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Background Student bullying in the clinical environment continues to have a substantial impact, despite numerous attempts to rectify the situation. However, there are significant gaps in the literature about interventions to help students, particularly a lack of specific guidance around which to formulate an intervention program likely to be effective. With this narrative review about student bullying interventions in the clinical learning environment, we examine and draw together the available, but patchy, information about ‘what works’ to inform better practice and further research. Methods We initially followed a PICO approach to obtain and analyse data from 38 articles from seven databases. We then used a general inductive approach to form themes about effective student bullying intervention practice, and potential unintended consequences of some of these, which we further developed into six final themes. Results The diverse literature presents difficulties in comparison of intervention efficacy and substantive guidance is sparse and inconsistently reported. The final analytical approach we employed was challenging but useful because it enabled us to reveal the more effective elements of bullying interventions, as well as information about what to avoid: an interventionist and institution need to, together, 1. understand bullying catalysts, 2. address staff needs, 3. have, but not rely on policy or reporting process about behaviour, 4. avoid targeting specific staff groups, but aim for saturation, 5. frame the intervention to encourage good behaviour, not target poor behaviour, and 6. possess specific knowledge and specialised teaching and facilitation skills. We present the themed evidence pragmatically to help practitioners and institutions design an effective program and avoid instigating practices which have now been found to be ineffective or deleterious. Conclusions Despite challenges with the complexity of the literature and in determining a useful approach for analysis and reporting, results are important and ideas about practice useful. These inform a way forward for further, more effective student bullying intervention and research: an active learning approach addressing staff needs, which is non-targeted and positively and skilfully administered. (331w). Electronic supplementary material The online version of this article (10.1186/s12909-019-1578-y) contains supplementary material, which is available to authorized users.

BackgroundWell-being in medical students has become an area of concern, with a number of studies reporting high rates of clinical depression, anxiety, burnout, and suicidal ideation in this population.ObjectiveThe aim of this study was to increase awareness of well-being in medical students by using a smartphone app. The primary objective of this study was to determine the validity and feasibility of the Particip8 app for student self-reflected well-being data collection.MethodsUndergraduate medical students of the Dunedin School of Medicine were recruited into the study. They were asked to self-reflect daily on their well-being and to note what experiences they had encountered during that day. Qualitative data were also collected both before and after the study in the form of focus groups and “free-text” email surveys. All participants consented for the data collected to be anonymously reported to the medical faculty.ResultsA total of 29 participants (69%, 20/29 female; 31%, 9/29 male; aged 21-30 years) were enrolled, with overall median compliance of 71% at the study day level. The self-reflected well-being scores were associated with both positive and negative experiences described by the participants, with most negative experiences associated with around 20% lower well-being scores for that day; the largest effect being “receiving feedback that was not constructive or helpful,” and the most positive experiences associated with around 20% higher scores for that day.ConclusionsThe study of daily data collection via the Particip8 app was found to be feasible, and the self-reflected well-being scores showed validity against participant’s reflections of experiences during that day.

Endocytosis, secretion, and endosomal trafficking are key cellular processes that control the composition of the plasma membrane. Through the coordination of these trafficking pathways, cells can adjust the composition, localization, and turnover of proteins and lipids in response to developmental or environmental cues. Upon being incorporated into vesicles and internalized through endocytosis, plant plasma membrane proteins are delivered to the trans-Golgi network (TGN). At the TGN, plasma membrane proteins are recycled back to the plasma membrane or transferred to multivesicular endosomes (MVEs), where they are further sorted into intralumenal vesicles for degradation in the vacuole. Both types of plant endosomes, TGN and MVEs, act as sorting organelles for multiple endocytic, recycling, and secretory pathways. Molecular assemblies such as retromer, ESCRT (endosomal sorting complex required for transport) machinery, small GTPases, adaptor proteins, and SNAREs associate with specific domains of endosomal membranes to mediate different sorting and membrane-budding events. In this review, we discuss the mechanisms underlying the recognition and sorting of proteins at endosomes, membrane remodeling and budding, and their implications for cellular trafficking and physiological responses in plants.

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Background Student bullying in clinical practice persists, and poor outcomes continue: for learning, academic achievement and career goals, for their mental and physical health and potentially affecting all staff and patients in a clinical workplace. We describe an emergent framework for the strategic design of a bullying intervention, presented as a staff development opportunity. Methods CAPLE (Creating A Positive Learning Environment) was a bullying intervention designed around current best evidence about ameliorating student bullying in the clinical environment. CAPLE was also an action research project delivered in two eight- week cycles, one in 2016 & another in 2017. CAPLE’s primary practical foci were to offer clinical staff in two separate hospital wards an opportunity to develop their clinical teaching skills and to guide them in reflection and cultivation of values around students and learning. Research foci were: 1. to gain insight into staff experiences of CAPLE as a development process and 2. to evaluate how CAPLE might best help staff reflect on, discuss and develop values around student learning, to include bullying. Staff undertook five active learning workshops combined with supportive contact with one researcher over the research period. Data include individual interviews, staff and researchers’ reflective journals and a paper survey about staff experiences of the 2017 intervention. Results We confirm the effectiveness of best evidence from the literature and also that a strategic four-part framework of approach, process, content and person can further enhance a bullying intervention by increasing the likelihood of participant engagement, learning and values change. Conclusions This research aggregates and adds weight to the current literature about student bullying and adds important pragmatic detail about best practice for bullying intervention design and delivery. Ultimately, this emergent framework offers insight to help move past some persistent barriers encountered by those wishing to improve workplace behaviour.

Purpose In order to foster positive student experiences in the clinical learning environment, we wanted to better understand which teaching practices they regard highly. Methods In 2016, the authors undertook a paper ‘exemplar’ survey (ES) of all fifth year medical students at one tertiary teaching site. Students had experienced all assigned clinical rotations over a two year period. Following a 66% response rate, we identified two clear exemplar clinical areas (ECAs). Over 2016–7, six focus groups with multidisciplinary staff members from these clinical areas were held, with the aim to identify, discuss and understand their specific teaching practices in more detail. Results The authors present descriptions of positive student experiences and related staff practices, in five themes. Themes emerged around foundational logistic and personal factors: central to student and staff data is that ‘welcome’ on a daily, and ongoing basis, can be foundational to learning. Central to ECA staff data are universal practices by which all staff purposefully work to develop a functional staff-student relationship and play a part in organising/teaching students. Students and ECA staff groups both understood teacher values to be central to student learning and that cultivating a student’s values is one of their major educational tasks. Conclusions The framework formed by this thematic analysis is useful, clear and transferrable to other clinical teaching contexts. It also aligns with current thinking about best supporting student learning and cultivating student values as part of developing professionalism. Instigating such practices might help to optimise clinical teaching. We also tentatively suggest that such practices might help where resources are scarce, and perhaps also help ameliorate student bullying. Electronic supplementary material The online version of this article (10.1186/s12909-019-1551-9) contains supplementary material, which is available to authorized users.

Background Medical student and health-care staff bullying remain international concerns. Our understanding about what might solve such problems is still developing. A common approach suggested for bystanders to bullying is that they challenge or “stand up” to the bully. At the same time, the considerable risks should they act (eg, verbal rebuke) are rarely acknowledged, and neither is the potential for considerable cognitive dissonance should they choose not to. Methods Drawing on a substantial literature review, we developed an interventional program, initially with medical student bullying in mind, that generally employed a discourse for values cultivation. We implemented and evaluated this program through 6 cycles of action research methodology in 6 different departments of one tertiary teaching hospital. Data include individual interviews, discussions with key participants plus freehand comments from wider staff’s workshop evaluations. Results Alongside others, an early serendipitous finding was the “IMO” [Indirect, focus on Me, focus on Outcome] framework, intended for bystanders to student bullying. From using this framework, participants reported developing confidence in tackling negative behaviours, that interactions had better outcomes and that the workplace atmosphere felt more relaxed. It’s use also significantly reduced cognitive dissonance. Encouragingly, participants went on to use IMO for staff–staff bullying incidents, and other common negative behaviours. We attribute IMO’s utility to its memorability, simplicity and for catering to the many possible causes of bullying, including values issues, without perpetuating or creating conflict. Conclusion The IMO framework is offered as a widely usable framework for all staff in a clinical environment – a useful addition to popular frameworks used in the clinical workplace, ideas from which might also help these be further refined. Further evaluation would establish whether IMO invites long-term change and its utility in other contexts.