Aims: To explore the subjective experience of developing a gender identity, a sexual identity and the intersection of the two, from the perspective of people who identify as LGBT+ and have ...questioned/explored both. Methodology: A qualitative methodology with a constructivist-interpretivist paradigm was employed. A community sample of 12 participants who self-identified as LGBT+ and having explored both gender identity and sexuality in childhood/adolescence were recruited. In-depth semi-structured interviews were conducted and analysed using Thematic Analysis. Results: Three themes and 11 subthemes were drawn out. The development of sexual identity was as an evolving process, which continued into adulthood and at times involved separating aspects of sexuality and overcoming internalised homophobia. Developing a gender identity was individualised and revolved around finding the aspects of gender that were acceptable to participants and rejecting those that were not. There were a number of intersections between gender identity and sexuality. It could be difficult to clearly pinpoint where one began and the other ended, meaning they can be confused and/or conflated. There also appeared to be a mutualism between these two parts of identity; as one developed for participants, so did the other. Conclusions: Gender identity and sexuality are two fundamental parts of identity which at times intersect and overlap. Consideration should be given to those who have the challenge of attempting to develop both, outside of perceived societal 'norms', with a move away from out-dated assumptions and labels. Implications are discussed in terms of therapeutic work for individuals seeking support in their identity development and the leadership role psychologists can take.
Little is known about the influence of personal experiences on learners’ trajectories toward mastery. Newell’s theory of constraints articulates the relationship between environmental, individual, ...and task-related factors for skill development. This study explores how undergraduate pharmacy students experience skill development on placements and what the barriers and facilitators are within Newell’s framework.
Year 3 undergraduate pharmacy students were invited to take part in focus groups exploring Newell’s theory relative to skill development. Verbatim transcripts were analyzed using an interpretive phenomenological approach.
Five focus groups were conducted with 16 students. The placement task provided structure through entrustable professional activities (EPAs). The resulting skill development varied but included EPA expected behaviors and also skills for mastery, eg, self-reflection. Students’ personal identities acted as both barriers and facilitators. For example, expecting or experiencing racial microaggressions limited participation; having a local accent facilitated rapport with patients. Students worked toward integration into the community of practice (the ward), where the staff was critical to inclusion. Where students had barriers related to their identities, they found it more difficult to access the community of practice.
Factors related to the community of practice (environment), students’ identities (individual), and the EPA behaviors (task) can influence skill development during placement. For some students, these factors will be more prevalent, and elements of their identities may intersect and conflict, acting as both barriers and facilitators to skill development. Educators can consider the influence of intersectionality on student identity when designing and preparing new placements and assessing students.
Initial education and training standards for pharmacists in Great Britain require early clinical exposure to patients using experiential work-based learning. However, there is poor evidence of this ...approach in some settings, such as paediatric care. The aim of this study was therefore to explore a novel model of experiential work-based learning for student pharmacists in a paediatric setting.
Fourth-year student pharmacists enrolled on a Master of Pharmacy programme were allocated five three-hour placement sessions at a paediatric hospital. Sessions consisted of a briefing, ward activities, scaffolded consultations with children and their carers, followed by a debriefing session with a clinical supervisor. Data were collected relating to the ward, patient details, student reported activities, learning outcomes and if follow up was required by a member of the clinical team. Data were cleaned, quality checked, then descriptive statistical analysis and inductive content analysis were conducted.
Seventy-four students took part in 28 individual sessions and 233 consultations were recorded. Consultations included a best-possible medical history (76%, n = 177), a satisfactory drug history (45%, n = 104), or discussed hospital discharge (11%, n = 26). Students were exposed to patients with diagnosed acute conditions (41%, n = 96) and chronic conditions (33%, n = 76), as well as children awaiting diagnosis (13%, n = 30). Students reported learning about the pathology, diagnosis and symptoms of paediatric conditions (48%, n = 81), medicines used in children (24%, n = 41), patient experiences of recieving care (15%, n = 25), carer experiences (2%, n = 3), the hospital environment (2%, n = 4), career progression (2%, n = 4), and experiences of social care (11%, n = 18). Findings were synthesised with existing entrustable professional activities from the literature to generate novel EPAs specific to paediatric settings.
A paediatric setting offers a suitable environment to host experiential work-based learning in pharmacy education. Standards of initial education and training which require pharmacists to prescribe in Great Britain must recognise the importance of exposure to the health needs and experiences of children, young people's and carers prior to graduation.
•Undergraduate pharmacy education is reforming to enable pharmacists to prescribe at the point of registration.•Limited work has explored how student pharmacists develop paediatric knowledge and skills prior to qualification.•Entrustable professional activities can support student pharmacist to learn about caring for children and young people.•Further work is needed to explore student pharmacists experiences during paediatric placements.
Background
Pharmacy students require knowledge of prescribing and supply of medicines; this is achievable through work-based learning. In UK hospitals, pharmacy technicians assess patient’s own drugs ...(PODs) so medicines can be used as they would be at home. Student-led POD checks have not yet been considered as an opportunity for legitimate peripheral participation (LPP).
Aim
To evaluate an undergraduate pharmacy placement model using POD checking as a way of gaining LPP within a UK tertiary hospital.
Method
Students (n = 100) attended nine placements over academic year 2020–2021; they were supervised by a pharmacy technician to complete POD checks. Data were collected concerning student activities and resulting medication-related issues (MRIs); data were descriptively analysed.
Results
1094 patients were seen by pharmacy students and 296 MRIs identified. Omitted (non-prescribed) medicines were the most common MRI (32.1%), followed by incorrect stock items (16.2%). Most MRIs were medium risk (65.5%). The most common actions/outcomes were handover to another ward member (41.6%) or medication removal (25.3%).
Conclusion
Clinically relevant MRIs relating to PODs can be identified by pharmacy students while experiencing LPP. These activities illustrate scalable work-based learning where pharmacy students can contribute to patient care in relation to the use and supply of medicines.
Pharmacist-patient counselling can benefit patients and optimise care, but appropriate training is required. A virtual patient (VP) tool to teach pharmacists non-vitamin K oral anticoagulant ...counselling was developed; the VP may be used for continuing professional development. The objective was to develop and show proof of concept of the VP. A cyclic development approach was adopted whereby the client, developers and a steering group informed VP design, content and aesthetic. This included formal and informal evaluation; ethical approval was not required. The VP received varied feedback. Positive feedback concerned the technology and the high-standard of animations. Negative elements concerned international VP use and differences in practice, also technological comments, regarding VP delivery and usability on various electronic devices. The VP was reported to be 'valuable' and realistic with high-quality animations. The steering group commented on VP's clinical appropriateness, cultural relevance and usability. Areas highlighted for improvement were rectified during development, including the incorporation of printable feedback. European considerations concerned differences in culture and practice. The development process successfully developed the VP and the proof of the concept was demonstrated. This will inform future VP development; a large-scale VP evaluation is underway.
Traffic signal timing has traditionally been designed and updated by modeling intersection operations. However, recent technological developments have introduced event logging capability within ...modern traffic signal controllers, which has shifted the process of retiming from modeling operations to measuring real performance. This allows signal engineers to retime signals on a proactive basis instead of reacting to complaint calls. Various performance measures and applications have been discussed in literature, but there has not yet been a comprehensive study of the process of deploying required infrastructure and conducting corridor retiming using signal performance measures. To develop guidance on deployment and use of signal performance measures for retiming, a case study was performed on State Road 9 (SR-9) in Anderson, Indiana. After completing an inventory of existing equipment on the corridor, traffic signal controllers and communication infrastructure were upgraded to enable the analysis of operations using high-resolution controller data. Using signal performance measures, a synchronized set of time-of-day plans was deployed, which decreased or held constant chronic split failures at most intersections on the corridor and improved travel time reliability. Next, local capacity was modified to improve service to over-utilized side-street and left turn movements, reducing localized split failures from 41.3 to 34.5 split failures per intersection per day. Finally, offsets were optimized to improve progression on the corridor during each time-of-day plan. The average percent of vehicles arriving on green increased or remained constant for all analysis periods, including an increase from 62% to 69% for the southbound PM period, which led to a 1-minute decrease in travel time during this analysis phase. As a result of the upgrade and retiming, travel time and corridor reliability were improved throughout the day, most notably decreasing travel time by 2 minutes from the existing conditions for the southbound PM plan. There were also opportunities to utilize the high-resolution controller data to monitor construction projects on the corridor. This document can serve as a blueprint for an agency or consultant to develop a new timing plan using traffic signal performance measures.
The unexpected closure of an interstate is a massive undertaking involving a variety of stakeholders. Such was the case in August 2015, when pier settlement of the Wildcat Creek Bridge on 1-65 N in ...Indiana, USA required an unplanned closure of a 37-mile stretch of the interstate for approximately 31 days. The detour route had little existing intelligent transportation systems infrastructure to assist engineers with managing operations. To fill this information need, real-time crowdsourced probe vehicle data were used to create real-time dashboards hosted on a Web site for use by Indiana Department of Transportation engineers and public safety officials to monitor mobility and queueing on the 62-mile detour route. This paper describes how the real-time dashboards were used to proactively identify congestion problems, as well as measure the impact of mitigation measures. In addition to using the real-time data during the detour operation, the data archive has been extremely valuable for post-detour after-action reviews to help improve future response efforts.
Introduction Patients commencing new medications, particularly those that are high risk such as non-vitamin K oral anticoagulants (NOACs), require counselling to ensure safe, effective and empowering ...use of the medicine. Pharmacists are well placed to provide this counselling, but they require an underpinning ability to do so. Training on NOACs is unstandardised and variable. A virtual patient (VP) educational tool on the topic of NOACs has been developed to help develop counselling skills relating to NOAC use in atrial fibrillation. VPs have been used to provide training for undergraduate students, but they are largely uninvestigated for use by qualified healthcare professionals. This study aims to evaluate the VP application and explore perspectives of pharmacists and pre-registration trainees on its use and potential. Methods The study followed a sequential exploratory mixed methods design using a sample of pharmacists and pre-registration trainees from sites across England. The participants completed a questionnaire pre and post-VP use. Following an interim analysis, a sample of the respondents were selected to undertake a follow-up semi-structured interview. Questionnaire results were analysed using a mixture of descriptive and inferential statistics; qualitative results were analysed using the Framework approach to thematic analysis. Results were then integrated via triangulation and corroborated to give an overall interpretation of the findings. Results and discussion NOAC training appears to be an under provided for area with many participants lacking in confidence in conducting NOAC patient counselling. There was a significant average increase in self-reported counselling ability across the respondents pre- to post-VP which suggests a benefit to VP use. The exact nature of the benefits were wide ranging and included changes in knowledge, confidence, contextualisation of content and an opportunity to practice. Some participants also cited effects of VP use on their practice, including using the learning as part of continuing professional development. Well recognised benefits to VP use were also further demonstrated including mobility and safety. The VP was largely well liked, usable and acceptable as a learning resource, but some improvements could be made prior to wider implementation. This includes changes to the delivery of feedback and increased flexibility in responses within the VP. The study considered how VP use maps to the theory of experiential learning to provide a learning opportunity routed in andragogical theory. There was a discussion around different VP users with no single ideal group identified but rather multiple groups that could all benefit from VP use; pre-registration trainees and newly qualified pharmacists were the most favoured. Implementation of the VP needs to be more well thought-out with a clear strategy and considerations for the required supporting infrastructure. This supporting infrastructure needs to be developed to support sustained and useful use of the VP application. Conclusion This research has demonstrated value of the VP, both from an individual user and wider educational perspective. A number of improvements, developments and further considerations have been identified including things to be addressed prior to any further implementation. The VP application is a useful additional resource which should be considered when pharmacy professionals are undertaking education and training around NOACs.
As a sunburnt country with droughts and flooding rains, rainforest and deserts, cities and the outback, Australia has a highly complex environment with widely variable issues across the landscape. In ...the 1990s, the Australian government supported a move to catchment-based natural resource management, which has built over a decade of learnings in how to achieve societal change at catchment scale under a range of different models. As one of the 56 regional bodies, Condamine Alliance have tested many innovative approaches, and have compiled invaluable insider knowledge on what has worked and what hasn't throughout this period. Natural resource management projects in the Condamine catchment have been built on partnerships in their truest form-everyone has "skin in the game", everyone invests (time and/or money) and everyone benefits. These partnerships ensure the buy-in and ownership necessary for success, and increase the buying potential of any individual investment. This partnership approach has also facilitated focusing on real priorities, as those involved need to all value an activity for it to happen; no one gets their outcomes for free. This legacy of ownership supports the continuation of work after the projects move on to other issues, with networks and skills left behind to maintain and expand upon the outcomes over time. From 2-year flood recovery projects to 10-year multi-award winning river recovery programs, the Condamine catchment has seen significant investment in improving the condition of its natural resources. The catchment-based partnership approach has built the region's capacity in a way that provides legacy way past the direct environmental benefits to the catchment and into the resilience of the catchment community. These challenges and successes of these activities and of the broader Australian approach, can provide important learnings of relevance to other regions and nations across the world.
PDF
