Clinical medicine (London, England)
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Research ethics committees exist internationally to review research proposals to protect the rights and safety of human participants and researchers involved in research. These committees recruit a panel of expert and lay members, mostly on an unpaid voluntary basis, with relevant scientific experience to appraise these studies. ⋯ A variety of global approaches to tackle these barriers include targeting specific populations, such as faith or community leaders, or implementing quotas have been adopted. Further research is needed to understand likely barriers preventing participation in research ethics committees in the UK and how they may be overcome.
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The UK Research Excellence Framework (REF) is an assessment of the quality of research carried out in UK Higher Education Institutions (HEIs), performed in 7-year cycles. The outcome impacts the rankings and funding of UK HEIs, which afford the exercise high priority. Much of what REF measures is known to be biased against academics with protected characteristics: for example, women and ethnic minority researchers are less likely to win grants or be published in prestigious journals. ⋯ The BMA Women in Academic Medicine and Medical Academic Staff Committee carried out a survey of UK clinical academics' experiences of REF2021. The data indicated the persistence of activities previously characterised as 'extremely harmful' in Research England-commissioned work, affecting up to 10% of clinical academics. While acknowledging the limitations of the data, women appeared to be disproportionately affected.
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Mental health conditions are highly prevalent among physicians with high rates of depression, anxiety, stress-related disorders, suicidal ideation and burnout reported among medical practitioners at all levels of training and practice. This phenomenon is in part contributed by a highly stressful clinical environment with an often suboptimal support system for doctors. ⋯ In general, drivers of mental health stigma in the medical profession include self-stigmatisation predisposed by physician personality and character traits, societal stereotypes about mental illness permeating through the medical community, and systemic constructs such as mandatory mental health declarations for medical licensure that perpetuate the unfortunate perception that mental illness appears synonymous with job impairment or incompetency. To destigmatise mental health issues in the medical profession, we herein propose multi-pronged strategies which can practically be implemented: 1) normalisation of mental health issues through open dialogue and sharing, 2) creating a supportive, "psychologically friendly" work environment through increased accessibility to workplace mental health support services, peer support systems, and reduction of psychiatric "name-calling" practices, and 3) reviewing systemic practices, in particular the mandatory mental health declarations for medical registration, that perpetuate mental health stigma.
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Specialist, associate specialist and specialty (SAS) doctors constitute a marginalised professional group who can struggle to achieve the professional development they desire. Our primary objective was to understand, from a theoretically informed perspective, the ways in which the professional identity of SAS doctors influences their professional development opportunities, including through appraisal. Ten UK SAS doctors participated in in-depth, narrative interviews. ⋯ Appraisal was often not perceived to have successfully addressed these issues. This study enhances our understanding of the lived experience of SAS doctors, which is often in stark contrast to formal policy on the range of roles that they can fulfil. The struggles and successes of SAS doctors described here suggest that there is scope to improve the professional status and professional development opportunities for SAS doctors, including through appraisal.
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A middle-aged man with no previous cardiac history was admitted to the hospital being treated for thigh cellulitis, during his stay he developed palpitations and tachycardia which on initial ECG showed atrial flutter with a 2:1 AV block and evidence of an accessory pathway. He was subsequently given AV nodal blocking agents in the form of beta-blockers (bisoprolol) to slow his heart rate down; unfortunately, this led to hemodynamic instability due to 1:1 conduction of the atrial flutter down the accessory pathway. This case report demonstrates the importance of recognising pre-excitation on an ECG and the potential adverse effect of administering AV nodal blockade.