A Qualitative Study of Developing Competency in Thyroid Surgery: A Resident’s Perspective With 5 Year Follow Up

2021 ◽  
pp. 000348942199691
Author(s):  
Gabriela DeVries ◽  
Megan Rudolph ◽  
Howard David Reines ◽  
Philip E. Zapanta
Keyword(s):  
Qualitative Study ◽  
Learning Strategies ◽  
Thyroid Surgery ◽  
Washington Dc ◽  
Structured Interviews ◽  
Self Directed Learning ◽  
Surgical Specialty ◽  
Long Term Follow Up ◽  
The Individual

Objectives: The Accreditation Council for Graduate Medical Education has guidelines on assessing surgical qualifications based on experience. Attending surgeons have various assumptions on how their trainees learn and acquire surgical skills. This study primarily investigates the resident’s perspective on gaining experience and achieving competency in thyroid surgical procedures. Methods: A qualitative study using semi-structured interviews was designed to derive themes that discuss the acquisition of competency in thyroid surgery. After IRB approval, data was collected from 2012 to 2014 at 4 academic centers in the Washington, DC area. Fourteen chief residents specializing in either general surgery or otolaryngology were interviewed until saturation was achieved. These semi-structured interviews were transcribed and broken up into codes utilizing Moustakas’ analysis. A comprehensive list of master themes in regards to achieving competency in thyroid surgery was developed. A follow up survey of the surgeons was undertaken at 5 years to determine if the perceptions during residency persisted in practice. Results: Surgical specialty residents experience and learn thyroid surgery in 5 learning themes: 1. Self—directed learning is significant during residency. 2. Repetition with graduated autonomy is key. 3. Effective mentors are competent surgeons who challenge residents and use positive teaching techniques. 4. Residents employ active learning through the “see one, do one, teach one” philosophy. 5. Learning from complexity is of importance to residency training. After several years in practice, the most important theme in learning after residency was repetition of cases. Conclusions: This study demonstrates how residents progress in approaching competency in thyroid surgery. Adult learning strategies are preferred, and programs should incorporate tailored techniques to meet the individual needs of the residents. Perceptions of what is most important shifted in long-term follow up. Further study is needed to assure competency in residency and in practice.

scholarly journals A story half told: a qualitative study of medical students’ self-directed learning in the clinical setting

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tzu-Hung Liu ◽  
Amy M. Sullivan
Keyword(s):  
Medical Students ◽  
Qualitative Study ◽  
Learning Strategies ◽  
Clinical Setting ◽  
Clinical Training ◽  
Student Experiences ◽  
Structured Interviews ◽  
Self Directed Learning ◽  
Patient Centered ◽  
Directed Learning

Abstract Background Medical educators have promoted self-directed learning (SDL) as an important means of enabling students to take responsibility for their own learning throughout their training and practice. While SDL has been well-studied in classroom settings, it remains a story half told: barriers to and facilitators of SDL in the clinical setting are not yet well described. The goals of this study were to explicate student experiences of SDL in their clinical training and to identify the roles that local social and cultural contexts play in shaping their experiences of SDL. Methods To understand students’ conceptualization and experiences of SDL in the clinical setting, we carried out a qualitative study with 15 medical students at Harvard Medical School. The semi-structured interviews were recorded and transcribed. Using an interpretivist approach, data were analyzed both deductively and inductively using the Framework method of content analysis. Results Participants described patient care activities as primary motivators for engagement in SDL in the clinical setting. Participants’ descriptions of SDL aligned with Knowles’ steps in SDL, with an additional step of consolidation of learning related to their patients’ diagnosis and management. Participants described using a range of cognitive, social-emotional, and peer learning strategies to enhance their SDL. Participants who described a growth mindset appeared to engage in SDL more easily. Learning environments that fostered SDL were those in which faculty and residents demonstrated an educational orientation, promoted psychological safety, and invited student engagement. Teams with perceived excessive work demands were perceived to be less supportive of SDL. Conclusions Our study enhances previous classroom-based models of SDL by providing specific, practical implications for both students and faculty in the clinical training setting. Participants described SDL in the clinical setting as patient-centered, and when effectively implemented, SDL appears to support a mastery rather than performance orientation. Our study paves the way for improving medical students’ clinical SDL and helping them become lifelong learners in the field of medicine.

scholarly journals Telemedicine in The Context of Covid-19- A Qualitative Study of Cancer Patients and Clinicians

2021 ◽  
Author(s):  
Dylan Chan Tai Kong ◽  
Ashfaq Chauhan ◽  
Anaïs Tiffany Ah Leung ◽  
Melvin Chin
Keyword(s):  
Qualitative Study ◽  
Theory Approach ◽  
Structured Interviews ◽  
Hospital Data ◽  
Metropolitan Regions ◽  
Theoretical Sampling ◽  
Proper Training ◽  
Grounded Theory Approach

Abstract Background:Prior to the Covid-19 pandemic, telemedicine was only used to deliver health care to patients living in remote areas of Australia. However, the spread of the Covid-19 virus pushed the widespread uptake of telemedicine across Australia, including in metropolitan regions. This qualitative study will explore the medical oncology (MO) patient and clinician experience of telemedicine in a metropolitan setting as a result of Covid-19.Method:Participants were selected and invited to participate by theoretical sampling from MO clinicians and patients attending MO clinics at Prince of Wales Hospital. Data was collected by in-depth semi-structured interviews. Thematic analysis was performed to analyse the interview data. Transcripts were coded using the grounded theory approach to identify overarching themes.Results:Twelve participants were recruited to the study. Most participants viewed the adoption of telemedicine positively because it was considered as convenient, efficient and could be used in order to reduce the spread of Covid-19. Nonetheless, participants complained about the poor implementation of telemedicine, technical difficulties and lack of proper training. Finally, providers expressed mixed views over the lack of personal interaction and the lack of physical examination from telemedicine. However, both clinicians and patients viewed telemedicine as acceptable to be used in the context of routine follow-ups.Conclusion:Although some operational improvements are necessary, the role of telemedicine in the follow up of MO patients seems likely to continue beyond Covid-19.

scholarly journals Patients’ experiences of discontentment one year after total knee arthroplasty- a qualitative study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Aamir Mahdi ◽  
Mia Svantesson ◽  
Per Wretenberg ◽  
Maria Hälleberg-Nyman
Keyword(s):  
Total Knee Arthroplasty ◽  
Qualitative Study ◽  
Knee Arthroplasty ◽  
Qualitative Content Analysis ◽  
Organizational Level ◽  
Structured Interviews ◽  
Common Procedure ◽  
Replacement Surgery ◽  
Total Knee ◽  
The Individual

Abstract Background Total knee arthroplasty is a common procedure with generally good results. However, there are still patients who are dissatisfied without known explanation. Satisfaction and dissatisfaction have previously been captured by quantitative designs, but there is a lack of qualitative studies regarding these patients’ experiences. Qualitative knowledge might be useful in creating strategies to decrease the dissatisfaction rate. Methods Of the 348 patients who responded to a letter asking if they were satisfied or dissatisfied with their surgery, 61 (18%) reported discontent. After excluding patients with documented complications and those who declined to participate, semi-structured interviews were conducted with 44 patients. The interviews were analyzed according to qualitative content analysis. The purpose was to describe patients’ experiences of discontentment 1 year after total knee arthroplasty. Results The patients experienced unfulfilled expectations and needs regarding unresolved and new problems, limited independence, and lacking of relational supports. They were bothered by pain and stiffness, and worried that changes were complications as a result of surgery. They described inability to perform daily activities and valued activities. They also felt a lack of relational supports, and a lack of respect and continuity, support from health care, and information adapted to their needs. Conclusion Patient expectation seems to be the major contributing factor in patient discontentment after knee replacement surgery. This qualitative study sheds light on the on the meaning of unfulfilled expectations, in contrast to previous quantitative studies. The elements of unfulfilled expectations need to be dealt with both on the individual staff level and on the organizational level. For instance, increased continuity of healthcare staff and facilities may help to improve patient satisfaction after surgery.

scholarly journals Management of pressure ulcers in palliative care patients: nurses' view

Rev Rene ◽  
2021 ◽  
Vol 22 ◽  
pp. e62774
Author(s):  
Sarah Vieira Figueiredo ◽  
Sherida Karanini Paz de Oliveira ◽  
Anne Kayline Soares Teixeira ◽  
Luciana Catunda Gomes de Menezes ◽  
Ilvana Lima Verde Gomes ◽  
...  
Keyword(s):  
Palliative Care ◽  
Qualitative Study ◽  
Clinical Improvement ◽  
Pressure Ulcers ◽  
Complete Healing ◽  
Nursing Management ◽  
Structured Interviews ◽  
Categorical Analysis ◽  
Clinical Stabilization ◽  
The Individual

Objective: to understand the management of pressure ulcers in palliative care patients from the perspective of nurses. Methods: qualitative study, in which 17 care nurses participated through semi-structured interviews. Data were submitted to thematic categorical analysis. Results: two categories were listed: Nursing management of pressure ulcers in palliative care patients and Outcome of pressure ulcers in palliative care patients. Their management occurs by means of individualized assistance and may vary according to the different moments in which the individual is and should be malleable. The possibility of three outcomes was also observed: complete healing, clinical improvement and clinical stabilization. Conclusion: despite all the frailty of these patients in palliative care, it was perceived that the clinical improvement of the lesions occurs, although it is a slow path, by means of handling the lesions in an individualized manner and focused on the search for comfort.

scholarly journals Family Perceptions of Newborn Cytomegalovirus Screening: A Qualitative Study

2021 ◽  
Vol 7 (4) ◽  
pp. 80
Author(s):  
Michael J. Cannon ◽  
Denise M. Levis ◽  
Holly McBride ◽  
Danie Watson ◽  
Carol Rheaume ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Healthcare Providers ◽  
Medical College ◽  
Follow Up Study ◽  
Opt Out ◽  
Long Term Follow Up ◽  
Family Perceptions ◽  
Congenital Cmv

Objectives: We sought to understand long-term retrospective parental perceptions of the utility of newborn screening in a context where many affected children never develop sequelae but where intensive support services and ongoing healthcare were provided. Study design: Qualitative study. Methods: Focus groups and interviews among parents (N = 41) of children with congenital CMV who had been enrolled in a long-term follow-up study at a large medical college for a mean of 22 years following diagnosis. Groups included parents whose children were: symptomatic at birth; initially asymptomatic but later developed sensorineural hearing loss; and who remained asymptomatic into adulthood. Results: With proper follow-up support, newborn CMV screening was viewed positively by parents, who felt empowered by the knowledge, though parents often felt that they and healthcare providers needed more information on congenital CMV. Parents in all groups valued newborn CMV screening in the long term and believed it should be embedded within a comprehensive follow-up program. Conclusions: Despite initial distress, parents of CMV-positive children felt newborn CMV screening was a net positive. Mandatory or opt-out screening for conditions with variable presentations and treatment outcomes may be valuable in contexts where follow-up and care are readily available.

scholarly journals The Subjective Experience of Pregnancy and the Ex-pectations of Childbirth on a Medicalized World: a Qualitative Study

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Rute Brites ◽  
Odete Nunes ◽  
Monica Pires ◽  
João Hipólito
Keyword(s):  
Health Care ◽  
Content Analysis ◽  
Qualitative Study ◽  
Subjective Experience ◽  
Negative Consequences ◽  
Structured Interviews ◽  
Pregnancy And Childbirth ◽  
Relational Experiences ◽  
Subsequent Discussion ◽  
The Individual

Background: To become a mother represents, for many women, a challenging existential process. Women have to deal with countless changes and adaptations, which can be experienced as sources of imbalance but also as moments of personal enrichment.  Currently, this process is influenced by the medicalization of pregnancy and childbirth, which may have positive or negative consequences to the individual experiences of pregnancy and childbirth.Goals: This study aimed to deepen the understanding of the experience of pregnancy and expectations regarding childbirth in a group of women, in a context where pregnancy and childbirth are increasingly medicalized processes.Methods: In this qualitative study, we used semi-structured interviews to collect data regarding the experience of pregnancy and regarding expectations about childbirth in a sample of women (n = 37), recruited in health care centres or obstetric clinics by research assistants. The individual interviews took place at their homes. Data resulting from these interviews, focusing on the relationship with the health team, the partner and the unborn baby, and on the moment of childbirth, were analysed using ALCESTE software. Two senior researchers, psychologists, conducted the content analysis. Investigator triangulation was achieved through independent content analysis by each researcher and subsequent discussion and consensual interpretation.Results: Thirty-seven pregnant women were interviewed. Four classes emerged from the analysis: "Expectations about childbirth and baby health", “Significant relational experiences of the past”, "Mother-baby relationship process" and “Health care in pregnancy". Results emphasize the desire of future mothers to have a quick childbirth, without stress and with minimal suffering and anxiety. Despite these worries, women described a positive subjective experience of pregnancy and a feeling of security related to the knowledge they attribute to health professionals. Discussion: “Medicalization” seems to be perceived as positive and securing, with no mention to a sense of disempowerment or loss of control. Therefore, the existence of spaces for sharing disturbing experiences and expectations of childbirth is prophylactic,contributing to the creation of conditions that foster positive expectations and mitigate fears related to childbirth.

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