Clare Sullivan

Medication use in pregnancy is common, but decisions balancing the needs of maternal and fetal health can be complex. Ongoing monitoring of medication use in pregnancy is essential to ensure their continued safe and appropriate use in this population. The aim of this review is to estimate the prevalence of prescribed medication use in pregnancy. This review was carried out in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol was registered in the PROSPERO database (CRD42024533866). PubMed, Medline, Cinahl (EBSCO), APA PsychINFO (EBSCO), Embase (Ovid), Scopus, and Web of Science databases were systematically searched for relevant articles published from January 2010 to May 2025. Inclusion criteria specified that studies provided a value for prescribed medication use in the general population of pregnant women during part or all of the gestational period. Articles were independently dual screened, and relevant data were extracted and validated from included studies. Quality and bias of the studies were assessed using the Joanna Briggs Institute critical appraisal tool for prevalence studies. A narrative synthesis was conducted for all studies. A random-effects meta-analysis with logit transformation was used to pool prevalence estimates (95% confidence interval, CI) where sufficient studies defined medication use in a similar way. Cochran's Q, I², and τ² were used to measure heterogeneity. A total of 13,416 unique articles were identified and screened. Seventy studies were included. The pooled prevalence for prescribed medication alone during pregnancy was 56% (CI 44-67%, p < 0.01, I² = 100%, τ² = 1.30), based on 23 studies and a population of 7.3 million. The pooled prevalence for prescribed medications alone for the first, second, and third trimesters was 31% (CI 22-40%, p < 0.01, I² = 100%, τ² = 0.65) from 14 studies, 30% (CI 21-42%, p < 0.01, I² = 100%, τ² = 0.56) from 9 studies, and 34% (CI 22-49%, p < 0.01, I² = 100%, τ² = 0.77) from 8 studies, respectively. The pooled prevalence for prescribed medications including prescribed vitamins and minerals was 83% (CI 75-89%, p < 0.01, I² = 100%, τ² = 1.66) based on 26 studies and a population of 4.9 million. For this more inclusive group, the pooled prevalence for the first, second, and third trimesters was 52% (CI 44-61%, p < 0.01, I² = 100%, τ² = 0.46) from 14 studies, 56% (CI 42-70%, p < 0.01, I² = 100%, τ² = 0.88), and 59% (CI 42-74%, p < 0.01, I² = 100%, τ² = 1.25) both from 10 studies, respectively. Methods used to estimate prevalence varied greatly owing to differences in the definition of prescribed medications, the measured exposure period, and the pregnancy outcomes included. From this review, it was evident that a large proportion of women use prescribed medications during pregnancy, but estimates vary greatly. A more standardized approach to studying medication use in pregnancy is needed to allow for consistent and standardised estimates that are comparable across populations.

Background: Simulation-based education (SBE) affords learners opportunities to develop communication skills, including those related to pediatrics. Feedback is an integral part of SBE, and while much research into feedback from multiple sources exists, the findings are mixed. The aim of this comparative study was to replicate some of this work in a novel area, pediatric medical education, to better understand how multisource feedback (self, educator, and simulated parent) may inform learning and curriculum design. Methods: During their pediatric rotation, medical students participated in a consultation with a simulated parent, engaged in video-assisted self-reflection, and received feedback from both an educator and the simulated parent through an e-learning platform. The Pediatric Consultation Skills Assessment Tool (PCAT) was used for self-assessment and educator feedback, and the Consultation and Relational Empathy (CARE) measure was used for simulated parent feedback. Results: Our results showed that high-performing students underrated their performance, and low-performing students overrated their performance. Feedback from multiple sources helps to identify both areas of weakness in student performance and areas of weakness in student self-appraisal. Overall, general areas of weakness identified for the learners related to making contingency plans and providing easy-to-understand explanations for simulated parents. Some simulated parent feedback did not align with educator and student ratings, highlighting the value of including the simulated parent perspective. Our findings question whether a third party can reliably judge the simulated parent’s level of understanding. Conclusion: Multisource feedback allows students to develop layered insights into their performance and supports self-appraisal. Aggregating feedback through an e-learning platform allows educators to gain greater insights into the strengths and weakness of students and design a more tailored teaching plan to support student needs.

In simulation-based education (SBE), educators integrate their professional experiences to prepare learners for real world practice and may embed unproductive stereotypical biases. Although learning culture influences educational practices, the interactions between professional culture and SBE remain less clear. This study explores how professional learning culture informs simulation practices in healthcare, law, teacher training and paramedicine. Using constructivist grounded theory, we interviewed 19 educators about their experiences in designing and delivering simulation-based communication training. Data collection and analysis occurred iteratively via constant comparison, memo-writing and reflexive analytical discussions to identify themes and explore their relationships. Varied conceptualizations and enactments of SBE contributed to distinct professional learning cultures. We identified a unique 'simulation culture' in each profession, which reflected a hyper-real representation of professional practice shaped by three interrelated elements: purpose and rationale for SBE, professional values and beliefs, and educational customs and techniques. Dynamic simulation cultures created tensions that may help or hinder learning for later interprofessional practice. The concept of simulation culture enhances our understanding of SBE. Simulation educators must be mindful of their uni-professional learning culture and its impacts. Sharing knowledge about simulation practices across professional boundaries may enhance interprofessional education and learners' professional practice.

Providing feedback is a key aspect of simulated participants' (SPs) educational work. In teaching contexts, the ability to provide feedback to learners is central to their role. Suboptimal feedback practices may deny learners the valuable feedback they need to learn and improve. This scoping review systematically maps the evidence related to SPs' role as educators and identifies how SPs prepare for their role and feedback practices. The authors conducted a scoping review and included a group of international stakeholders with experience and expertise in SP methodology. Five online databases were systematically searched and ERIC, MedEdPortal and MedEdPublish were hand searched to identify relevant studies. Inclusion/exclusion criteria were developed. Data screening and subsequently data charting were performed in pairs. The results of data charting were thematically analysed including categories relating to the Association of SP Educators (ASPE) Standards of Best Practice (SOBP). From 8179 articles identified for the title and abstract screening, 98 studies were included. Studies reported the benefit of SPs' authentic role portrayal and feedback interactions for learners and on the reported learning outcomes. Data was heterogeneous with a notable lack of consistency in the detail regarding the scenario formats for communication skills training interventions, SP characteristics, and approaches to training for feedback and role portrayal. The published literature has considerable heterogeneity in reporting how SPs are prepared for role portrayal and feedback interactions. Additionally, our work has identified gaps in the implementation of the ASPE SOBP, which promotes effective SP-learner feedback interactions. Further research is required to identify effective applications of SP methodology to prepare SPs for their role as educators.

Despite the demonstrated value of simulated participant (SP) feedback, we are only beginning to understand how to optimize SPs’ feedback practices for communication skills and strengthen their role...

Introduction: Simulated patients (SPs) are involved widely in the support of health care education for communication and consultation skills teaching. This study aimed to explore SPs' perspectives of their role and contribution to health professions education. Methods: A qualitative approach was used. Twenty‐two SPs (actor and non‐actor) involved in teaching at the Royal College of Surgeons Ireland (RCSI) participated in one of four focus groups, which were audiorecorded. Two focus groups involved professional actors ( n = 7), and two focus groups involved non‐actor SPs ( n = 15). Transcribed data were analysed using thematic analysis. Results: The first theme ‘Reward of Contribution’ highlights how the SP role is situated in a position of mutual benefit for both SP and student. The second theme ‘Multiple Personas’ demonstrates the complexity of SP role portrayal. The third theme ‘Culture and Communication’ is a new finding and demonstrates the role SPs feel they have in helping to change the culture of health care practice. The fourth theme ‘A touchy subject’ addresses the preferences of SPs concerning involvement in both intimate and nonintimate physical examination. Conclusions: SPs believe they have an important role to play in health care education and they also learn from their involvement. SPs' perspectives need to be considered to ensure they feel supported in their role and that their unique insights remain beneficial for student learning.

Introduction: Driving is a job, a hobby and a form of transport that enables occupation. This research investigated the impact of the inability to drive due to epilepsy on community mobility and occupational participation, and compared both men and women's perceptions of the impact of driving cessation on romantic relationships and family involvement. Method: By means of an internet-based survey, data were collected concerning community mobility, personal impact of driving cessation, previous driving practices, epilepsy and demographics. Statistical analysis was performed on quantitative data and content analysis was used with responses to open questions. The survey received 95 eligible participants. Findings: Participants used public transport more than the general population; however, when unable to drive, being driving by friends or relatives was the main mode of transport. As a result, people experienced restricted access to the community, had to give up activities, had a reduced quality of life and a lowered self-esteem. Significantly more men than women felt that driving cessation had a negative impact on romantic relationships (p = 0.024) yet men and women did not differ significantly in their feelings about the impact of driving cessation on family involvement (p = 0.58). Conclusion: Independent access to the community is often dependent on the ability to drive.