Call for e-Editor Intern applications

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Interested in learning the ‘behind-the-scenes’ of the journals Medical Education and The Clinical Teacher?

Interested in building experience in online engagement and publishing through interaction with Editors-in-Chief, the e-Council and the Editorial Office?

Consider applying for the e-Editor Intern position!

Information can be found here.

If you can’t click the embedded hyperlink for some reason, you can copy and paste this into your browser: http://onlinelibrary.wiley.com/store/10.1111/(ISSN)1743-498X/asset/homepages/e-Internship_2015.pdf?v=1&s=b77fabce661b7b7d8831b18b36b2ae11758a6e0e

Conversation Kickstarter for The Clinical Teacher (#ClinTeachJ): Bullying

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In the April issue of The Clinical Teacher (#ClinTeachJ, linked here), Katie Cresswell and colleagues tackle an important topic; bullying in graduate medical education. Their article, entitled Bullying workshops for obstetric trainees: a way forward, describes important work done in the National Health Service within the United Kingdom in Obstetrics & Gynecology training.

Bullying as part of education or of training is certainly not unique to Obstetrics & Gynecology in the UK system, nor even to medicine. Its ill effects have been well documented (including excellent references in the Cresswell article), and yet it is still pervasive.

Questions to consider:

  • Do you have alternative views of the role of bullying in education and training?
  • What are some examples you can think of from your own context?
  • Is this systemic, or the result of a ‘few bad actors’?
  • Would implementing a workshop such as that described in the article be feasible in your situation?

Reference: Cresswell, K., Sivashanmugarajan, V., Lodhi, W. and Yoong, W. (2015), Bullying workshops for obstetric trainees: a way forward. Clin Teach, 12: 83–87. doi:10.1111/tct.12261

Conversation Kickstarter | Feedback and the learner

Featured

by Teresa Chan, MD, FRCPC
e-Editor intern, Assistant Professor, McMaster University

In this month’s upcoming issue of The Clinical Teacher, David Boud writes a commissioned paper that provides us with helpful tips and hints regarding feedback.  This article is most definitely a ‘go to’ resource for any health professional who teaches in the clinical setting.

As he highlights in the article,”… [f]eedback in clinical settings, must be characterised
not solely in terms of inputs, but also by the effects that result.”  Particularly, this concept hit home for me.  You see, for the past few years I’ve been hard at work at my institution working with our residency education program to redesign workplace based assessment to emphasize feedback.  This has resulted in the McMaster Modular Assessment Program, and I must say, even after all of the literature I’ve read, Dr. Boud’s paper really synthesized and summarized some really pragmatic tips that I will be taking to the bedside.

As a learner, I was always the pesky learner that asked for feedback… and I recall being quite aggressive in asking for specific ways to improve my burgeoning practice.  Now, as a junior clinician educator that is interested in assessment and feedback, I have lived my life with trying to figure out how to best design a system that creates the opportunities for residents to do the same.

At times, I worry that by being too much of an educational designer, I am removing the agency from the learner, and decreasing the impetus for them to self-direct this feedback. Recently, I have read the book by Stone & Heen which emphasizes the key skill of receiving feedback well (Thanks for the Feedback: The Science and Art of Receiving Feedback Well).

And so, I am wondering if I might engage The Clinical Teacher audience in a discussion around the idea of feedback using these three questions:

  • Q1: Are we ‘babying’ learners these days too much by creating systems that encourage feedback?
  • Q2: Or does the system need to be there to provide a scaffold for learners so that they might one day more fully participate in the feedback experience?
  • Q3: Ultimately, what is the role of the adult health professions learner in the feedback process?

Please drop a line below to reply to these questions (and be sure to mark which question you’re answering using Q1/Q2/Q3).  Feel free to tweet around this using the hashtag #ClinTeach.

Featured Article | Portrait of a Rural Health Graduate; exploring alternate health spaces.

Summary by Susan Law
This paper describes some of the barriers, challenges and support that a student in South Africa experienced on his journey to become a Health Professional. His journey was more challenging than many but South Africa is not alone in having barriers to professional education for those from non-traditional backgrounds or from rural/remote areas. Some of the issues described – schools that don’t offer the relevant courses; teachers who don’t consider career options and low parental income were mentioned to me recently by a Dundee student from a rural area.
  • we know that recruiting from rural backgrounds is more likely to produce practitioners who return to rural areas  (Curran & Rourke (2004)
  • we believe that patients need health professionals from a wide range of backgrounds and that we need to encourage widening participation and the recruitment of students from non-traditional backgrounds.
Where to next?
  • new models of learning
    • longitudinal clerkships have been tried in the USA, Australia and Canada (Biden and Wilson (2012), Norris et al (2009))
      • they produce students of the same standard as traditional curricula
      • the students seem to be more patient centred
      • they offer supportive one on one tutor/student relationships
At a recent meeting with medical students we discussed some of the issues they perceive to be relevant in developing a longitudinal clerkship and some of the suggested solutions they offered to the recruitment crisis, what do you think?
  •      political interventions
    • good rural infrastructure (Internet access)
    • jobs for partners
    • schools for children
    • housing
    • fee waivers
    • reward higher education facilities that promote widening participation in health professional education
  • university/college issues
    • investment in student support
    • investment in widening participation
    • willingness to explore new options
    • new models of learning
References:
Biden H & Wilson I (2012) Rural placements are effective for teaching medicine in Australia: Evaluation of a cohort of students studying in rural placements Rural and Remote Health (accessed http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=2167)
Curran V, Rourke J. (2004)The role of medical education in the recruitment and retention of rural physicians. Med Teach 26: 265-72 (PDF accessible on line)
Norris T el al (2009) Longitudinal Integrated Clerkships for Medical Students: An innovation adopted by Medical Schools in Australia, Canada, South Africa and the United States Academic Medicine 84: 7: 902-907

Excellent Medical Education Programme winners announced

The Association for the Study of Medical Education (ASME) and the General Medical Council of the United Kingdom have selected three winners for their Excellent Medical Education Programme. ASME is based in the UK and along with the publisher John Wiley & Sons Ltd. produce the two journals, Medical Education and The Clinical Teacher. For more information about the Excellent Medical Education Programme and other awards available through ASME, visit the ASME site at www.asme.org.uk or click here. The press release follows.

 

Excellent Medical Education Programme winners announced

The three winners of the joint Association for the Study of Medical Education and General Medical Council Excellent Medical Education Programme have been announced, with each receiving £5,000 in funding.

The Excellent Medical Education Programme is a set of national awards established by ASME and the GMC in order to fund high quality medical education research, development and innovation. This was in response to recognition of the need for further research-based evidence related to medical education and training.

Applications were invited relating to the topics Innovation in Education, Sustaining Excellent Education and Developing and Supporting Educators.

  • Continuing Professional Development Winner

Mandy Moffat, University of Aberdeen     

Submission title – Educational Development in Context: Developing a Regional Community of Practice (CoP) in Psychiatry

Mandy says: “Together with my colleagues, Dr Isobel Cameron and Dr Daniel Bennett, we are delighted to have been successful in winning the ASME and GMC Excellent Medical Education Programme funding bid. We plan to explore and analyse how our activities around a summer educational CPD event influence the wider community of medical teachers across a large geographical area (Aberdeen, Elgin and Inverness). With the funding, we can arrange more planning meetings with our colleagues in Elgin and Inverness, provide a summer studentship to one of our MBChB students to carry out key data collection and initial analysis, and explore and examine our approaches to educational CPD in much more detail, going beyond simple evaluation.”

  • Postgraduate Winner

Jeremy Brown, Edge Hill University              

Submission title – An investigation into Specialty Trainee Engagement with E-learning in Health Education North West

Jeremy says: “Our Postgraduate project, to be delivered in the next 12 months, will provide an assessment of the e-learning resources that are being utilised and valued by specialist trainee doctors in Health Education North West. It is important that those managing doctors on Specialist Training Programmes are provided with guidance on e-learning packages and whether they are likely to be beneficial for them. There is a massive increase in technology enhanced learning and it can be argued that research is not keeping up with the pace needed to provide the necessary evidence on its impact on medical education practice.”

Jeremy will be working on the project with Prof Nigel J Shaw, Evidence-based Practice Research Centre, Edge Hill University; Dr Stevie Agius, Health Education North West, and

Prof Jacky Hayden, Dean of Postgraduate Medical Studies, Health Education North West.

  • Undergraduate Winner

Dr Janet Lefroy, Keele University School of Medicine                  

Submission title – Authentic Undergraduate Placements in GP: A Recruiting Force for Generalists?

Dr Lefroy says: “We will be extending an existing study of the transition from student to doctor to explore a) what underpins the choice of speciality for training of Foundation2 doctors from Keele and other medical schools, and b) the influence of undergraduate curricula, in particular exposure to specialities, including general practice, on the doctor’s thinking about career options. The Medical Education Research Group at Keele is grateful to ASME and GMC for funding the award and we are excited to be embarking on this study in autumn 2015.”

Dr Lefroy will be working on the study with Bob McKinley, Ruth Kinston, Simon Gay, Stu McBain and Sarah Yardley.

Nicky Pender, ASME chief executive, says: “We have been impressed with the standard of submissions for the awards and wish all three winners luck with their projects. We very much look forward to seeing the results.”

Dr Vicky Osgood, Director of Education and Standards at the GMC, said: “We value the Excellent Medical Education Programme and support all manner of research, development and innovation in this field. It was pleasing to see so many entries for the programme and the winners are fully deserving of their prizes. This programme will help to continue to improve medical education and training through innovative research projects. We hope this will inspire others in future to take part in such a valuable initiative.”

May 2015 Really Good Stuff | A Journal Club Review – Tips for promoting professional identity development

e-Editor Intern’s note:  The following is a scholarly review of several articles found in our Really Good Stuff section of this month’s edition.  We thank Carey & Megan for their thoughtful review. – TC

By Carey Mather & Megan Quentin-Baxter

Four short papers appearing in the May issue of Medical Education focus on a constructivist learning approach and personal accountability to develop appropriate professional behaviours and identity. The first three are relatively low cost interventions using existing tools or infrastructure in new, authentic ways, minimising the impact on staff, and explicitly recognising the challenges of an overcrowded curricula. The fourth builds on establishing a safe environment for ‘raising concerns’. The tools provide students with mechanisms for bridging between theory and experiential learning environments, and promoting the development of ‘agency’.(1)

‘Off to a good start’(2) describes medical student orientation to “highlight the central role of physician-patient relationship on the first morning of the first day” and teasing out the reasons why students chose this profession. This sharing forms a platform for an on-going relationship with the programme educators and peers and promotes “facilitating transition into the medical profession”. The researchers claimed that the “profoundly moving stories that emerge not only help each student calibrate their individual moral compass … also serve as an important team building experience”. One student said that it “set an inspirational tone” and the researchers found “professional identity that embraces inquisitive and altruistic professional behaviour” consistent with theories elsewhere.(3)

‘Using Twitter to teach problem based learning’(4) harnessed an emerging social media technology as a useful adjunct for a crowded curricula to “use an innovative approach to optimise the method in which we delivered PBL tutorials.” This innovation minimised impact on student and staff time because participants could post or review the microblogs asynchronously outside scheduled tutorials. It enabled connectivity within the group even though they only met intermittently.(5) Identifying the learning objectives and answering simple questions as they arose enabled more complex interactions during tutorials. Despite staff using the same ‘tutor’ account students indicated they developed rapport with staff members. This strategy also promoted a learner-centred approach that is reshaping pedagogy.(6)

The ‘Professional competencies toolkit: Teaching reflection with flash cards’(7) project sent students into clinical experience every two weeks with at least one of 28 flash cards defining a topic (such as ‘the invisible patient’) and tasks and tips for dealing with it to promote concepts that define habitual professionalism. The flash card/aide memoire provided a specific hook to remind students to collect evidence to facilitate subsequent reflection. This process encouraged to students to bring “their story back to the group” for further discussion in small group settings. The authors claim that encouraging students to focus on “manageable learning “bites” or ”one or two basic elements” promoted a level of reflection leading to “deep understanding of the importance and complexity of the broader issue.” reflecting the early stages of theoretical concepts of Fink’s ‘significant learning’.(8)

Concerns about raising concerns’(9) described an environment based on (10) responding to the UK’s Francis Report (11) where dental students were encouraged to “explore their understanding and beliefs regarding professional behaviours” in workshops, annual learning agreements, lectures and final year seminars. New policies and practices (many escalating externally to the school) were put in place to ensure “visibly fair and effective” actions arising from student’s views. The authors observed that students raised “significantly” far more concerns about “themselves, colleagues and staff” than were expected.

In all the use of narrative and communication inform professional identity and promote rapport development with teachers, students or patients. Collaborative, interactive team-building strategies were used to model and explore the central themes, with a common outcome of increased collaboration or connectivity between students, staff or patients. Communication processes were orientated towards relationship-building and increase of rapport to support patient-centred care and habituate professional behaviours.

These approaches give students an opportunity to contribute through articulation of self and their experiences. The student role is elevated to co-creator of knowledge, co-owner of responsibility, and students provided with real opportunities to contribute to patient safety and care.

Collectively these novel approaches could be tailored to other healthcare programmes to foster professional behaviours and student accountability. It would be interesting to hear from institutions using similar or a mixture of methods to promote professional identity development of students.

References

  1. Billett S. Relational interdependence between social and individual agency in work and working life. Mind, Culture, and Activity 2006;13(1):53-69.
  2. Danoff A, Garabedian M, Harnik V, Rosenthal M. Off to a good start. Medical Education 2015;49(5):514.
  3. Stern DT. Measuring Medical Professionalism. New York: Oxford University Press 2006.
  4. Lasker R, Vicneswararajah N.. Using Twitter to teach problem-based learning. Medical Education 2015;49(5):531.
  5. Kamel Boulos MN, Wheeler S. The emerging Web 2.0 social software: an enabling suite of sociable technologies in health and healthcare education. Health Information and Libraries Journal 2007;24(1):2-23.
  6. Caplan W, Myrick F, Smitten J, Kelly W. What a tangled web we weave: How technology is reshaping pedagogy. Nurse Education Today 2014;34(8):1172-4.
  7. Seymour P, Watt M. The professional competencies toolkit: teaching reflection with flash cards. Medical Education 2015;49(5):518.
  8. Fink LD. Creating Significant Learning Experiences: An Integrated Approach to Designing College Courses. Jossey-Bass 2003.
  9. Ellis JS, Bateman H, Thomason JM, Whitworth J. Concerns about raising concerns. Medical Education 2015;49(5):514-5.
  10. Kelly M, O’Flynn S, McLachlan JC, Sawdon MA. The clinical conscientiousness index: a valid tool for exploring professionalism in the clinical undergraduate setting. Academic Medicine 2012;87(9):1218-24.
  11. The Mid Staffordshire NHS Foundation Trust. Public Inquiry Chaired by Robert Francis QC. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. 3 vols. London: Stationery Office 2013.

Portrait of a rural health graduate: exploring alternative learning spaces

By Andrew Ross and Daisy Pillay

Link to article here.

Context

Given that the staffing of rural facilities represents an international challenge, the support, training and development of students of rural origin at institutions of higher learning (IHLs) should be an integral dimension of health care provisioning. International studies have shown these students to be more likely than students of urban origin to return to work in rural areas. However, the crisis in formal school education in some countries, such as South Africa, means that rural students with the capacity to pursue careers in health care are least likely to access the necessary training at an IHL. In addition to challenges of access, throughput is relatively low at IHLs and is determined by a range of learning experiences. Insight into the storied educational experiences of health care professionals (HCPs) of rural origin has the potential to inform the training and development of rural-origin students.

Methods

Six HCPs of rural origin were purposively selected. Using a narrative inquiry approach, data were generated from long interviews and a range of arts-based methods to create and reconstruct the storied narratives of the six participants. Codes, categories and themes were developed from the reconstructed stories. Reid’s four-quadrant model of learning theory was used to focus on the learning experiences of one participant.

Results

Alternative learning spaces were identified, which were made available through particular social spaces outwith formal lecture rooms. These offered opportunities for collaboration and for the reconfiguring of the participants’ agency to be, think and act differently. Through the practices enacted in particular learning spaces, relationships of caring, sharing, motivating and mentoring were formed, which contributed to personal, social, academic and professional development and success.

Conclusions

Learning spaces outwith the formal lecture theatre are critical to the acquisition of good clinical skills and knowledge in the development of socially accountable HCPs of rural origin.

Article first published online: 28 APR 2015 | DOI: 10.1111/medu.12676

The impact of programmatic assessment on student learning: theory versus practice

By Sylvia Heeneman, Andrea Oudkerk Pool, Lambert W T Schuwirth, Cees P M van der Vleuten and Erik W Driessen

Link to article here.

Context

It is widely acknowledged that assessment can affect student learning. In recent years, attention has been called to ‘programmatic assessment’, which is intended to optimise both learning functions and decision functions at the programme level of assessment, rather than according to individual methods of assessment. Although the concept is attractive, little research into its intended effects on students and their learning has been conducted.

Objectives

This study investigated the elements of programmatic assessment that students perceived as supporting or inhibiting learning, and the factors that influenced the active construction of their learning.

Methods

The study was conducted in a graduate-entry medical school that implemented programmatic assessment. Thus, all assessment information, feedback and reflective activities were combined into a comprehensive, holistic programme of assessment. We used a qualitative approach and interviewed students (n = 17) in the pre-clinical phase of the programme about their perceptions of programmatic assessment and learning approaches. Data were scrutinised using theory-based thematic analysis.

Results

Elements from the comprehensive programme of assessment, such as feedback, portfolios, assessments and assignments, were found to have both supporting and inhibiting effects on learning. These supporting and inhibiting elements influenced students’ construction of learning. Findings showed that: (i) students perceived formative assessment as summative; (ii) programmatic assessment was an important trigger for learning, and (iii) the portfolio’s reflective activities were appreciated for their generation of knowledge, the lessons drawn from feedback, and the opportunities for follow-up. Some students, however, were less appreciative of reflective activities. For these students, the elements perceived as inhibiting seemed to dominate the learning response.

Conclusions

The active participation of learners in their own learning is possible when learning is supported by programmatic assessment. Certain features of the comprehensive programme of assessment were found to influence student learning, and this influence can either support or inhibit students’ learning responses.

Article first published online: 28 APR 2015 | DOI: 10.1111/medu.12645

The impact of adopting EHRs: how losing connectivity affects clinical reasoning

By Lara Varpio, Kathy Day, Pat Elliot-Miller, James W King, Craig Kuziemsky, Avi Parush, Tyson Roffey and Judy Rashotte

Link to article here.

Context

As electronic health records (EHRs) are adopted by teaching hospitals, educators must examine how this change impacts trainee development.

Objectives

We investigate this influence by studying clinician experiences of a hospital’s move from paper charts to an EHR. We ask: how does each chart modality present conceptions of time and data interconnections? How do these conceptions affect clinical reasoning?

Methods

This two-phase, longitudinal study employed constructivist grounded theory. Data were collected at a paediatric teaching hospital before (Phase 1), during and after (Phase 2) the transition from a paper chart to an EHR system. Data collection consisted of field observations (146 hours involving 300 health care providers, 22 patients and 32 patient family members), think-aloud (n = 13) and think-after (n = 11) sessions, interviews (n = 39) and document retrieval (n = 392). Theories of rhetorical genre studies and visual rhetoric informed analysis.

Results

In the paper flowsheet, clinicians recorded and viewed patient data in chronologically organised displays that emphasised data interconnections. In the EHR flowsheet, clinicians viewed and recorded individual data points that were largely chronologically and contextually isolated. Clinicians reported that this change resulted in: (i) not knowing the patient’s evolving status; (ii) increased cognitive workload, and (iii) loss of clinical reasoning support mechanisms.

Conclusions

Understanding how patient data are interconnected is essential to clinical reasoning. The use of EHRs supports this goal because the EHR is a tool for collecting dispersed data; however, these collections often deconstruct data interconnections. Where the paper flowsheet emphasises chronology and interconnectedness, the EHR flowsheet emphasises individual data values that are largely independent of time and other patient data. To prepare trainees to work with EHRs, the ways of thinking and acting that were implicitly learned through the use of paper charts must be made explicit. To support clinical reasoning, medical educators should provide lessons in connectivity – the chronologically framed data interconnections upon which clinicians rely to provide patient care.

Article first published online: 28 APR 2015 | DOI: 10.1111/medu.12665

Reclaiming a theoretical orientation to reflection in medical education research: a critical narrative review

By Stella L Ng, Elizabeth A Kinsella, Farah Friesen and Brian Hodges

Link to article here.

Context

Reflection and reflective practice have become popular topics of scholarly dialogue in medical education. This popularity has given rise to checklists, portfolios and other tools to inspire and document reflection. We argue that some of the common ways in which reflection has been applied are influenced by broader discourses of assessment and evidence, and divorced from original theories of reflection and reflective practice.

Methods

This paper was developed using a critical narrative approach. First we present two theoretical lenses provided by theories of reflection. Next we present a summary of relevant literature, indexed in PubMed from 2004 to 2014, relating to the application of reflection or reflective practice to undergraduate and postgraduate medical education. We categorise these articles broadly by trends and problematise the trends relative to the two theoretical lenses of reflection.

Results

Two relevant theoretical orientations of reflection for medical education are: (i) reflection as epistemology of practice, and (ii) reflection as critical social inquiry. Three prevalent trends in the application of reflection to medical education are: (i) utilitarian applications of reflection; (ii) a focus on the self as the object of reflection, and (iii) reflection and assessment. These trends align with dominant epistemological positions in medicine, but not with those that underpin reflection.

Conclusions

We argue for continued theorising of and theoretically informed applications of reflection, drawing upon epistemologies of practice and critical reflection as critical social inquiry. These directions offer medical education research broad and deep potential in theories of reflection, particularly in relation to knowledge creation within uncertain and complex situations, and challenging of dominant discourses and structures. Future work could explore how dominant epistemological positions and discourses in medicine influence theories from other disciplines when these theories are deployed in medical education.

Article first published online: 28 APR 2015 | DOI: 10.1111/medu.12680

#MedEdJ | Medical Education Journal Club Returns!

At the end of this month we will be having one of our #MedEdJ virtual journal clubs. Below are the questions we are posing about the article featured in April 2015’s edition of Medical Education entitled:

‘Sorry, I meant the patient’s left side’: impact of distraction on left–right discrimination (pages 427–435)
John McKinley, Martin Dempster and Gerard J Gormley
Article first published online: 20 MAR 2015 | DOI: 10.1111/medu.12658

R-L-Error

Image provided via Creative Commons by Dr. Gerry Gormley.

This article looks at left / right confusion by medical students, using a neuropsychological paradigm.  As Dr. Gerry Gormley often asks when talking about this topic: “What is the fuss about right left confusion? Surely everyone can tell R from L?”

Specifically, this can be really important for patient care.  Remember, most procedures and surgeries will be on a single pathologic side (e.g. a Thoracocentesis), so for patient safety it can be important to identify the correct side.  Errors in such identification have lead to poor patient outcomes.

In this article, the authors explore issues such as:

  • Why are some individuals are more challenged in distinguishing right from left?

Link to the article here.

The publisher has made this article available for reading even if you don’t have a subscription to the journal.

***

This month, we have decided to create some guiding questions to help our readers think about the article.  Below are some questions compiled by our e-council and avid readers.

How this #MedEdJ Virtual Journal Club will work:

Similar to previous journal clubs for Medical Education, we invite you, the participants, to answer the questions in the blog comments below (just write Q1, Q2, Q3… etc.. to denote your answers).

Then starting on May 1, 2015, members of the authorship team will be online to respond.  We will have a live Tweet Chat on May 1, 2015 with one of the authors (Dr. Gerry Gormley, @DrGerryG) from 3-4pm British Standard Time (10am-11am Eastern Daylight Time; 7am-8am Pacific Standard Time).

During the Tweet Chat, we will use the hashtag #MedEdJ.

After that, you can continue to comment on the areas below and we will help facilitate answers and discussion with the authors via the blog.

Questions:

  1. Is there any evidence about the best way to improve left/right discrimination?
  2. Should medical schools be screening students for LR discrimination ability? And if so what impact would that information have on you?
  3. How is your medical school going to help students improve their left/right discrimination and deal with distraction?
  4. Is your medical school considering helping students to deal with distraction in medical practice generally?
  5. Given that distraction management is also a function of attentional control, would it have been helpful for the authors to measure working memory?
  6. How would their conclusions about sex and L/R distraction have changed if they had measured visual spatial intelligence and working memory capacity?

Don’t be shy!  Join into the conversation below!  All answers are welcome!

Acknowledgements:

Thanks to Kulamakan Kulasegaram, Ellie Hothersall, and Karen Scott for their contributions to these questions.