EDI Research in School of Medicine – Monthly blog
The School of Medicine hosts an array of teams performing critical research into EDI related issues. Here we host a monthly blog where we ask these researchers about their work, what inspired them and how they hope it will make a difference.
November 2025:
This month we are delighted to hear from Adam Shanley, Research Assistant and PhD student in the Centre for Health Policy & Management, about his ongoing research on the PrEPTIMISE Study - PrEP Transformation & Innovation to Make Improvements in Service Efficiency.
Co-authors: Dr Irina Kinchin, Prof Fiona Lyons, Prof Noel McCarthy, Dr Clara O’Flaherty
What does EDI in Medicine mean to you?
For me, equality, diversity, and inclusion in medicine means recognising that healthcare is never ‘one size fits all’. It’s about understanding that people’s experiences, identities, and circumstances shape how they access care and the outcomes they experience.
EDI means building healthcare that meets people where they are, listens to their realities, and adapts accordingly. I think inclusion in healthcare is possible when every person feels seen, heard, and able to access care that fits their life.
Tell us a bit about your research
HIV continues to be an important public health issue in Ireland, with significant national and international commitments to end new transmissions by 2030. One of the most important tools we have for HIV prevention is pre-exposure prophylaxis (PrEP), a medication that, when taken daily or around risk events, effectively prevents HIV acquisition. PrEP has been available for free through the HSE since 2019, yet many people still face challenges in accessing it. Despite strong demand, limited clinic capacity and logistical barriers often make it hard for people to start or stay on PrEP.
During the COVID-19 pandemic, virtual consultations by phone or video call were introduced in some services to help people continue their PrEP care when in-person services were disrupted. In 2022, the HSE launched a free national home STI testing service, which also supports some PrEP users by reducing the frequency of returning to the clinic for testing. While both approaches have helped, they remain unstructured within the wider national HIV PrEP Programme. What is needed now is a more sustainable, streamlined PrEP delivery system that leverages digital innovation to give patients more control over their care while improving efficiency for providers.
Our research team received funding from the Health Research Board through the Department of Health’s Evidence for Policy Programme 2024 call. Together, we’re co-designing and piloting an online pathway of care for PrEP at the GUIDE clinic at St James’ Hospital in Dublin and the PrEP service at the South Infirmary Victoria University Hospital in Cork. Our research aims to explore the implementation process and assess the effectiveness, acceptability, and impact of the online intervention for both service users and providers.
We are taking a mixed-methods approach, collecting data through structured surveys and semi-structured interviews with both PrEP users and healthcare providers at different timepoints during the 12-month pilot. Those who decline to take part in the pilot service will also be invited to share their reasoning so we can better understand barriers and identify potential gaps in the service delivery model.
The central focus of my PhD is the evaluation of this online care component. My ultimate aim is to inform best practices for implementing and evaluating digital pathways of care in sexual and reproductive health, ensuring these innovations improve access rather than creating or widening divides.
Why are you passionate about this research topic?
This research is deeply connected to my personal and professional journey. I’ve worked in gay men’s sexual health for over ten years, most recently creating and leading the MPOWER programme. A big part of that work focused on advocating for PrEP access and improving how services reach the community.
Through outreach, I’ve met countless gay and bi men who are eager to use PrEP but face hurdles such as clinic waiting lists, work commitments, travel distances, or stigma. My work has long focused on removing these barriers, ensuring sexual health care is culturally appropriate and accessible in ways that align with people’s real lives.
At MPOWER, we introduced innovations in HIV testing by creating peer-led, community-based services and Ireland’s first HIV self-testing service. Now, I see an opportunity to innovate again by leveraging digital care pathways for PrEP.
Why is equality, diversity and inclusion (EDI) an important aspect of this research?
Equality, diversity, and inclusion are at the heart of this research because access to PrEP isn’t the same for everyone. While PrEP is available nationwide, some people still face more barriers than others, whether due to geography, stigma, or economic factors. We know that even well-designed health services can unintentionally leave people out.
To counter this, our study has been co-designed with community input through public and patient involvement (PPI) and PrEP provider input by sector stakeholder engagement. This means the online pathway and research tools have been shaped by those who will use them, ensuring they are practical, respectful, and responsive to real needs.
How can the outcomes of your research improve EDI in medical research and/or education?
Our hope is that this research helps shape future digital health policy in Ireland. By studying how a digital PrEP pathway works in practice, we can identify what makes it accessible, who it works best for, and where the challenges lie.
What we learn can inform how digital health services are rolled out in other areas of care while keeping user experience and inclusion at the centre. Perhaps these findings could also influence how healthcare providers are trained, encouraging a stronger focus on inclusive, patient-centred care when using digital tools.
Ultimately, we hope this research contributes to building a fairer, more flexible healthcare system, one that uses technology to reach more people without leaving anyone behind.
October 2025:
This month we are delighted to hear from Dr Elaine Burke, Assistant Professor in the Discipline of Medical Education, about her ongoing research of PlayDecide Teamwork, a discussion game for junior doctors to explore workplace bullying and harassment.
Co-authors: Declan Byrne, Mark Donegan, Oisín Hannigan, Julie O’Grady, Alice Waugh and Martina Hennessy
What does EDI in Medicine mean to you?
EDI is an important issue in Medicine – it’s about social justice and representation, but we also know that diverse perspectives enhance all aspects of our work, as doctors, scientists, and educators. A true meritocracy is one that addresses inequity, so embracing EDI principles benefits us all. Medicine as a profession can be quite traditional in some ways, with a strict hierarchy – but I believe most doctors and academics have a strong sense of fairness and social justice, so while there is still some work to be done, I’m very hopeful for the future!
Tell us a bit about your research:
This project was developed initially in response to a survey by the Irish Medical Council which found that almost half of interns (junior doctors in their first year of postgraduate clinical training) reported experiences of workplace bullying and harassment (WBH), with only a small number taking action to report the behaviour. These findings highlighted a need to provide an educational intervention which would enable interns to identify the types of behaviours that constitute WBH, and the different supports available to help them address the issue. This is important to protect and support junior doctors and ensure that they themselves don’t model these behaviours in the future.
Working with a multidisciplinary team based in St James’s Hospital, including colleagues from nursing, allied health and human resources, we used a freely available template called Play/Decide to develop a serious card-based discussion game. Using story cards, interns discuss realistic scenarios which depict different behaviours ranging from positive teamwork to definite bullying or harassment, and the effects these behaviours can have on staff, students, patients, and family members. They use info cards to help define the behaviour types and identify the supports that could be activated in each scenario. When we piloted the game in St James’s Hospital, we got great feedback, so we applied for and were awarded funding from the HSE NDTP Development Fund to roll the game out to other intern networks around the country.
We have shared the game with three other intern networks nationally. Feedback across all the sites from both interns and trainers was very positive - the interns found the game to be acceptable, the cards realistic and relevant, and they agreed that it was a safe space to discuss workplace issues. Trainers on all sites retained their own versions of the game so they could run sessions with interns in the future.
The success of this project is largely due to the multidisciplinary nature of the team who developed the game, and support of our hospital colleagues and colleagues in the Intern Network Executive, who reviewed the content, helped organize and facilitate trainer and intern sessions, and helped us collect feedback from the interns – emphasizing once again the importance of good teamwork!
Why are you passionate about this research topic?
The clinical workplace is a high-pressure environment and having worked in full-time clinical practice for a number of years, I’m very aware of how stressful it can be. WBH and incivility can arise, and the impact on trainees may be significant. However, most healthcare workers don’t set out to bully or harass their co-workers, it’s often a learned behaviour, and can be seen as an acceptable, even necessary, part of training. There is a need to break this cycle, and education is the key. Approaching the issue with understanding and empathy for both the target and bully, who may be modelling behaviours they themselves have experienced, is important. Ultimately, this will help us sustain a clinical workplace that is harmonious, collegiate, and safe for clinicians and patients.
Why is equality, diversity and inclusion (EDI) an important aspect of this research?
Harassment refers to unwanted conduct on any of the 9 grounds of discrimination, which include gender, sexual orientation, age, disability, race, and membership of the Travelling community. Harassment and sexual harassment create a degrading, intimidating, humiliating or offensive environment for the person who experiences it. While anyone can experience WBH, groups who are under-represented in medicine may be more likely to be a target of some of these behaviours. Eliminating WBH goes hand in hand with respecting equality, diversity, and inclusion.
How can the outcomes of your research improve EDI in medical research and/or education?
It’s probably a stretch to say that a single board game will change the culture of an institution! I would see it more as contributing to a conversation about how we talk to and treat each other, especially in high pressure environments. Incivility, bullying and harassment have a real impact and shouldn’t be considered acceptable or normal in any workplace. My hope is that this conversation brings us closer to understanding and eventually eliminating these behaviours. At a time when voices of intolerance seem to be getting louder, these conversations become more important than ever.
For more information on the research of Dr Burke and her colleagues, see their recent publication here.