Publications by authors named "Stephen Mason"

136 Publications

A qualitative study of bereaved relatives' end of life experiences during the COVID-19 pandemic.

Palliat Med 2021 Mar 30:2692163211004210. Epub 2021 Mar 30.

Palliative Care Institute Liverpool, North West Cancer Research Centre, University of Liverpool, Liverpool, UK.

Background: Meeting the needs of relatives when a family member is dying can help facilitate better psychological adjustment in their grief. However, end of life experiences for families are likely to have been deleteriously impacted by the COVID-19 crisis. Understanding how families' needs can be met during a global pandemic will have current/future relevance for clinical practice and policy.

Aim: To explore relatives' experiences and needs when a family member was dying during the COVID-19 pandemic.

Design: Interpretative qualitative study using semi-structured interviews. Data were analysed thematically.

Setting/participants: A total of 19 relatives whose family member died during the COVID-19 pandemic in the United Kingdom.

Results: In the absence of direct physical contact, it was important for families to have a clear understanding of their family member's condition and declining health, stay connected with them in the final weeks/days of life and have the opportunity for a final contact before they died. Health and social care professionals were instrumental to providing these aspects of care, but faced practical challenges in achieving these. Results are presented within three themes: (1) entering into the final weeks and days of life during a pandemic, (2) navigating the final weeks of life during a pandemic and (3) the importance of 'saying goodbye' in a pandemic.

Conclusions: Health and social care professionals can have an important role in mitigating the absence of relatives' visits at end of life during a pandemic. Strategies include prioritising virtual connectedness and creating alternative opportunities for relatives to 'say goodbye'.
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http://dx.doi.org/10.1177/02692163211004210DOI Listing
March 2021

Virtual reality in specialist palliative care: a feasibility study to enable clinical practice adoption.

BMJ Support Palliat Care 2021 Feb 17. Epub 2021 Feb 17.

Palliative Care Unit, University of Liverpool, Liverpool, UK.

Background: The use of virtual reality (VR) is increasing in palliative care. However, despite increasing interest in VR, there is little evidence of how this technology can be implemented into practice.

Aims: This paper aims to: (1) explore the feasibility of implementing VR therapy, for patients and caregivers, in a hospital specialist inpatient palliative care unit and a hospice, and (2) to identify questions for organisations, to support VR adoption in palliative care.

Methods: The Samsung Gear VR system was used in a hospital specialist palliative inpatient unit and a hospice. Patients and caregivers received VR distraction therapy and provided feedback of their experience. Staff completed a feedback questionnaire to explore their opinion of the usefulness of VR in palliative care. A public engagement event was conducted, to identify questions to support implementation of VR in palliative care settings.

Results: Fifteen individuals (12 (80%) patients and 3 (20%) caregivers) participated. All had a positive experience. No adverse effects were reported. Ten items were identified for organisations to consider ahead of adoption of VR in palliative care. These were questions about: the purpose of VR; intended population; supporting evidence; session duration; equipment choice; infection control issues; content choice; setting of VR; person(s) responsible for delivery and the maintenance plan.

Conclusions: It is feasible to use VR therapy in palliative care; however, further evidence about its efficacy and effectiveness is needed. Palliative care practitioners considering VR use should carefully consider several factors, to ensure that this technology can be used safely and effectively in clinical practice.
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http://dx.doi.org/10.1136/bmjspcare-2020-002327DOI Listing
February 2021

Chinese medical teachers' cultural attitudes influence palliative care education: a qualitative study.

BMC Palliat Care 2021 Jan 12;20(1):14. Epub 2021 Jan 12.

Faculty of Medicine, Department of Palliative Care, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.

Background: China holds one fifth of the world's population and faces a rapidly aging society. In its ambition to reach a health care standard comparable to developed countries by 2030, the implementation of palliative care gains special importance. Until now, palliative care education in China is limited and disparate. This study aims to explore and determine factors that have impeded the development and implementation of palliative care education in China.

Methods: We conducted semi-structured interviews with n=28 medical teachers from seven Chinese universities. Interviews were transcribed, and thematic analysis applied.

Results: Three themes with two subthemes were constructed from data analysis. Theme 1 covers the still ambivalent perception of palliative care and palliative care education among participants. The second theme is about cultural attitudes around death and communication. The third theme reflects participants' pragmatic general understanding of teaching. All themes incorporate obstacles to further implementation of palliative care and palliative care education in China.

Conclusions: According to the study participants, palliative care implementation through palliative care education in China is hindered by cultural views of medical teachers, their perception of palliative care and palliative care education, and their understanding of teaching. The study demonstrates that current attitudes may work as an obstacle to the implementation of palliative care within the health care system. Approaches to changing medical teachers' views on palliative care and palliative care education and their cultural attitudes towards death and dying are crucial to further promote the implementation of palliative care in China.
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http://dx.doi.org/10.1186/s12904-020-00707-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805147PMC
January 2021

Importance of building a digital species index (spindex) for entomology collections: A case study, results and recommendations.

Biodivers Data J 2020 23;8:e58310. Epub 2020 Dec 23.

Academy of Natural Sciences of Drexel University, Philadelphia, United States of America Academy of Natural Sciences of Drexel University Philadelphia United States of America.

The Entomology Collection at the Academy of Natural Sciences of Drexel University (ANSP) contains approximately four million insect specimens including some of the oldest in the Western Hemisphere. Like most large entomology collections, no complete inventory of the species represented in the collection was available and even a physical search for a species could not ensure that all available specimens would be recovered for study. Between 2010 and 2014, we created a species-level index (called here spindex) of all species and their specimen counts at ANSP, along with each species' location in the collection. Additional data captured during the project included the higher level classification of each species and type of specimen preparation. The spindex is searchable online: http://symbiont.ansp.org/entomology/. The spindex project documented 96,126 species in the ANSP Entomology Collection, representing about 10% of the described insect fauna. Additionally, over 900 putative primary types were discovered outside the Primary Type Collection. The completion of this project has improved access to the collection by enabling scientists and other users worldwide to search these collection holdings remotely and has facilitated staff in curation, research, collection management and funding proposals. A spindex is an important tool that is overlooked for planning and carrying out specimen level digitisation. This project is a case study for building a species-level index. A detailed protocol is provided, along with recommendations for other collections, including cost estimates and strategies for tracking progress and avoiding common obstacles.
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http://dx.doi.org/10.3897/BDJ.8.e58310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773715PMC
December 2020

The impact of death and dying on the personhood of medical students: a systematic scoping review.

BMC Med Educ 2020 Dec 28;20(1):516. Epub 2020 Dec 28.

Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.

Background: The re-introduction of medical students into healthcare systems struggling with the COVID-19 pandemic raises concerns as to whether they will be supported when confronted with death and dying patients in resource-limited settings and with reduced support from senior clinicians. Better understanding of how medical students respond to death and dying will inform educationalists and clinicians on how to best support them.

Methods: We adopt Krishna's Systematic Evidence Based Approach to carry out a Systematic Scoping Review (SSR in SEBA) on the impact of death and dying on medical students. This structured search process and concurrent use of thematic and directed content analysis of data from six databases (Split Approach) enhances the transparency and reproducibility of this review.

Results: Seven thousand six hundred nineteen were identified, 149 articles reviewed and 52 articles included. The Split Approach revealed similar themes and categories that correspond to the Innate, Individual, Relational and Societal domains in the Ring Theory of Personhood.

Conclusion: Facing death and dying amongst their patients affect how medical students envisage their personhood. This underlines the need for timely, holistic and longitudinal support systems to ensure that problems faced are addressed early. To do so, there must be effective training and a structured support mechanism.
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http://dx.doi.org/10.1186/s12909-020-02411-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768997PMC
December 2020

Development of an international Core Outcome Set (COS) for best care for the dying person: study protocol.

BMC Palliat Care 2020 Nov 30;19(1):184. Epub 2020 Nov 30.

University Center for Palliative Care, Department of Oncology, Inselspital, Bern University Hospital, Bern, Switzerland.

Background: In contrast to typical measures employed to assess outcomes in healthcare such as mortality or recovery rates, it is difficult to define which specific outcomes of care are the most important in caring for dying individuals. Despite a variety of tools employed to assess different dimensions of palliative care, there is no consensus on a set of core outcomes to be measured in the last days of life. In order to optimise decision making in clinical practice and comparability of interventional studies, we aim to identify and propose a set of core outcomes for the care of the dying person.

Methods: Following the COMET initiative approach, the proposed study will proceed through four stages to develop a set of core outcomes: In stage 1, a systematic review of the literature will identify outcomes measured in existing peer reviewed literature, as well as outcomes derived through qualitative studies. Grey literature, will also be included. Stage 2 will allow for the identification and determination of patient and proxy defined outcomes of care at the end of life via quantitative and qualitative methods at an international level. In stage 3, from a list of salient outcomes identified through stages 1 and 2, international experts, family members, patients, and patient advocates will be asked to score the importance of the preselected outcomes through a Delphi process. Stage 4 consists of a face-to-face consensus meeting of international experts and patient/family representatives in order to define, endorse, and propose the final Core Outcomes Set.

Discussion: Core Outcome Sets aim at promoting uniform assessment of care outcomes in clinical practice as well as research. If consistently employed, a robust set of core outcomes for the end of life, and specifically for the dying phase, defined by relevant stakeholders, can ultimately be translated into best care for the dying person. Patient care will be improved by allowing clinicians to choose effective and meaningful treatments, and research impact will be improved by employing internationally agreed clinically relevant endpoints and enabling accurate comparison between studies in systematic reviews and/or in meta-analyses.
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http://dx.doi.org/10.1186/s12904-020-00654-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7706044PMC
November 2020

The impact of caring for dying patients in intensive care units on a physician's personhood: a systematic scoping review.

Philos Ethics Humanit Med 2020 11 25;15(1):12. Epub 2020 Nov 25.

Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Background: Supporting physicians in Intensive Care Units (ICU)s as they face dying patients at unprecedented levels due to the COVID-19 pandemic is critical. Amidst a dearth of such data and guided by evidence that nurses in ICUs experience personal, professional and existential issues in similar conditions, a systematic scoping review (SSR) is proposed to evaluate prevailing accounts of physicians facing dying patients in ICUs through the lens of Personhood. Such data would enhance understanding and guide the provision of better support for ICU physicians.

Methods: An SSR adopts the Systematic Evidenced Based Approach (SEBA) to map prevailing accounts of caring for dying patients in ICUs. To enhance the transparency and reproducibility of this process, concurrent and independent use of tabulated summaries, thematic analysis and directed content analysis (Split Approach) is adopted.

Results: Eight thousand three hundred fifty-eight abstracts were reviewed from four databases, 474 full-text articles were evaluated, 58 articles were included, and the Split Approach revealed six categories/themes centered around the Innate, Individual, Relational and Societal Rings of Personhood, conflicts in providing end of life care and coping mechanisms employed.

Conclusion: This SSR suggests that caring for dying patients in ICU impacts how physicians view their personhood. To resolve conflicts within individual concepts of personhood, physicians use prioritization, reframing and rely on accessible, personalized support from colleagues to steer coping strategies. An adapted form of the Ring Theory of Personhood is proposed to direct timely personalized, appropriate and holistic support.
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http://dx.doi.org/10.1186/s13010-020-00096-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685911PMC
November 2020

Examining the effect of non-specialised clinical rotations upon medical students' Thanatophobia and Self-efficacy in Palliative Care: a prospective observational study in two medical schools.

BMJ Open 2020 11 18;10(11):e041144. Epub 2020 Nov 18.

CEDAR-Center for Educational Development and Research in Health Sciences, University Medical Centre Groningen, Groningen, Netherlands

Introduction: Including palliative care (PC) in overloaded medical curricula is a challenge, especially where there is a lack of PC specialists. We hypothesised that non-specialised rotations could provide meaningful PC learning when there are enough clinical experiences, with adequate feedback.

Objective: Observe the effects of including PC topics in non-specialised placements for undergraduate medical students in two different medical schools.

Design: Observational prospective study.

Setting: Medical schools in Brazil.

Participants: 134 sixth-year medical students of two medical schools.

Methods: This was a longitudinal study that observed the development of Self-efficacy in Palliative Care (SEPC) and Thanatophobia (TS) in sixth-year medical students in different non-specialised clinical rotations in two Brazilian medical schools (MS1 and MS2). We enrolled 78 students in MS1 during the Emergency and Critical Care rotation and 56 students in MS2 during the rotation in Anaesthesiology. Both schools provide PC discussions with different learning environment and approaches.

Primary Outcomes: SEPC and TS Scales were used to assess students at the beginning and the end of the rotations.

Results: In both schools' students had an increase in SEPC and a decrease in TS scores.

Conclusion: Non-specialised rotations that consider PC competencies as core aspects of being a doctor can be effective to develop SEPC and decrease TS levels.
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http://dx.doi.org/10.1136/bmjopen-2020-041144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677329PMC
November 2020

Assessing Professionalism in Medicine - A Scoping Review of Assessment Tools from 1990 to 2018.

J Med Educ Curric Dev 2020 Jan-Dec;7:2382120520955159. Epub 2020 Oct 16.

Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Background: Medical professionalism enhances doctor-patient relationships and advances patient-centric care. However, despite its pivotal role, the concept of medical professionalism remains diversely understood, taught and thus poorly assessed with Singapore lacking a linguistically sensitive, context specific and culturally appropriate assessment tool. A scoping review of assessments of professionalism in medicine was thus carried out to better guide its understanding.

Methods: Arksey and O'Malley's (2005) approach to scoping reviews was used to identify appropriate publications featured in four databases published between 1 January 1990 and 31 December 2018. Seven members of the research team employed thematic analysis to evaluate the selected articles.

Results: 3799 abstracts were identified, 138 full-text articles reviewed and 74 studies included. The two themes identified were the context-specific nature of assessments and competency-based stages in medical professionalism.

Conclusions: Prevailing assessments of professionalism in medicine must contend with differences in setting, context and levels of professional development as these explicate variances found in existing assessment criteria and approaches. However, acknowledging the significance of context-specific competency-based stages in medical professionalism will allow the forwarding of guiding principles to aid the design of a culturally-sensitive and practical approach to assessing professionalism.
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http://dx.doi.org/10.1177/2382120520955159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7580192PMC
October 2020

The palliative care needs and experiences of people with advanced head and neck cancer: A scoping review.

Palliat Med 2021 Jan 21;35(1):27-44. Epub 2020 Oct 21.

Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK.

Background: The palliative care needs of people with advanced head and neck cancer pose unique complexities due to the impact the illness has on eating, speaking, appearance and breathing. Examining these needs would help provide guidance about developing relevant models of care and identify gaps in research knowledge.

Aim: To identify and map out the palliative care needs and experiences for people with advanced head and neck cancer.

Design: A scoping literature review following the methods described by the Joanna Briggs Institute.

Data Sources: An electronic search of the literature was undertaken in MEDLINE (Ovid), EMBASE and CINAHL covering the years January 1996 to January 2019.

Results: People with advanced head and neck cancer often had palliative care needs but there was variability in the timing and access to relevant services. A high prevalence of interventions, for example hospital admissions were needed even during the last month of life. This was not necessarily negated with early engagement of palliative care. Dissonance between patients and family carers about information needs and decision-making was an additional complexity. Studies tended to be descriptive in nature, and often involved a single centre.

Conclusion: This scoping review demonstrates the complexity of care for people with advanced head and neck cancer and the issues related to the current healthcare systems. Focus on appropriate referral criteria, increased integration and coordination of care and robust evaluation of specific care components seems key. Linkage between research and service design delivery across teams, disciplines and care settings seems pertinent.
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http://dx.doi.org/10.1177/0269216320963892DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797618PMC
January 2021

Interprofessional communication (IPC) for medical students: a scoping review.

BMC Med Educ 2020 Oct 16;20(1):372. Epub 2020 Oct 16.

Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.

Background: Effective Interprofessional Communication (IPC) between healthcare professionals enhances teamwork and improves patient care. Yet IPC training remains poorly structured in medical schools. To address this gap, a scoping review is proposed to study current IPC training approaches in medical schools.

Methods: Krishna's Systematic Evidence Based Approach (SEBA) was used to guide a scoping review of IPC training for medical students published between 1 January 2000 to 31 December 2018 in PubMed, ScienceDirect, JSTOR, Google Scholar, ERIC, Embase, Scopus and PsycINFO. The data accrued was independently analysed using thematic and content analysis to enhance the reproducibility and transparency of this SEBA guided review.

Results: 17,809 titles and abstracts were found, 250 full-text articles were reviewed and 73 full text articles were included. Directed Content analysis revealed 4 categories corresponding to the levels of the Miller's Pyramid whilst thematic analysis revealed 5 themes including the indications, stages of trainings and evaluations, content, challenges and outcomes of IPC training. Many longitudinal programs were designed around the levels of Miller's Pyramid.

Conclusion: IPC training is a stage-wise, competency-based learning process that pivots on a learner-centric spiralled curriculum. Progress from one stage to the next requires attainment of the particular competencies within each stage of the training process. Whilst further studies into the dynamics of IPC interactions, assessment methods and structuring of these programs are required, we forward an evidenced based framework to guide design of future IPC programs.
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http://dx.doi.org/10.1186/s12909-020-02296-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574565PMC
October 2020

The Pivotal Role of Host Organizations in Enhancing Mentoring in Internal Medicine: A Scoping Review.

J Med Educ Curric Dev 2020 Jan-Dec;7:2382120520956647. Epub 2020 Sep 30.

Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

In undergraduate and postgraduate medical education, mentoring offers personalized training and plays a key role in continuing medical education and the professional development of healthcare professionals. However, poor structuring of the mentoring process has been attributed to failings of the host organization and, as such, we have conducted a scoping review on the role of the host organization in mentoring programs. Guided by Levac et al's methodological framework and a combination of thematic and content analysis, this scoping review identifies their "defining" and secondary roles. Whilst the "defining" role of the host is to set standards, nurture, and oversee the mentoring processes and relationships, the secondary roles comprise of supporting patient care and specific responsibilities toward the mentee, mentor, program, and organization itself. Critically, striking a balance between structure and flexibility within the program is important to ensure consistency in the mentoring approach whilst accounting for the changing needs and goals of the mentees and mentors.
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http://dx.doi.org/10.1177/2382120520956647DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7536487PMC
September 2020

Enhancing Mentoring in Palliative Care: An Evidence Based Mentoring Framework.

J Med Educ Curric Dev 2020 Jan-Dec;7:2382120520957649. Epub 2020 Sep 23.

National University Hospital, National University Health System, Singapore.

Background: Growing concerns over ethical issues in mentoring in medicine and surgery have hindered efforts to reinitiate mentoring for Palliative Care (PC) physicians following the easing of COVID-19 restrictions. Ranging from the misappropriation of mentee's work to bullying, ethical issues in mentoring are attributed to poor understanding and structuring of mentoring programs, underlining the need for a consistent approach to mentoring practices.

Methods: Given diverse practices across different settings and the employ of various methodologies, a novel approach to narrative reviews (NR)s is proposed to summarize, interpret, and critique prevailing data on novice mentoring. To overcome prevailing concerns surrounding the reproducibility and transparency of narrative reviews, the Systematic Evidenced Based Approach (SEBA) adopts a structured approach to searching and summarizing the included articles and employed concurrent content and thematic analysis that was overseen by a team of experts.

Results: A total of 18 915 abstracts were reviewed, 62 full text articles evaluated and 41 articles included. Ten themes/categories were ascertained identified including Nature; Stakeholders; Relationship; Approach; Environment; Benefits; Barriers; Assessments; Theories and Definitions.

Conclusion: By compiling and scrutinizing prevailing practice it is possible to appreciate the notion of the mentoring ecosystem which sees each mentee, mentor, and host organization brings with them their own microenvironment that contains their respective goals, abilities, and contextual considerations. Built around competency based mentoring stages, it is possible to advance a flexible yet consistent novice mentoring framework.
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http://dx.doi.org/10.1177/2382120520957649DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7517982PMC
September 2020

A Qualitative Study Exploring Patient, Family Carer and Healthcare Professionals' Direct Experiences and Barriers to Providing and Integrating Palliative Care for Advanced Head and Neck Cancer.

J Palliat Care 2021 Apr 15;36(2):121-129. Epub 2020 Sep 15.

Faculty of Health and Social Care, 6249Edge Hill University, Ormskirk, United Kingdom.

Objectives: To report on direct experiences from advanced head and neck cancer patients, family carers and healthcare professionals, and the barriers to integrating specialist palliative care.

Methods: Using a naturalistic, interpretative approach, within Northwest England, a purposive sample of adult head and neck cancer patients was selected. Their family carers were invited to participate. Healthcare professionals (representing head and neck surgery and specialist nursing; oncology; specialist palliative care; general practice and community nursing) were recruited. All participants underwent face-to-face or telephone interviews. A thematic approach, using a modified version of Colazzi's framework, was used to analyze the data.

Results: Seventeen interviews were conducted (9 patients, 4 joint with family carers and 8 healthcare professionals). Two main barriers were identified by healthcare professionals: "lack of consensus about timing of Specialist Palliative Care engagement" and "high stake decisions with uncertainty about treatment outcome." The main barrier identified by patients and family carers was "lack of preparedness when transitioning from curable to incurable disease." There were 2 overlapping themes from both groups: "uncertainty about meeting psychological needs" and "misconceptions of palliative care."

Conclusions: Head and neck cancer has a less predictable disease trajectory, where complex decisions are made and treatment outcomes are less certain. Specific focus is needed to define the optimal way to initiate Specialist Palliative Care referrals which may differ from those used for the wider cancer population. Clearer ways to effectively communicate goals of care are required potentially involving collaboration between Specialist Palliative Care and the wider head and neck cancer team.
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http://dx.doi.org/10.1177/0825859720957817DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7961626PMC
April 2021

Structuring Mentoring in Medicine and Surgery. A Systematic Scoping Review of Mentoring Programs Between 2000 and 2019.

J Contin Educ Health Prof 2020 ;40(3):158-168

Mr. Chua: Fourth year medical student, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Ms. Cheong: Fourth year medical student, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, and Division of Palliative Medicine, National Cancer Centre Singapore, Singapore. Ms. Lee: Fourth year medical student, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Dr. Koh: Medical officer, Tan Tock Seng Hospital, Singapore. Dr Toh is an Adjunct Lecturer at the Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Dr. Toh: National University Hospital Singapore, Family Medicine Residency, Singapore. Dr. Mason: Research and Development Lead, Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, United Kingdom. Dr. Krishna: Senior Consultant, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, National University Hospital Singapore, Family Medicine Residency, Singapore, Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, United Kingdom, Duke-NUS Medical School, Singapore, and Centre of Biomedical Ethics, National University of Singapore, Singapore.

Introduction: Evidence of novice mentoring's successes in having senior clinicians support junior doctors and/or medical students in their clinical, academic, and research goals has spurred efforts to include mentoring in the core medical curriculum. However, lack of effective structuring threatens the viability of mentoring programs, precipitating ethical concerns about mentoring. This review aims to answer the question "what is known about mentoring structures in novice mentoring among medical students and junior doctors in medicine and surgery postings?," which will guide the design of a consistent structure to novice mentoring.

Methods: Levac (2010)'s framework was used to guide this systematic scoping review of mentoring programs in medicine and surgery published between 1 January 2000 and 31 December 2019 in PubMed, ScienceDirect, ERIC, Embase, Scopus, Mednar, and OpenGrey. A "split approach" involving concurrent independent use of a directed content analysis and thematic approach was used to analyze included articles.

Results: Three thousand three hundred ninety-five abstracts were identified. There was concordance between the 3 themes and categories identified in analyzing the 71 included articles. These were the host organization, mentoring stages, and evaluations.

Conclusion: The data reveal the need for balance between ensuring consistency and flexibility to meet the individual needs of stakeholders throughout the stages of the mentoring process. The Generic Mentoring Framework provides a structured approach to "balancing" flexibility and consistency in mentoring processes. The Generic Mentoring Framework is reliant upon appropriate, holistic, and longitudinal assessments of the mentoring process to guide adaptations to mentoring processes and ensure effective support and oversight of the program.
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http://dx.doi.org/10.1097/CEH.0000000000000308DOI Listing
January 2020

Status of palliative care education in Mainland China: A systematic review.

Palliat Support Care 2020 Aug 25:1-11. Epub 2020 Aug 25.

Faculty of Medicine, Department of Palliative Care, RWTH Aachen University, Aachen, Germany.

Objective: China is home to one-fifth of the world's population. In the setting of a growing and aging population as well as the designation of palliative care access as a human right in 2013, the implementation of palliative care in China gains special importance. Palliative care education is an important precondition to ensure a nationwide access to palliative care. This systematic review details the status of under- and postgraduate palliative care education in China, examining both the students' and physicians' perception, knowledge, and skills in palliative care, and the available educational interventions and programs.

Method: Four databases were searched in September 2018, using considered search terms. Titles, abstracts, and, if necessary, full texts were scanned to identify publications matching the inclusion criteria.

Results: Nine publications were included. They revealed six findings: palliative care education is lacking in both under- and postgraduate medical education, only a few programs exist. Palliative care as a concept is well known, detailed knowledge, and practical skills are less developed. Chinese physicians consider palliative care an important field to be developed in cancer care, yet the majority of healthcare professionals are not willing to work in palliative care services. Communication should be a main emphasis in palliative care education, especially in undergraduate training. Finally, there is no highly qualified research on under- or postgraduate palliative care education in Mainland China.

Significance Of Results: These findings suggest that palliative care education in China is in demand and should be systematically integrated into medical education. Further research on the topic is urgently needed.
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http://dx.doi.org/10.1017/S1478951520000814DOI Listing
August 2020

Impact of Caring for Terminally Ill Children on Physicians: A Systematic Scoping Review.

Am J Hosp Palliat Care 2021 Apr 20;38(4):396-418. Epub 2020 Aug 20.

63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Introduction: Caring for terminally ill children influences nurses' and allied health provider's quality of life, ability to provide personalized, dignified and empathetic care and even their concepts of personhood. In the absence of data this review utilizes the Ring Theory of Personhood (RToP) to evaluate how a physician's concept of personhood is affected caring for terminally ill children in order to better support them holistically.

Methods: Using PRISMA Guidelines, 14 researchers carried out independent searches of PubMed, CINAHL, PsycINFO, Cochrane Library and gray literature databases for articles published between 2000 to 2019. Concurrent and independent employment of content and thematic analysis (Split Approach) was used to enhance the trustworthiness of the analysis.

Results: 13,424 titles and abstracts were retrieved, 188 full texts were evaluated, and 39 articles were included and analyzed. Identical categories and themes identified using the Split Approach suggest that caring for dying children in PPC impacts the physician's professional identity, clinical decision making, personal well-being and relationships. The data also suggests that the magnitude of these effects depends on the presence of protective and risk factors.

Conclusion: Aside from providing a novel insight into the upon the physician, this review proffers a unique approach to accounting for the presence, magnitude and influence of incoming catalysts, resultant conflicts, and protective and risk factors upon the physician's personhood. Further studies into the changes in personhood are required. Design of a personalized assessment tool based on the RToP will help direct timely, appropriate and personalized support to these physicians.
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http://dx.doi.org/10.1177/1049909120950301DOI Listing
April 2021

A systematic scoping review of ethical issues in mentoring in medical schools.

BMC Med Educ 2020 Jul 31;20(1):246. Epub 2020 Jul 31.

Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.

Background: Mentoring provides mentees and mentors with holistic support and research opportunities. Yet, the quality of this support has been called into question amidst suggestions that mentoring is prone to bullying and professional lapses. These concerns jeopardise mentoring's role in medical schools and demand closer scrutiny.

Methods: To better understand prevailing concerns, a novel approach to systematic scoping reviews (SSR) s is proposed to map prevailing ethical issues in mentoring in an accountable and reproducible manner. Ten members of the research team carried out systematic and independent searches of PubMed, Embase, ERIC, ScienceDirect, Scopus, OpenGrey and Mednar databases. The individual researchers employed 'negotiated consensual validation' to determine the final list of articles to be analysed. The reviewers worked in three independent teams. One team summarised the included articles. The other teams employed independent thematic and content analysis respectively. The findings of the three approaches were compared. The themes from non-evidence based and grey literature were also compared with themes from research driven data.

Results: Four thousand six titles were reviewed and 51 full text articles were included. Findings from thematic and content analyses were similar and reflected the tabulated summaries. The themes/categories identified were ethical concerns, predisposing factors and possible solutions at the mentor and mentee, mentoring relationship and/or host organisation level. Ethical concerns were found to stem from issues such as power differentials and lack of motivation whilst predisposing factors comprised of the mentor's lack of experience and personality conflicts. Possible solutions include better program oversight and the fostering of an effective mentoring environment.

Conclusions: This structured SSR found that ethical issues in mentoring occur as a result of inconducive mentoring environments. As such, further studies and systematic reviews of mentoring structures, cultures and remediation must follow so as to guide host organisations in their endeavour to improve mentoring in medical schools.
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http://dx.doi.org/10.1186/s12909-020-02169-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395401PMC
July 2020

From European Association for Palliative Care Recommendations to a Blended, Standardized, Free-to-Access Undergraduate Curriculum in Palliative Medicine: The EDUPALL Project.

J Palliat Med 2020 12 21;23(12):1571-1585. Epub 2020 Jul 21.

Medical School, Transilvania University of Brasov, Brasov, Romania.

The World Health Organization recommends that "palliative care should be integrated as a routine element of all Undergraduate Medical Education." However, the provision of training for medical undergraduates is variable; only 18% of 51 European countries have mandatory training in palliative medicine. EDUPALL is an ERASMUS+ funded international collaborative project to develop and pilot an undergraduate program for training in palliative medicine. The objective of this study was to critically review and revise current European Association for Palliative Care (EAPC) Recommendations for the Development of Undergraduate Curricula in Palliative Medicine and translating these into an updated curriculum document. Clinicians, academics, and researchers from Romania, Ireland, Germany, Austria, Spain, and the United Kingdom reviewed the EAPC recommendations using a variant of consensus methodology, Nominal Group Technique. From the updated document, four working-groups translated each recommendation into a specific learning objective, and developed associated learning outcomes, stratified by domain: attitude, cognition, and skills. The outcomes and objectives were organized into discrete teaching units and transferred into a curriculum template, identifying notional hours, teaching, and assessment strategies. To ensure quality control, the draft template was circulated to experts from 17 European countries, together with a brief survey instrument, for peer review purposes. All 17 reviewers returned overwhelmingly positive comments. There was large agreement that: the teaching units were logically organized; learning outcomes covered core training needs; learning objectives provided guidance for teaching sessions; learning modalities were appropriately aligned; and assessment strategies were fit for purpose. An updated and standardized curriculum was developed, which provides a platform for the sequential development of the next phases of the EDUPALL project.
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http://dx.doi.org/10.1089/jpm.2020.0119DOI Listing
December 2020

Evaluating assessment tools of the quality of clinical ethics consultations: a systematic scoping review from 1992 to 2019.

BMC Med Ethics 2020 07 1;21(1):51. Epub 2020 Jul 1.

Division of Supportive and Palliative Care, National Cancer Centre Singapore, Level 4, 11 Hospital Drive, Singapore, 169610, Singapore.

Background: Amidst expanding roles in education and policy making, questions have been raised about the ability of Clinical Ethics Committees (CEC) s to carry out effective ethics consultations (CECons). However recent reviews of CECs suggest that there is no uniformity to CECons and no effective means of assessing the quality of CECons. To address this gap a systematic scoping review of prevailing tools used to assess CECons was performed to foreground and guide the design of a tool to evaluate the quality of CECons.

Methods: Guided by Levac et al's (2010) methodological framework for conducting scoping reviews, the research team performed independent literature reviews of accounts of assessments of CECons published in six databases. The included articles were independently analyzed using content and thematic analysis to enhance the validity of the findings.

Results: Nine thousand sixty-six abstracts were identified, 617 full-text articles were reviewed, 104 articles were analyzed and four themes were identified - the purpose of the CECons evaluation, the various domains assessed, the methods of assessment used and the long-term impact of these evaluations.

Conclusion: This review found prevailing assessments of CECons to be piecemeal due to variable goals, contextual factors and practical limitations. The diversity in domains assessed and tools used foregrounds the lack of minimum standards upheld to ensure baseline efficacy. To advance a contextually appropriate, culturally sensitive, program specific assessment tool to assess CECons, clear structural and competency guidelines must be established in the curation of CECons programs, to evaluate their true efficacy and maintain clinical, legal and ethical standards.
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http://dx.doi.org/10.1186/s12910-020-00492-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329412PMC
July 2020

Assessing palliative care education in undergraduate medical students: translation and validation of the Self-Efficacy in Palliative Care and Thanatophobia Scales for Brazilian Portuguese.

BMJ Open 2020 06 29;10(6):e034567. Epub 2020 Jun 29.

Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil

Background: As the global population ages, palliative care is ever more essential to provide care for patients with incurable chronic conditions. However, in many countries, doctors are not prepared to care for dying patients. Palliative care education should be an urgent concern for all medical schools all around the world, including Latin America and Brazil. Advances in palliative care education require robust assessment tools for constant evaluation and improvement of educational programmes. Bandura's social cognitive theory proposes that active learning processes are mediated by self-efficacy and associated outcome expectancies, both crucial elements of developing new behaviour. The Self-Efficacy in Palliative Care (SEPC) and Thanatophobia Scales were developed using Bandura's theory to assess the outcomes of palliative care training.

Objectives: We aimed to translate and validate these scales for Brazilian Portuguese to generate data on how well doctors are being prepared to meet the needs of their patients.

Design: Cross-sectional study.

Setting: One Brazilian medical school.

Participants: Third-year medical students.

Methods: The authors translated the scales following the European Organisation for Research and Treatment of Cancer's recommendations and examined their psychometric properties using data collected from a sample of 111 students in a Brazilian medical school in 2017.

Results: The Brazilian versions of SEPC and Thanatophobia Scales showed good psychometric properties, including confirmatory factor analysis, replicating the original factors (factor range: 0.51-0.90), and acceptable values of reliability (Cronbach's alpha: 0.82-0.97 and composite reliability: 0.82-0.96). Additionally, the Brazilian versions of the scales showed concurrent validity, demonstrated through a significant negative correlation.

Conclusions: The Brazilian version of the scales may be used to assess the impact of current undergraduate training and identify areas for improvement within palliative care educational programmes. The data generated allow Brazilian researchers to join international conversations on this topic and educators to develop tailored pedagogical approaches.
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http://dx.doi.org/10.1136/bmjopen-2019-034567DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328756PMC
June 2020

Modified Alphavirus-Vesiculovirus Hybrid Vaccine Vectors for Homologous Prime-Boost Immunotherapy of Chronic Hepatitis B.

Vaccines (Basel) 2020 Jun 5;8(2). Epub 2020 Jun 5.

CaroGen Corporation, Farmington, CT 06032, USA.

Virus-like vesicles (VLV) are hybrid vectors based on an evolved Semliki Forest virus (SFV) RNA replicon and the envelope glycoprotein (G) from vesicular stomatitis virus (VSV) [...].
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http://dx.doi.org/10.3390/vaccines8020279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349932PMC
June 2020

Combined novice, near-peer, e-mentoring palliative medicine program: A mixed method study in Singapore.

PLoS One 2020 5;15(6):e0234322. Epub 2020 Jun 5.

Department of Family Medicine, National University Health System, Singapore, Singapore.

Introduction: An acute shortage of senior mentors saw the Palliative Medicine Initiative (PMI) combine its novice mentoring program with electronic and peer mentoring to overcome insufficient mentoring support of medical students and junior doctors by senior clinicians. A three-phased evaluation was carried out to evaluate mentees' experiences within the new CNEP mentoring program.

Methods: Phase 1 saw use of a Delphi process to create a content-valid questionnaire from data drawn from 9 systematic reviews of key aspects of novice mentoring. In Phase 2 Cognitive Interviews were used to evaluate the tool. The tool was then piloted amongst mentees in the CNEP program. Phase 3 compared mentee's experiences in the CNEP program with those from the PMI's novice mentoring program.

Results: Thematic analysis of open-ended responses revealed three themes-the CNEP mentoring process, its benefits and challenges that expound on the descriptive statistical analysis of specific close-ended and Likert scale responses of the survey. The results show mentee experiences in the PMI's novice mentoring program and the CNEP program to be similar and that the addition of near peer and e-mentoring processes enhance communications and support of mentees.

Conclusion: CNEP mentoring is an evolved form of novice mentoring built on a consistent mentoring approach supported by an effective host organization. The host organization marshals assessment, support and oversight of the program and allows flexibility within the approach to meet the particular needs of mentees, mentors and senior mentors. Whilst near-peer mentors and e-mentoring can make up for the lack of senior mentor availability, their effectiveness hinges upon a common mentoring approach. To better support the CNEP program deeper understanding of the mentoring dynamics, policing and mentor and mentee training processes are required. The CNEP mentoring tool too needs to be validated.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234322PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274408PMC
September 2020

Assessing mentoring: A scoping review of mentoring assessment tools in internal medicine between 1990 and 2019.

PLoS One 2020 8;15(5):e0232511. Epub 2020 May 8.

Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Background: Mentoring's success in enhancing a mentee's professional and personal development, and a host organisations' reputation has been called into question, amidst a lack of effective tools to evaluate mentoring relationships and guide oversight of mentoring programs. A scoping review is proposed to map available literature on mentoring assessment tools in Internal Medicine to guide design of new tools.

Objective: The review aims to explore how novice mentoring is assessed in Internal Medicine, including the domains assessed, and the strengths and limitations of the assessment methods.

Methods: Guided by Levac et al.'s framework for scoping reviews, 12 reviewers conducted independent literature reviews of assessment tools in novice mentoring in PubMed, Embase, Scopus, ERIC, Cochrane, GreyLit, Web of Science, Open Dissertations and British Education Index databases. A 'split approach' saw research members adopting either Braun and Clarke's approach to thematic analysis or directed content analysis to independently evaluate the data and improve validity and objectivity of the findings.

Results: 9662 abstracts were identified, 187 full-text articles reviewed, and 54 full-text articles included. There was consensus on the themes and categories identified through the use of the split approach, which were the domains assessed and methods of assessment.

Conclusion: Most tools fail to contend with mentoring's evolving nature and provide mere snap shots of the mentoring process largely from the mentee's perspective. The lack of holistic, longitudinal and validated assessments propagate fears that ethical issues in mentoring are poorly recognized and addressed. To this end, we forward a framework for the design of 'fit for purpose' multi-dimensional tools.

Practice Points: Most tools focus on the mentee's perspective, do not consider mentoring's evolving nature and fail to consider mentoring holistically nor longitudinallyA new tool capable of addressing these gaps must also consider inputs from all stakeholders and take a longitudinal perspective of mentoring.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232511PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7209188PMC
July 2020

Palliative care for all: An international health education challenge.

Palliat Support Care 2020 12;18(6):760-762

Faculty of Medicine, Transilvania University,Brasov, Romania.

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http://dx.doi.org/10.1017/S1478951520000188DOI Listing
December 2020

Nurturing professionalism in medical schools. A systematic scoping review of training curricula between 1990-2019.

Med Teach 2020 06 17;42(6):636-649. Epub 2020 Feb 17.

Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore.

Professionalism is an evolving, socioculturally informed multidimensional construct that influences doctor-patient relationships, patient satisfaction and care outcomes. However, despite its clinical significance there is little consistency in how professionalism is nurtured amongst medical students. To address this gap a systemic scoping review of nurturing professionalism in medical schools, is proposed. Levac's framework and the PRISMA-P 2015 checklist underpinned a 6-stage systematic review protocol. Concurrent use of Braun and Clarke's approach to thematic analysis and directed content analysis was used to identify the key elements in nurturing professionalism. 13921 abstracts were identified from six databases, 854 full-text articles reviewed, and 162 full-text included articles were included. The 4 themes identified through thematic analysis are consistent with findings of the directed content analysis. These were the definition of professionalism, the approaches, content, barriers and enablers to teaching professionalism. Informed by a viable definition of professionalism and clear milestones nurturing professionalism nurturing professionalism begins with culturally appropriate training in clinical competence, humanistic qualities and reflective capacity. This process requires effective evaluations of professional identity formation, and the impact of the learning environment underlining the need for longitudinal assessments of the training process.
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http://dx.doi.org/10.1080/0142159X.2020.1724921DOI Listing
June 2020

A Systematic Scoping Review of Ethical Issues in Mentoring in Surgery.

J Med Educ Curric Dev 2019 Jan-Dec;6:2382120519888915. Epub 2019 Dec 19.

Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Background: Mentoring is crucial to the growth and development of mentors, mentees, and host organisations. Yet, the process of mentoring in surgery is poorly understood and increasingly mired in ethical concerns that compromise the quality of mentorship and prevent mentors, mentees, and host organisations from maximising its full potential. A systematic scoping review was undertaken to map the ethical issues in surgical mentoring to enhance understanding, assessment, and guidance on ethical conduct.

Methods: Arksey and O'Malley's methodological framework was used to guide a systematic scoping review involving articles published between January 1, 2000 and December 31, 2018 in PubMed, Embase, Scopus, ERIC, ScienceDirect, Mednar, and OpenGrey databases. Braun and Clarke's thematic analysis approach was adopted to compare ethical issues in surgical mentoring across different settings, mentee and mentor populations, and host organisations.

Results: A total of 3849 abstracts were identified, 464 full-text articles were retrieved, and 50 articles were included. The 3 themes concerned ethical lapses at the levels of mentor or mentee, mentoring relationships, and host organisation.

Conclusions: Mentoring abuse in surgery involves lapses in conduct, understanding of roles and responsibilities, poor alignment of expectations, and a lack of clear standards of practice. It is only with better structuring of mentoring processes and effective support of host organisation tasked with providing timely, longitudinal, and holistic assessment and oversight will surgical mentoring overcome prevailing ethical concerns surrounding it.
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http://dx.doi.org/10.1177/2382120519888915DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923696PMC
December 2019

Educational roles as a continuum of mentoring's role in medicine - a systematic review and thematic analysis of educational studies from 2000 to 2018.

BMC Med Educ 2019 Nov 27;19(1):439. Epub 2019 Nov 27.

Department of Family Medicine, National University Health System, Singapore, Singapore.

Background: Recent studies have gone to great lengths to differentiate mentoring from teaching, tutoring, role modelling, coaching and supervision in efforts to better understand mentoring processes. This review seeks to evaluate the notion that teaching, tutoring, role modelling, coaching and supervision may in fact all be part of the mentoring process. To evaluate this theory, this review scrutinizes current literature on teaching, tutoring, role modelling, coaching and supervision to evaluate their commonalities with prevailing concepts of novice mentoring.

Methods: A three staged approach is adopted to evaluate this premise. Stage one involves four systematic reviews on one-to-one learning interactions in teaching, tutoring, role modelling, coaching and supervision within Internal Medicine, published between 1st January 2000 and 31st December 2018. Braun and Clarke's (2006) approach to thematic analysis was used to identify key elements within these approaches and facilitate comparisons between them. Stage two provides an updated view of one-to-one mentoring between a senior physician and a medical student or junior doctor to contextualise the discussion. Stage three infuses mentoring into the findings delineated in stage one.

Results: Seventeen thousand four hundred ninety-nine citations were reviewed, 235 full-text articles were reviewed, and 104 articles were thematically analysed. Four themes were identified - characteristics, processes, nature of relationship, and problems faced in each of the four educational roles.

Conclusions: Role modelling, teaching and tutoring, coaching and supervision lie within a mentoring spectrum of increasingly structured interactions, assisted by assessments, feedback and personalised support that culminate with a mentoring approach. Still requiring validation, these findings necessitate a reconceptualization of mentoring and changes to mentor training programs and how mentoring is assessed and supported.
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http://dx.doi.org/10.1186/s12909-019-1872-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882248PMC
November 2019

A systematic scoping review of ethical issues in mentoring in internal medicine, family medicine and academic medicine.

Adv Health Sci Educ Theory Pract 2020 05 9;25(2):415-439. Epub 2019 Nov 9.

Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Mentoring's role in medical education is threatened by the potential abuse of mentoring relationships. Particularly affected are mentoring relationships between senior clinicians and junior doctors which lie at the heart of mentoring. To better understand and address these concerns, a systematic scoping review into prevailing accounts of ethical issues and professional lapses in mentoring is undertaken. Arksey and O'Malley's (Int J Soc Res Methodol 8(1):19-32, 2005. https://doi.org/10.1080/1364557032000119616) methodological framework for conducting scoping reviews was employed to explore the scope of ethical concerns in mentoring in general medicine. Databases searcheed included PubMed, ScienceDirect, ERIC, Embase, Scopus, Mednar and OpenGrey. 3391 abstracts were identified from the initialy search after removal of duplicates, 412 full-text articles were reviewed, 98 articles were included and thematically analysed. Unsatisfactory matching, misaligned expectations, inadequate mentor training, cursory codes of conduct, sketchy standards of practice, meagre oversight and unstructured processes have been identified as potential causes for ethical and professional breaches in mentoring practice. Changes in how professionalism is viewed suggest further studies of educational culture should also be carried out. The host organization plays a major role in establishing codes of conduct, expectations, and holistically, longitudinally oversight of the mentoring process and mentoring relationships.
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http://dx.doi.org/10.1007/s10459-019-09934-0DOI Listing
May 2020

Virus-like Vesicles Expressing Multiple Antigens for Immunotherapy of Chronic Hepatitis B.

iScience 2019 Nov 24;21:391-402. Epub 2019 Oct 24.

CaroGen Corporation, Farmington, CT 06032, USA. Electronic address:

Infections with hepatitis B virus (HBV) can initiate chronic hepatitis and liver injury, causing more than 600,000 deaths each year worldwide. Current treatments for chronic hepatitis B are inadequate and leave an unmet need for immunotherapeutic approaches. We designed virus-like vesicles (VLV) as self-amplifying RNA replicons expressing three HBV antigens (polymerase, core, and middle surface) from a single vector (HBV-VLV) to break immune exhaustion despite persistent HBV replication. The HBV-VLV induces HBV-specific T cells in naive mice and renders them resistant to acute challenge with HBV. Using a chronic model of HBV infection, we demonstrate efficacy of HBV-VLV priming in combination with DNA booster immunization, as 40% of treated mice showed a decline of serum HBV surface antigen below the detection limit and marked reduction in liver HBV RNA accompanied by induction of HBsAg-specific CD8 T cells. These results warrant further evaluation of HBV-VLV for immunotherapy of chronic hepatitis B.
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http://dx.doi.org/10.1016/j.isci.2019.10.040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889364PMC
November 2019