Situations that prompt teachers in problem-based curricula to reflect on their beliefs, identity and mission

Teachers have different perceptions of how to enhance student learning. Whereas some take a teacher-centred perspective, others lean more towards a student-centred approach. Many studies in higher education have invoked Korthagen's onion model (2014) to explain how teachers' perspectives can impact their teaching practices. Spanning six interrelated layers, this model contains both outer (environment, behaviour, competencies) and inner (beliefs, identity, and mission) aspects. Focusing essentially on teachers' outer aspects, previous studies have paid scant attention to how particular situations affect teachers' inner aspects and, consequently, how teachers perceive student-centred learning. In this descriptive qualitative study, we explored situations that encouraged or discouraged teachers to embrace student-centred beliefs, identities and missions. We held three focus-group discussions with 18 teachers from two Indonesian medical schools, performing a thematic analysis of the data thus obtained. We found that certain situations made teachers reflect on their inner aspects, which either favourably or adversely affected their acceptance of a student-centred learning approach. Teachers' outer aspects (i.e. their prior problem-based teaching and learning experiences, learning situations from their own training as well as clinical duties) strongly interacted with their inner aspects, thereby shaping their teaching perspectives. Understanding how specific situations can influence teachers' inner aspects might help institutions to design faculty development programmes that address teachers' specific educational needs.

Pediatric Otolaryngology Short-Term Mission Outcomes at a Surgical Mission Hospital in Guatemala

OBJECTIVE

The frequency of humanitarian surgical mission trips has grown over recent decades. Unfortunately, research on patient outcomes from these trips has not increased proportionately. We aim to analyze the safety and efficacy of surgeries in a low- and middle-income country missions-based surgery center in Guatemala City, Guatemala, and identify factors that influence surgical outcomes.

STUDY DESIGN

Retrospective cohort study.

SETTING

Guatemalan surgery center is called the Moore Center.

METHODS

Pediatric patients underwent otolaryngology surgery between 2017 and 2019. All patients required follow up. We analyzed the effect of patient, surgical, and geographic factors on follow up and complications with univariate and multivariate analyses.

RESULTS

 A total of 1094 otolaryngologic surgeries were performed between 2017 to 2019, which comprised 37.4% adenotonsillectomies, 26.8% cleft lip (CL)/cleft palate (CP) repairs, 13.6% otologic, and 20% "other" surgeries. Patients traveled on average 88 km to the center (±164 km). Eighty-nine percent attended their first follow up and 55% attended their second. The 11% who missed their first follow up lived farther from the center (p < .001) and had a higher ASA classification (p < .001) than the 89% who did attend. Sixty-nine (6.3%) patients had 1 or more complications. CL/CP surgery was associated with more complications than other procedures (p < .001). Of 416 tonsillectomies, 4 patients (1%) had a bleeding episode with 2 requiring reoperation.

CONCLUSION

This surgical center models effective surgical care in low-resource areas. Complications and follow-up length vary by diagnosis. Areas to improve include retaining complex patients for follow up and reducing complications for CL/CP repair.

North America's Amish-Mennonites Adopt Abroad: The Ideologies and Institutional Conditions that Cracked the Homogeneity of an Ethnic Religion

Under what social conditions would ethnic sectarians in developed countries engage in inter-country adoption, grafting ethnically-racially diverse children into their homogenous contexts? In this article, we present a case study of Amish-Mennonite adoption-oriented children's homes in underdeveloped countries. As the ethnic-sectarian, family-oriented, evangelical Amish-Mennonites meet little success proselytizing adults, adoption-oriented children's home allowed adoptive parents to demonstrate their commitment to mission while maintaining sectarian-style control over a child's socialization. Ultimately, the children's homes were short-lived, coming and going based on larger geo-political dynamics, signaling that this unusual international adoption project is internally motivated but enabled and constrained by larger institutional contexts. Though the actual percent of inter-country adoptees to Amish-Mennonite homes is small, this case demonstrates that the right combination of values and broader political dynamics create conditions facilitating migration of children from lesser developed countries into wealthy contexts, a process cracking - even if not fully opening - Amish-Mennonite ethnic/racial homogeneity.

[Birth of an IPA collective within a hospital]

Since 2020, the Charles-Perrens Hospital Center in Bordeaux has been supporting the implementation of advanced practice nursing. The formation of a group of five advanced practice nurses (APNs) has enabled the deployment of numerous missions consistent with the APN model. With a view to developing the nursing discipline and enriching the healthcare offer, they are developing direct clinical missions or missions addressed to professionals and the healthcare system. The collective represents a major lever for implementation, and allows this new professional identity to be positioned within the hospital institution.

[Practice improvement: workshops for caregivers]

The transmission of good practices is one of the missions of the mobile geriatric outreach teams (EMGE). In this context, the EMGE Centre-Nord 92 has proposed two activities for caregivers in residential care facilities for the dependent elderly (Ehpad) in a concrete and participatory form, called "workshop". The purpose of the workshop on handling hearing aids is to help caregivers handle these technologies used to correct hearing loss in the elderly. The etymology-card game workshop is designed to help caregivers review and use medical vocabulary.

The Caring Mission - Nursing Personnel's Inner Driving Force in End-of-Life Care

Constantly facing human suffering and impending death can generate anxiety and insecurity in nursing personnel in end-of-life care. The aim of the study is to reveal nursing personnel's inner driving force in end-of-life care. A phenomenological hermeneutical method was used to search for meaning in the narrative data collected in this study. The structural analysis resulted in four themes: The appeal in the patient's vulnerability, The appeal in the patient's joy, Facing one's own existence in vulnerability, and Being at home with colleagues. Both vulnerability and joy motivated nursing personnel in caring. The care was often emotionally engaging and oscillated between grief and joy, which required a great deal from the nursing personnel both as professionals and fellow human beings. At the same time the emotionally engaging constituted an inner driving force, which gave them courage to do the best for the patients at the end of life.

Beyond the pandemic: The truth of life after COVID-19

This study focused on how to deal with the psychological trauma from the perspective of a doctor on the front line of the fight against COVID-19. As the pandemic continues to ravage our world, post-pandemic psychological counseling urgently needs to be addressed. Based on the experience of fighting the epidemic, this study discusses the psychological changes since the COVID-19 outbreak in 2020. Taking a 19-year-old with breast cancer as an example, this study considered how to find spiritual comfort, and examined how to find meaning in today's complicated world and lives, as well as turning the crisis into an opportunity for spiritual renewal and adding meaning to our lives. It is hoped that this study will inspire readers to overcome the difficulties of the epidemic, find strength and see it as a life-changing opportunity.

Gut Microbiota in Military International Travelers with Doxycycline Malaria Prophylaxis: Towards the Risk of a Simpson Paradox in the Human Microbiome Field

Dysbiosis, developed upon antibiotic administration, results in loss of diversity and shifts in the abundance of gut microbes. Doxycycline is a tetracycline antibiotic widely used for malaria prophylaxis in travelers. We prospectively studied changes in the fecal microbiota of 15 French soldiers after a 4-month mission to Mali with doxycycline malaria prophylaxis, compared to changes in the microbiota of 28 soldiers deployed to Iraq and Lebanon without doxycycline. Stool samples were collected with clinical data before and after missions, and 16S rRNA sequenced on MiSeq targeting the V3-V4 region. Doxycycline exposure resulted in increased alpha-biodiversity and no significant beta-dissimilarities. It led to expansion in Bacteroides, with a reduction in Bifidobacterium and Lactobacillus, as in the group deployed without doxycycline. Doxycycline did not alter the community structure and was specifically associated with a reduction in Escherichia and expression of Rothia. Differences in the microbiota existed at baseline between military units but not within the studied groups. This group-effect highlighted the risk of a Simpson paradox in microbiome studies.

Head and neck surgery global outreach: Ethics, planning, and impact

Background

Head and neck surgical oncology and reconstruction are uniquely suited to address burdens of disease in underserved areas. Since these efforts are not well known in our specialty, we sought to understand global outreach throughout our society of surgeons.

Methods

Survey distributed to members of the American Head and Neck Surgery involved in international humanitarian head and neck surgical outreach trips.

Results

Thirty surgeons reported an average of seven trips to over 70 destinations. Identification of candidates, finances, on‐site patient care, complications, long‐term post‐surgical care, ethics, and educational goals are reported. We report a success rate of 90% on 125 free flaps performed in these settings.

Conclusions

The effort to answer the call for alleviating the global burden of surgical disease is strong within our specialty. There is a shared focus on humanitarian effort and teaching. Ethics of high resource surgeries such as free flap reconstruction remains controversial.

Mission and Structure of Health Services

This chapter aims at providing the student with a general overview of the appropriate structure and ethics healthcare organizations are based on, the concept of ethical leadership, the importance of having clear statements of mission, vision and value in healthcare organizations and the Health Promotion Charters implemented in a Globalized World.

International Nursing Program Accreditation

The Accreditation Commission for Education in Nursing (ACEN) is committed to being a supportive partner in strengthening the quality of nursing education for all levels of nursing programs domestically and internationally. With a longstanding history of accreditation dating back 66 years, the ACEN accredited its first international program in 2004 adding international accreditation to its repertoire. Recognizing geographic, cultural, and national differences, the ACEN common core of Standards and Criteria equip faculty with autonomy to embrace unique attributes of their programs regardless of location, culture, and nationality. Further, the ACEN review process fosters self-evaluation, peer review, and the promotion of educational equity, access, and mobility. As a result, the number of international nursing programs pursuing and attaining accreditation with the ACEN has increased thus validating the inclusiveness and relevance of the ACEN Standards and Criteria. The purpose of this article is to highlight ways in which ACEN Standards and Criteria apply to domestic and international nursing programs.

Acad. Prof. Yucel Kanpolat, Distinguished and Internationally Recognized Neurosurgeon and Friend of the Republic of Macedonia

The sad news about the death of Acad. Yucel Kanpolat (September 17, 2016), a famous scholar, a pioneer in the field of neurosurgery, and a friend of the Republic of Macedonia, saddened the members of the Editorial Board of the journal PRILOZI of the Department of Medical Sciences of the Macedonian Academy of Sciences and Arts, of which he was a member, as well as the other members of the Academy. Yucel Kanpolat was an international figure, linking Turkey to almost every country in the world. Neurosurgery has lost a very special surgeon, scientist and humanitarian. During the visit to the Macedonian Academy of Sciences and Arts in 2011, we discussed the cooperation between the Turkish Academy of Sciences and the Macedonian Academy of Sciences and Arts, which he respected very much, as well as the role of the academies. He delivered a lecture on The Mission of Academia in the Age of Science, PRILOZI, MASA, XXXII, 2, p. 7-10 (2011), which we reprint in addition.

A Case Report Examining Early Extubation Following Congenital Heart Surgery in a Low Resource Setting

This case report aims to critically analyse the evidence surrounding early extubation in the post-operative phase following complex congenital cardiac surgery. Child A was an 8 year old female who had undergone complex congenital cardiac surgery during an international surgical charity mission. On admission to the paediatric intensive care unit Child A appeared to be in good condition and no major complications had occurred intra-operatively. This was considered alongside the situational pressures of resource limitations and the mission's aim to offer surgery to as many children as possible during the available time frame. The decision was made by the team that Child A was a suitable candidate for 'early extubation.' Some members of the team were uncomfortable with this approach and felt it could lead to poorer outcomes for patients. Current evidence surrounding early extubation both within international surgical mission trips to low-income and middle-income countries and established cardiac centres within high-income countries is examined and discussed alongside the context of resource limitation. Although the process and implications of early extubation following cardiac surgery needs further research, on the basis of the evidence currently available clinicians could potentially encourage the use of early extubation within clinical practice (for appropriately selected patients) through the utilisation of a multidisciplinary approach, both within the UK and during international surgical charity missions to low-income and middle-income countries.

Surgical management of CHD in the adult population: the role of humanitarian cardiac surgery mission in Nigeria

BACKGROUND

The clinical effects of CHD can occur during the neonatal period, childhood, adolescent, and even adulthood. Some CHD in the adult population have indications for surgical management.

OBJECTIVE

The objective of this study was to review the role of humanitarian cardiac surgery missions in the surgical management of CHD in the adult population in a developing country.Materials and methodOver a 5.5-year period - June, 2003, February, 2013-October, 2017 - five different humanitarian cardiac surgery teams visited National Cardiothoracic Center of Excellence, Nigeria. During the period, they operated on adults with CHD. A retrospective study of the patients treated was performed using data obtained from our Hospital Information Technology Department. The demography of the patients, types of CHD, operative modalities, as well as the outcome was analysed using Microsoft Excel. The results were presented in arithmetic of percentages using tables.

RESULTS

During the period, a total of 18 CHD patients were treated.

Lecture 3-Measuring Pharmacy's Work in the 21st Century

The importance of developing a thoroughly shared understanding of mission, vision, and values is highlighted in reference to the creation of meaningful and sustainable key performance indicators (KPIs). A review of clinical practice KPIs (cpKPIs) and operational KPIs (opKPIs) is provided using work load measurement activities from Canada, its province of Alberta, and the United Kingdom. In order for Singaporean pharmacy clinicians and leaders to embrace a unified KPI system, the natural tendency to measure what is easy and available, instead of what matters to patients, is difficult but must be overcome.

Awakened by Love: Saint Francis of Assisi as Model for the Church's Mission to Health Care and Charitable Service

Departing from the story of his encounter with the leper, Saint Francis of Assisi is offered as a paradigm of Christian health care and charitable service. In this grace-filled moment, Francis testifies that what had previously seemed bitter to him "was turned into sweetness of soul and body." He was changed by the encounter and awakened to his capacity to love. Francis's story witnesses to the divine initiative in calling us to charity, of recognizing the presence of Christ in those who suffer, and of acknowledging that our service of others is a privileged space in which the mystery of God becomes a reality. Weaved together with reflections from recent magisterial teachings, Francis's experience teaches us that Christian charity can never be reduced to an ideology or the accomplishment of works but flows from a heart touched by God, converted to truth, and expanded by love. Summary: In speaking to those involved in the charitable mission of the Church, Pope Benedict XVI once spoke of the need for a formation of the heart through an "encounter with God in Christ which awakens their love and opens their spirits to others." In this reflection, I offer Saint Francis of Assisi as a model of such formation, inspired by the celebrated moment of his encounter with the leper on the road: an encounter which witnesses to the primacy of God's initiative in enabling us to love with His own love and see His presence in those we serve.

Data Monitoring Committees: Current issues

Maintaining confidentiality of emerging data and ensuring the independence of Data Monitoring Committees are best practices of considerable importance to the ability of these committees to achieve their mission of safeguarding the interests of study participants and enhancing the integrity and credibility of clinical trials. Even with the wide recognition of these principles, there are circumstances where confidentiality issues remain challenging, controversial or inconsistently addressed. First, consider settings where a clinical trial's interim data could provide the evidence regulatory authorities require for decisions about marketing approval, yet where such a trial would be continued post-approval to provide more definitive evidence about principal safety and/or efficacy outcomes. In such settings, data informative about the longer term objectives of the trial should remain confidential until pre-specified criteria for trial completion have been met. Second, for those other than Data Monitoring Committee members, access to safety and efficacy outcomes during trial conduct, even when presented as data pooled across treatment arms, should be on a limited "need to know" basis relating to the ability to carry out ethical or scientific responsibilities in the conduct of the trial. Third, Data Monitoring Committee members should have access to unblinded efficacy and safety data throughout the trial to enable timely and informed judgments about risks and benefits. Fourth, it should be recognized that a mediator potentially could be useful in rare settings where the Data Monitoring Committee would have serious ethical or scientific concerns about the sponsor's dissemination or lack of dissemination of information. Data Monitoring Committee Contract Agreements, Indemnification Agreements and Charters should be developed in a manner to protect Data Monitoring Committee members and their independence, in order to enhance the Data Monitoring Committee's ability to effectively address their mission.

Strategic planning in an academic radiation medicine program

Background

In this paper, we report on the process of strategic planning in the Radiation Medicine Program (rmp) at the Princess Margaret Cancer Centre. The rmp conducted a strategic planning exercise to ensure that program priorities reflect the current health care environment, enable nimble responses to the increasing burden of cancer, and guide program operations until 2020.

Methods

Data collection was guided by a project charter that outlined the project goal and the roles and responsibilities of all participants. The process was managed by a multidisciplinary steering committee under the guidance of an external consultant and consisted of reviewing strategic planning documents from close collaborators and institutional partners, conducting interviews with key stakeholders, deploying a program-wide survey, facilitating an anonymous and confidential e-mail feedback box, and collecting information from group deliberations.

Results

The process of strategic planning took place from December 2014 to December 2015. Mission and vision statements were developed, and core values were defined. A final document, Strategic Roadmap to 2020, was established to guide programmatic pursuits during the ensuing 5 years, and an implementation plan was developed to guide the first year of operations.

Conclusions

The strategic planning process provided an opportunity to mobilize staff talents and identify environmental opportunities, and helped to enable more effective use of resources in a rapidly changing health care environment. The process was valuable in allowing staff to consider and discuss the future, and in identifying strategic issues of the greatest importance to the program. Academic programs with similar mandates might find our report useful in guiding similar processes in their own organizations.

[Humanitarian nurse, the strength of commitment]

Every year, hundreds of volunteers leave their home, for few weeks or months, to provide humanitarian aid across the world. Joining a humanitarian mission, far from being a simple exotic adventure, requires, specially, a strong professional skills and personal abilities, maturely and thoughtful motivations. The work of humanitarian nurse is first and foremost a full-blown profession.

Recommendations for Planning and Managing International Short-term Pharmacy Service Trips

International pharmacy service trips by schools and colleges of pharmacy allow students to provide health care to medically underserved areas. A literature review (2000-2016) in databases and Internet searches with specific keywords or terms was performed to assess current practices to establish and maintain successful pharmacy service trips. Educational documents such as syllabi were obtained from pharmacy programs and examined. A preliminary draft was developed and authors worked on sections of interest and expertise. Considerations and current recommendations are provided for the key aspects of the home institution and the host country requirements for pharmacy service trips based on findings from a literature search and the authors' collective, extensive experience. Evaluation of the trip and ethical considerations are also discussed. This article serves as a resource for schools and colleges of pharmacy that are interested in the development of new pharmacy service trips and provides key considerations for continuous quality improvement of current or future activities.

The Need to Be Seen

When we recognize our common humanity, suspend judgment and embrace the intrinsic value and worth of every individual, we elevate those we serve, and we elevate ourselves. Whether or not we are able to offer cure, we are always capable of fulfilling our mission to heal.

Operation airway: the first sustainable, multidisciplinary, pediatric airway surgical mission

OBJECTIVE

This study aimed to describe the development and implementation of the first sustainable, multidisciplinary, pediatric airway surgical mission in an underserved country.

METHODS

This prospective, qualitative study was conducted for the first 4 Operation Airway missions in Quito, Ecuador. The major goals of the missions were to assist children with aerodigestive abnormalities, create a sustainable program where the local team could independently provide for their own patient population, develop an educational curriculum and training program for the local team, and cultivate a collaborative approach to provide successful multidisciplinary care.

RESULTS

Twenty patients ages 4 months to 21 years were included. Twenty-three bronchoscopies, 5 salivary procedures, 2 tracheostomies, 1 T-tube placement, 1 tracheocutaneous fistula closure, 2 open granuloma excisions, and 6 laryngotracheal reconstructions (LTRs) were performed. All LTR patients were decannulated. A new type of LTR (1.5 stage) was developed to meet special mission circumstances. Two videofluoroscopic swallow studies and 40 bedside swallow evaluations were performed. One local pediatric otolaryngologist, 1 pediatric surgeon, 3 anesthesiologists, 7 intensivists, 16 nurses, and 2 speech-language pathologists have received training. More than 25 hours of lectures were given, and a website was created collaboratively for educational and informational dissemination (http://www.masseyeandear.org/specialties/pediatrics/pediatric-ent/airway/OperationAirway/).

CONCLUSION

We demonstrated the successful creation of the first mission stemming from a teaching institution with the goal of developing a sustainable, autonomous surgical airway program.

Community engagement in US and Canadian medical schools

INTRODUCTION

This study examines the integration of community engagement and community-engaged scholarship at all accredited US and Canadian medical schools in order to better understand and assess their current state of engagement.

METHODS

A 32-question data abstraction instrument measured the role of community engagement and community-engaged scholarship as represented on the Web sites of all accredited US and Canadian medical schools. The instrument targeted a medical school's mission and vision statements, institutional structure, student and faculty awards and honors, and faculty tenure and promotion guidelines.

RESULTS

Medical school Web sites demonstrate little evidence that schools incorporate community engagement in their mission or vision statements or their promotion and tenure guidelines. The majority of medical schools do not include community service terms and/or descriptive language in their mission statements, and only 8.5% of medical schools incorporate community service and engagement as a primary or major criterion in promotion and tenure guidelines.

DISCUSSION

This research highlights significant gaps in the integration of community engagement or community-engaged scholarship into medical school mission and vision statements, promotion and tenure guidelines, and service administrative structures.