Specifies the number of studies evaluated orselected
Steps, and targets of constructing a good review article are listed in Table 3 . To write a good review article the items in Table 3 should be implemented step by step. [ 11 – 13 ]
Steps of a systematic review
Formulation of researchable questions | Select answerable questions |
Disclosure of studies | Databases, and key words |
Evaluation of its quality | Quality criteria during selection of studies |
Synthesis | Methods interpretation, and synthesis of outcomes |
It might be helpful to divide the research question into components. The most prevalently used format for questions related to the treatment is PICO (P - Patient, Problem or Population; I-Intervention; C-appropriate Comparisons, and O-Outcome measures) procedure. For example In female patients (P) with stress urinary incontinence, comparisons (C) between transobturator, and retropubic midurethral tension-free band surgery (I) as for patients’ satisfaction (O).
In a systematic review on a focused question, methods of investigation used should be clearly specified.
Ideally, research methods, investigated databases, and key words should be described in the final report. Different databases are used dependent on the topic analyzed. In most of the clinical topics, Medline should be surveyed. However searching through Embase and CINAHL can be also appropriate.
While determining appropriate terms for surveying, PICO elements of the issue to be sought may guide the process. Since in general we are interested in more than one outcome, P, and I can be key elements. In this case we should think about synonyms of P, and I elements, and combine them with a conjunction AND.
One method which might alleviate the workload of surveying process is “methodological filter” which aims to find the best investigation method for each research question. A good example of this method can be found in PubMed interface of Medline. The Clinical Queries tool offers empirically developed filters for five different inquiries as guidelines for etiology, diagnosis, treatment, prognosis or clinical prediction.
As an indispensable component of the review process is to discriminate good, and bad quality researches from each other, and the outcomes should be based on better qualified researches, as far as possible. To achieve this goal you should know the best possible evidence for each type of question The first component of the quality is its general planning/design of the study. General planning/design of a cohort study, a case series or normal study demonstrates variations.
A hierarchy of evidence for different research questions is presented in Table 4 . However this hierarchy is only a first step. After you find good quality research articles, you won’t need to read all the rest of other articles which saves you tons of time. [ 14 ]
Determination of levels of evidence based on the type of the research question
I | Systematic review of Level II studies | Systematic review of Level II studies | Systematic review of Level II studies | Systematic review of Level II studies |
II | Randomized controlled study | Crross-sectional study in consecutive patients | Initial cohort study | Prospective cohort study |
III | One of the following: Non-randomized experimental study (ie. controlled pre-, and post-test intervention study) Comparative studies with concurrent control groups (observational study) (ie. cohort study, case-control study) | One of the following: Cross-sectional study in non-consecutive case series; diagnostic case-control study | One of the following: Untreated control group patients in a randomized controlled study, integrated cohort study | One of the following: Retrospective cohort study, case-control study (Note: these are most prevalently used types of etiological studies; for other alternatives, and interventional studies see Level III |
IV | Case series | Case series | Case series or cohort studies with patients at different stages of their disease states |
Rarely all researches arrive at the same conclusion. In this case a solution should be found. However it is risky to make a decision based on the votes of absolute majority. Indeed, a well-performed large scale study, and a weakly designed one are weighed on the same scale. Therefore, ideally a meta-analysis should be performed to solve apparent differences. Ideally, first of all, one should be focused on the largest, and higher quality study, then other studies should be compared with this basic study.
In conclusion, during writing process of a review article, the procedures to be achieved can be indicated as follows: 1) Get rid of fixed ideas, and obsessions from your head, and view the subject from a large perspective. 2) Research articles in the literature should be approached with a methodological, and critical attitude and 3) finally data should be explained in an attractive way.
Need to write a critical review but unsure of where to start? Don’t worry, it’s normal to feel stuck when writing a critical review.
So, how should you approach a critical review? Well, you need to consider the strengths and weaknesses of the article. But, more than this, you need to draw links between this article and other relevant papers. This is important if you want a first-class grade!
Critical reviews are difficult, but they can help you improve your research and selection skills. That said, let’s explore how to write a critical review of an article.
First and foremost, be clear on what it means to be ‘critical’. If you’ve read our guide on how to critically discuss , you’ll know that being critical isn’t just about being negative.
Being critical means weighing up the strengths and weaknesses of a particular piece of work and considering its implications and applications from various perspectives.
That said, in order to ‘be critical’ you must:
Understanding why your tutor has set this piece of work can help you to feel more motivated to finish it. So, why would your tutor ask you to critically review an article?
Well, being able to critically appraise others’ work is considered essential to thrive as a student. This is especially true if you want to progress to master’s or PhD level study.
Writing a critical review can help you to become a more discerning researcher, because it teaches you how to appraise other people’s work.
If you can become good at critically appraising one paper, you can become good at appraising a bunch of papers. So, this means that when writing subsequent essays, you can accurately discern which research papers are worth including in your essays, and which are not.
Not to mention, an assignment like this also introduces you to the practice of peer-review; another practice that is central to UK academia.
The expectation of what a critical review should include will vary between subjects. As a rough guide, it should include the following:
Generally, you should assume that your reader has not read the article, so you will need to include a brief description of its content. Remember to be brief in order to leave enough space for critique.
It’s up to you whether you write a short paragraph at the beginning of your review summarising the article, or whether you describe and critique the paper as you go along. The latter strategy can be more impressive, but it is more difficult to do.
Ask yourself, why did the author(s) write this article? What problem or issue were they trying to solve? Ultimately, your review should say whether you agree that there was a problem to be solved, and whether you think this article has addressed this problem effectively.
So, for example, let’s say you need to review an article that tested whether putting stricter quotas on fishing can tackle the overfishing crisis.
First, ask yourself, is there enough evidence to confirm that we are facing an overfishing crisis? Use your response to this question to determine how ‘important’ you see this article to be. Moreover, ask yourself, were the authors right to focus on stricter quotas as a potential solution, or could/should they have focused on something else?
Remember, you are not just critiquing the paper itself but the decisions (or rationale) that led the authors to formulate this type of paper in the first place.
Most critical reviews should discuss the strengths and weaknesses of the methodology, since the choice of methodology relates to issues like reliability and validity.
When critiquing the methodology, ask yourself why you think the author(s) chose this approach. For example, if they chose to conduct qualitative interviews rather than administer a quantitative questionnaire, why do you think they did this?
Tip: Most journal articles have a section at the end where the authors discuss the limitations of their paper (including the methodology), so this can give you some hints if you’re struggling to find any weaknesses with the methodology.
Research methods is a broad area of study, so we strongly recommend you take out a research methods textbook from your university library; this will introduce you to the basics of different research methods which will help you to critique the article confidently.
Remember we said that a critical review shouldn’t only be negative? Indeed, you should generally say positive things about the article, too.
One way to do this is to consider alternative applications of the author’s theory or argument. So, let’s say that the paper found that caffeine helps improve people’s memory. You might wonder whether caffeine could be an effective treatment for memory disorders and recommend this as a potential avenue for future research.
Remember, one of the aims of a critical review is to ‘fit it in’ to the wider literature. This will show off your ability to draw links between theories, concepts, and disciplines.
Depending on the type of article you are reviewing, you might also want to comment on the language skills of the authors.
Have they presented their ideas coherently? Is the argument easy to follow? If you had written the article, would you have approached it differently? Under this remit, you might also consider the quality of presentation.
As mentioned, your tutor might have some quite unique requirements for what to include in your review. But, generally speaking, these are some good questions to get you started:
Your tutor will be able to tell you whether your critical review should include other references.
However it is a good idea to include additional references because this shows you can ‘fit’ this article into the ‘bigger picture’ and draw links between different theorists’ ideas.
Moreover, when making an evaluative statement about a particular weakness within the paper, including a citation can help you to appear more authoritative.
For example, let’s say you write ‘The authors only included 12 participants so the sample size was very small; this means the findings cannot be generalised’ (Smith, 2010).
By including a reference to Smith (2010), you are showing that you have read up about sampling and the effects of using a small sample size. This demonstrates that you have thought carefully about various aspects of the article and done your own research to critique it confidently.
As with all academic papers, getting started is often the hardest part. That said, here are some tips to help you kickstart your critical review:
You are a student at Pomona College and you have been asked to write a critical review. Never mind the fact that you have probably never encountered such a thing, you just so happen to have a million and one other things to do. Fear not, this worksheet will get you through it.
A critical review, sometimes referred to as a critical book review, is a summary and analysis of the information and argument of a text in light of your own personal opinions. Those personal opinions, however, should be informed by what you have learned in class through readings, lectures, and discussions, along with any guidelines your professor may set.
So, you have the prompt in one hand and this worksheet in another. Let’s get this critical review underway.
To begin, you need to reread the material that you are supposed to review. How can you effectively critique a text that you can’t remember? Reread, my friend.
In order to sift through the mass of information that many readings are riddled with it is helpful to ask yourself a few framing questions.
As you summarize a text within your critical review, your professor is looking to see how well you have discussed important arguments, trends, ideas, and themes in light of your own thoughts and opinions. That means you are not to spend the whole review talking about what the author said and not following up with what you believe, whether you agree or not.
Remember, college writing insists that you come from behind the author and speak up for yourself.
Your critical review need not be a comprehensive report on the whole text, it just has to discuss a few main issues that you may have agreed, disagreed, or partially agreed/disagreed on.
Now that you have got a few guidelines on how to right a critical review, you can expect to have a solid paper. Remember, you are engaging in a conversation with the author of a text, don’t let the conversation become the author’s monologue!
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Learn how to write a review article.
What is a review article? A review article can also be called a literature review, or a review of literature. It is a survey of previously published research on a topic. It should give an overview of current thinking on the topic. And, unlike an original research article, it will not present new experimental results.
Writing a review of literature is to provide a critical evaluation of the data available from existing studies. Review articles can identify potential research areas to explore next, and sometimes they will draw new conclusions from the existing data.
To provide a comprehensive foundation on a topic.
To explain the current state of knowledge.
To identify gaps in existing studies for potential future research.
To highlight the main methodologies and research techniques.
There are some journals that only publish review articles, and others that do not accept them.
Make sure you check the aims and scope of the journal you’d like to publish in to find out if it’s the right place for your review article.
Below are 8 key items to consider when you begin writing your review article.
Make sure you have read the aims and scope for the journal you are submitting to and follow them closely. Different journals accept different types of articles and not all will accept review articles, so it’s important to check this before you start writing.
Define the scope of your review article and the research question you’ll be answering, making sure your article contributes something new to the field.
As award-winning author Angus Crake told us, you’ll also need to “define the scope of your review so that it is manageable, not too large or small; it may be necessary to focus on recent advances if the field is well established.”
When finding sources to evaluate, Angus Crake says it’s critical that you “use multiple search engines/databases so you don’t miss any important ones.”
For finding studies for a systematic review in medical sciences, read advice from NCBI .
Spend time writing an effective title, abstract and keywords. This will help maximize the visibility of your article online, making sure the right readers find your research. Your title and abstract should be clear, concise, accurate, and informative.
For more information and guidance on getting these right, read our guide to writing a good abstract and title and our researcher’s guide to search engine optimization .
Does a literature review need an introduction? Yes, always start with an overview of the topic and give some context, explaining why a review of the topic is necessary. Gather research to inform your introduction and make it broad enough to reach out to a large audience of non-specialists. This will help maximize its wider relevance and impact.
Don’t make your introduction too long. Divide the review into sections of a suitable length to allow key points to be identified more easily.
Make sure you present a critical discussion, not just a descriptive summary of the topic. If there is contradictory research in your area of focus, make sure to include an element of debate and present both sides of the argument. You can also use your review paper to resolve conflict between contradictory studies.
Angus Crake, researcher
As part of your conclusion, include making suggestions for future research on the topic. Focus on the goal to communicate what you understood and what unknowns still remains.
Always perform a final spell and grammar check of your article before submission.
You may want to ask a critical friend or colleague to give their feedback before you submit. If English is not your first language, think about using a language-polishing service.
Find out more about how Taylor & Francis Editing Services can help improve your manuscript before you submit.
Differences in... | ||
---|---|---|
Presents the viewpoint of the author | Critiques the viewpoint of other authors on a particular topic | |
New content | Assessing already published content | |
Depends on the word limit provided by the journal you submit to | Tends to be shorter than a research article, but will still need to adhere to words limit |
Complete this checklist before you submit your review article:
Have you checked the journal’s aims and scope?
Have you defined the scope of your article?
Did you use multiple search engines to find sources to evaluate?
Have you written a descriptive title and abstract using keywords?
Did you start with an overview of the topic?
Have you presented a critical discussion?
Have you included future suggestions for research in your conclusion?
Have you asked a friend to do a final spell and grammar check?
Taylor & Francis Editing Services offers a full range of pre-submission manuscript preparation services to help you improve the quality of your manuscript and submit with confidence.
How to edit your paper
Writing a scientific literature review
BMC Medical Education volume 24 , Article number: 942 ( 2024 ) Cite this article
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Intersex describes a diversity of individuals with variations in sex characteristics (VSC), reflecting underlying differences in reproductive anatomy, hormones, and/or genes and chromosomes. With a shift towards socially-conscious clinical practices, genetic counsellors (GCs) are increasingly needing to provide comprehensive care to individuals with VSC and their families. However, the current quality of training provided to genetic counsellors on intersex health is unclear.
Qualitative interviews were conducted between Jan-Feb 2021 with 20 current and graduated students of Canadian GC training programs to assess the quality of GC education on intersex health topics. An agency-based model of VSC health as proposed by Crocetti et al. was used to guide the inductive thematic data analysis.
Results revealed three key themes: limited discussions on psychosocial considerations when caring for intersex individuals, enthusiasm for integrating more intersex training into the curriculum, and personal initiative in ensuring equity and justice in the care of individuals with VSC.
These findings demonstrate existing knowledge gaps in the GC curriculum, with a need to increase the profession’s overall awareness on intersex issues. GC training programs have an opportunity to meet the desires of students while promoting person-centered and validating healthcare for the intersex community.
Peer Review reports
Intersex variations and variations of sex characteristics (VSC) are umbrella terms used to describe individuals with congenital variations in sex characteristics and/or reproductive anatomy, reflecting underlying variations in genitalia, gonads, hormones, or genetic differences [ 1 , 2 ]. Most notably, it includes differences in sex chromosomes or single genes. The vocabulary surrounding intersex, disorders of sexual development (DSD), and variations of sex characteristics (VSC) has evolved, reflecting community perspectives and priorities [ 3 ] however medical texts often prefer the term DSD or will refer to the specific congenital variation falling under the intersex umbrella. It is estimated that intersex individuals represent approximately 1.7% of the general population [ 1 , 4 ]. Variations in sexual characteristics can be detected at different life stages (prenatally, at birth, during puberty, and adulthood) and healthcare providers (HCPs) engagement with intersex individuals can occur anywhere along this trajectory. Individuals with VSCs are culturally stigmatized, and report human rights violations and pathologization worldwide. These experiences translate to medical communication where many individuals report negative experiences as a result of their intersex status including misinformation and the concealment of personal medical information, [ 5 ] contributing to a culture of “secrecy and shame” [ 4 , 6 ], infringing on human rights of bodily integrity and self-determination, [ 7 ] and perpetuating the lack of social visibility of the intersex community [ 8 , 9 ].
Stigmatization may be perpetuated through apologetic or judgment-ridden language by HCPs at the time of identification of an intersex trait. In studies conducted by Jaramillo et al. [ 10 ] and Streuli et al. [ 11 ] they demonstrated that styles of pathologizing versus non-pathologizing communication by HCPs strongly influenced the decisions made by parents or parental proxies regarding the care of children with VSC. Continued stigmatization of VSC can stem from a lack of HCP awareness of potential trauma, uses of inappropriate terminology, [ 12 ] or knowledge gaps in understanding the needs of individuals with VSC [ 13 ]. Various advocates, allied health professionals, and international human rights bodies have called for movement away from a purely biomedical model of intersex, which centres around a dialogue of intersex variations as “abnormalities” or “disorders”, towards more neutral and accepting language and attend to psychosocial needs [ 9 ]. Moreover, the communication should focus on the health concerns, if relevant, rather than merely emphasize physical differences compared to the statistical norm. To complement this shift, patient-centred and rights-based models that emphasize the use of non-pathologizing language are encouraged [ 14 , 15 ].
Recommendations for improving intersex care often include the formation of multidisciplinary HCP teams to guide individuals with VSC and their families [ 6 , 16 , 17 , 18 , 19 ]. Within these teams, genetic counsellors (GCs) are suggested to take on roles in pediatric settings, such as educating patients and families on genetic etiologies of VSCs, providing outreach resources for children and adolescents with VSC, and providing parents with communication tools like letters to explain VSC to family members [ 20 , 21 , 22 ]. Genetic counselors facilitate individuals understanding and adaption to the medical, psychological, and familial implications of genetic contributions of particular differences that may impact health [ 23 ]. For intersex adults, GCs can also facilitate discussions about reproductive goals and fertility. Additionally, genetic counsellors have opportunities to encounter VSC topics in a prenatal setting. With the increasing availability of non-invasive prenatal genetic screening (NIPS), the detection of some VSC conditions related to sex chromosome aneuploidies are likely to increase [ 24 ]. Recent studies on NIPS for sex prediction call for guidance on pretest counseling from professional organizations, continuing education focused on sex and gender-diverse approaches to avoid stigma, anxiety and psychological harms [ 25 , 26 ]. This furthers the increasing need for GCs to be aware of social issues surrounding VSC and provide context specific, non-directive counselling [ 27 , 28 ].
Previous research has explored the perceived levels of competency and comfort of GCs when working with sexual orientation minorities such as gay, lesbian, bisexual patients, [ 29 ] or gender identity minorities such as transgender and non-binary patients [ 30 , 31 , 32 , 33 , 34 ]. While intersex variations are independent of sexual orientation and gender identity (SOGI) research highlights the challenges of developing rapport and effective communication when professionals lack of vocabulary and ease utilizing the terminology [ 35 ]. Barnes, Tuite, and Sheehan all reflect on the lack of universally accepted standards to accurately represent the uniqueness of individual identities in healthcare settings, particularly with regards to the use of symbols in drawing pedigrees and family history intake during a genetic counseling (GC) encounter [ 31 , 33 , 36 ]. However, an important portion of intersex individuals do not identify themselves as belonging to a SOGI minority group. Furthermore, the distinct needs of individuals with VSC are not specifically examined in these studies, with both Barnes and Sheehan commenting on the need for intersex-focused research in genetic counselling settings in the future [ 31 , 33 ]. Broad themes encompassed in these studies also include the importance of using validating language, the responsibility of the counsellor to create a safe space for discussion, and the widespread desire for more education in working with these patient populations. Therefore, training focused on these topics would be valuable to GCs and students.
An initial approach to address the need for intersex-focused research in GC is to assess the current state of intersex education provided to GCs during their training. Despite calls for continuing education and guidance from professional organizations including the 2023 Accreditation Council for Genetic Counseling (ACGC) standards, there are no specific requirements on the provision of training addressing the needs of situationally marginalized groups such as individuals with VSC [ 37 ]. Integrating the social and biomedical models of intersex health such as Crocetti et al.’s agency-based model will inform the analysis to examine the sociocultural constructions of medical treatment and management of intersex health and how this related to GC training in this space. This qualitative study aims to assess the experiences of Canadian GCs and students regarding their education and training (psychosocial and medical) on intersex individuals’ healthcare, related topics of variations of sexual characteristics and nuances of the specific counseling settings (prenatal, newborn, puberty and adulthood). Without a clearer understanding of the current knowledge gaps in VSC education, it is challenging to specify training competencies for GCs to provide patient-centred and validating healthcare for this patient community.
This study utilized an interview approach with thematic analysis to assess the richness of participants’ responses [ 38 ]. The approach was chosen as it compliments early stages of research with limited coverage in the existent field, while individual interviews allow for detailed discussions of the participant’s personal experiences, opinions, and reflections [ 39 ]. An agency-based model of intersex, or VSC health, as proposed by Crocetti et al. was used to guide the analysis [ 9 ]. It integrates both the social and biomedical models of intersex health to address health issues concerning individuals with VSCs, as well as the sociocultural constructions that guide the medical treatment of individuals with VSCs. Social model of intersex health is inspired by critical disability theory, which challenges the biomedical pathologization of intersex individuals, and recognizes that the ‘disabling’ aspect of intersex embodiment is a direct outcome of societal norms, prejudice, and discrimination [ 40 ].
The authorship team includes authors who identify as queer, disabled, people of color, and as a parent of a nonbinary child. The authors also have a range of clinical, academic, legal and advocacy involvement with LGBTQIA + communities. The manuscript was supported by Social Sciences Research Council grant # 435-2018-0626 (Toward effective health communication with intersex Canadians: A study of ethical and legal challenges).
Ethics approval for the study was obtained from McGill University’s Research Ethics Board in Winter 2020 (REF #20-11-054).
Eligible participants included current students and recent graduates of Canadian genetic counselling programs. “Recent graduates” were defined as genetic counsellors who completed their training within the 5 years prior to the conduction of this study, including individuals from the graduating class of 2015. Exclusion criteria included having participated in the pilot interviews conducted during the design stage of the study.
Participants were recruited via purposeful sampling through email blasts sent by the Canadian Association of Genetic Counsellors (CAGC) to members registered on their listserv, as well as via emails from the Program Directors of Canadian genetic counselling programs to current students and alumni. The initial recruitment email included an invitation to connect with the researcher. The researcher contacted each participant to provide more information regarding the background of the study and a consent form. Participants were then scheduled for an individual interview in English on the video conference platform Zoom.
Between January to February 2021, the researcher conducted 20 individual interviews using Zoom with participants in the location of their choice. Individual interviews lasted between 23 and 59 min (median: 39.8 min) each and were audio recorded. Throughout the interview process, care was taken to check in with the participants, to ensure they felt safe, and reduce the possibility of participant discomfort in discussing details related to intersex topics or related gender, sex, and sexuality minorities. Participants were extended the opportunity to decline answering any question or could withdraw from the study at any time without explanation.
The semi-structured interview guide (see Appendix ) was based on a review of existing literature exploring the experiences of genetic counsellors, [ 29 , 30 , 32 , 33 ] training related to counselling considerations for SOGI minorities, and intersex issues in general. Similar to Zayhowski et al., 2019, the interview guide provided structure for the formal interview, with open-ended questions and prompts allowing participants’ responses to follow trajectories of relevant topics as they emerged [ 41 ]. The interview guide was piloted by GC students who closely resembled the study’s intended demographic to maximize the content validity, assess the appropriateness of questions and estimate approximate interview length [ 42 ]. The final guide included 14 questions on the following topics: (a) education received and/or desired regarding intersex healthcare, (b) participants’ awareness of intersex issues, and (c) personal or extra-curricular experiences contributing to awareness of intersex issues. Questions related to participants’ demographics such as age, gender identity, pronouns, and student status (e.g., first-year, second-year, or recent graduate) were also asked.
Recordings of each interview were saved to an encrypted and password-protected laptop and sent for transcription by a third-party transcription service. Resulting transcripts were reviewed for accuracy, and participants’ names as well as any identifying information was deleted to maintain confidentiality. Transcripts of the interview were not returned to participants for comment or correction. Transcribed data from individual interviews were then uploaded into NVivo Version 20.6.1 (2020). The coding team consisted of the lead researcher (A.A), and two members of the research team with extensive familiarity in qualitative methodologies (N.P. and M.C.). A thematic codebook was developed using an inductive approach by independently identifying emergent concepts and highlighting representative quotes across the data set [ 43 ]. Coding of the transcripts occurred independently. Together, the team reviewed the coded transcripts. Once completed, the coding was compared to the codebook and differences were reconciled through iterative discussion to reach a consensus and identify overarching themes and subthemes.
An inductive thematic analysis was used, as it permitted the examination of patterns in participants’ perspectives and the generation of unanticipated themes without the application of a pre-existing framework [ 44 , 45 ]. The lead coder (A.A.) reviewed the raw data and assigned initial codes to recurrent patterns in the participants’ responses. These codes were then reviewed by the secondary coders (N.P and M.C.) and the codes were organized into broader themes that relate to the research questions. Participant checking was not employed in this project as there was limited time for the student led project. This report presents the emergent themes and how they relate to existent intersex education literature.
A total of 20 participants enrolled in the study, comprising 3 first-year students, 6 second-year students, and 11 recent graduates across 5 GC programs in Canada. The counselling programs were distributed between four provinces (two in Québec, one in each of Manitoba, British Columbia, and Ontario). All demographic information is listed in Table 1 .
The three major themes identified through thematic analysis include: (1) limited discussions of psychosocial aspects of intersex identity during training (2) enthusiasm towards integration of training specific to intersex issues into the curriculum and (3) collective responsibility of GCs in ensuring equity and undoing historic harms in the care of individuals with VSC.
Participants noted that the medical aspects of intersex were formally covered in course learning objectives and were discussed in depth. However, discussions on the psychosocial aspects of intersex identity and the impact of stigma occurred primarily in informal settings and were often initiated by interested students (rather than indicated by the curriculum). Most participants ( n = 19) believed that medical topics related to intersex conditions (such as factors influencing diagnosis or clinical management) were addressed in formal lectures. Notably, the topics were predominantly conveyed using language of disorders of sex development (DSD) and taught by medical professionals (geneticists and/or GCs). Regarding clinical experience, several participants ( n = 11) shared that they had limited or no exposure to cases involving intersex conditions and/or variations of sexual characteristics. By contrast, discussions on psychosocial issues related to intersex identity, ethical considerations (e.g., patient autonomy, self-determination, and bodily integrity), adaptations in counselling strategies emerged in informal group discussions, and debriefing clinical cases with fellow students were raised through student-led presentations ( n = 13). Many participants ( n = 19) commented that intersex topics were included within the broader context of training related to SOGI minority groups. However, it meant that intersex issues were rarely, if ever, treated as a distinct entity in formal training. Notably, three participants recounted instances during training when a GC student experienced resistance and backlash from medical residents and physicians in response to a presentation delivered by a peer GC student. The presentation sought to analyze an article which criticized certain practices in the care of infants or fetuses with congenital adrenal hyperplasia (CAH), a condition that can be categorized under the umbrella of intersex. All three participants described feeling uneasy with the situation, with one participant saying that they felt it was unfortunate that the burden of initiating discourse on potentially charged topics often fell onto students.
All 20 participants expressed positive attitudes about incorporating more intersex topics into training, and a diversity of responses emerged from participants upon being prompted to expand on these sentiments of support towards additional training in this domain. Some wanted a curriculum that provided formal introduction to intersex topics, as well as addressing misconceptions of what intersex is and is not. A few ( n = 11) cautioned on assuming incoming students would have a baseline knowledge of intersex topics and the lived experiences of intersex individuals (due to the increasing social advocacy of the intersex community), as it assumes that students already understand how to approach these topics with patients. Interestingly, a few participants ( n = 10) touched on how the assumed transferability of strategies for counselling from one patient population to another may create unintentional gaps in training. These responses reflected on adjustments in counselling approaches when working with different marginalized populations - participants shared that counselling considerations for groups such as SOGI minorities, patients (or parents of a child) with Down syndrome, or the disability community may have been covered in classes, but no explicit considerations specific to intersex counselling were included in training.
Participants proposed novel and diverse formats of training and education devoted to intersex issues (such as role-playing, simulated sessions, or workshops), training regarding language considerations, pedigree nomenclature to represent diverse patient identities, as well as opportunities for advocacy and affirming care in clinical settings (e.g., terminology used in medical documentation, inclusiveness in questionnaires and forms, etc.). Overwhelmingly, all participants placed a high degree of value in directly learning from the intersex community to have a better understanding of the perspective of this patient group. A few participants ( n = 5) suggested opportunities for programs to invite patient representatives and/or intersex advocates to speak and present to students.
Participants reflected on the roles of GCs in advocacy and undoing historic harms experienced by the intersex community, tying it to equity and responsibility to provide services to an underrepresented population which faces stigmatization and systemic barriers to quality healthcare.
Participants identified opportunities for GCs to be involved at many points in an intersex individual’s care throughout their lifetime (prenatal, pediatric, adult and fertility genetics). Many ( n = 13) respondents detailed various considerations in a counsellor’s role in the prenatal setting when discussing intersex traits and variations of sexual characteristics with prospective parents. “We can go into a counselling session with someone who is from a different culture and have some idea of values and issues that we might want to bring up and see if that’s influencing decision making or, you know, accepting or adjusting to a diagnosis.” All participants described feeling confident in their ability to provide non-directive counselling, regardless of whether they had previously participated in the care of an intersex patient.
However, some identified areas of uncertainty in their approach or delivery of information. One participant commented that “it is not a challenge to be non-directive, but in some cases, it can be more complex,” acknowledging that they would feel a level of discomfort if a couple expressed wanting to terminate a pregnancy based on variations of sexual characteristics, without the presence of significant medical complications. A separate respondent expressed that a similar situation would create a conflict with their internal values, sharing that they would be “torn between wearing my counselling hat and my advocacy hat.”
Many participants ( n = 13) expressed a desire to spend time thoroughly preparing for a consultation involving intersex in a prenatal setting. Almost half of the participants ( n = 9) emphasized the dilemma of wanting to present a more balanced and nuanced perspective on the quality of life of intersex individuals or those with VSCs, without having had a previous exposure to this information in training or in clinical practice. Several participants ( n = 16) anticipated the types of strategies they might use to address these challenges in a GC session. For example, being aware of how tone and language affects the decision-making process when discussing VSC topics, how a couple might perceive a child with VSC, or how that person or family may go on to interact with the healthcare system. Other participants commented on possible benefits of “front-loading” assessments of their patients’ values and beliefs at the beginning of a session to best adapt to their needs ( n = 2). One respondent expanded on this, stating that it was important to be aware that discussions which challenge patients’ sociocultural beliefs on sex and/or gender binary can be polarizing. Finally, a few participants ( n = 3) warned against over-emphasizing intersexuality as a dimension of a person’s identity and/or “creating a centrepiece” out of variations of sexual characteristics as this may perpetuate stigmatization, despite an underlying intention to be open and inclusive.
These interviews elucidated the perspectives of current students and recent graduates of Canadian genetic counselling programs regarding the quality of education on care for intersex individuals. Participants generally reported satisfaction in the medical aspects of intersex education provided within the curriculum. However, the education on VSCs was situated in the biomedical model of care, focused on the disordered aspects of an individual, and characterized by using DSD terminology. This focus on pathologization reflects the societal constructs of “othering”, discrimination, and prejudice that could be mediated by integrating social and psychosocial approaches to healthcare. This narrow approach to instruction can lead to missed opportunities for GC students to engage in personalized care, develop cultural competence, recognize opportunities to ameliorate health inequalities and advocate for patients’ human rights. However, according to our participants, discussions about psychosocial aspects, issues tied to social identities, and the impact of stigma occurred primarily in informal settings and were largely driven by student interests. “If I hadn’t had that one lecture by a second-year student who took the initiative to do it, I don’t think we would have received the education that we did” remarked one participant on their Intersex training. Though there can be arguments made that counseling skills can be transferred to multiple counseling situations excluding these topics from the curricula places a burden on CGs to learn the material on their own and deprives them of opportunities of working with groups for whom engagement with the medical establishment is for many already fraught. [ 46 ] This knowledge gap is reflected in the most recent Accreditation Council for Genetic Counseling (ACGC) standards. Categories for required curriculum content related to psychosocial topics are defined (e.g., sensitivity and competency in the context of multiculturalism, disability awareness, etc.), but there are no specific requirements on the provision of training that addresses the needs of situationally marginalized groups such as individuals with VSC [ 37 ]. In response to this division in training, all participants expressed support for formal integration on intersex topics into the curriculum. The participants’ identification of existing knowledge gaps and their further interest on resources for intersex management is consistent with other studies where GCs have been assessed regarding training opportunities to provide more comprehensive care to other minority groups [ 32 , 36 ].
Participants noted the current inadequacy in training on psychosocial aspects of intersex issues and recommended adding lectures or workshops to rectify this knowledge gap. This would provide opportunities to incorporate existing teaching infrastructure into training, such as the eQuality virtual module, developed by the University of Louisville School of Medicine [ 47 ]. The module touches on issues faced by SOGI and intersex communities and continues to be updated via continuous input by the patient populations in question [ 47 ]. Additionally, participants attributed a high level of value to learning about the lived patient experience and gaining a better understanding of the quality of life for intersex individuals. As described in some of the challenges to counselling in the prenatal setting, the ability to provide a balanced perspective when counselling about intersex can be facilitated by exposure and encounters with intersex individuals and patient advocacy groups. Intersex community training would be invaluable in that one community embodies a range counselling contexts (prenatal, at birth, puberty, and adult) with the concomitant variation in terminology and communication associated the age and culture of the patient. Further, positive interactions with healthcare providers by this community helps to build trusting relationships necessary for quality care. Thus, training that is centered on the voices of the intersex community is necessary for GCs to encourage patients and prospective parents to develop a more nuanced understanding of the situation. This is also observed in literature commenting on the training needs of healthcare providers regarding intersex issues [ 27 ].
Lastly, participants noted that discussions about intersex topics during training are often lumped into discussions about SOGI minorities. Many respondents questioned this practice as it may treat these groups as a monolith population, lacking clarity or distinction between these possible dimensions of personal identity. While the intersex community is commonly included in the popular “LGBTQIA2S+” acronym and may share important social trajectories with SOGI minorities, [ 3 ] the needs of intersex individuals are still distinct from these groups [ 48 ]. Intersex people ultimately face unique challenges in medical settings which warrant individual concern. Concerns raised by participants are in line with recommendations described by Parent et al., outlining how some advocacy groups have called for awareness of these differences and highlighted the importance of treating the needs of marginalized groups with careful distinction [ 49 ].
There are several limitations to this study. First, it is a qualitative study drawing from a diversity of participants across Canada from eight separate cohorts. Due to the relatively small number of participants, perspectives detailed in this study may not be representative of all Canadian GC students. Second, enrollment into the study was voluntary, which may contribute to a positive response bias and the views may possibly reflect those with a vested interest in the topic and those with more available time to participate. In parallel, the interpretation of participants’ responses is also subject to the researchers’ viewpoints and understanding. However, the development of a codebook, and having multiple independent reviewers were employed to minimize researcher bias. Participant experiences reflect that of current students and recent graduates in the field. Separate research is needed for middle or late career GCs currently practicing, regarding their readiness and quality or educations on intersex, and possible supplementary continuing education opportunities. Finally, while the population of interest in this study is GCs and students, the topic of intersex education implicates the larger intersex community which has historically been underrepresented in medical settings and by extension, research as well. Therefore, it is essential that in addition to research data, any changes to the GC training curriculum be centered around intersex voices and perspectives. Such a perspective was sought in another study.
In summary, this study has identified gaps in the Canadian GCs’ training curriculum related to intersex issues and described best practices to foster social awareness in person-centred care for intersex individuals. Through interviews, genetic counselling students and recent graduates reflected on their experiences during training regarding care of intersex individuals. Thematic analysis revealed that gaps in training further perpetuates of the stigma and marginalization experienced by the intersex community. Participants reported adequate training on the medical aspects of intersex, but inadequate training on psychosocial aspects of intersex identity and social stigma (which were relegated to informal or student-initiated settings). In response to this apparent division in GC training, participants expressed support for a more formal integration of intersex topics into the curriculum. A major challenge raised by participants was uncertainty in approaching discussions of identification of VSC with patients or parents, particularly in a prenatal setting. Overall, these findings demonstrate the need for additional training so that GCs can provide nuanced and affirming psychosocial support in the care of intersex individuals. To achieve this, the educational gaps related to intersex topics must first be bridged. GC training programs have an opportunity to address these gaps in the broader context of promoting person-centred and inclusive care that is more accessible to the wide diversity of patients and families seen by GCs.
Redacted transcripts of the interviews are available from the corresponding author on reasonable request.
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The authors would like to thank Marilou Charron for her assistance in recoding the original data and Terese Knoppers for their invaluable advice.
Funding for this project was provided by McGill University’s Genetic Counselling program and the Social Sciences and Humanities Research Council (SSHRC) grant 435-2018-0626 (Toward effective health communication with intersex Canadians: A study of ethical and legal challenges).
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Conceptualization: YJ, AA; Data curation: AA; Formal analysis: AA, NP, MC; Funding acquisition: YJ; Investigation: AA; Methodology: AA; Project administration: YJ, NP; Resources: AA, KH; Software: AA, NP, KH; Supervision: YJ, NP; Validation: AA, KH, MC, NP; Visualization: AA, KH; Writing-original draft: AA, KH; Writing-review & editing: KH, NP, AA.
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Atayan, A.B., Huerne, K., Palmour, N. et al. Towards equity & inclusion: a critical examination of genetic Counselling Education on Intersex Healthcare. BMC Med Educ 24 , 942 (2024). https://doi.org/10.1186/s12909-024-05898-x
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Carbon negative biochar systems contribute to sustainable urban green infrastructure: a critical review.
Biochar from biomass and waste is a valuable component of various urban green infrastructures, including green roofs, permeable pavements, green walls, and green parking lots. Incorporating biochar into substrate mixtures offers numerous benefits, including improved water retention, nutrient availability, plant growth, and carbon sequestration. Moreover, biochar plays a crucial role in stormwater management by effectively retaining and filtering stormwater, reducing runoff, mitigating urban flooding, and improving surface water quality. This study conducted a comprehensive bibliometric analysis and synthesis of the literature to provide a broad perspective of the current understanding of biochar use in green infrastructure projects, focusing on the impact of biochar on soil and environmental quality, water retention, pollutant removal and the overall performance and sustainability of green infrastructure systems. This review also provides a comprehensive synthesis of the potential of biochar in enhancing green infrastructure systems and guiding future research and implementation strategies. The insights provided in this review can guide corporate stakeholders in understanding the benefits, challenges, and applications of biochar in urban green infrastructure management, empowering them to make informed decisions and contribute to the development of sustainable and resilient urban environments aligned with the principles of the UN SDGs and ESG considerations.
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A critical review is an assessment of an original research article. Writing a critical review of a journal article can help you improve your research skills. By assessing the work of others, you develop skills as a critical reader and become familiar with the types of evaluation criteria that will be applied to research in your field.
appraisal, critical analysis) is a detailed commentary on and critical evaluation of a text. You might carry out a critical review as a stand-alone exercise, or as part of your research and preparation for writing a literature review. The following guidelines are designed to help you critically evaluate a research article. What is meant by ...
Critical review: A critical review is a detailed analysis and assessment of the strengths and weaknesses of the ideas and information in written text. Research students who propose a "conceptual" paper (i.e. a paper with no empirical data) as their first publication will soon find that the contribution(s) and publication success of ...
A critical review is a description and evaluation of a source, usually a journal article or book. It moves beyond a summary to assess the strengths and weaknesses of the source and to comment on the quality of the source as a whole. Do not be confused by the term "critical": it does not mean that you only look at the negative aspects of ...
The critical review can be of a book, a chapter, or a journal article. Writing the critical review usually requires you to read the selected text in detail and to also read other related texts so that you can present a fair and reasonable evaluation of the selected text. What is meant by critical? At university, to be critical does not mean to ...
A critical review is not just a summary. It is an evaluation of what an author has said about a topic. It is critical in the sense that it is a thoughtful consideration of the validity and accuracy of the author's claims; considers the benefits and limitations of the author's point of view; and identifies other valid points of view (Monash ...
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Critical Review Structure . The Critical Review has a specific structure: Introduction • The title of the article or book. • The author • An overview of the article or book stating its aim and identifying the aim argument • Your response to the article (positive, negative, mixed (For an article the introduction should be
What is a Critical Review?A critical review is your opportunity to analyze the content and presentation of a book. or an article objectively. You determine the strengths and weaknesses of the text and provide an evaluation of the author's discus. ion of the subject matter. A critical review is an assessment of the author's thesis.
In this editorial we survey the various forms review articles can take. As well we want to provide authors and reviewers at CMEJ with some guidance and resources to be able write and/or review a review article. ... Reclaiming a theoretical orientation to reflection in medical education research: a critical narrative review. Medical Education ...
A critical review evaluates the strengths and weaknesses of an item's ideas and content. It provides description, analysis and interpretation that assess the item's value. It's an exercise that can be carried out on many different types of writing, but is most often carried out on a report, a book or a journal article.
Writing an article CRITIQUE A critique asks you to evaluate an article and the author's argument. You will need to look critically at what the author is claiming, evaluate the research methods, and look for possible problems with, or applications of, the researcher's claims.
Summarising and paraphrasing are essential skills for academic writing and in particular, the critical review. To summarise means to reduce a text to its main points and its most important ideas. The length of your summary for a critical review should only be about one quarter to one third of the whole critical review. The best way to summarise.
Good review methods are critical because they provide an unbiased point of view for the reader regarding the current literature. There is a consensus that a review should be written in a systematic fashion, a notion that is usually followed. ... Review articles are divided into 2 categories as narrative, and systematic reviews. Narrative ...
Generally, you should assume that your reader has not read the article, so you will need to include a brief description of its content. Remember to be brief in order to leave enough space for critique. It's up to you whether you write a short paragraph at the beginning of your review summarising the article, or whether you describe and ...
A Critical Review is 1/3 summary 2/3 your critique. As you summarize a text within your critical review, your professor is looking to see how well you have discussed important arguments, trends, ideas, and themes in light of your own thoughts and opinions. That means you are not to spend the whole review talking about what the author said and ...
A review article can also be called a literature review, or a review of literature. It is a survey of previously published research on a topic. It should give an overview of current thinking on the topic. And, unlike an original research article, it will not present new experimental results. Writing a review of literature is to provide a ...
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Critical Review: A Journal of Politics and Society is a quarterly academic journal covering political science that is published by Routledge for the Critical Review Foundation. It publishes papers on political theory, public opinion, and political economy.It was established in 1986 by editor-in-chief Jeffrey Friedman, who works with authors in "an aggressive, often substantive editing process ...
It aims to review the risks associated with counterfeit and falsified medications and identify knowledge gaps, areas of controversy, and avenues for future research that can contribute to a more robust understanding of this critical global health issue. 2. Materials and Methods
The presentation sought to analyze an article which criticized certain practices in the care of infants or fetuses with congenital adrenal hyperplasia (CAH), a condition that can be categorized under the umbrella of intersex. ... Critical Review of Psychosocial Health Care Research and indications for practice. J Sex Res. 2019;56(4-5):511-28.
Article type Critical Review. Submitted 25 Jun 2024. Accepted 15 Aug 2024. First published 28 Aug 2024. Download Citation. Green Chem., 2024, Accepted Manuscript Permissions. Request permissions Carbon Negative Biochar Systems Contribute to Sustainable Urban Green Infrastructure: A Critical Review ...
Undersea infrastructure is vital in a global economy powered by data. 99% of the world's data is transmitted through a global network of subsea cables. An estimated USD 10 trillion in financial transactions alone traverses these vast cable networks each day. As well as data cables, critical undersea infrastructure also includes electricity connectors and pipelines supplying oil and gas.
Arriving 36 years on, this follow-up to the director's classic supernatural comedy is a gleefully zany farce packed with knock-out punchlines and great practical effects.