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Article ; Online: A scoping review of the ethical impacts of international medical electives on local students and patient care.

Chmura, Magdalena / Nagraj, Shobhana

2024 Volume 25, Issue 1, Page(s) 5

Abstract: Background: International electives are often considered a valuable learning opportunity for medical students. Yet, as travelling to lower and middle income countries (LMICs) becomes more common, ethical considerations of such practices emerge. We ... ...

Abstract	Background: International electives are often considered a valuable learning opportunity for medical students. Yet, as travelling to lower and middle income countries (LMICs) becomes more common, ethical considerations of such practices emerge. We conducted a scoping review to assess the extent to which five ethical themes were addressed in existing literature about electives, with the aim of investigating the ethical impacts of medical student electives on local resources, patients and clinicians in LMICs. Methods: We systematically searched PubMed, Global Health and Embase databases using the search terms "(ethics) AND (medical electives)". Thematic content analysis was undertaken using a combination of deductive and inductive themes. The deductive themes included: exceeding clinical competence, use of limited local resources, respect for patients and local culture, collaboration with local community/colleagues, and one-sided benefits in partnership. In addition, we also allowed for emerging themes within the data, and conducted a narrative synthesis of the results. Results: A total of 37 papers discussed ethical issues relating to medical student international electives to LMICs. More publications were written from the medical student perspective (n = 14), than by the host-institution (n = 5), with nearly half written from third-party perspectives (n = 18). Negative impacts on local host students and impact upon patient care were identified as additional ethical considerations. Conclusions: Our review demonstrated that while there is a degree of awareness in the existing literature of the potential negative impacts of medical electives to local LMIC students' access to medical education and patient care, continued work is needed to ensure equitable partnerships. We recommend that these ethical themes should be further explored in pre-departure elective teaching courses and post-elective debriefs to increase medical students' awareness of the impact of their presence on host communities.
MeSH term(s)	Humans ; Clinical Competence ; Developing Countries ; Education, Medical ; Education, Medical, Undergraduate ; Patient Care ; Students, Medical
Language	English
Publishing date	2024-01-03
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2041552-7
ISSN	1472-6939 ; 1472-6939
ISSN (online)	1472-6939
ISSN	1472-6939
DOI	10.1186/s12910-023-00998-7
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Women as a driver to address gaps in the global surgical workforce.

Busa, Isabella / Nagraj, Shobhana

Human resources for health

2023 Volume 21, Issue 1, Page(s) 22

Abstract: Five billion people around the world lack access to safe and affordable surgical, anaesthetic, and obstetric care. There is a link between countries in which women are underrepresented in the surgical workforce and those struggling to meet their surgical ...

Abstract	Five billion people around the world lack access to safe and affordable surgical, anaesthetic, and obstetric care. There is a link between countries in which women are underrepresented in the surgical workforce and those struggling to meet their surgical need. In this commentary article, the underrepresentation of women in low- and middle-income country's (LMIC) surgical workforce is discussed. It is argued that the issue is self-reinforcing. On one hand, active change requires a sufficient number of female surgeons to initiate it. On the other, women can only start to penetrate the surgical workforce once they are safe, healthy, and motivated enough to do so, in turn depending on the presence of female surgeons to advocate for their female patients and empower future generations of young girls and women.
MeSH term(s)	Female ; Humans ; Surgeons ; Workforce
Language	English
Publishing date	2023-03-16
Publishing country	England
Document type	Journal Article
ZDB-ID	2126923-3
ISSN	1478-4491 ; 1478-4491
ISSN (online)	1478-4491
ISSN	1478-4491
DOI	10.1186/s12960-023-00808-6
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Article: Improving child health service interventions through a Theory of Change: A scoping review.

Jones, Benjamin / Paterson, Amy / English, Mike / Nagraj, Shobhana

Frontiers in pediatrics

2023 Volume 11, Page(s) 1037890

Abstract: Background: The objective of this scoping review was to map how child health service interventions develop, utilise, and refine theories of change. A Theory of Change (ToC) is a tool for designing, implementing, and evaluating interventions that is ... ...

Abstract	Background: The objective of this scoping review was to map how child health service interventions develop, utilise, and refine theories of change. A Theory of Change (ToC) is a tool for designing, implementing, and evaluating interventions that is being increasingly used by child health practitioners who are aiming to enact change in health services. Methods: A published protocol guided this scoping review. Relevant publications were identified through selected electronic databases and grey literature Findings: 38 studies were included in the analysis. This scoping review highlights the disparate and inconsistent use, and reporting of ToCs in the child health service intervention literature. Conclusion: A ToC may be a helpful tool to enact change in a child health service but careful consideration must be undertaken by the child health service regarding how to maximise the benefits of doing a ToC, and how to accurately report it.
Language	English
Publishing date	2023-04-06
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2023.1037890
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Article ; Online: A scoping review of the post-discharge care needs of babies requiring surgery in the first year of life.

Maraschin, Francesca Giulia / Adella, Fidelis Jacklyn / Nagraj, Shobhana

PLOS global public health

2023 Volume 3, Issue 11, Page(s) e0002424

Abstract: Congenital anomalies are among the leading causes of under-5 mortality, predominantly impacting low- and middle-income countries (LMICs). A particularly vulnerable group are babies with congenital disorders requiring surgery in their first year. ... ...

Abstract	Congenital anomalies are among the leading causes of under-5 mortality, predominantly impacting low- and middle-income countries (LMICs). A particularly vulnerable group are babies with congenital disorders requiring surgery in their first year. Addressing this is crucial to meet SDG-3, necessitating targeted efforts. Post-discharge, these infants have various care needs provided by caregivers, yet literature on these needs is scant. Our scoping review aimed to identify the complex care needs of babies post-surgery for critical congenital cardiac conditions and non-cardiac conditions. Employing the Joanna Briggs Institute's methodological framework for scoping reviews we searched Pubmed, EMBASE, CINAHL, PsychINFO, and Web of Science databases. Search terms included i) specific congenital conditions (informed by the literature and surgeons in the field), ii) post-discharge care, and iii) newborns/infants. English papers published between 2002-2022 were included. Findings were summarised using a narrative synthesis. Searches yielded a total of 10,278 papers, with 40 meeting inclusion criteria. 80% of studies were conducted in High-Income Countries (HICs). Complex care needs were shared between cardiac and non-cardiac congenital conditions. Major themes identified included 1. Monitoring, 2. Feeding, and 3. Specific care needs. Sub-themes included monitoring (oxygen, weight, oral intake), additional supervision, general feeding, assistive feeding, condition-specific practices e.g., stoma care, and general care. The post-discharge period poses a challenge for caregivers of babies requiring surgery within the first year of life. This is particularly the case for caregivers in LMICs where access to surgical care is challenging and imposes a financial burden. Parents need to be prepared to manage feeding, monitoring, and specific care needs for their infants before hospital discharge and require subsequent support in the community. Despite the burden of congenital anomalies occurring in LMICs, most of the literature is HIC-based. More research of this nature is essential to guide families caring for their infants post-surgical care.
Language	English
Publishing date	2023-11-22
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0002424
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Article ; Online: The role of medical support workers during the COVID-19 pandemic in the NHS in the UK: A qualitative service evaluation at the Oxford University Hospitals NHS Foundation Trust.

Chakma, Samprita / Wang, Hanyu / English, Mike / Namedre, Mesulame / Hill, Elaine / Nagraj, Shobhana

Clinical medicine (London, England)

2024 Volume 24, Issue 1, Page(s) 100006

Abstract: We conducted a service evaluation of the medical support worker (MSW) role at Oxford University Hospitals NHS Foundation Trust following the Coronavirus 2019 (COVID-19) pandemic. The aim was to explore the roles of MSWs, their contributions to the NHS, ... ...

Abstract	We conducted a service evaluation of the medical support worker (MSW) role at Oxford University Hospitals NHS Foundation Trust following the Coronavirus 2019 (COVID-19) pandemic. The aim was to explore the roles of MSWs, their contributions to the NHS, factors influencing their career choices, and the goals of the MSW position, to inform quality improvement in relation to their integration into the Trust. The perspectives of MSWs, their supervisors and recruiters were analysed through nine semi-structured interviews and two focus group discussions involving 18 participants. Results were categorised into micro-, meso-, and macro-levels of the health system. At the micro-level, MSWs were recognised as a diverse group of highly qualified international medical graduates (IMGs) who had a crucial role during the pandemic. At the meso-level, participants emphasised the importance of a comprehensive induction by the hospital, to clarify responsibilities and familiarise MSWs with the health system. At the macro-level, the role facilitated MSW integration within the NHS, with the aim of practising as doctors. The importance of comprehensive hospital induction, with role clarity for both MSWs and their teams, supportive supervision and assistance with applying for registration with the General Medical Council, were highlighted as key quality improvement areas.
MeSH term(s)	Humans ; Hospitals, University ; Pandemics ; State Medicine ; COVID-19 ; United Kingdom/epidemiology
Language	English
Publishing date	2024-01-19
Publishing country	England
Document type	Journal Article
ZDB-ID	2048646-7
ISSN	1473-4893 ; 1470-2118
ISSN (online)	1473-4893
ISSN	1470-2118
DOI	10.1016/j.clinme.2023.100006
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Article: Using theory of change in child health service interventions: a scoping review protocol.

Jones, Benjamin / Nagraj, Shobhana / English, Mike

Wellcome open research

2022 Volume 7, Page(s) 30

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2022-01-28
Publishing country	England
Document type	Journal Article
ISSN	2398-502X
ISSN	2398-502X
DOI	10.12688/wellcomeopenres.17553.1
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Article ; Online: The roles of physician associates and advanced nurse practitioners in the National Health Service in the UK: a scoping review and narrative synthesis.

Wang, Hanyu / English, Mike / Chakma, Samprita / Namedre, Mesulame / Hill, Elaine / Nagraj, Shobhana

Human resources for health

2022 Volume 20, Issue 1, Page(s) 69

Abstract: Background: Mid-level practitioners (MLPs), including physician associates (PAs) and advanced nurse practitioners (ANPs), have emerged to address workforce shortages in the UK and perform specific roles in relation to population needs. This has resulted ...

Abstract	Background: Mid-level practitioners (MLPs), including physician associates (PAs) and advanced nurse practitioners (ANPs), have emerged to address workforce shortages in the UK and perform specific roles in relation to population needs. This has resulted in new ways of working and changes to established professional hierarchies. We conducted a study to investigate the career development, competencies, effectiveness, perceptions, and regulation of PAs and ANPs, with the aim of understanding ways to effectively integrate MLPs into the NHS workforce. Methods: We conducted a systematic scoping review following PRISMA guidelines. Embase, Medline, the Cochrane database, Pubmed, and CINAHL databases were searched, using terms relating to PAs and ANPs in the UK. A total of 128 studies (60 on PAs and 68 on ANPs) were included in the final analysis. A narrative synthesis, guided by the pre-defined themes and emerging themes, was conducted to bring together the findings. Results: PAs are educated on a medical model with basic medical skills but lack formal professional regulation and do not have prescribing rights. ANPs are educated on a nurse model with enhanced skills that depend on roles within specific specialities, and their governance is mostly employer-led. PAs are primarily employed in secondary care. ANPs are employed widely in both primary and secondary care. No defined career progression exists for PAs. In contrast, becoming an ANP is a form of career progression within nursing. Both roles were regarded as cost-effective in comparison to doctors performing simple tasks. PAs were less understood compared to ANPs and received a mixed reception from colleagues, which sometimes undermined their professional identity, whereas ANPs were mostly welcomed by colleagues. Conclusions: Potential ways to better integrate PAs and ANPs into the NHS workforce include further initiatives by regulatory bodies and the NHS to create more awareness and clearer role definitions for MLPs, outline potential for career progression, offer transparency with regard to remuneration, and introduction of prescribing rights. Future research might include more cadres of MLPs and explore the international literature.
MeSH term(s)	Atrial Natriuretic Factor ; Humans ; Nurse Practitioners ; Physicians ; State Medicine ; United Kingdom
Chemical Substances	Atrial Natriuretic Factor (85637-73-6)
Language	English
Publishing date	2022-09-15
Publishing country	England
Document type	Journal Article ; Review ; Systematic Review ; Research Support, Non-U.S. Gov't
ZDB-ID	2126923-3
ISSN	1478-4491 ; 1478-4491
ISSN (online)	1478-4491
ISSN	1478-4491
DOI	10.1186/s12960-022-00766-5
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Article: The role of community health workers in cervical cancer screening in low-income and middle-income countries: a systematic scoping review of the literature.

O'Donovan, James / O'Donovan, Charles / Nagraj, Shobhana

BMJ global health

2019 Volume 4, Issue 3, Page(s) e001452

Abstract: Introduction: Community-based screening for cervical cancer and task sharing to community health workers (CHWs) have been suggested as a potential way to increase screening coverage in low- and middle-income countries (LMICs). The aims of the scoping ... ...

Abstract	Introduction: Community-based screening for cervical cancer and task sharing to community health workers (CHWs) have been suggested as a potential way to increase screening coverage in low- and middle-income countries (LMICs). The aims of the scoping review were to understand the following: (i) where and how CHWs are currently deployed in screening in LMIC settings; (ii) the methods used to train and support CHWs in screening, and (iii) The evidence on the cost-effectiveness of using CHWs to assist in screening. Methods: A scoping literature search of 11 major databases and the grey literature was performed between 1978 and 2018. We included comprehensive search terms for 'CHWs' and 'Cervical Cancer', and used the World Bank criteria to define LMICs. Results: Of the 420 articles screened, 15 met the inclusion criteria for review. Studies were located in Africa (n=5), Asia (n=5), and South and Central America (n=5). CHWs played a role in community education and raising awareness (n=14), conducting or assisting in cervical screening (n=5), or follow-up (n=1). 11 studies described CHW training activities. Only one study provided a formal cost analysis. Conclusion: The roles of CHWs in cervical cancer screening in LMICs have largely to date focused on education, outreach, and awareness programmes. Community-based approaches to cervical cancer screening are feasible, although the sociocultural context plays an important role in the acceptability of these interventions. Further in-depth contextually grounded studies exploring the acceptability of such interventions are required, as well as studies exploring the cost-effectiveness of involving CHWs in cervical cancer screening activities.
Language	English
Publishing date	2019-05-13
Publishing country	England
Document type	Systematic Review
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2019-001452
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Article: Lessons from developing, implementing and sustaining a participatory partnership for children's surgical care in Tanzania.

Philipo, Godfrey Sama / Nagraj, Shobhana / Bokhary, Zaitun M / Lakhoo, Kokila

BMJ global health

2020 Volume 5, Issue 3, Page(s) e002118

Abstract: Global surgery is an essential component of Universal Health Coverage. Surgical conditions account for almost one-third of the global burden of disease, with the majority of patients living in low-income and middle-income countries (LMICs). Children ... ...

Abstract	Global surgery is an essential component of Universal Health Coverage. Surgical conditions account for almost one-third of the global burden of disease, with the majority of patients living in low-income and middle-income countries (LMICs). Children account for more than half of the global population; however, in many LMIC settings they have poor access to surgical care due to a lack of workforce and health system infrastructure to match the need for children's surgery. Surgical providers from high-income countries volunteer to visit LMICs and partner with the local providers to deliver surgical care and trainings to improve outcomes. However, some of these altruistic efforts fail. We aim to share our experience on developing, implementing and sustaining a partnership in global children's surgery in Tanzania. The use of participatory methods facilitated a successful 17-yearlong partnership, ensured a non-hierarchical environment and encouraged an understanding of the context, local needs, available resources and hospital capacity, including budget constraints, when codesigning solutions. We believe that participatory approaches are feasible and valuable in developing, implementing and sustaining global partnerships for children's surgery in LMICs.
MeSH term(s)	Child ; Humans ; International Cooperation ; Pediatrics ; Surgical Procedures, Operative ; Tanzania
Language	English
Publishing date	2020-03-17
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2019-002118
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Article ; Online: Medical Students' Views About Having Different Types of Problem-Based Learning Tutors.

Nagraj, Shobhana / Miles, Susan / Bryant, Pauline / Holland, Richard

Medical science educator

2018 Volume 29, Issue 1, Page(s) 93–100

Abstract: Background: At Norwich Medical School, Year 3 or 4 medical students taking a year out of the 5-year undergraduate MBBS degree to do a master's degree in clinical education worked as near-peer problem-based learning (PBL) tutors for students in Year 2. ... ...

Abstract	Background: At Norwich Medical School, Year 3 or 4 medical students taking a year out of the 5-year undergraduate MBBS degree to do a master's degree in clinical education worked as near-peer problem-based learning (PBL) tutors for students in Year 2. Peer-assisted learning has been shown to benefit both peer tutors and tutees; in this study, experiences of students with near-peer PBL tutors were compared to students with other types of PBL tutor. Methods: Using existing student evaluation data, we compared student views about PBL tutor performance, PBL group functioning, and overall satisfaction with PBL learning experience according to whether their PBL tutor/s were (1) a single near-peer tutor (later-year MB BS student), (2) a single staff tutor, (3) multiple staff tutors, or (4) multiple newly qualified doctor tutors. Results: Results indicated that students' evaluation of tutor performance was more positive for near-peer PBL tutors compared to both groups of staff tutors for most areas evaluated. Additionally, students' evaluation of overall satisfaction with PBL was more positive for near-peer PBL tutors compared to multiple staff tutors. Tutor performance for multiple staff tutors was evaluated less positively compared to both single staff and multiple newly qualified doctor groups. But there were no statistically significant differences between the four groups regarding PBL group functioning. Conclusion: Near-peer PBL tutors perform comparably or better to staff PBL tutors in salient measures of tutor performance and group functioning. We conclude that medical students find near-peer PBL tutors to be an acceptable addition to the PBL tutor workforce.
Language	English
Publishing date	2018-11-14
Publishing country	United States
Document type	Journal Article
ISSN	2156-8650
ISSN (online)	2156-8650
DOI	10.1007/s40670-018-00634-9
Database	MEDical Literature Analysis and Retrieval System OnLINE

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