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AnteayerBMJ Open

The adaptive physical activity programme in stroke (TAPAS): protocol for a process evaluation in a sequential multiple assignment randomised trial

Por: Rocliffe · P. · Whiston · A. · O Mahony · A. · OReilly · S. M. · OConnor · M. · Cunningham · N. · Glynn · L. · Walsh · J. C. · Walsh · C. · Hennessy · E. · Murphy · E. · Hunter · A. · Butler · M. · Paul · L. · Fitzsimons · C. F. · Richardson · I. · Bradley · J. G. · Salsberg · J. · Hayes
Introduction

Participation in physical activity (PA) is a cornerstone of the secondary prevention of stroke. Given the heterogeneous nature of stroke, PA interventions that are adaptive to individual performance capability and associated co-morbidity levels are recommended. Mobile health (mHealth) has been identified as a potential approach to supporting PA post-stroke. To this end, we used a Sequential Multiple Assignment Randomised Trial design to develop an adaptive, mHealth intervention to improve PA post-stroke – The Adaptive Physical Activity programme in Stroke (TAPAS) (Clinicaltrials.Gov NCT05606770). As the first trial in stroke recovery literature to use this design, there is an opportunity to conduct a process evaluation for this type of adaptive intervention. The aim of this process evaluation is to examine the implementation process, mechanism of change and contextual influences of TAPAS among ambulatory people with stroke in the community.

Methods and analysis

Guided by the Medical Research Council Framework for process evaluations, qualitative and quantitative methods will be used to examine the (1) implementation process and the content of TAPAS (fidelity adaptation, dose and reach); (2) mechanisms of change (participants’ response to the intervention; mediators; unexpected pathways and consequences) and (3) influence of the context of the intervention. Quantitative data will be presented descriptively, for example, adherence to exercise sessions. Qualitative data will be collected among TAPAS participants and the interventionist using semi-structured one-to-one or focus group interviews. Transcribed interviews will be analysed using reflexive thematic analysis. Key themes and sub-themes will be developed.

Ethics and dissemination

Ethical approval has been granted by the Health Service Executive Mid-Western Ethics Committee (REC Ref: 026/2022) (25/03/2024). The findings will be submitted for publication and presented at relevant national and international academic conferences.

Socioeconomic and demographic predictors of extracurricular achievements among UK medical students (FAST study)

Por: Ferreira · T. · Collins · A. M. · Handscomb · A. · French · B. · Bolton · E. · Fortescue · A. · Plumb · E. · Feng · O. · The FAST Collaborative · Fallows · Valnarov-Boulter · Kuo · Sagdeo · McDermott · Luo · Wong · Fitzsimons-West · Ho · Hemayet · Sreekumar · Burley · Stavrinou · Lew
Objective

To investigate the relationship between demographic characteristics and extracurricular achievements among UK medical students.

Design

National, cross-sectional survey.

Setting

All 44 UK medical schools recognised by the General Medical Council.

Participants

8,395 medical students.

Outcomes

Binary indicators of extracurricular engagement, including PubMed-indexed authorship, academic presentations, quality improvement projects, leadership roles and academic prizes. Logistic regression models were used to explore associations with demographic and extracurricular achievement predictors.

Results

Logistic regression analysis showed that students from private schools (OR 1.35, CI 1.20 to 1.53, p

Conclusions

Significant disparities in extracurricular achievement exist among UK medical students, principally associated with gender, private schooling and familial links to medicine. Apparent ethnic differences were largely attenuated after adjustment for other variables, indicating socioeconomic factors as stronger predictors of engagement. Given the role of these achievements in postgraduate selection, targeted interventions by medical schools and professional bodies to widen access to funding, mentorship and structured guidance for all students, regardless of perceived advantage, may support equitable opportunity without undermining merit-based standards.

Specialty choices among UK medical students: certainty, confidence and key influences--a national survey (FAST Study)

Por: Ferreira · T. · Collins · A. M. · Handscomb · A. · French · B. · Bolton · E. · Fortescue · A. · Plumb · E. · Feng · O. · the FAST Collaborative · Fallows · Valnarov-Boulter · Kuo · Sagdeo · McDermott · Luo · Wong · Fitzsimons-West · Ho · Hemayet · Sreekumar · Burley · Stavrinou · Lew
Objective

To explore factors influencing UK medical students’ specialty choices and examine variations in these influences across demographic groups and stages of training.

Design

National, cross-sectional online survey.

Setting

All 44 UK medical schools recognised by the General Medical Council.

Participants

8,395 medical students.

Primary and secondary outcomes

The primary outcome was the specialty preferences of UK medical students. The secondary outcomes were factors behind these preferences and how these factors vary across demographic groups and different stages of training.

Results

General Practice (15.3%), Paediatrics (10.6%) and Anaesthetics (9.9%) were the most preferred specialties among final-year students. Work-life balance (84.1%), compatibility with family life (78.2%), positive training experiences (85.2%) and future specialty outlook (74.9%) were key factors influencing specialty choice. Only 23.1% of students felt confident about securing a specialty training post, with confidence higher among males (OR 1.36, 95% CI 1.21 to 1.52, p

Conclusions

This study highlights disparities in specialty preferences and influencing factors among UK medical students. A focus on improving career guidance, exposure to various specialties and supporting equitable access to training opportunities is essential for fostering a motivated and sustainable medical workforce.

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