecting these insights to later, discerning educational moments, we argue that orientation reveals tensions between the overt and hidden curricula within medical education, including what being a good doctor means. Our findings are based on data from semi-structured interviews, focus groups, and participant-observation in didactic and clinical settings. This article answers calls within medical anthropology and medical education literature to recognize implicit values at play in producing physicians, unearthing ethnographically how these values are learned longitudinally via persisting gaps between formal and hidden curricula. Assumptions hidden in plain sight call for ongoing medical education reform.

Consensus statement on an updated core communication curriculum for UK undergraduate medical education

OBJECTIVES

Clinical communication is a core component of undergraduate medical training. A consensus statement on the essential elements of the communication curriculum was co-produced in 2008 by the communication leads of UK medical schools. This paper discusses the relational, contextual and technological changes which have affected clinical communication since then and presents an updated curriculum for communication in undergraduate medicine.

METHOD

The consensus was developed through an iterative consultation process with the communication leads who represent their medical schools on the UK Council of Clinical Communication in Undergraduate Medical Education.

RESULTS

The updated curriculum defines the underpinning values, core components and skills required within the context of contemporary medical care. It incorporates the evolving relational issues associated with the more prominent role of the patient in the consultation, reflected through legal precedent and changing societal expectations. The impact on clinical communication of the increased focus on patient safety, the professional duty of candour and digital medicine are discussed.

CONCLUSION

Changes in the way medicine is practised should lead rapidly to adjustments to the content of curricula.

PRACTICE IMPLICATIONS

The updated curriculum provides a model of best practice to help medical schools develop their teaching and argue for resources.

Incorporation of Professionalism Expectations and Evaluative Processes Within a College of Pharmacy

Objective. To determine professionalism factors of interest to the University of South Florida (USF) College of Pharmacy (COP) and develop a programmatic plan to monitor the professionalization of students, faculty, preceptors and staff. Methods. In 2013, the USF COP began investigating how best to incorporate processes to capture professionalism across all aspects of the program. A Professionalism Task Force was convened to identify key professionalism factors valued by faculty and preceptors to be incorporated in pharmacy practice experiences, didactic courses, faculty, and preceptor performance evaluations. A factor analysis was performed to identify items for inclusion in professional practice experience evaluations, course syllabi, faculty, preceptor and staff evaluations. Results. The analysis identified 11 factors for practice experiences, three for syllabi, and five for performance evaluations. The information from the factor analysis spurred additional discussion that led to the development of a programmatic plan for professionalization. Conclusion. A brief description of the programmatic professionalization plan is provided, including possible assessment processes. The goal of this endeavor was to ensure appropriate support and development of professionalization across the COP community.

Graduating student nurses' and student podiatrists' wound care competence - An integrative literature review

The objective of this literature review is to describe graduating student nurses' and student podiatrists' wound care competence. This integrative literature review has been conducted with a systematic search process. Original studies were analysed by qualitative content analysis with the following stages: open coding, creating categories and abstraction. The literature search was conducted on May 2016 and reconducted on October 2016 using the Medline/Pubmed, CINAHL, Cochrane Library, Web of Science, Scopus and National Medic databases and 12 original studies were found. All the studies addressed graduating student nurses' wound care competence. According to original studies, graduating student nurses' wound care competence was inadequate. However, the students showed a positive attitude towards wound care. Subthemes of this literature review were: 1) Wound care knowledge, 2) Attitudes towards wound care, 3) Wound care preparedness and 4) Wound care education which created the main theme Graduating nurses' wound care competence. No studies were found about graduating student podiatrists' wound care competence. Graduating student nurses' wound care knowledge was deficient. Wound care education seemed to have a positive relation to students' wound care competence. The findings indicate that more information about graduating student nurses', and especially graduating podiatrists', wound care competence is needed.

The interplay of text, meaning and practice: methodological considerations on discourse analysis in medical education

CONTEXT

The study of discourses (i.e. verbal interactions or written accounts) is increasingly used in social sciences to gain insight into issues connected to discourse, such as meanings, behaviours and actions. This paper situates discourse analysis in medical education, based on a framework developed in organisational discourse analysis and widely deployed in other social science disciplines.

OBJECTIVES

This paper aims to examine the constructs of 'discourse' and 'discourse analysis', and how various understandings of discourse and discourse analysis may play out in empirical and analytical settings, with a particular focus on the field of medical education.

METHODS

The study is based on a literature analysis of discourse analysis approaches published in Medical Education.

RESULTS

Findings suggest that empirical studies through discourse analysis can be heuristically understood in terms of the links between text, practices and meaning.

CONCLUSIONS

Discourse analysis provides a more strongly supported argument when it is possible to defend claims on three levels: practice, using observational data; meaning, using ethnographic data, and text, using conversational and textual data.

An exploration of the views of paramedics regarding airway management

BACKGROUND

Paramedics are a skilled group of clinicians with expertise in airway management. Our research group has completed a trial comparing supraglottic airway devices with tracheal intubation during out of hospital cardiac arrest. This is a contentious topic amongst paramedics in the United Kingdom (UK). We explored the customs and beliefs of UK paramedics in relation to airway management, and whether tracheal intubation contributes to and sustains paramedic professional identity.

METHODS

The study took place within South Western Ambulance Service NHS Foundation Trust. We used a qualitative approach, conducting interviews and focus groups with paramedics. The themes arising from interviews were discussed in focus groups, developing a deeper understanding and providing insight and recommendations for future research and policy. Purposive sampling accounted for differing training and for participation in the main trial. There were 17interviews and five focus groups with a further 17 participants. Data saturation was achieved.

RESULTS

Four domains were identified. Pride - The ability to use a life-saving skill in austere conditions. Utility - Different training routes and experience have led to different attitudes towards airway management. Inconsistent expectations - Paramedics felt that there were different perceptions of their abilities amongst hospital staff and the general public. Professionalization - Debate over airway management is not founded on good evidence.

CONCLUSION

We have demonstrated that UK paramedics have a wide range of views regarding airway management, and that these are based on evidence and experience rather than dogma. Airway management contributes to paramedics' professional identity, but is not reliant on this.