Medical Student Perceptions of Psychological Safety in the Clinical Learning Environment

The Clinical Teacher · 2026-01-29 · 3 citations

INTRODUCTION: Psychological safety in the learning environment allows students to take risks without fear of humiliation or negative consequences. The psychological safety of healthcare teams has been studied at three levels: organizational, team and individual. Prior work has shown how leadership behaviours contribute to student perceptions of psychological safety in the clinical learning environment, but less is known about the impact of organizational and individual factors. The present study explored student perceptions of facilitators and barriers of psychological safety in the clinical learning environment. METHODS: We conducted a qualitative case study in Academic Year 2022-2023. We held four focus groups with 23 third- and fourth-year medical students at Spencer Fox Eccles School of Medicine. Focus groups were recorded and transcribed verbatim; transcripts were analysed using thematic analysis. RESULTS: Thematic analysis revealed that there were organizational supports and barriers, inclusive and exclusive leadership behaviours and individual student characteristics that affected psychological safety in the learning environment. Psychological safety exists when high levels of organizational support and inclusive behaviour are present. However, it is also possible for an organizational support or an inclusive leader behaviour to overcome an exclusive leader behaviour or an organizational barrier, respectively. CONCLUSIONS: Organizational support and inclusive leadership behaviours foster psychological safety. Furthermore, it appears that psychological safety factors do not exist in isolation, but rather in tandem with one another. This makes it possible for an individual medical educator or organizational support to foster psychological safety even when organizational barriers or exclusionary behaviours from other supervisors exist.

The association of an exercise and rehabilitation clinical workflow algorithm on sedentary behavior and performance status from time of breast cancer diagnosis and throughout care

Breast Cancer Research and Treatment · 2026-04-17

Abstract PS3-03-08: Initial results from RECAST DCIS: Multicenter platform trial testing active surveillance and novel endocrine therapy agents for DCIS management

Clinical Cancer Research · 2026-02-17

Abstract Ductal carcinoma in situ (DCIS) of the breast is a heterogeneous, non-invasive condition characterized by the proliferation of malignant epithelial cells within the duct, with variable risk of progression to invasive disease. Current standard treatment involves surgical resection followed by possible adjuvant endocrine therapy and/or adjuvant radiation. However, a substantial proportion of DCIS may never progress to invasive disease and thus may be overtreated with the current standard of care. Consequently, active surveillance (AS) is emerging as a treatment option for patients with DCIS. DCIS is definitely a risk factor for breast cancer, and should be reframed as an opportunity for preventive intervention. RECAST (Re-evaluating Conditions for Active Surveillance Suitability as Treatment) is a Phase II adaptive platform trial studying the efficacy of up front endocrine therapy to identify appropriate candidates for long-term active surveillance versus those who would benefit from standard surgical treatment. Patients with hormone receptor positive DCIS of any grade undergo baseline breast MRI and are randomized to one of four hormonal therapy regimens, including standard endocrine therapy, z-endoxifen, elacestrant or HAV-008 with the potential to offer equivalent or improved benefit with less adverse effects. Serial MRI at 3 and 6 months is then used to evaluate change in background parenchymal enhancement (BPE) and DCIS lesion. Patients deemed low risk based on imaging response have the option to continue AS and avoid surgery and radiation and continue their endocrine therapy for 3 years. The primary endpoint of the trial is to determine whether novel endocrine therapy increases the fraction of patients who will be suitable for long-term AS as measured by the fraction of patients who remain on active surveillance at 7 months compared to control. To date, over 50 patients are enrolled in the trial. Our target accrual of 400 patients. A total of 17 (34%) patients have reported an AE, all grade 1 or 2, with no serious adverse events reported and no safety signals identified. Of the 50 patients currently on treatment, 25 have reached or gone beyond the 6-month mark and 22 (88%) of those patients remain on active surveillance with a median follow up of 351 days. At the 3 month point, one patient progressed on imaging and two chose to come off surveillance due to other reasons. At 6 months, 8% (2/25) progressed on imaging and one additional patient has proceeded to surgery at the 1 year point. One patient who went on to have surgery was found to have invasive disease (pT1bN0). Robust accrual continues at sixteen currently active sites with five more sites anticipated to open in the next few months. The shift to using hormonal therapy in the neoadjuvant setting allows investigators to assess response to endocrine therapy, characterize risk of progression to invasive cancer and helps to better inform treatment-making decisions before continuing AS or proceeding with surgery, and appropriately assesses the value of endocrine risk reduction prior to surgery to avoid it. The trial uses a patient-centered approach and gives all patients a window of opportunity to assess their response as well as medication tolerability to make an informed decision about treatment approach. Citation Format: K. C. Hewitt, C. Yau, R. Mukhtar, C. Thompson, J. Hui, K. Westbrook, J. Jackson, C. Carruthers, C. Farley, S. Bommakanti, K. Brownson, B. Fan, I. Meszoely, T. Balija, M. H. Mcnatt, P. Gilman, J. Marti, T. Li, S. Horton, A. Borowsky, J. Rosenbluth, L. Esserman. Initial results from RECAST DCIS: Multicenter platform trial testing active surveillance and novel endocrine therapy agents for DCIS management [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-03-08.

NOVEMBER, A Phase 2 Trial of a 9-Day Course of Whole Breast Radiation Therapy With a Simultaneous Lumpectomy Boost for Early-Stage Breast Cancer

International Journal of Radiation Oncology*Biology*Physics · 2025-05-02

Feasibility and acceptability of the Comprehensive Oncology Rehabilitation and Exercise (CORE) clinical workflow algorithm in patients with newly diagnosed stage I–III breast cancer who undergo surgery as first‐line treatment

Cancer · 2025-04-28 · 2 citations

BACKGROUND: This pilot, mixed-methods, randomized controlled trial determined the feasibility and acceptability of the Comprehensive Oncology Rehabilitation and Exercise (CORE) clinical workflow algorithm. CORE was designed to connect patients with newly diagnosed breast cancer to exercise and rehabilitation services from the time of diagnosis throughout cancer care. METHODS: In total, 72 patients with newly diagnosed, stage I-III breast cancer who required surgery as first-line treatment were randomized 2:1 to CORE or standard of care. CORE included a triaging tool of two questionnaires regarding self-reported exercise (the Godin Leisure Time physical activity questionnaire) and functional status (the Patient-Reported Outcomes Measurement Information System physical function questionnaire), which were administered at the check-in desk for routine breast surgical oncology clinic visits at the initial surgical consultation, postoperatively, and 24 weeks after surgery. Responses to questionnaires in the triaging tool triaged participants to one of three pathways within the algorithm: exercise service, rehabilitation service, or exercise self-management (not a service). Service pathways required referral by clinic staff. Feasibility was determined based on completing the triaging tool (≥66%) and referral completion (≥50%) at the initial surgical consultation visit. Acceptability was determined by four study participant focus groups and one clinic team focus group (≥50% positive response). RESULTS: Ninety-three percent of participants in CORE (n = 40) completed the triaging tool. Among those triaged to a service pathway (n = 29), 62% completed their referral. Focus group feedback was primarily positive. CONCLUSIONS: The CORE clinical workflow algorithm is feasible and acceptable among women who have newly diagnosed stage I-III breast cancer with plans for surgery as first-line treatment. CORE was also acceptable among clinic staff. CLINICAL TRIALS REGISTRATION: NCT04594473.

Awareness of Breast Cancer Among Male and Female High School Students in Southern Ghana

International Journal of Breast Cancer · 2025-01-01

Background: In Ghana, the incidence of breast cancer is increasing with disproportionately high mortality rates. Awareness about the disease process is critical for achieving early diagnosis of breast cancer in countries without a national screening program. Targeting adolescents in school will help to inculcate good health seeking behaviors with widespread reach. This study assessed the baseline knowledge in high school males and females as an important first step to inform the development of appropriate educational interventions to address identified gaps in student knowledge about breast cancer. Methodology: A multisite cross‐sectional study was carried out in 14 high schools in two regions in southern Ghana to assess the baseline student knowledge of breast cancer. Self‐administered questionnaires were used covering the following four domains: (1) general breast cancer knowledge, (2) breast cancer symptoms, (3) risk factors for breast cancer, and (4) breast self‐examination/screening for breast cancer. For each domain of knowledge tested, the total score was categorized as adequate knowledge (≥ 50% of questions answered correctly) or inadequate knowledge (< 50% of questions answered correctly). Logistic regression was used to determine factors associated with each of the knowledge domains. Stata 14.0 was used for the statistical analysis, and a p < 0.05 was considered statistically significant. Results: Nine thousand seven hundred sixty‐seven students from 10 coeducational and 4 girls‐only schools participated with 68% of respondents being female. The mean student age was 16.9 ± 1.2 years. Eighty‐four percent of the students demonstrated adequate general knowledge on breast cancer and 54% demonstrated adequate knowledge of breast cancer symptoms. However, only 34% and 21%, respectively, received a score of adequate knowledge in regard to breast cancer risk factors and BSE/breast cancer screening. After combining all domain scores to evaluate overall breast cancer knowledge, less than half (47%) of the students received an adequate breast cancer knowledge score. Females and the girls‐only schools had statistically significant adequate levels of knowledge of breast cancer. Conclusion: The overall knowledge of breast cancer among senior high school students in southern Ghana is inadequate especially on knowledge of breast cancer risk factors, breast self‐examination, and breast cancer screening. Breast cancer educational activities should be incorporated into the national school health curriculum in senior high schools across the country to ameliorate this knowledge gap, with special emphasis on risk factors and breast self‐examination. Adolescent males should be included in breast cancer education.

Exploring Knowledge, Beliefs, And Misconceptions on Breast Cancer in an Urban Fishing Community in Ghana - A Qualitative Study

Postgraduate Medical Journal of Ghana · 2025-03-28

Objective: This study set out to understand the beliefs of an indigenous population and explore the reasons behind this delayed presentation. Methodology: This qualitative study adopted a cross-sectional design and was carried out in Jamestown, Ghana. The participants included opinion leaders and ordinary community members. Four focused group discussions (FGDs) and six key-informant interviews (KIIs) were conducted. A general inductive approach was used to analyze the data. Transcripts of interviews were coded in line with the developed codebook. Results: A total of 46 participants aged 18-70 years were enrolled in this study comprising six key informants and 40 FGD participants. The median age of the key informants was 47.4 years and that of the FGD participants was 39.1 years. Females constituted 45.7% of all participants. The main themes that emerged for causes of breast cancer were; sexual fore play, exposures (risky practices), infections and “at risk groups”. “Breast changes” was the main theme for presentation of breast cancer while stigma, fear, support systems, religion and attitude of healthcare workers were the dominant themes that influenced care seeking behaviour of participants. Conclusion: The people of Jamestown had some misconceptions regarding the causes of breast cancer. They also had some knowledge about the signs and symptoms of breast cancer. They believed that early diagnosis and prompt treatment could improve the outcome of breast cancer but fear and stigma associated with the condition prevented affected individuals from seeking care early.

Cervical cancer knowledge among high school students in Southern Ghana

BMC Women s Health · 2025-12-10

BACKGROUND: Cervical cancer (CC) causes significant morbidity and mortality in low-and middle-income settings, ranking second commonest female cancer in Ghana, affecting 26.4/100,000 with mortality rate 22.9/100,000 women. Previous studies focused on adults, females and involved smaller sample sizes. This study assessed CC knowledge among secondary school students in Ghana to generate evidence for implementing school-based educational interventions. METHODS: It was a multi-site, cross-sectional study across 14 secondary schools in Greater Accra (GAR) and Central regions(C/R) of Ghana. Self-administered pre-tested questionnaires focused on students' knowledge on causes, risk factors, symptoms, and prevention of CC. Four main domains were covered: general knowledge; cervical cancer features; risk factors; and screening and prevention. Domain scores were categorised into adequate knowledge (>50%) and inadequate knowledge (< 50%). Chi-square was used to test association between knowledge in various domains with participants' gender, school type, and region. P-value below 0.05 was considered statistically significant. RESULTS: A total of 9,767 students from 14 schools, 25.6% (n=2,280) males and 74.4% (n=6,630) females with mean age 16.9+1.2years participated. Overall, 58.4% of students had adequate general knowledge about CC; 61.1% demonstrated adequate knowledge of risk factors; 21.5% adequate knowledge of features, and 51.8% also had adequate knowledge of screening and prevention. Across all domains tested, 60.6%% of students had inadequate knowledge. More female students(60.9%) had adequate general knowledge than males(50.1%) (p< 0.001). CONCLUSION: Significant knowledge gaps exist on risk factors, features, screening and prevention of cervical cancer among senior high school students in Ghana, necessitating targeted educational interventions based on identified gaps.

Cervical Cancer Knowledge among High School Students in Southern Ghana

Research Square · 2025-10-15

Staging Invasive Lobular Carcinoma: A Prospective Study on the Efficacy of 18F-Fluoroestradiol (FES)-PET/CT

Clinical Breast Cancer · 2025-11-08 · 1 citations