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Introduction: Vaccine hesitancy poses a challenge to healthcare professionals. Prior to graduation, medical students may not be fully equipped with the knowledge or skills to manage interactions with vaccine-hesitant patients. The aim of this scoping review was to identify and evaluate the characteristics of educational interventions that improve medical students' skills in communicating with vaccine-hesitant patients. Methods: EMBASE, OVID Medline, CINAHL and ERIC databases were searched with keywords related to "vaccine hesitancy" and "undergraduate medical education". One hundred and fourteen primary studies were identified, and seven articles were included for review. Data extraction included the characteristics of educational interventions, such as the modality, duration, frequency and assessment methods. Results: There is limited literature describing educational interventions that help medical students develop skills to communicate effectively with vaccine-hesitant patients. This makes it difficult to draw conclusions on the effectiveness of different pedagogical approaches. Although the included studies generally reported an increase in student self-reported confidence to communicate with vaccine-hesitant patients, none assessed whether the interventions led to changes in student clinical practice or improvements in patient outcomes. Conclusion: Additional research into the identification of educational interventions that establish persistent changes in students' knowledge, attitudes and skills to communicate with vaccine-hesitant patients is required. An evidence-based medicine component of an education program, which can adapt to evolving contributors to vaccine hesitancy and the variety of concerns across different vaccines, may present a potential solution. Educators would be better directed with further research that aligns health outcomes with teaching, assessment and evaluation of a proposed vaccine-hesitancy curriculum. [ABSTRACT FROM AUTHOR]

BackgroundUniversal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset.MethodOrdinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA.ResultsEducation, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) < 0.01]. The structure of EPDS responses significantly differed between Europe and the USA (∆*CFI > 0.01), but not between European countries (∆*CFI < 0.01).ConclusionsInvestigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted. [ABSTRACT FROM PUBLISHER]

Objective Despite the increasing use of screening instruments to identify women with postnatal depression (PND), many do not access services and supports. It is unclear how women's experiences of PND influence their beliefs and attitudes and their choice to seek help. We will also explore ways family, friends and health professionals can facilitate help seeking behaviours. Design A qualitative study which explored: 'experiences after having a baby', 'recognition of symptoms', 'seeking help', 'treatment experiences and options' and 'ideal treatment'. Setting Participants were recruited from either hospital based outpatient PND treatment programs or community based mutual support programs. Subjects Forty women experiencing PND and either receiving treatment or attending support groups. Main Outcome Measure To gain an insight into the ways women experience PND and perceive their distress, and how this influences their beliefs and attitudes towards acknowledging their distress and seeking treatment. Results Findings suggest the lived experience of PND and associated attitudes and beliefs result in significant barriers to accessing help. Eight theme clusters were identified: expectations of motherhood; not coping and fear of failure; stigma and denial; poor mental health awareness and access; interpersonal support; baby management; help-seeking and treatment experiences and relationship with health professionals. Conclusion Implications for improved identification and management include helping health professionals to be aware of the personal and societal barriers preventing mothers from acknowledging their distress. Media campaigns may also be helpful in challenging community views of PND, as well as highlighting the range of treatment options available to mitigate concerns over medical/pharmacological approaches. [ABSTRACT FROM AUTHOR]

The article presents abstracts on health topics which include the health of women who have been discharged from a specialist inpatient parent-infant unit, perinatal mental health care needs of women, and maternal lifestyle.

Objectives: This scoping review explores the extent to which undergraduate medical education have incorporated complementary and alternative medicine in their curricula and evaluates the teaching, delivery and assessment approaches used., Methods: ERIC, Ovid Medline and Pubmed databases were searched with keywords related to "complementary and alternative medicine" and "undergraduate medical education" for relevant articles published until August 2020. Data extraction included the presence/absence of complementary and alternative medicine integration, program duration, instructor background, and assessment methods., Results: Of 1146 citations, 26 met the inclusion criteria. Complementary and alternative medicine teaching in undergraduate medical education was widely inconsistent and not well aligned with clearly identified aims and objectives. Various complementary and alternative medicine disciplines were taught, demonstrated or observed, and several programs included teaching on evidence-based medicine. Educational outcomes mainly assessed student satisfaction and learning through self-evaluation and rarely assessed for effectiveness with regards to changing clinical practice or impacts on patient outcomes., Conclusions: Inconsistencies in complementary and alternative medicine teaching and assessment in undergraduate medical education reflect the lack of defined graduate competencies. An evidence-based medicine component of an educational program is a potential solution to overcoming breadth and content challenges. Curriculum developers would be better guided with research that determines if complementary and alternative medicine program design, content and assessment influence clinical practice and/or patient outcomes.

This article was migrated. The article was marked as recommended. Background: Anatomy teaching at medical schools has undergone significant changes in philosophy, and reduction in content, in recent years. Senior clinicians and speciality training Colleges have raised concerns regarding these changes and questioned their impact on 'anatomical competence' and adequacy of training for safe clinical practice. The literature on the perceptions of medical school anatomy teaching among those preparing to enter post-graduate training (i.e. towards a specialist qualification) is sparse. Aim: To assess the motivations for study, and experiences of training, in junior doctors undertaking an intensive post-graduate anatomy training program. Methods: A sample of candidates (13/119, 10%) undertaking the University of Melbourne Graduate Diploma in Surgical Anatomy were recruited for interview. These interviews were recorded, transcribed and then analysed using a combination of thematic and contextual approaches. Key themes were identified and explored. Results: Participant responses fell into two broad categories - motivations for enrolling into the course and their actual experiences of the course. The primary motivation for enrolling into the course was the perceived career requirement to do so, with participants asserting that attending such courses was perceived as mandatory for success in specialty training. Once enrolled, participants valued the teaching and learning and enjoyed the academic pursuit of high-level anatomy study. These benefits, however, were offset by a range of undesirable outcomes associated with undertaking the course. Participants identified the financial cost of the course, the unwillingness of employers to provide rostered study leave and the negative impact on work-life balance as the most significant challenges. Conclusions: Understanding the concerns and expectations of junior doctors preparing for a speciality training program by increasing their anatomy knowledge has implications for both Colleges and medical educators. The participants in this study recognised the limitations in their anatomy knowledge and actively sought additional training at significant financial and personal cost to themselves. This was counterbalanced by the perceived benefits to their career, and an opportunity to enter a specialist training program, by completing additional study., (Copyright: © 2019 Cameron J et al.)

Background: The perinatal period is a time of high risk for onset of depressive disorders and is associated with substantial morbidity and mortality, including maternal suicide. Perinatal depression comprises a heterogeneous group of clinical subtypes, and further refinement is needed to improve treatment outcomes. We sought to empirically identify and describe clinically relevant phenotypic subtypes of perinatal depression, and further characterise subtypes by time of symptom onset within pregnancy and three post-partum periods., Methods: Data were assembled from a subset of seven of 19 international sites in the Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium. In this analysis, the cohort was restricted to women aged 19-40 years with information about onset of depressive symptoms in the perinatal period and complete prospective data for the ten-item Edinburgh postnatal depression scale (EPDS). Principal components and common factor analysis were used to identify symptom dimensions in the EPDS. The National Institute of Mental Health research domain criteria functional constructs of negative valence and arousal were applied to the EPDS dimensions that reflect states of depressed mood, anhedonia, and anxiety. We used k-means clustering to identify subtypes of women sharing symptom patterns. Univariate and bivariate statistics were used to describe the subtypes., Findings: Data for 663 women were included in these analyses. We found evidence for three underlying dimensions measured by the EPDS: depressed mood, anxiety, and anhedonia. On the basis of these dimensions, we identified five distinct subtypes of perinatal depression: severe anxious depression, moderate anxious depression, anxious anhedonia, pure anhedonia, and resolved depression. These subtypes have clear differences in symptom quality and time of onset. Anxiety and anhedonia emerged as prominent symptom dimensions with post-partum onset and were notably severe., Interpretation: Our findings show that there might be different types and severity of perinatal depression with varying time of onset throughout pregnancy and post partum. These findings support the need for tailored treatments that improve outcomes for women with perinatal depression., Funding: Janssen Research & Development., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Despite a major research focus on clinical reasoning over the last several decades, a method of evaluating the clinical reasoning process that is both objective and comprehensive is yet to be developed.The aim of this study was to test whether a dual approach, using two measures of clinical reasoning, the Clinical Reasoning Problem (CRP) and the Script Concordance Test (SCT), provides a valid, reliable and targeted analysis of clinical reasoning characteristics to facilitate the development of diagnostic thinking in medical students., Methods: Three groups of participants, general practitioners, and third and fourth (final) year medical students completed 20 on-line clinical scenarios -10 in CRP and 10 in SCT format. Scores for each format were analysed for reliability, correlation between the two formats and differences between subject-groups., Results: Cronbach's alpha coefficient ranged from 0.36 for SCT 1 to 0.61 for CRP 2, Statistically significant correlations were found between the mean f-score of the CRP 2 and total SCT 2 score (0.69); and between the mean f-score for all CRPs and all mean SCT scores (0.57 and 0.47 respectively). The pass/fail rates of the SCT and CRP f-score are in keeping with the findings from the correlation analysis (i.e. 31% of students (11/35) passed both, 26% failed both, and 43% (15/35) of students passed one but not the other test), and suggest that the two formats measure overlapping but not identical characteristics. One-way ANOVA showed consistent differences in scores between levels of expertise with these differences being significant or approaching significance for the CRPs., Conclusion: SCTs and CRPs are overlapping and complementary measures of clinical reasoning. Whilst SCTs are more efficient to administer, the use of both measures provides a more comprehensive appraisal of clinical skills than either single measure alone, and as such could potentially facilitate the customised teaching of clinical reasoning for individuals. The modest reliability of SCTs and CRPs in this study suggests the need for an increased number of items for testing. Further work is needed to determine the suitability of a combined approach for assessment purposes.

The recent 100-year anniversary of the Flexner review and the release of the Australian Medical Education Study have stimulated vigorous debate about the role of bioscience knowledge in medical education. Two critical questions define debate in this area: does bioscience learning assist in educating medical students to become competent doctors, and, if so, what are the most effective teaching and learning methods to facilitate this outcome? There is tacit acceptance that specific bioscience knowledge is critical for the development of clinical expertise; however, there are few empirical data to support this notion. Two differing theories have been proposed to describe the role of bioscience learning in the development of clinical reasoning skills - the "two-worlds" model and the "encapsulation" model. A series of studies provides support for the encapsulation model. Some medical programs are now integrating bioscience teaching into the clinical years of the course. Evidence of the effectiveness of this on outcomes, such as improved clinical reasoning, is inconclusive.

Objective: The aim of this paper is to review the clinical, demographic and psychosocial characteristics of consecutive admissions to a specialist inpatient parent-infant psychiatric service during a 2-year period., Methods: Data from consecutive admissions between January 2006 and December 2007 were evaluated in terms of primary and secondary diagnosis, demographics and psychosocial risk, psychiatric history, referral source, inpatient care and child protection involvement., Results: The majority of admissions (n = 149) recorded during the audit period were for a major depressive disorder (n = 69; 46%), schizophrenia (n = 29; 19%) or postnatal psychosis (n = 19; 13%); the most common comorbidities were a physical health problem (35%), substance abuse (24%) or borderline personality disorder (15%). The average length-of-stay was 23.8 ± 15.5 days; the average baby's age at admission was 15.1 ± 11.6 weeks. There were no statistically significant differences between women with a history of a mood disorder and those with no such history, in any of the demographic or psychosocial variables evaluated., Conclusion: This paper provides a unique appraisal of those individuals actively seeking psychiatric assessment and treatment through a specialist perinatal psychiatric service. Such information is useful in promoting better understanding of this population and the complex treatment and management needs of this patient group.

Objective: The aim of this paper was to collect feedback on a specialist parent-infant psychiatric service in terms of client satisfaction with inpatient treatment, and the impact on health outcomes of providing written information about available support options in the community following discharge., Methods: Women (n = 37) from consecutive admissions between January 2006 and December 2007 were contacted by telephone and administered a service quality evaluation questionnaire., Results: Women were happy with the quality of inpatient care provided but suggested areas of improvement included continuity of staff during the inpatient stay and better communication between inpatient and outpatient services post-discharge. At discharge, women were not confident with their ability in coping with motherhood but confidence with parenting skills increased post-discharge. Use of recommended post-discharge community support and/or health services was poor., Conclusion: As adherence with discharge recommendations was less than ideal, greater involvement of primary/community health care professionals, and active participation of clients and carers, in discharge planning is required. Increased emphasis on the practical skills of motherhood as well as opportunities to develop the mother-infant relationship may assist mothers in gaining confidence to interact with their baby and pick up infant cues.

Background: To assess the acceptability of routine screening for perinatal depression., Method: Postnatal women (n=860) and health professionals (n=916) were surveyed after 3 years of routine perinatal (antenatal and postnatal) use of the Edinburgh Postnatal Depression Scale (EPDS)., Results: Over 90% of women had the screening explained to them and found the EPDS easy to complete; 85% had no difficulties completing it. Discomfort with screening was significantly related to having a higher EPDS score. A majority of health professionals using the EPDS was comfortable and found it useful., Limitations: The sample involved only maternity services supporting depression screening. In addition, the response rate from GPs was low., Conclusions: Routine screening with the EPDS is acceptable to most women and health professionals. Sensitive explanation, along with staff training and support, is essential in implementing depression screening.

Objective: To identify ways to improve detection and access to treatment., Methods: A survey of general practitioners and postnatal women across Australia addressing knowledge of, and attitudes to, postnatal depression using case vignettes., Results: General practitioners were significantly more likely to recognise depression than postnatal women, who were likely to seek help for more general or baby related issues. Both GPs and women favoured help from partners and counselling, but GPs significantly favoured antidepressants and women, natural therapies., Discussion: Women have a low likelihood of presenting for depression, suggesting a role for screening by GPs. Women preferred psychological and social management than drugs for depression perinatally.