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Medical Education 2011: 45: 1251-1261 Objectives Professional status and working arrangements can inhibit doctors from acknowledging and seeking care for their own ill health. Research identifies that a culture of immunity to illness within the medical profession takes root during training. What happens when trainee doctors become unwell during their formative period of education and training? What support do they receive and how do they perceive that the experience of ill health affects their training trajectory? These research questions were developed by a multidisciplinary team of researchers and health professionals, who adopted a qualitative approach to investigate the experiences of personal illness among trainees in their Foundation Programme (FP) years. Methods Semi-structured interviews were conducted with eight FP trainees from the Severn Deanery in southwest England who had experienced significant illness. Interpretative phenomenological analysis was used to conduct and analyse the interviews, resulting in a comprehensive list of master themes. This paper reports an interpretative analysis of the themes of Support, Illness Experience, Crossing the Line, Medical Culture, Stigma and Disclosure. Results Ineffective communication within the medical education and employment system underpins many of the difficulties encountered by trainees who are unwell. Coping style plays a key role in predicting how trainees experience support during and after their illness, although this may be influenced by their particular diagnoses. The barriers to disclosure of their illnesses are discussed within the context of mobilising and maintaining support. Concern about the impact of missing training as a result of ill health appears to be significant in the transmitting of an ethos of invulnerability within the medical culture. Conclusions Suggestions to improve support procedures for trainees who are unwell include the provision of greater flexibility within the rotation system along with independent pastoral support. Promoting the importance of disclosing significant illness as early as possible might go some way towards challenging the culture of invulnerability to illness that prevails among doctors. [ABSTRACT FROM AUTHOR]

Context Working effectively in interprofessional teams is a core competency for all health care professionals, yet there is a paucity of instruments with which to assess the associated skills. Published medical teamwork skills assessment tools focus primarily on high-acuity situations, such as cardiopulmonary arrests and crisis events in operating rooms, and may not generalise to non-high-acuity environments, such as in-patient wards and out-patient clinics. Objective We undertook the current study to explore the constructs underlying interprofessional teamwork in non-high-acuity settings and team members' perspectives of essential teamwork attributes. Methods We used an ethnographic approach to study four interprofessional teams in two different low-acuity settings: women's HIV (human immunodeficiency virus) clinics and in-patient paediatric wards. Over a period of 17 months, we collected qualitative data through direct observations, focus groups and individual interviews. We analysed the data using qualitative thematic analysis, following an iterative process: data from our observations (20 hours in total) informed the focus group guide and focus group data informed the interview guide. To enhance the integrity of our analysis, we triangulated data sources and verified themes through member checking. Results We conducted seven focus groups and 27 individual interviews with a total of 39 study participants representing eight professions. Participants emphasised shared leadership and collaborative decision making, mutual respect, recognition of one's own and others' limitations and strengths, and the need to nurture relationships. Team members also discussed tensions around hierarchy and questioned whether doctor leadership is appropriate for interprofessional teams. Our findings indicate that there are differences in teamwork between low-acuity and high-acuity settings, and also provide insights into potential barriers to effective interprofessional teamwork. Conclusions Our study delineates essential elements of teamwork in low-acuity settings, including desirable attributes of team members, thus laying the foundation for the development of an individual teamwork skills assessment tool. [ABSTRACT FROM AUTHOR]

Context An increasing number of medical students are engaging in international medical electives, the majority of which involve travel from northern, higher-income countries to southern, lower-income countries. Existing research has identified benefits to students participating in these experiences. However, reports on the impacts on host communities are largely absent from the literature. Objectives The current study aims to identify host country perspectives on international medical electives. Methods Questionnaires were delivered to a convenience sample of supervisors hosting international elective students ( n = 39) from a Canadian medical school. Responses represented 22 countries. Conventional content analysis of the qualitative data was used to identify themes in host supervisor perspectives on the impact of international medical electives. Results Host country supervisors identified that in addition to the benefits realised by the elective students, supervisors and their institutions also benefited from hosting Canadian students. Although some host supervisors denied the occurrence of any harm, others expressed concern that international elective students may negatively impact the local community in terms of resource use and patient care. Host country supervisors also identified potential harms to travelling students including health risks and emotional distress. Ideas for improving international electives were identified and were largely centred around increasing the bidirectional flow of students by establishing formal partnerships between institutions. Conclusions This research provides important insights into the impacts of international medical student electives from the perspective of host country supervisors. This research may be a starting point for further research and the establishment of meaningful partnerships that incorporate the self-identified needs of receiving institutions, especially those in lower-income settings. [ABSTRACT FROM AUTHOR]

Medical Education 2011: 45: 1241-1250 Context Doctors do not follow guidance when managing their own health and illness. This behaviour may start at medical school. This study aimed to investigate whether inappropriate responses to illness are an issue for medical students and, if so, to identify the determinants of students' responses to illness. Methods We undertook a qualitative study using framework analysis to explore the views of medical students at two UK medical schools. Results Eight focus groups carried out with 35 medical students identified four main themes in students' cognitions about their intended behaviour: not using usual patient pathways; informal consultation; self-treatment, and keeping going when ill. The reasons or assumptions underlying these beliefs referred to: time and resources, including wider issues such as responsibility to colleagues; stigma and attitudes of others including regulatory bodies; beliefs about themselves in terms of taking on the patient role and issues relating to coping and self-sufficiency; the behaviour and attitudes of peers; patient safety considerations; patients' views about sick doctors; barriers to accessing care; the ease of self-care, and uncertainty about ability to self-care. Conclusions Many different factors related to medical students' beliefs about illness. Conflicts occur among student needs to be seen as competent and dedicated to medicine, to protect personal privacy, to maintain convenience, and to seek care appropriately in order to be fair on colleagues and protect the public. These conflicts were complicated by perceptions of the system, peers and doctors as unsupportive of ill health except by facilitating informal access to care. Beliefs underlying intentions are similar between doctors and medical students, but further research is needed to fully determine how and when these beliefs are formed. [ABSTRACT FROM AUTHOR]