Diabetes Distress: Understanding the Hidden Struggles of Living with Diabetes and Exploring Intervention Strategies

Diabetes Distress is a rational emotional response to the threat of a life-changing illness. Distinct from depression, it is rooted in the demands of diabetes management and is a product of psychological adjustment. Diabetes distress has been found to be significantly associated with HbA1c and self-care, which demonstrates its clinical use in treatment outcomes. Interpersonal factors such as perceived support and protectiveness of partners significantly contribute to elevated distress, suggesting that these are valued areas of focus for interventions. Pioneering large-scale research, DAWN2, gives voices to the families of those with diabetes and reaffirms the need to consider psychosocial factors in routine diabetes care. Structured diabetes education programmes are the most widely used in helping individuals cope with diabetes, but they fail to consider the psychological or interpersonal aspects of diabetes management. Psycho-educational approaches are found to be effective in reducing diabetes distress while also improving HbA1c. Certain limitations in the current literature are discussed, along with future directions. Of utmost importance is the need for health practitioners, irrespective of background, to demonstrate an understanding of diabetes distress and actively engage in discussion with individuals struggling to cope with diabetes; to normalize this and integrate it into routine diabetes practice.

Implications of aligning full registration of doctors with medical school graduation:a qualitative study of stakeholder perspectives

OBJECTIVES: The Shape of Training report recommended that full registration is aligned with medical school graduation. As part of a General Medical Council-funded study about the preparedness for practice of UK medical graduates, we explored UK stakeholders' views about this proposal using qualitative interviews (30 group and 87 individual interviews) and Framework Analysis.

SETTING: Four UK study sites, one in each country.Save

PARTICIPANTS: 185 individuals from eight stakeholder groups: (1) foundation year 1 (F1) doctors (n=34); (2) fully registered trainee doctors (n=33); (3) clinical educators (n=32); (4) undergraduate/postgraduate Deans, and Foundation Programme Directors (n=30); (5) other healthcare professionals (n=13); (6) employers (n=7); (7) policy and government (n=11); (8) patient and public representatives (n=25).

RESULTS: We identified four main themes: (1) The F1 year as a safety net: patients were protected by close trainee supervision and 'sign off' to prevent errors; trainees were provided with a safe environment for learning on the job; (2) Implications for undergraduate medical education: if the proposal was accepted, a 'radical review' of undergraduate curricula would be needed; undergraduate education might need to be longer; (3) Implications for F1 work practice: steps to protect healthcare team integration and ensure that F1 doctors stay within competency limits would be required; (4) Financial, structural and political implications: there would be cost implications for trainees; clarification of responsibilities between undergraduate and postgraduate medical education would be needed. Typically, each theme comprised arguments for and against the proposal.

CONCLUSIONS: A policy change to align the timing of full registration with graduation would require considerable planning and preliminary work. These findings will inform policymakers' decision-making. Regardless of the decision, medical students should take on greater responsibility for patient care as undergraduates, assessment methods in clinical practice and professionalism domains need development, and good practice in postgraduate supervision and support must be shared.

Current status of Gerodontology teaching in Europe: preliminary findings

Aim(s): The aim of this study was to explore the findings of a survey on the prevalence, contents and status of Gerodontology teaching amongst the European Dental Schools.
Materials and Methods: A first wave of emails, including an electronic questionnaire in English, and two weeks later a first reminder, were sent to the Deans or other contact persons in 185 dental schools in 40 European countries. The electronic questionnaire recorded the prevalence, contents and status of Gerodontology education at the undergraduate, postgraduate and continuing education levels.
Results: The first wave of responses included 70 dental schools from 28 countries. Gerodontology was included in the undergraduate curricula of 77% of the respondents and was compulsory in 61% of them. It was taught as an independent course in 39% of the respondents. When embedded in other courses, these were mainly the Prosthodontics lectures. Clinical training in Gerodontology was on the curriculum of 56% of the respondents. Sixteen percent of the schools had a Gerodontology Division, and 43% an assigned Programme Director. Gerodontology was taught in the postgraduate programmes of 33% of the schools, again mostly embedded in Prosthodontic programmes. Continuing education courses in Gerodontology were offered by 34% of the responding schools.
Discussion and Conclusions: When interpreting the results of this still ongoing study, a "worst case scenario" has to be born in mind, where dental schools, who failed to participate in the survey, may not be teaching in Gerodontology. Under this perspective, a moderate prevalence of Gerodontology is recorded in the undergraduate curricula of European dental schools. At a postgraduate level, it is less frequently offered, and mainly embedded in the Prosthodontic programmes. European guidelines on the dental curriculum might help to increase awareness and introduce Gerodontology to undergraduate, postgraduate and continuing education.