Beyond STEMI: paramedics' views on how to improve their ability to interpret ECGs

Background: Internationally, the paramedic scope of practice is developing. Bypassing emergency departments in favour of direct access to primary percutaneous coronary intervention laboratories has been limited largely to cases of ST-elevation myocardial infarction and new-onset left bundle branch block, but updates to international guidelines suggest that enhancing paramedics' skills in interpreting electrocardiograms (ECGs) and widening the bypass criteria could be beneficial. Aim: The aim of the study is to explore paramedics' views on ways to improve their ECG interpretation abilities. Method: A two-arm design was used with an online questionnaire (quantitative) and one-to-one interviews (qualitative). The questionnaire results were used to inform the interview guide. Findings: One hundred and eighteen paramedics completed the survey, and 11 took part in interviews. The major themes identified from the template analysis of the interviews were ‘a profession in transition’, ‘lagging professional development’ and ‘supporting the frontline’. Self-directed learning resources before, during and after action were proposed. Conclusion: Paramedicine is evolving in Ireland and practitioners have reported undertaking self-directed learning activities. The resulting heterogeneity in skills such as ECG interpretation, and perceived barriers to education, can cause feelings of vulnerability within the profession. Supporting the frontline by introducing some Group-Orchestrated Self-Directed Learning resources could empower practitioners and contribute to the evolution of prehospital care in Ireland.

The Intersection of Older Students and Disability: How Age-Friendly Universities Can Boost Visibility and Accessibility

The needs of older learners differ from traditional students, and many services and resources available at higher education institutions are geared towards students aged 18-25 (Silverstein, Choi, & Bulot, 2001). Age Friendly University (AFU) principles highlight the need to consider older learners at a university. Older learners face various barriers to education including balancing schoolwork with responsibilities and accessibility of campus resources (Silverstein et al., 2001). This study examined how an AFU designated university is working to better understand their older students. Methods A web-based pilot survey of older learners (N=248) asked all students ages 40 and older a series of questions regarding motivation to attend school, barriers and supports, campus environment, and connection with AFU principles. Analysis: A t-test analysis explored differences in motivation, barriers and challenges, and connection to campus between students who identified as having a disability and those who did not. Findings: We found there were significant differences between the groups in how health impacted their education (p=.001), being able to physically access campus (p=.014), the availability of online classes (p=.047), and the hours of operation of student support services (p=.045). There were also differences between groups in how connected they felt to campus based on feeling welcomed by faculty (p = .033) and feeling satisfied with their level of engagement at the university (p = .002). Discussion Our results demonstrate the need to fully engage older learners with a disability as part of diversity and inclusion efforts to facilitate connection to the campus community.

LGBTQ+ Psychosocial Concerns in Nursing and Midwifery Education Programmes: Qualitative Findings from a Mixed-Methods Study

LGBTQ+ people experience significant physical and psychosocial health issues and concerns, and encounter barriers when accessing healthcare services. We conducted a mixed-methods research study across all Schools of Nursing and Midwifery in the United Kingdom and Ireland using a survey and qualitative interviews. This was to identify the current content within nursing and midwifery pre-registration programmes in relation to LGBTQ+ health and to identity best practice and education innovation within these programmes. The survey was completed by 29 academics, with 12 selected to participate in a follow-up in-depth qualitative interview. Analysis of the data from the survey and interviews identified five themes: there is variable programme content; academics are developing their own programmes with no clear consistency; LGBTQ+ health is being linked to equality and diversity; there are barriers to education provision; and these is some evidence of best practice examples. The findings of the study support the need to develop and implement a curriculum for LGBTQ+ health in nursing and midwifery pre-registration programmes with learning aims and outcomes. Academics need support and tools to prepare and deliver LGBTQ+ health content to nurses and midwives as they ultimately have the potential to improve the experiences of LGBTQ+ people when accessing healthcare.

Cultural Barriers to Education of the Girl Child and Its Implication to Educational Attainment of the Oroko Children in Secondary Schools in the Kumba Municipality

The purpose of this study was to investigate the cultural practices that pose a barrier to female educational attainment of the Oroko people. Looking at the cultural barrier to the education of the girl child and its implication on educational attainment, the researcher realized that culture has played a great part in the attainment of education of the girl child in the Oroko land. The population of this study was made up of three secondary schools in the Kumba municipality. The instrument for data collection was the questionnaire. Data was analyzed by the use of descriptive and inferential statictics. The results showed that cultural barriers such as early marriages and the preference of the boy child’s education over that of a girl child affect the girls’ educational attainment in the Oroko land. Based on the finding the researcher recommended that the government should open schools in all villages so as to encourage the girls to go to school, the few girls who are already in school should try and impress their parents so that can change their mentality and conception that they have concerning female education.

997 A Systematic Review of Hernia Repair Simulation Models

Introduction There are barriers to education in both open and laparoscopic hernia repair technique, due to the laparoscopic learning curve, as well as reduced theatre time for junior surgical trainees. This is particularly evident during the current COVID-19 pandemic. Simulation models may provide further opportunities for training in hernia repair outside of the traditional surgical apprenticeship model. Method A systematic review was carried out following PRISMA guidelines to identify and evaluate simulation models in hernia repair. Of the 865 records screened, 26 were found to be relevant. These were assessed for face, content, and construct validity, as well as attempts to assess educational impact. Results Simulation models were identified comprising of animal tissues, synthetic materials, as well as VR technology. Models were designed for instruction in repair of inguinal, umbilical, incisional and diaphragmatic hernias. 4 of the 21 laparoscopic hernia repair models described demonstrated validity across several domains, and 3 of these 4 models were part of simulation-based courses demonstrating transferability of skills learnt in simulation to the operating room. Of the 5 open hernia repair simulation models, none were found to have demonstrated an educational impact in addition to assessing validity. Conclusions Few models individually were able to demonstrate validity and educational impact. Several novel assessment tools have been developed for assessment of progress when performing simulated and real laparoscopic inguinal hernia repair. More study is required, particularly for open hernia repair, including randomized controlled trials with large sample sizes to assess the transferability of skills.

Improving Access to Education for Marginalised Girls in Conflict Areas

A high proportion of out-of-school children across the world live in conflict-affected contexts. To remove barriers to education for marginalised girls in those contexts, a key challenge is to understand the multiple and intersecting forms of marginalisation and their changing dynamics during violent conflict. Research from the REALISE education project in the Democratic Republic of the Congo (DRC) identifies key considerations for education programmes for marginalised girls in conflict areas, such as inclusive education for girls and boys, links between education and peace-building, and extra-curricular activities to support social relationships.

Needs of Young African Neurosurgeons and Residents: A Cross-Sectional Study

Introduction: Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice.Methods: African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and a P-value < 0.05 was considered to be statistically significant.Results: 112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, and 52 (46.4%) were residents. 39 (34.8%) had regular journal club sessions at their hospital, 100 (89.3%) did not have access to cadaver dissection labs, and 62 (55.4%) had never attended a WFNS-endorsed conference. 67.0% of respondents reported limited research opportunities and 58.9% reported limited education opportunities. Lack of mentorship (P = 0.023, Phi = 0.26), lack of access to journals (P = 0.002, Phi = 0.332), and limited access to conferences (P = 0.019, Phi = 0.369) were associated with the country income category.Conclusion: This survey identified barriers to education, research, and practice among African trainees and young neurosurgeons. The findings of this study should inform future initiatives aimed at reducing the barriers faced by this group.

Psychological Health and Life Experiences of Pregnant Adolescent Mothers in Jamaica

A recent Jamaican school-based survey revealed that 23.1% of 13–15 year-olds, had attempted suicide one or more times during the last 12 months. Research that links adolescent pregnancy and suicidal behaviour is lacking in Jamaica. Psychological distress and suicidal behaviours amongst pregnant adolescents elsewhere in the Americas has been documented at prevalence of between 13.3%–20%. The purpose of the study was to explore the experiences and the impact of pregnancy on pregnant adolescent psychological health. Individual interviews and focus groups were conducted with adolescents in two Jamaican antenatal clinics. One clinic was designed as a ‘Teen Pregnancy Clinic’ and the other used the standard antenatal clinic design. The following themes were identified: decision-making, resilience, social support, community support system, distress, and perceptions of service. Participants reported positively on the specific interventions tailored to their needs at the Teen Clinic. Although motherhood is valued, none of the pregnancies in this study were planned by the mother. Of the 30 adolescents interviewed, seven cases were referred for counseling due to their need for emotional and psychological support. One of the adolescents reported recent sexual violence and another reported having experienced childhood sexual abuse. Historically, Jamaican adolescent mothers faced barriers to education, self determination, and family planning. Empowering, adolescent-centred healthcare and comprehensive reproductive health education may mitigate psychosocial distress.

Psychological Health and Life Experiences of Pregnant Adolescent Mothers in Jamaica

A recent Jamaican school-based survey revealed that 23.1% of 13–15 year-olds, had attempted suicide one or more times during the last 12 months. Research that links adolescent pregnancy and suicidal behaviour is lacking in Jamaica. Psychological distress and suicidal behaviours amongst pregnant adolescents elsewhere in the Americas has been documented at prevalence of between 13.3%–20%. The purpose of the study was to explore the experiences and the impact of pregnancy on pregnant adolescent psychological health. Individual interviews and focus groups were conducted with adolescents in two Jamaican antenatal clinics. One clinic was designed as a ‘Teen Pregnancy Clinic’ and the other used the standard antenatal clinic design. The following themes were identified: decision-making, resilience, social support, community support system, distress, and perceptions of service. Participants reported positively on the specific interventions tailored to their needs at the Teen Clinic. Although motherhood is valued, none of the pregnancies in this study were planned by the mother. Of the 30 adolescents interviewed, seven cases were referred for counseling due to their need for emotional and psychological support. One of the adolescents reported recent sexual violence and another reported having experienced childhood sexual abuse. Historically, Jamaican adolescent mothers faced barriers to education, self determination, and family planning. Empowering, adolescent-centred healthcare and comprehensive reproductive health education may mitigate psychosocial distress.