Introduction Breast cancer is the commonest cancer in women, and screening can allow earlier-stage diagnosis. While there are European recommendations on the age-range and frequency of breast cancer screening, participation in these programmes varies substantially, and this could be due to differences in how they are organised and implemented. The role that primary healthcare professionals play in the process is unclear.We aimed to describe the breast cancer screening programmes in European countries and investigate how primary healthcare professionals are involved in this screening process.Methods A cross-sectional survey in 32 countries. Key informants with relevant expertise answered online questions about the characteristics of their screening programmes and general practitioners’ (GPs’) roles in this. Responses were refined through an iterative consensus process. Data were examined to identify patterns in GP engagement.Results We found important differences between European breast cancer screening systems. While most had population-based screening, four countries relied on opportunistic screening. In 15 countries GPs had little or no involvement in the process of breast cancer screening, and in 13 countries GPs had some involvement, including identifying eligible patients, issuing referrals, and following-up results. Screening uptake rates tended to be higher in countries with well-established population-based screening programmes which give little or no GP involvement. Few countries linked GP engagement to incentives or performance measures.Conclusion Countries with lower screening uptake should consider either enhancing GP involvement or transitioning to a structured, population-based screening system. Further research should explore how best to integrate primary care within national screening strategies.

BACKGROUND:The United Kingdom's National Health Service has a workload which is increasingly moving from secondary to primary care. The proportion of Foundation Year 2 (F2) doctor specialty training applicants appointed to General Practitioner (GP) training programmes has historically been in decline. Though recent figures show an increase in applications, the pattern of high competition and many F2s not progressing directly into GP training is ongoing. AIM:To explore the features of F2 GP placements that influence career choice DESIGN & SETTING: A retrospective mixed methods study using an on-line survey followed by semi-structured interviews. METHOD:A survey of 77 F2 doctors from 3 Health Education England regions was completed, of which 20 took part in interviews following their 4-month GP placement. Survey data were analysed using descriptive statistics, and qualitative data using thematic analysis. RESULTS:This study found considerable variation between practice placements in terms of F2s' workload, the quality of supervision and support, whether they encountered inspiring GP role models, the degree of isolation, educational opportunities and the culture of the practice. F2 doctors consider that their GP placements are invaluable for their learning. However, placement experiences were mixed, with F2 doctors being attracted and "put off" a GP career in equal numbers. CONCLUSION:There is a need to ensure consistently high-quality GP placement experiences for F2 doctors' that can best inform their career choice. F2 doctors made several recommendations following their GP placement which, if implemented, may help to increase the attractiveness of GP as a career.

BackgroundAlthough telemedicine grew rapidly during the COVID-19 pandemic, instruments to assess general practitioners’ (GPs) attitudes and behavioral intentions to use it are scarce. In Sweden, the Physicians’ Attitudes and Intentions to use Telemedicine (PAIT) questionnaire was developed from the “theory of planned behavior” in 2019 and translated into English in 2022. ObjectiveThe aim of this study was to explore similarities and differences between behavioral intentions and predictors of intentions to use telemedicine among GPs in England and Sweden. MethodsThis study compared attitudes, behavioral intentions, and self-reported use of telemedicine after the COVID-19 pandemic among 52 GPs in England and 101 GPs in Sweden. The PAIT questionnaire has 33 items with 7-point Likert scale options ranging from “strongly disagree” to “strongly agree,” examining 3 predictors of intentions: attitudes (12 items), subjective norms (6 items), perceived behavioral control (9 items), and “intentions” (6 items) to use telemedicine; 22 items assess use of telemedicine tools, general questions about telemedicine, training experience, free-text comments, and demographic and background questions. ResultsBoth English and Swedish GPs reported little training and low use of telemedicine after the COVID-19 pandemic. Swedish GPs had significantly higher mean scores for intentions to use telemedicine in daily practice compared with English GPs. More positive attitudes and higher perceived behavioral control were significantly associated with higher behavioral intention scores in both English and Swedish GPs. ConclusionsWhile our results are exploratory due to sample size constraints, these findings provide insights into the similarities and differences between English and Swedish GPs regarding telemedicine adoption—attitudes, behavioral intentions, and self-reported use of telemedicine assessed by the PAIT questionnaire—which proved useful for cross-country comparisons and could be used for further international studies.

Background: Implementation of evidence-based practice often fails when interventions are not adapted to real-world clinical settings. Existing questionnaires mainly assess general competencies, knowledge, or the presence of barriers and facilitators, but rarely capture the specific, individualised needs of healthcare professionals for implementing particular methods. A standardised, universal instrument that identifies these needs could support more effective and tailored implementation strategies. The aim of this paper is to develop a universal questionnaire to assess healthcare professionals’ implementation needs and to evaluate its content and face validity among family doctors in Ukraine. Methods: The Healthcare Professionals’ Implementation-needs Questionnaire (HPIQ) was developed by selecting determinants from the Determinants of Implementation Behavior Questionnaire (DIBQ) that could be considered as healthcare professionals’ needs. These determinants were then used to create HPIQ items that capture the importance of each need and provide details on how it can be addressed. Content validity was assessed in two rounds, by 12 and 10 experts respectively. Face validity was evaluated by 25 family doctors. Quantitative measures (Content Validity Ratio (CVR), Content Validity Index (CVI), Item Impact Score (IIS)) and qualitative feedback guided item refinement. The version validated among family doctors is referred to as HPIQ-FD. Results: We developed an initial pool of 31 items (12 Likert-scale, 19 open-ended). After evaluation, 14 items (6 Likert-scale, 8 open-ended) met all thresholds for content (CVR ≥0.62, CVI ≥0.79) and face validity (IIS ≥1.5) and were retained. These items reflect key needs, such as clear instructions, practical skills, additional time, financial motivation, access to resources, organisational support, and other factors affecting successful implementation. The edited final version of the questionnaire appeared to be concise, practical and structured for use in primary care. Conclusions: The HPIQ was developed as a universal instrument to assess healthcare professionals’ implementation needs. Its initial validation among family doctors (HPIQ-FD) confirmed content and face validity in this context. The questionnaire supports systematic and personalised identification of critical needs, enables tailored implementation strategies, and could be adapted for other specialties and clinical settings to promote effective, sustainable evidence-based practice.

Objective Relative one-year cancer survival rates in the Baltic states are lower than the European mean; in the Nordic countries they are higher than the mean. This study investigated the likelihood of General Practitioners (GPs) investigating or referring patients with a low but significant risk of cancer in these two regions, and how this was affected by GP demographics.Design A survey of GPs using clinical vignettes.Setting General Practice in Denmark, Estonia, Finland, Latvia, Lithuania, Norway, and Sweden.Subjects General Practitioners.Outcome measures A regional comparison of GPs’ stated immediate diagnostic actions (whether or not they would perform a key diagnostic test and/or refer to a specialist) for patients with a low but significant risk of cancer (between 1.2 and 3.6%).Results Of the 427 GPs that completed the questionnaire, those in the Baltic states, and GPs that were more experienced, were more likely to arrange a key diagnostic test and/or refer their patient to a specialist than those in Nordic Countries or who were less experienced (p < 0.001 for both measures). Neither GP sex nor practice location within a country showed a significant association with these measures.Conclusion While relative one-year cancer survival rates are lower in the Baltic states than in four Nordic countries, we found no evidence that this is due to their GPs’ reluctance to take immediate diagnostic action, as GPs in the Baltic states were more likely to investigate and/or refer at the first consultation. Research on patient and secondary care factors is needed to explain the survival differences.

BackgroundRecruiting and retaining International Medical Graduates (IMGs) has been identified as a key component in addressing the ongoing workforce crisis in general practice. However, research shows IMG General Practitioners (GPs) face unique challenges compared to their UK-trained counterparts, impacting their welfare, retention in the workforce, and ability to provide patient care.AimThis study examined the challenges facing early-career IMG GPs, the help and support they access and want to access, and their perceptions and utilisation of the help and support available.Design and settingA mixed-methods study that collected primary data in an online survey and interviews between March and May 2023.MethodEarly-career IMG GPs based in South West England were invited to complete an online survey consisting of 5-point Likert-scale and free-text questions. Interviews were completed with key informants and some survey respondents. Qualitative data were analysed thematically. Data from the survey and interviews were analysed and merged using a convergent parallel design.ResultsBased on 29 survey replies and 9 interviews, four interrelated themes were identified: (i) communication and language, (ii) racism, unequal treatment, and developing coping mechanisms (iii), exclusion and being 'othered', and (iv) adapting to new ways of living and working. Although some IMG GPs access help and support, many feel this is insufficient and poorly accessible.ConclusionIMG GPs face interrelated and unique challenges in their personal and professional lives and do not feel adequately supported by the NHS. Addressing this disconnect will be vital to sustaining the general practice workforce.

Background/objectives: Attitudes towards COVID-19 vaccination vary globally, influenced by political and cultural factors. This research aimed to assess the views of people without a healthcare qualification in Europe on COVID-19 vaccination safety, effectiveness, and necessity as well as how well informed they felt. The secondary outcomes focused on how respondents’ views were affected by demographic and context factors and included a comparison by country of the level of feeling well informed. Methods: A mixed-method cross-sectional online survey in eight European countries, using convenience sampling. Results: A total of 1008 adults completed the survey, 60% of whom were female. While only 44.1% considered the vaccines safe, 43.5% effective, and 44.9% necessary, 80.0% had been vaccinated. Four in ten adults strongly agreed that they were well informed, while over a quarter did not answer the question. Younger respondents, well-informed individuals, and German respondents were more inclined to perceive COVID-19 vaccination as both effective and necessary. Conclusions: Motivations for vaccination included perceived health and social benefits, while concerns included a preference for “natural immunity”, the rapid development of the vaccine, and potential unknown long-term effects. A correlation existed between respondents feeling well informed about the different COVID-19 vaccines in their country and the likelihood of having been vaccinated.

PURPOSE:This study was designed to elicit medical students' opinions on the characteristics of a good ultrasound tutor. The results should help educators to create an optimal teaching environment and inform tutor training. MATERIALS AND METHODS:The qualitative study recruited 15 participants from a larger mixed-methods study of 64 medical students who underwent a basic course on abdominal ultrasound taught by faculty and near-peer tutors. During semi-structured interviews, they were asked which characteristics make a good ultrasound tutor. We used inductive thematic analysis to identify the most important categories. RESULTS:Medical students identified teaching themes and subthemes relating to teaching skills (e.g., course structure, repetition, vocabulary, feedback, guidance of participants), tutors' attitudes (e.g., atmosphere creation, empathy) and knowledge as the crucial components of being a good ultrasound tutor. CONCLUSIONS:While some of the themes that students identified are generic to medical education, others are specific to ultrasound teaching. Tutors can use our results to assess their own teaching. They should aim to address learning needs, optimise understanding, give adequate feedback, and create a non-threatening atmosphere with empathic interactions. Accounting for the ultrasound-specific setting they should possess the necessary knowledge, provide verbal guidance to their students, and distribute examination time wisely.

Abstract Background The introduction of ultrasound (US) courses into medical undergraduate courses is usually met with a particularly high level of student motivation. The reasons for this are unclear. The aim of this study was to investigate the factors that contribute to undergraduate medical students’ motivation to learn US skills. Understanding what motivates students to learn US will inform the efforts of faculty to foster students’ motivation to learn. Methods We carried out in-depth semi-structured one-to-one interviews with medical students participating in an optional US course at two Swiss universities. The interview guide consisted of 10 main questions. The content was informed by experts in the field of medical education and US, as well as by a literature review of motivation theories for learning, in particular by self-determination theory (SDT). SDT was used to guide the development of the interview guide and to reflect on the resulting themes in the discussion section. The interview guide was piloted with two medical students. The interviews lasted an average of 45 min and were audio recorded and transcribed. Thematic analysis was used to analyse the data. Results Fourteen undergraduate medical students in their preclinical (year 3) and clinical studies (years 4 and 5) elaborated on a wide range of reasons for their high motivation to learn US. They were motivated for US training because of the positive nimbus of the US modality, emphasising the advantages of visualisation. Students acknowledged the potential professional benefits of learning US and described it as a fun, exciting group activity. Conclusions The four themes we found in our analysis can all be related to the three universal needs described in SDT. The strong focus on the visual aspect and the positive nimbus of the modality goes beyond that and reflects the visuo-centric Zeitgeist, which claims the superiority of visual information over other data. Educators should be aware that motivation to learn is affected by the Zeitgeist and ensuing preconceptions, such as the perception of the positive nimbus surrounding a topic. Other key elements that can be implemented to motivate students are just-in-time feedback, enabling group experiences and creating awareness of the clinical relevance of learning content.

BackgroundNear-peer teaching is increasingly used in medical education, supporting or replacing faculty teaching. It has positive aspects for learners and tutors, some of which are explained by higher social and cognitive congruence between learners and near-peer tutors (NPTs). This study investigates the optimal combination of faculty tutors (FTs) and NPTs in an abdominal ultrasound course.MethodsSixty-four third-year medical students underwent a basic ultrasound course, with 75% of lessons taught by NPTs and 25% by FTs. Each of four groups had a different faculty teaching timing. A mixed methods approach used a survey and semi-structured interviews at the course end to elicit learners' preferences, and end-of-course examination scores to look for differences in outcomes.ResultsMost learners preferred having faculty teaching in the second half of the course, saying it would be overwhelming to start with FTs. Learners preferred between a quarter and a third of the teaching to be from FTs, with NPTs rated better at teaching basics, and FTs contributing unique, helpful clinical knowledge. There was no significant between-group difference in examination scores.ConclusionsMedical students preferred most of their teaching to be from NPTs, with some faculty input in the second half of the course.

Innovativeness and performance are keys to understanding the capability of SMEs. However, scant research examines the motivational frames that enhance behaviors, such as innovation, in SMEs. Regulatory focus theory provides the lens through which to we examined how SME owner motivation impacts innovation and firm performance, given that the SME owner primarily displays either a promotion or prevention focus. As such, we hypothesize the moderating effects of dominant regulatory foci radical on the relationship between innovation and SME performance. Based on a sample of 422 small business owners, we find a positive and significant direct relationship between both incremental and radical innovation on performance. Further, we report that prevention focus heightens the positive relationship between incremental innovation and performance, while radical innovation negatively impacts the relationship between radical innovation and performance; thus, highlighting the critical nature of strategic alignment that exists between regulatory focus strategy, innovation type and performance outcomes. This study brings the entrepreneur back into focus for small business research and investigates the intersection of firm-level and individual-level units of analyses.

Additive manufacture (AM) involves creating a part layer by layer and is a rapidly evolving manufacturing process. It has multiple strengths that apply to space-based optics, such as the ability to consolidate multiple parts into one, reducing the number of interfaces. The process also allows for greater mass reduction, making parts more cost-effective to launch, achieved by optimising the shape for intended use or creating intricate geometries like lattices. However, previous studies have highlighted issues associated with the AM process. For example, when trying to achieve high-precision optical surfaces on AM parts, the latticing on the underside of mirrors can provide insufficient support during machining, resulting in the quilting effect. This paper builds on previous work and explores such challenges further. This will be implemented by investigating ways to apply AM to a deployable mirror from a CubeSat project called A-DOT. The reflective surface has a spherical radius of curvature of 682 mm and approximate external dimensions of 106 x 83 mm. The aim is to produce two mirrors that will take full advantage of AM design benefits and account for the challenges in printing and machining a near-net shape. The designs will have reduced mass by using selected internal lattice designs and topologyoptimised connection points, resulting in two mirrors with mass reduction targets of 50% and 70%. Once printed in aluminium using laser powder bed fusion, the reflective surface will be created using single point diamond turning. Finally, an evaluation of the dimensional accuracy will be conducted, using interferometry, to quantify the performance of the reflective surface.

BACKGROUND:British general practice is facing a workforce crisis against a backdrop of an ageing population experiencing increasingly complex health challenges. The NHS must increase the supply of GPs, including international medical graduate (IMG) GPs, by increasing recruitment and retention. IMG GPs face distinct challenges during training and their early careers. Understanding these challenges, as well as the help and support offered to early career IMG GPs, is crucial to building and sustaining the general practice workforce.AIM:To understand the challenges facing early career IMG GPs and the help and support they can access.DESIGN & SETTING:Rapid review of studies and grey literature on UK-based IMG GPs.METHOD:Six databases were searched. Four websites were searched to find grey literature. Titles and abstracts were screened according to inclusion and exclusion criteria, followed by the full study where applicable. The included studies were analysed using a thematic synthesis approach to identify the challenges faced by early career IMG GPs, as well as the help and support available.RESULTS:The database search yielded 234 studies, with 38 additional studies identified via other methods. Twenty-one studies were included in the synthesis. Seven challenges were identified, as well as a range of help and support available. Early career IMG GPs face a range of psychological, social, and practical challenges, which may not be adequately addressed by the help and support currently offered by the NHS.CONCLUSION:Further research is required to understand the extent to which early career IMG GPs access the help and support offered, and if it adequately addresses the unique challenges they face.

Objectives Safety culture surveys have been widely used in healthcare for more than two decades predominantly as a tool for measuring the level of safety culture (as defined as the beliefs and attitudes that staff express about how their organisation ought to work and how it does in fact work). However, there is the potential for the survey process itself to influence the safety culture and working practices in departments and organisations. The objective of this study was to identify the mechanism by which these changes might occur.Design, setting and participants Mixed methods combining qualitative semi-structured interviews and quantitative scores from patient safety surveys.This evaluation was conducted across general practice, community and acute hospitals in two NHS regions in England; South West and Greater Manchester. The study was undertaken between 2015 and 2018 during the implementation of a series of Patient Safety Collaboratives. Safety, Communication, Operational Reliability, and Engagement (SCORE) surveys were administered in 15 units, followed by a staff debriefing and a second SCORE survey. Semi-structured interviews were conducted with clinicians (n=61). Results from the first and second surveys were compared in order to test for differences in responses. Sixty-one semi structured interviews were conducted across participating units and thematically analysed.Analysis and results Results from the first and second surveys were compared using chi-squared and Fisher's exact tests. Sixtyone semi-structured interviews were conducted across participating units and thematically analysed.There was little change in responses between the first and second SCORE surveys. Within general practice there was some improvement in responses in three survey domains; however, these differences were not conclusive. The qualitative interview data demonstrated a beneficial effect on safety culture. Staff stated that the survey debriefings created a new safe space where problems could be discussed and improvement plans created.Conclusions Safety culture surveys can improve safety culture within departments if they are followed by a process that includes debriefing the staff and working with them to develop improvement plans.

ObjectiveDiagnosis of cancer is challenging in primary care due to the low incidence of cancer cases in primary care practice. A prolonged diagnostic interval may be due to doctor, patient or system factors, or may be due to the characteristics of the cancer itself. The objective of this study was to learn from Primary Care Physicians' (PCP) experiences of incidents when they had failed to think of, or act on, a cancer diagnosis.DesignA qualitative, online survey eliciting PCP narratives. Thematic analysis was used to analyse the data.Setting and subjectsA primary care study, with narratives from 159 PCPs in 23 European countries.Main outcome measuresPCPs' narratives on the question 'If you saw this patient with cancer presenting in the same way today, what would you do differently?ResultsThe main themes identified were: thinking broadly; improvement in communication and clinical management; use of other available resources and 'I wouldn't do anything differently'.Conclusion (Implications)To achieve more timely cancer diagnosis, PCPs need to provide a long-term, holistic and active approach with effective communication, and to ensure shared decision-making, follow-up and continuing re-assessment of the patients' clinical conditions. Diagnosing cancer in primary care is challenging due to the low incidence of cancer in practice and the multiple confounding factors that are involved in the diagnostic process.The need to think broadly, make improvements in communication and clinical management, and use other available resources were the main themes from Primary Care Physicians' (PCPs') narratives about their learning experiences from missed or late cancer diagnoses.A long-term, holistic and active approach with effective communication, follow-up and continuing re-assessment of the patients' clinical conditions was another theme for making improvements.Some PCPs, on reflection, would not have done anything differently.

It is intuitively appealing and common in the literature to describe social ties as one large category that represents multiple constructs which have similar relations across operationalizations. However, that approach does not capture the nuance in the literature and might obscure notable differences between subjective and objective network tie measures, and how those differences extend to relations with venture-level outcomes. Drawing upon novel objective measures of network ties derived from analyses of entrepreneurs’ Gmail data, we offer an empirical assessment of subjective social ties relative to objective social ties. In examining how those assessments relate to multiple metrics of venture performance, we look at both subjective and objective measures. We find that objective network measures predict overall subjective (but not objective) venture performance at an average of r = .31 (for network size) and r = .29 (for network engagement). We delve into the implications of our work, and discuss how future research can progress more effectively and efficiently with an eye towards the practical usefulness of our findings for entrepreneurs and entrepreneurship service organizations.

Background Diagnosing cancer at an early stage increases the likelihood of survival, and more advanced cancers are more difficult to treat successfully. Primary care practitioners (PCPs) play a key role in timely diagnosis of cancer. PCPs’ knowledge of their own patient populations and health systems could help improve the planning of more effective approaches to earlier cancer recognition and referral. How PCPs act when faced with patients who may have cancer is likely to depend on how their health systems are organised, and this may be one explanation for the wide variation on cancer survival rates across Europe. Objectives To identify and characterise clusters of countries whose PCPs perceive the same factors as being important in improving the timeliness of cancer diagnosis. Methods A cluster analysis of qualitative data from an online survey was carried out. PCPs answered an open-ended survey question on how the speed of diagnosis of cancer in primary care could be improved. Following coding and thematic analysis, we identified the number of times per country that an item in a theme was mentioned. k -means clustering identified clusters of countries whose PCPs perceived the same themes as most important. Post-hoc testing explored differences between these clusters. Setting Twenty-five primary care centres in 20 European countries. Each centre was asked to recruit at least 50 participants. Participants Primary care practitioners of each country. Results In all, 1,351 PCPs gave free-text answers. We identified eighteen themes organising the content of the responses. Based on the frequency of the themes, k -means clustering identified three groups of countries. There were significant differences between clusters regarding the importance of: access to tests ( p = 0.010); access to specialists ( p = 0.014), screening ( p < 0.001); and finances, quotas & limits ( p < 0.001). Conclusions Our study identified three distinct clusters of European countries within which PCPs had similar views on the factors that would improve the timeliness of cancer diagnosis. Further work is needed to understand what it is about the clusters that have produced these patterns, allowing healthcare systems to share best practice and to reduce disparities.

The impact of COVID-19 on university students is multi-faceted and varies depending on the student profile. A study was conducted at a regional university in the Midwest. A quick-reaction or pulse study was done to assess the immediate effects on students in designated classes at the onset of the pandemic. A follow-up study was completed at the campus level during the subsequent fall semester. Naturally, quality of instruction and adequate technology are key to student success, but a more holistic understanding of students' lives is necessary to properly support them during challenging times. While COVID-19 provided the context for this study, the benefits of the lessons learned can be ongoing.

Background While primary care physicians (PCPs) play a key role in cancer detection, they can find cancer diagnosis challenging, and some patients have considerable delays between presentation and onward referral. Aim To explore European PCPs’ experiences and views on cases where they considered that they had been slow to think of, or act on, a possible cancer diagnosis. Design & setting A multicentre European qualitative study, based on an online survey with open-ended questions, asking PCPs for their narratives about cases when they had missed a diagnosis of cancer. Method Using maximum variation sampling, PCPs in 23 European countries were asked to describe what happened in a case where they were slow to think of a cancer diagnosis, and for their views on why it happened. Thematic analysis was used to analyse the data. Results A total of 158 PCPs completed the questionnaire. The main themes were as follows: patients’ descriptions did not suggest cancer; distracting factors reduced PCPs’ cancer suspicions; patients’ hesitancy delayed the diagnosis; system factors not facilitating timely diagnosis; PCPs felt that they had acted wrongly; and problems with communicating adequately. Conclusion The study identified six overarching themes that need to be addressed. Doing so should reduce morbidity and mortality in the small proportion of patients who have a significant, avoidable delay in their cancer diagnosis. The ‘Swiss cheese’ model of accident causation showed how the themes related to each other.