Search

Mentoring is suffering from a shortage of trained mentors which compromise the efficacy of novice mentoring or mentoring between a senior clinician and a junior clinician. E-mentoring is proposed as a means of supplementing this dominant form of mentoring in medicine by providing accessible, timely and longitudinal support for mentees. However, with little is known about e-mentoring nor its role in a blended mentoring approach, a systematic scoping review is proposed to evaluate these gaps in understanding in order to better understand e-mentoring and assess the viability of employing e-mentoring practice to support novice mentoring. Using Arksey and O'Malley's (Int J Soc Res Methodol 8(1):19-32, 2005) approach, 5 reviewers carried out independent literature reviews of e-mentoring as an adjuvant to novice mentoring in PubMed, Embase, PsycINFO, ERIC, Cochrane Database of Systematic Reviews, Google Scholar, Scopus, GreyLit, OpenGrey, and Web of Science databases. Braun and Clarke's (Qual Res Psychol 3(2):77-101, 2006) thematic analysis approach was used to thematically analyse accounts of e-mentoring across different settings. 6557 abstracts were identified, 109 full text articles were reviewed, and 18 articles were included and thematically analysed. The themes identified include definitions, role, stages, processes, platforms, evaluation, and relationships in e-mentoring. The themes identified provide a clinically relevant definition of e-mentoring, and in highlighting the similarities in the phases of novice and e-mentoring reaffirms the validity of a blended approach as a means of addressing shortfalls in mentoring in medicine.

A consistent mentoring approach is key to unlocking the full benefits of mentoring, ensuring effective oversight of mentoring relationships and preventing abuse of mentoring. Yet consistency in mentoring between senior clinicians and medical students (novice mentoring) which dominate mentoring processes in medical schools is difficult to achieve particularly when mentors practice in both undergraduate and postgraduate medical schools. To facilitate a consistent approach to mentoring this review scrutinizes common aspects of mentoring in undergraduate and postgraduate medical schools to forward a framework for novice mentoring in medical schools. Four authors preformed independent literature searches of novice mentoring guidelines and programmes in undergraduate and postgraduate medical schools using ERIC, PubMed, CINAHL, OVID and Science Direct databases. 25,605 abstracts were retrieved, 162 full-text articles were reviewed and 34 articles were included. The 4 themes were identified--preparation, initiating and supporting the mentoring process and the obstacles to effective mentoring. These themes highlight 2 key elements of an effective mentoring framework-flexibility and structure. Flexibility refers to meeting the individual and changing needs of mentees. Structure concerns ensuring consistency to the mentoring process and compliance with prevailing codes of conduct and standards of practice.

The acceptability of an action is determined by the intention behind it. This is particularly relevant within end-of-life care setting where acts of utilising treatments involving opioids and sedatives ostensibly to ameliorate suffering can result in the hastening of death of a terminally ill patient. It is in elucidating the dominant intentions behind the decision to utilise these drugs that determines its acceptability. Yet the process of determining the intentions of an individual is not easy. In the face of a rise in unsanctioned practices such as physicianassisted suicide and euthanasia, which continue to plague legitimate end-of-life practices, and mounting concerns as to the efficacy of prevailing methods of discernment of intentions, Palliative Medicine (PM) adopted a novel triadic approach to determining the acceptability of actions. The first was the employ of a Multi-Disciplinary Team (MDT) approach to ensure accountability within care determinations and to temper any ill-considered actions of any healthcare professional (HCP) within the team. The second was the employ of evidencebased medical practice and clear lines of accountability to all actions taken surrounding end-of-life care. Here, the combination of the MDT approach and having determinative processes shepherded by the law, corralled by regnant sociocultural and professional expectations, guided by professional standards and influenced and tampered by the MDT would mean that only a few intentions will be acted upon. This is deemed to improve the chances of delineating the primary intentions of a clinician. The third and final element to this approach was the employ of the Principle of Proportionality to determine if actions taken were both commensurate with the exigencies of the situation and in keeping with prevailing standards of legal practice, clinical guidelines and psychosocial expectations considered within the patient's particular context. This last element of this triadic approach has, however, faced increasing problems. The context-dependent nature of determinations of proportionality and the inherent subjectivity that accompanies such conditions raise questions as to the viability of this process. A return to the practice of elucidating intention has increasingly been called for, albeit this time in tandem with judgements as to the proportionality of an action within the prevailing evidence-based MDT approach. This paper studies the viability of reintroduction of elucidations of intentions for the purposes of determining the acceptability of actions within the context of an evidence-based MDT approach. By doing so, it forwards the Model for the Elucidation of Intention (MEI) within the Multi-Disciplinary Team (MDT) as a means of confronting the inherent subjectivity within end-of-life care determinations. [ABSTRACT FROM AUTHOR]

Why does family-centric decision-making, replete with the practices of collusion, familial determination and the circumnavigation of direct patient involvement in their own care decisions, continue to dominate end of life decision-making within the Singapore setting, particularly in light of the embrace of individualistic principlism? Received knowledge would point to the inherent dissonance in the manner in which familialism and principlism conceive the individual. Familialism envisages the individual as inextricably entwined with his/her family, leaving the interests of the family unit uppermost in any determination. This contrasts starkly with principlism, which sees the patient as a discrete individual who, though not entirely removed from his/her sociocultural surroundings, still places the interests of the individual at the centre of any decision-making process. In this paper we will highlight the inherent flaws in the proposed Relational Autonomy (RA) framework as it attempts to bridge the differences between principlism and regnant familialism, and forward a flexible patient-centred, context-sensitive, welfare-based model of care that we believe will better address the clinical issues faced by local healthcare professionals. Guided by regnant sociocultural and professional standards, and employed under the aegis of a multidisciplinary palliative team approach to ensure transparency and accountability, the Welfare Model provides a clinically relevant, ethically sensitive, promising alternative to the present predicament. [ABSTRACT FROM AUTHOR]

The article presents a perspective on withdrawing artificial hydration and nutrition (AHN) from patients in persistent vegetative state (PVS) in the context of Singapore. Within the Confucian-centric socio-cultural beliefs prevailing in Singapore, withdrawal of AHN are met with resistance and foster guilt among family members. AHN withdrawal therefore cannot be abrupt and unilateral but rather a multi-dimensional review that considers socio-cultural norms and familial and religious beliefs.

The article explores the perspectives of palliative care patients on personhood within the context of end-of-life care by interview instead of unvalidated tools within end-of-life settings. Findings showed that these patients place great value on palliative care based on Confucian-inspired concept of personhood grounded on relational ties and social interaction. It suggests that these patients are rendered vulnerable if palliative care is made on the basis of theoretical concepts of personhood.

In this article the author dispels the misconceptions associated with the practice of continuous sedation until death (CSD). Topics discussed include the position of Samuel LiPuma on CSD as published in his article in the "Journal of Medical Philisophy," the application of pharmacological agents such as barbiturates in CSD, and the cessation of clinically assisted nutrition and hydration (CANH). Also presented is the Ring Theory which reveals the richer concept of personhood.

The seven-item Hospital Anxiety and Depression Scale Depression subscale (HADS-D) and the total score of the 14-item HADS (HADS-T) are both used for major depression screening. Compared to the HADS-D, the HADS-T includes anxiety items and requires more time to complete. We compared the screening accuracy of the HADS-D and HADS-T for major depression detection. We conducted an individual participant data meta-analysis and fit bivariate random effects models to assess diagnostic accuracy among participants with both HADS-D and HADS-T scores. We identified optimal cutoffs, estimated sensitivity and specificity with 95% confidence intervals, and compared screening accuracy across paired cutoffs via two-stage and individual-level models. We used a 0.05 equivalence margin to assess equivalency in sensitivity and specificity. 20,700 participants (2,285 major depression cases) from 98 studies were included. Cutoffs of ≥7 for the HADS-D (sensitivity 0.79 [0.75, 0.83], specificity 0.78 [0.75, 0.80]) and ≥15 for the HADS-T (sensitivity 0.79 [0.76, 0.82], specificity 0.81 [0.78, 0.83]) minimized the distance to the top-left corner of the receiver operating characteristic curve. Across all sets of paired cutoffs evaluated, differences of sensitivity between HADS-T and HADS-D ranged from -0.05 to 0.01 (0.00 at paired optimal cutoffs), and differences of specificity were within 0.03 for all cutoffs (0.02-0.03). The pattern was similar among outpatients, although the HADS-T was slightly (not nonequivalently) more specific among inpatients. The accuracy of HADS-T was equivalent to the HADS-D for detecting major depression. In most settings, the shorter HADS-D would be preferred. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objectives: Training in Geriatric Oncology is in crisis, facing increasing demands in the face of a growing population of older adults, a lack of trainers, and the need to adapt training to different settings and trainee needs. A combination of novice mentoring and near-peer and peer mentoring (C-NP mentoring) has been proposed to provide trainees with personalized training and additional support. This study proposes to evaluate the possibility of establishing a C-NP mentoring program in geriatric oncology, through extrapolation of data from well-established practices in Internal Medicine programs., Materials and Methods: A systematic scoping review was carried out to provide scope of prevailing data and highlight the key processes behind effective C-NP mentoring programs. Six reviewers carried out independent literature searches on C-NP mentoring in medicine using Embase, ERIC, PubMed, and Scopus databases for articles published between 1st January 2000 and 31st December 2017. The Best Evidence Medical Education (BEME) collaboration guide and the STORIES (STructured apprOach to the Reporting In healthcare education of Evidence Synthesis) statement were used to develop a narrative from the thematic analysis of selected articles. Braun & Clarke (2006)'s approach to thematic analyses [1] and Sambunjak et al. (2010)'s approach of "negotiated consensual validation" were then used to identify the final list of themes., Results: 3913 citations were identified, 133 full-text articles were reviewed, and fifteen full-text articles were included. Thematic analysis was employed to circumnavigate mentoring's context-specific nature and identified ten semantic themes including the need, outcomes, obstacles, and improvements for C-NP mentoring, mentee and mentor participation and training, and matching and mentoring processes., Conclusion: Data from this review allows the forwarding of the C-NP Mentoring Framework that will potentially enhance Geriatric Oncology training. The framework ensures a balance of consistency in recruitment, training, matching, pre-mentoring meetings, assessments processes, and flexibility to inculcate personalized aspects to the training and support. The C-NP Mentoring Framework will also enable effective oversight of the program and timely support of mentees in need., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare. There was no funding received for this research article., (Copyright © 2019 Elsevier Inc. All rights reserved.)