Oral Presentations

Jessica Sinyor and Lindsay Muscroft

Warwick Medical School

Background Previous literature has investigated the experiences of the growing number of non-science graduates studying graduate-entry medicine.^1,2 However, there is little published on what motivates this cohort to apply to medical school and obstacles to entry they encounter.

Aims The aim of this study is to explore non-science graduates' motivations for studying medicine and their perceived barriers to entry, with the overarching aim of maximising this cohort's potential as future doctors by supporting their recruitment.

Methods A total of 12 students were recruited from four cohorts on the MBChB programme at Warwick Medical School for individual semi-structured interviews. The data then underwent descriptive thematic analysis.

Results Overarching data themes for participants' motivations were as follows: educational, professional and personal factors. These were divided into sub-themes: Educational factors were categorised according to whether they occurred at school, university or post-graduation. Under professional factors, sub-themes were as follows: job satisfaction and stability and transferability of existing skills/experience. Personal factors included changing direction during the COVID-19 pandemic and experiences as a patient/family member of a patient. Participants reported several barriers to entry including: demanding entrance tests and stringent eligibility requirements, lack of awareness about programmes accepting non-science graduates, academic anxieties and a fear of falling behind in ‘life stages’ having invested time in an unrelated career.

Conclusion Non-science graduates describe different reasons to study medicine than those previously given by undergraduate students.³ There are specific obstacles to entry into medical school for this cohort. Educators should consider how to address barriers that particularly affect non-science applicants to better support this cohort to reach medical school.

Keywords admissions; education; medical; motivations; non-science

References

1. Lam JTH, Hanson MD, Martimianakis MAT. Exploring the socialisation experiences of medical students from social science and humanities backgrounds. Acad Med 2020;95(3):401–10. https://doi.org/10.1097/ACM.0000000000002901

2. Rapport F, Jones GF, Favell S, Bailey J, Gray L, Manning A, Sellars P, Taylor J, Byrne A, Evans A, Cowell C, Rees S, Williams R What influences student experience of graduate entry medicine? Qualitative findings from Swansea School of Medicine. Med Teach 2009;31(12):e580–5. https://doi.org/10.3109/01421590903193570

3. Wouters A, Isik U, Ter Wee MM, Croiset G, Kusurkar RA. Motivation and academic performance of medical students from ethnic minorities and majority: a comparative study. BMC Med Educ 2017;17(1):233. https://doi.org/10.1186/s12909-017-1079-9

Charlie Williams, Andy Adam, Jack Massingham, Michelle Fromage, Sue O'Connor and Joanna Rutterford

UEA

Despite best efforts to diversify medical school applications, there is still an urgent need to make medicine accessible to all. The Medical Schools Council (MSC) Select Alliance data¹ show a lower number of applicants from traditionally disadvantaged backgrounds: ethnicity, school type and socioeconomic status. While this trend is mostly reversed in Gateway programmes, the trend remains in Standard Entry programmes. At the University of East Anglia, the outreach team have been working in collaboration with Norwich Medical School and current medical students to demystify the role of a doctor and to increase confidence in applying to medicine through a programme of interventions from reception year through to year 13.

An innovative programme—Explore Medicine—involves year 12 students watching a dramatised accident happening to Janet and the subsequent hospital consultation. Students then attend a series of four workshops focusing on (1) anatomy, (2) communication skills, (3) physical examination and (4) diagnostics, before making a diagnosis of the patient.

In the first year (2022–2023), this event was scheduled to run twice and was open for school sign up. In the second year (2023–2024), the event was open to individual sign up from students, and preference was given to those from disadvantaged backgrounds. Student attendance was low when offered to school signups, but high when offered individually to students. Teachers found that the hands-on sessions were helpful as they showed practical application of biochemistry techniques learned at school, while participants appreciated the chance to speak with current medical students.

Keywords medical school applications; outreach; widening participation.

Reference

1. MSC Selection Alliance. MSC Selection Alliance Annual Report. 2023. Medical school council. January 23, 2024. https://www.medschools.ac.uk/media/3125/selection-alliance-update-2023.pdf

Thomas Adamson, Clare Guilding and Robert Bain

Newcastle University

Background UCAT scores are commonly used to rank students for selection for interview in UK medical schools. Selected applicants are then interviewed to determine which candidates receive offers. Nationally, male applicants tend to score higher on the UCAT than female applicants¹. As part of an admissions quality improvement project in one UK University, we assessed how demographics (e.g. gender, WP status) impacted the different stages of the selection process.

Methods Applicants to the A100 course with ‘Home Fees’ status from 2020 to 2023 were analysed. T-tests and χ-squared were performed to test for statistical significance.

Results In total, 6707 applicants were included in the analysis, of whom 3585 received interviews. Males had higher UCAT scores across all 4 years than females (2779 versus 2727 respectively, p < 0.001). Therefore, a greater proportion of male applicants were interviewed (OR 1.28, 95%CI 1.19, 1.38, p < 0.001). At interview, females performed significantly better, with a narrower distribution of scores (p < 0.001).

Conclusion Male applicants tend to score higher on the UCAT in comparison to female applicants. This could create a left censoring bias, where only the top performing female applicants are interviewed, meaning females tend to score higher with a narrower distribution of scores at interview. Additional factors could also contribute to this and require exploration.

Medical schools that utilise the UCAT as a significant selector within their admissions processes should be aware of the potential biases this could introduce and ensure a full range of selection measures are used to minimise potential bias in any stage.

Keywords admissions; gender; interviews; quantitative; UCAT

Reference

1. Kulkarni S, Parry J, Sitch A. An assessment of the impact of formal preparation activities on performance in the university clinical aptitude test (UCAT): a national study. BMC Med Educ. 2022;22(1). https://doi.org/10.1186/s12909-022-03811-y

Oliver O'Neill, Sian Killett and Emily Roisin Reid

University of Warwick

Background Since the release of Dearing's report in 1997, the government has adopted the Policy of Widening Participation (WP).¹ This Policy has aimed to improve the University attendance of students who do not traditionally attend University. In Medicine, the most underrepresented populations are those from the lowest socio-economic backgrounds, first-in-family applicants to university and those from underperforming schools.² To assess if Widening participation has been effective, the solutions must have addressed the barriers these students face, and the number of underrepresented students nationally should be increasing.

Methods A systematic search of two databases was carried out by one reviewer.³ The search was carried out in October 2023 and included papers that studied the demographics of UK Medical Schools since the inception of Widening Participation by the UK government. A thematic analysis of these papers was performed to extract demographic data, solutions to WP and barriers faced by underrepresented students.

Results A total of 34 papers of the 81 found were used in the study. From those 34 papers only 5 solutions to WP were reported on (Student-Led WP activities, Medical Schools helping students access Work Experience, Peer Support, Consultant pen pals, Learning from more inclusive Medical Schools). There were nine barriers found that affected underrepresented students (UCAT, Secondary School, Finances, Medical School, Perceived lack of diversity, Lack of Contacts, Concerns about the future of the NHS, Age, Covid-19). Demographic data for the socio- economic status, race and secondary school status since 1997 were reported.

Keywords admissions; participation; review; solutions; widening

References

1. Waters B. Widening participation in higher education: the legacy for legal education. The Law Teacher 2013;47(2):261–269. https://doi.org/10.1080/03069400.2013.790153

2. BMA. Widening participation in medicine. BMA. Accessed 22nd of November, 2023. https://www.bma.org.uk/advice-and-support/studying-medicine/becoming-a-doctor/widening

3. PRISMA. PRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers only. PRISMA. Accessed 28th of October, 2023. http://www.prisma-statement.org/PRISMAStatement/FlowDiagram.aspx?AspxAutoDetectCookieSupport=1

Rini Paul¹ and Kate Bazin²

¹School of Medicine, King's College London; ²School of Physiotherapy, Kings College London

Background Schwartz Rounds are a structured, 1-hour, multidisciplinary, reflective space, sharing stories of the emotional impact of clinical work. Introduced in the UK in 2009 by the Point of Care Foundation (POCF), they are now common in healthcare settings. Regular attendees report less stress, a breakdown of hierarchies and normalising emotions (1). Since 2016, they have been run in Higher Education (2). King's College London introduced them online in 2020 for students enrolled on pre-registration healthcare programmes. Titles included “There's no ‘I’ in Team” and “In at the Deep End.

Methodology We run six Rounds per year and collect feedback using the POCF questionnaire, a mix of Likert-scale and free text questions. This is an evaluation of the first 12 rounds, our challenges and successes.

Results An average of 34 students attend per round with a 60% evaluation return rate. They are positively evaluated. King's Schwartz Rounds offer the opportunity for students to connect across professional boundaries through affective shared experiences of healthcare.

‘Such an open, free, non-judgmental space for people to share their stories of providing care to patients and working in a MDT and everything in-between’.

‘… it was such a validating experience. It's easy to feel lost and alone with experiences in placement and hearing others reminded me it was ok to feel whatever it is you are feeling’.

‘Being a part of this experience has opened up my understanding of the need for honest conversations from diverse backgrounds to add my understanding and depth of compassion’.

Keywords interprofessional education; reflection; Schwartz rounds; undergraduate

References

Maben J, Taylor C, Dawson J, Leamy M, McCarthy I, Reynolds E, Ross S, Shuldham C, Bennett L, Foot C A realist informed mixed-methods evaluation of Schwartz center rounds® in England. Southampton (UK): NIHR Journals Library; November 2018. https://doi.org/10.3310/hsdr06370

Grimbly, V, Golding, L. Running interprofessional Schwartz Rounds with healthcare students in the North of England: building capacity and evaluating impact. University of Liverpool Report. https://s16682.pcdn.co/wp-content/uploads/2022/03/Schwartz-North-2020-2021-Annual-Report-final-002.pdf. Accessed 21st Jan 2024

Monisha Tarini Premkumar and Muhammad Asim Javaid

School of Medicine, Anglia Ruskin University

Introduction/Background Anatomy is the foundation of all medical fields. Neurophobia, the fear of neuroanatomy and its connection to clinical neurology, has become a global educational issue. Understanding small 3D-structures, like those in the brain, poses challenges and leads to difficulties in learning. This lack of understanding affects neurology and undermines the confidence of general practitioners. Consequently, there is an increase in unnecessary neurology referrals, longer wait times and delayed diagnoses, resulting in higher patient fatalities and health problems. To address this, instructional approaches and technology like 3D-Digital Models and Virtual Reality are being explored to improve neuroanatomy education.

Methodology and Results Existing research on neuroanatomical tools have been developed without direct input from students, such as an e-tool using brain MRI-images to teach ventricular anatomy¹ and e-learning tool for spinal pathway neuroanatomy², and thus are influenced by researchers' biases. To overcome this, we will directly survey medical students and educators to identify challenging areas of brain anatomy. Our goal is to design a custom e-learning tool addressing these challenges. To achieve this, we will survey students and educators from multiple medical schools in the UK. The survey will focus on visually challenging neuroanatomy areas, reasons for the difficulties and important features for 3D-design that can alleviate these challenges.

Conclusion By understanding weaknesses from the users' perspective and considering cognitive load, we can create a targeted neuroanatomy teaching tool. This tool will enhance the learning experience for students and teachers, combat neurophobia and contribute to a better future for the NHS.

Keywords education; medical; neuroanatomy; teaching tool

References

1. Adams CM, Wilson TD. Virtual cerebral ventricular system: an MR-based three-dimensional computer model. Anat Sci Educ. 2011. https://anatomypubs.onlinelibrary.wiley.com/doi/epdf/10.1002/ase.256. Accessed Jan 24, 2024.

2. Javaid MA, Schellekens H, Cryan JF, Toulouse A. Neuroanatomy of the spinal pathways: evaluation of an interactive multimedia e-learning resource. MedEdPublish. 2020;9. https://doi.org/10.15694/mep.2020.000088.1

Jo Hartland¹ and Megan Brown²

¹University of Bristol; ²Newcastle University

Background Medical Education policies determine access to education, support, and outcomes. Policies are not neutral; they embody socio-political contexts and dominant ideologies [1]. Critically examining policies to ensure they align with the pursuit of social justice is important. One area of medical education where exploration of policy is necessary relates to the support of disabled learners. Disabled trainees encounter significant barriers in environments not designed for their needs and may require tailored support [2]. It is imperative that policies address systemic barriers rather than perpetuate them, and so critical examination of disability policy is essential to identify strengths and areas of improvement, and ensure policies remain responsive to evolving socio-political dynamics.

Methods The General Medical Council's 2021 guidance, ‘Welcome and Valued’, was a prominent and important development in UK medical education disability policy. We conducted an in-depth, critical poetic inquiry, adhering to Glesne's principles [3], exploring power dynamics, underlying ideologies and potential implications for disabled learners within this guidance. We created a “literature-voiced” poem “(Un)Welcomed and (De)Valued,” using language to advocate for systemic policy change.

Findings/Discussion We will perform the poem live, exploring tensions and conflicts of the organisation and the disabled learner as two distinct voices. In doing so, we will communicate key themes of our critical analysis, for example, productivity, competence, responsibility and gatekeeping. Following the live performance, we will give insight into our creative process, exploring how attendees can use this research as a template to critically examine medical education policy through a social justice lens.

Keywords accessibility; critical analysis; disability; poetry

References

1. Iwasa, N. (2010). The impossibility of political neutrality. Croatian Journal of Philosophy, 10(29), 147–155.

2. Jain, N. R., & Scott, I. (2023). When I say … removing barriers. Med Educ., 57, 6, 514, 515, https://doi.org/10.1111/medu.15075

3. Glesne, C. (1997). That rare feeling: re-presenting research through poetic transcription. Qualitative Inquiry, 3(2), 202–221, https://doi.org/10.1177/107780049700300204.

Andrew O'Malley and Ayla Ahmed

University of St Andrews

This research aims to employ an artificial intelligence (AI) large language model (LLM) to generate valid single best answer (SBA) exam questions for undergraduate medical students. The objective is to design a prompt that generates SBA questions, which can be quality-assured using established methods to ensure they are valid; this will enable rapid replenishment of depleted assessment banks, which resulted from Covid-era open-book exams, and provide students with more formative assessments.

Methods A commercially available LLM (OpenAI GPT-4¹) was prompted to generate 200 SBA questions based on Medical Schools Council guidance and Scottish Graduate-Entry Medicine (ScotGEM) Learning Outcomes (LOs). The questions were screened to ensure they conformed with the guidelines and LO before a subset were included in an examination alongside an equal number of human-authored questions, which was undertaken by students. Facility and discrimination index was calculated for each item, and the performance of AI- and human- authored questions was compared.

Results Most AI-generated SBAs were exam-ready with little to no modifications. Adjustments were made to correct, for example, the inclusion of ‘all of the above’ answers, American spellings and non-alphabetised options.

Statistical analysis showed no significant difference between AI- and human-authored questions in terms of facility and discrimination index.²

Conclusion LLMs can produce questions adhering to best-practice guidelines and relevant LOs, though a quality-assurance process is needed to ensure proper formatting and alignment. Future work will refine AI prompts for more curriculum-specific question alignment.

Keywords AI; assessment; medical; undergraduate

References

1. Achiam, Josh et al. GPT-4 Technical Report. arXiv. Preprint posted online March 15, 2023. https://doi.org/10.48550/arXiv.2303.08774

2. Godfrey Pell, Richard Fuller, Matthew Homer & Trudie Roberts (2010) How to measure the quality of the OSCE: a review of metrics – AMEE guide no. 49, Med Teach, 32:10, 802–811. https://doi.org/10.3109/0142159X.2010.507716

Rasi Mizori, Muhayman Sadiq, Malik Takreem Ahmad, Anthony Siu, Zijing Yang, Helen Oram and James Galloway

King's College London (KCL)

Background The shift to remote learning models due to the COVID-19 pandemic has necessitated a re-evaluation of assessment methods across STEM disciplines. This study investigates the impact of open-book examinations (OBEs) versus closed-book examinations (CBEs) on student performance, offering insights that could inform the optimisation of learning strategies across diverse scientific fields.

Methods This study adhere to PRISMA guidelines, a systematic review of peer-reviewed articles from PubMed, Scopus and ERIC. Research design validity was assessed using the Newcastle-Ottawa scale, and a random-effects model accounted for study variability, with I² and Tau² statistics measuring heterogeneity.

Results From 63 identified studies, 8 were included. The meta-analysis revealed a notable increase in marks for OBEs compared to CBEs, with an overall mean difference of 5.91, while showing substantial heterogeneity (I² value of 97%). Subgroup analysis showed higher mean differences in observational and quasi-experimental studies for OBEs.

Discussion While results favour OBEs, limitations of our study, such as the small pool of included studies, make it difficult to be confident in their superiority. Factors like proctoring and technical issues necessitate a nuanced understanding of their effectiveness. Moreover, the emergence of large language models (LLMs) prompts a re- evaluation of OBE integrity, challenging traditional assessment with advanced information retrieval capabilities.

Conclusion The high heterogeneity makes generalising our results challenging. We conclude that OBEs and CBEs likely assess different competencies, with OBEs more aligned with the requisite skills for contemporary STEM examinations. The impact of LLMs on the effectiveness of OBEs warrants further investigation.

Keywords assessment; closed-book; education; examination; open-book; STEM

Ben Kumwenda

Centre for Medical Education, School of Medicine, University of Dundee

Background The Multiple Mini Interview (MMI) is used internationally as a selection tool for medical school admissions. The MMI is a series of short, one-on-one interviews that assess such attributes as communication, problem-solving and teamwork skills.^1,2 This study investigated the predictive validity of the MMI for the following outcome measures: medical school performance (Educational Performance Measure [EPM], Situational Judgement Test [SJT], Prescribing Safety Assessment [PSA]) and passing professional membership exams in medicine (RCGP, MRCP, MRCS).

Methods Data from doctors who graduated from UK medical schools and sat the first part of professional membership exams in 2017–2019 were used. The UK Medical Education Database³ provided linked data from different sources, including medical school admissions, assessments and postgraduate training. Multinomial logistic regression analyses estimated the odds of passing college membership exam on first attempt.

Results and Conclusion MMI was a significant predictor of medical school performance, even after controlling for other factors such as high school grades and clinical aptitude tests. The MMI was also a significant predictor of passing college exams on first attempt, but the effect size was smaller than for those assessments that occur nearer to postgraduate training - EPM, SJT, and PSA scores.

Although the proportion of variance explained by MMI and all other predictors is small, MMI remains a valuable tool for medical school admissions. In the absence of innovations that can improve prediction, medical schools should continue using MMI in combination with other factors, such as UCAS and UCAT scores, to make admissions decisions.

Keywords admissions; assessment; career progression; postgraduate training; predictive validity

References

1. Brownell K, Lockyer J, Collin T, Lemay J. Introduction of the multiple mini interview into the admissions process at the University of Calgary: acceptability and feasibility. Med Teach 2007; 29(4):394–396. https://doi.org/10.1080/01421590701311713

2. Dowell, J., Lynch, B., Husbands, A., Kumwenda, B. The multiple mini-interview in the UK context: three years of experience at Dundee. Med Teach, 2012; 34, 297–304. https://doi.org/10.3109/0142159X.2012.652706

3. Dowell, J., et al. “The UK medical education database (UKMED) what is it? Why and how might you use it?“BMC Med Educ. 2018;18(1): 6.

Jess Gurney

University of Edinburgh

Background Fairness is considered a fundamental principle of assessment though is a principle that is not simple to define.¹ Parallels have been made to social principles of justice; procedural justice, distributive justice and interactional justice.²

Context The MSc Clinical Education at Edinburgh University is an online, distance learning course. The assessment in the first year entails three 20 credit courses, each of which is assessed with a 3000-word written assignment relating educational theory to the student's wider context.

Methods Eight semi-structured interviews were completed and analysed using interpretive phenomenological analysis.

Results Considering distributive justice, students perceived their grades and feedback to be fair and reflective of the time and effort they had put into the assessment. Procedural justice was emphasised in relation to the transparency of the process such as assignment instructions, marking rubrics and exemplars. There were contrasting opinions relating to optionality in assessment. The benefits of flexibility in relation to fairness were recognised but this was balanced by concerns for consistency in marking different formats. The consideration of special circumstances was of particular importance to students in the postgraduate distance learning context. Considering interactional justice, they identified that they were respected as adult learners and that some students required more support than others.

Conclusions Student perspectives regarding fairness in assessment related to the aspects of social justice previously identified in the literature.² These aspects paralleled expectancy of success from expectancy-value theory.³ This improved understanding of fairness and motivation can allow us to shape future assessment practices.

Keywords assessment; education; fairness; medical; postgraduate

References

Valentine N, Durning SJ, Shanahan EM, Van Der Vleuten C, Schuwirth L. The pursuit of fairness in assessment: looking beyond the objective. Med Teach 2022;44(4):353–9. https://doi.org/10.1080/0142159X.2022.2031943

Rasooli A, Zandi H, Deluca C. Conceptualising fairness in classroom assessment: exploring the value of organisational justice theory. Assessment in education: principles, policy &amp; Practice 2019;26(5):584–611. https://doi.org/10.1080/0969594X.2019.1593105

Wigfield A, Eccles JS. Expectancy–value theory of achievement motivation. Contemporary Educational Psychology 2000;25(1):68–81. https://doi.org/10.1006/ceps.1999.1015

Sahena Haque¹, Paul Baker² and Eliot Rees³

¹Manchester University NHS Foundation Trust; ²NHSE WTE NW; ³Keele University

The Academic or Specialised Foundation Programme (AFP/SFP) was designed to allow trainees to gain experience in research, teaching and leadership with the ultimate aim of increasing recruitment and retention of clinician academics. Trainees typically spend a third of the F2 year pursuing academic activities. There is no published literature about the ARCP process or other evaluation of AFP/SFP.

The aim of the study was to explore how foundation training programme directors (FPD) conceptualise success in the AFP/SFP.

Methods Semi-structured interviews were conducted with FPDs across the UK involved in Foundation ARCP.

Results and Conclusions Five FPDs responsible for 66 AFP/SFP were interviewed: three were female and two were male. All were consultants with > 5 years experience in medical education.

Five main themes emerged indicating FPDs hold AFP/SFP trainees in high regard and are generally impressed with their performance/achievements. They expressed frustration about the lack of structure around the documentation and assessment. All FPDs desired better standardisation in the assessment of SFP trainees. In the absence of formal guidelines, trainers determined aspects of a successful programme. However, components of a successful AFP/SFP differed between FPDs and ranged from clearly measurable outcomes, such as presentation of a research project, to aspects that are not easily measured, for example, achieving personal development and exploring interests.

Development of a process for the formal documentation and standards for assessing the SFP would be welcomed by trainers, reduce variability across the UK of ARCP for SFPs and may improve the effectiveness of the programme.

Keywords ARCP; assessment; educators; foundation; postgraduate

References

The academic careers committee of modernising medical careers and the UK clinical research Collaboration medically- and dentally-qualified academic staff: recommendations for training the researchers and educators of the future. Report. London 2005.

Guide to the foundation annual review of competence progression (ARCP) process. Health education England. 2017 The foundation programme curriculum 2016. Health Education England. 2016

Lynn Urquhart

University of Dundee

There have been many developments in assessment with the UK medical education sphere, notably with the imminent implementation of the MLA.¹ At local level, the medical school in Dundee has, for many years, struggled with improving students' perceptions of Assessment and Feedback as evidenced by poor NSS scores.² Previous attempts to improve assessment have focused on data and systems with limited improvement in perception and performance. An alternative approach to improvement has been trialled this academic year focusing on how students feel about assessment. Using Mentimeter to identify the mood of various cohorts, those aspects related to assessment with the most striking negative feelings related to assessment and feedback were addressed first and foremost with early and significant positive feedback from students. This approach has significantly improved the ‘them and us’ feeling that existed around assessment which has been shown to be detrimental to feedback success.³ Through this work came the ‘no surprises’ mantra leading to a clear new way of working and learning with and for students. In this what is your point, the author will address a feelings-based approach to improvement as one potential solution to many challenges seen in medical education. In particular, it will be argued that this approach might be the solution in this challenging educational post-covid climate where mental health is noted to be such a challenge in higher education.⁴

Keywords assessment; emotions; improvement

References

1. https://www.gmc-uk.org/education/medical-licensing-assessment

2. https://www.officeforstudents.org.uk/advice-and-guidance/student-information-and-data/national-student-survey-nss/

3. Urquhart, L. M., Rees, C. E., & Ker, J. S. (2014). Making sense of feedback experiences: a multi-school study of medical students' narratives. Med Educ, 48(2), 189–203. https://doi.org/10.1111/medu.12304

4. Dogan-Sander, E., Kohls, E., Baldofski, S., & Rummel-Kluge, C. (2021). More depressive symptoms, alcohol and drug consumption: increase in mental health symptoms among university students after one year of the COVID-19 pandemic. Front Psych, 12, 790974. https://doi.org/10.3389/fpsyt.2021.790974

Lakshminarayanan Varadhan, Ruth Kinston, Matthew Webb, Peter Coventry and Stuart McBain

Keele University

In preparation for the introduction of the Medical Licensing Assessment (MLA), it is essential that Schools offering Primary Medical Qualifications can demonstrate effective alignment between their clinical assessments and the requirements of the Clinical and Professional Skills Assessment (MLA-CPSA).¹ The MLA content map provides an extensive mapping of the various clinical capabilities on which medical students need to be assessed.² Mapping this information against curricular content during clinical years of undergraduate programmes can provide a useful template to blueprint OSCEs that form part of undergraduate medical programmes.

Keywords assessment; blueprint; longitudinal; OSCE

References

1. https://www.gmc-uk.org/education/medical-licensing-assessment

2. MLA Content Map. General Medical Council, first published 2019, updated 2021. https://www.gmc-uk.org/-/media/documents/mla-content-map_pdf-85707770.pdf

David Hettle, Annie Noble-Denny and Elizabeth Anderson

University of Bristol

Background Junior doctors are important assets in supporting workplace-based learning.¹ Their training requirements reflect the GMC's mandate that teaching is integral to a doctor's role.² Despite the existence of professional standards for educators, little is known about how to support doctors' development towards such goals, with limited research exploring junior doctors' perspectives.³

Methodology This qualitative study employed semi-structured interviews to explore eight junior doctors' views on their practice and development as educators. Using a constructivist viewpoint and interpretative phenomenological approach, themes were identified through reflexive thematic analysis, developing understanding on junior doctors as educators, framed by community of practice theory.

Results As junior doctors largely educate within workplaces, challenges include time constraints, accessing educator communities and token support from training programmes. Doctors described tension between clinical and educator roles, yet those engaged in medical education beyond educational delivery felt more settled and supported in their educator status. Junior doctors struggled with educator development, particularly alongside clinical progression, feeling discouraged by non-existent career pathways and self-driven development, lacking support from clinical or educator communities. When available, the impact of role models, dedicated time and networks were invaluable.

Conclusions If junior doctors being educators is truly important then how educator practice and development is assessed and promoted must be addressed. Strategies which afford time, role models and access to educational communities of practice, in context of maintaining roles as clinicians in training must be established. Most critically, development of integrated career pathways for junior doctors and educators must be pursued and created.

Keywords careers; faculty development; junior doctors; research; support

References

1. Ramani S, Mann K, Taylor D, Thampy H. ‘Residents as teachers: near peer learning in clinical work settings: AMEE guide no. 106’. Med Teach 2016;38(7):642–655. https://doi.org/10.3109/0142159X.2016.1147540

2. General Medical Council. Good medical practice. London: General Medical Council.

3. Bussey S. Teaching undergraduate medical students: exploring the clinical teacher experience. EdD thesis, The Open University, 2019.

Gillian Vance

Newcastle University

The NIHR Incubator for Clinical Education¹ was established in 2020 with the goal of building capacity and capabilities in clinical education research. In this field, researchers seek to enhance the education, training and development of health and social care practitioners and the structures and contexts in which they work and learn, in order to improve the health and care needs of society.

Many talented and enthusiastic researchers—across professions—are unable to develop their careers due to lack of opportunity, or awareness of opportunity. The Incubator network provides targeted support, guidance and opportunities for researchers to develop their career.

In this session, we will share our successes in building an Incubator community. We will give examples of how members have developed the evidence base around research careers and established practical, creative ways to reach, engage and support others. These include the ‘Mastering the Basics’ training programme, where we delivered a series of interactive webinars around key elements of research design and delivery ahead of an in- person event, where attendees set about preparing a fictional funding application and presenting this to a panel of ‘funders’. We will also share our success in setting collaboratively national priorities for clinical education research and agreeing the relationships, structures and support needed for long-lasting research infrastructure.

The Incubator has received further NIHR funding to continue its work. We welcome all those who wish to pursue academic careers in Clinical Education, as well as those who support and mentor aspiring researchers in this field.

Keywords career development; multi-professional

Reference

1. https://www.nihr.ac.uk/researchers/supporting-my-career-as-a-researcher/incubators.htm

Helen Church¹, Megan Brown², Lynelle Govender³ and Deborah Clark⁴

¹University of Nottingham; ²Newcastle University; ³University of Cape Town; ⁴The University of Sheffield

Introduction Health professionals (HCPs) who change careers from clinical practice to become dedicated health professions educators provide valuable expertise. However, some evidence¹ suggests this career change brings significant professional and personal challenges. The extent of this evidence is unclear—no existing reviews have consolidated evidence across professional and geographical contexts. Our scoping review addresses this gap.

Methods Using Arksey and O′Malley's² methodology, we analysed literature focussed on HCPs (from medicine, nursing, dentistry, and allied health professions) who work in education and no longer practice clinically. Covidence software aided the four reviewers to independently screen, select and extract data from articles sourced from seven databases and grey literature. Thematic analysis was used to deliver the qualitative results of the review. Articles from any country (accessible in English language) were considered.

Results A total of 51 articles were included. Results will be reported through a quantitative demographics summary and qualitative themes of ‘Making the leap’, ‘Identity transition’ and ‘Interprofessional differences’.

Discussion The challenges faced by HCPs when transitioning to education vary globally. Complex licensing requirements and identify shifts create a period of ‘liminality’ in which individuals must redefine their ideas of ‘self’. Effective recruitment and retention strategies are needed for those making this transition. Significant gaps in the literature exist e.g. in professions beyond nursing, and outside the Global West.

Conclusion This scoping review highlights the need for tailored support and comprehensive research to understand and ease the complex transition HCPs face when shifting from clinical practice to a career in medical education.

Keywords career transition; faculty, professional identity; health professions educators; scoping review

References

1. Church H, Brown MEL. Rise of the Med-Ed-ists: achieving a critical mass of non-practicing clinicians within medical education. Med Educ 2022;56(12):1160–2. https://doi.org/10.1111/medu.14940

2. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005;8(1):19–32. https://doi.org/10.1080/1364557032000119616

Matthew Byrne¹, Megan Brown² and MedEd Collaborative

¹University of Oxford; ²Newcastle University

Introduction Engaging learners in health professions education research (HPER) from the beginning of their career is a critical strategy in addressing the academic workforce crisis [1]. However, there are limited opportunities for learners to become involved in high-quality HPER. We aimed to create a ‘community of scholars’ for trainees and students to increase HPER opportunities. A community of scholars is a community of practice where the common area of interest is scholarly work - such as publications and presentations [2].

Methods We formed ‘MedEd Collaborative’ in September 2020, which consists of a committee of trainees, students, and early-career researchers, who oversee a network of collaborators around the UK. We cultivated our community thorough collaborative writing following guidance by Ramani et al. [2]. Our primary objective was to publish one original research article that used a collaborative research approach and incorporated theory.

Results In 3 years, we have written 14 publications, including four original research articles, we have delivered 19 presentations, and won four international prizes and two grants. Our projects have involved a total of 82 trainees and students. The collaborative structure facilitates increasing ‘legitimate peripheral participation’ in HPER [3]: acting as a collaborator provides basic research skills development; and learners can gradually assume more responsibility as their skills progress by acting on project committees.

Conclusions MedEd collaborative has developed a community of scholars that increased access to high-quality HPER opportunities for students and trainees, aided development of those individuals' research skills and worked together to produce high impact outputs.

Keywords collaborative; community of scholars; health professions education research; undergraduate; postgraduate

References

1. Williams CS, Rathmell WK, Carethers JM, Harper DM, Lo YMD, Ratcliffe PJ, Zaidi M A global view of the aspiring physician-scientist. . Azziz R, ed Elife. 2022;11:e79738. https://doi.org/10.7554/eLife.79738

2. Ramani S, McKimm J, Forrest K, Hays R, Bishop J, Thampy H, Findyartini A, Nadarajah VD, Kusurkar R, Wilson K, Filipe H, Kachur E Co-creating scholarship through collaborative writing in health professions education: AMEE guide no. 143. Med Teach 2022;44(4):342–352. https://doi.org/10.1080/0142159X.2021.1993162

3. Lave J, Wenger E. Situated learning: legitimate peripheral participation. Cambridge University Press; 1991. https://doi.org/10.1017/CBO9780511815355

Arushi Vemprala¹, Parvati Nandy², Rakesh Kumar² and Shomik Bhattacharya²

¹Reading, Royal Berkshire Hospital; ²Sikkim Manipal Institute of Medical Science, Sikkim, India

Medical students are unaware of the specialisation to pursue and the majority settle for an area that they receive by a principle of exclusion and circumstances rather than based on pure choice. The idea of informed decision-making for postgraduate courses after MBBS is still far from actuality. It has been suggested that an understanding of factors that influence career decisions may help in work planning, and avoiding over or under- supplying of doctors in different specialties. Factors that influence career decisions have been reported by medical colleges around the globe. However, there is very little information about the career preferences of medical students in India.

We sought to identify the career preferred by medical students and Interns at our institution and the factors influencing it in choosing their specialty before significant clinical exposure.

The study was conducted in the Sikkim Manipal Institute of Medical Sciences, India, after obtaining clearance from the institute's ethical committee. In a cross-sectional study, 200 participants were enrolled who fulfilled the inclusion criteria. Prior consent for participation was obtained. Participants were given an information sheet before enrollment. An online questionnaire was sent to participants to look for the desired specialty, the reasons for the choice and factors playing a role in choosing the area. Data was recorded in a predesigned proforma and Excel sheet for analysis. Findings, implications and strategies to provide adequate career counselling and workforce planning will be discussed at the time of the presentation.

Keywords career; medical; preferences; students; undergraduate

References

1. Wright B, Scott I, Woloschuk W, Brenneis F, Bradley J. Career choice of new medical students at three Canadian universities medicine versus specialty medicine CMAJ 2004;170:1920–4. https://doi.org/10.1503/cmaj.1031111

2. Soethout MB, Heymans MW,tenCate OJ. Career preference and medical students' biographical characteristics and academic achievement. Med Teacher 2008;30:e15–22. https://doi.org/10.1080/01421590701759614

Bethany Bracewell¹, Alison Ledger² and Anne-Marie Reid¹

¹University of Leeds; ²University of Queensland, Australia

Background Lack of recruitment to clinical academic careers is of national and international concern, due to future workforce implications.¹ Contributing factors are beginning to receive UK researchers' attention,² with limited awareness and promotion in undergraduate medical education likely part of the story. Our study explored undergraduate experiences which support or hinder take up of the UK academic pathway, to identify ways to encourage future clinical academics.

Methods We chose interview methods to co-construct detailed accounts of undergraduate experiences and motivations for clinical academic careers, and recruited a purposeful sample of specialised foundation programme (SFP) doctors and final year medical students who had applied for SFP positions. We interpreted interview transcripts using reflexive thematic analysis, consistent with our constructivist lens.

Results Four key stages stimulated and supported students in pursuing an academic career: (1) lighting the inner spark, (2) igniting the fire, (3) feeding the fire and (4) seeing through the smoke. Although students showed strong inner drive, meaningful undergraduate experiences and positive interactions with academics were crucial. Extra-curricular activities played a more persuasive role than core undergraduate education (which seemed to reinforce a misguided assumption that clinical academics are less accomplished in clinical or social skills).

Conclusions Early positive experiences are needed to overcome stereotypes and for students to realise their potential as a clinical academic. We recommend schools raise awareness of academic careers early, ensure all students have opportunities to participate in relevant activities with academic teams and develop educators and researchers who can engage and inspire others.

Keywords academic; careers; education; research; undergraduate

References

1. Medical Schools Council. Survey of medical clinical academic staffing levels. July 2018. Accessed: December 2, 2023. Medical Schools Council. https://www.medschools.ac.uk/media/2491/msc-clinical-academic-survey-report-2018.pdf.

2. Finn G, Morgan J. From the sticky floor to the glass ceiling and everything in between: a systematic review and qualitative study focusing on gender inequalities in clinical academic careers. University of Manchester. November 2020. Accessed December 2, 2023. https://www.hyms.ac.uk/assets/docs/research/inequalities-in-clinical-academic-careers-full-report.pdf.

Robert Bain, Gillian Vance and Bryan Burford

School of Medicine, Newcastle University

Background Clinical academics comprise a small but important sector of the medical workforce, and structured pipelines exist for doctors to follow these careers.^1,2 In the UK the earliest step is the Specialised Foundation Programme (SFP, formerly Academic Foundation Programme [AFP]) immediately after medical school, which is highly competitive.³ However, there is no publicly available data detailing the demographics or backgrounds of those who apply to, or enter the SFP nationally.

Methods Data were drawn from the UKMED for all those who entered medical school from 2010 to 2018 and who applied to the UK foundation programme from 2014 to 2022. Logistic regression examined the outcome of applying/not applying to SFP, with predictors categorised into three groups—socioeconomic background, academic background and protected characteristics. A second analysis considered predictors of a successful application.

Results Analysis considered data for 43,306 doctors. About 21.5% of individuals had applied to the SFP, with 33.6% of these being successful. Males, those with additional or intercalated degrees and those from a black or minority ethnic background were more likely to apply to the SFP. Those with additional or intercalated degrees were more likely to be offered an SFP. Those with disabilities were significantly less likely to be offered an SFP.

Conclusion This analysis provides insights into the future clinical academic workforce. Findings also raise questions for undergraduate programme directors, and selectors within the SFP around ensuring all can access early academic training opportunities.

Keywords careers; cohort study; specialised foundation programme; UKMED; widening participation

References

1. Baroness Brown of Cambridge. Clinical academics in the NHS inquiry. House of lords science and technology committee; 2023. Available from: https://committees.parliament.uk/publications/33678/documents/184035/default/

2. Ologunde R, Sismey G, Kelley T. The UK Academic Foundation Programmes: are the objectives being met?. J R Coll Physicians Edinb 2018;48(1):54–61. https://doi.org/10.4997/jrcpe.2018.114

3. Donaldson CJ, Sequeira Campos M, Ridgley J, Light A. Effect of medical school attended on the chances of successfully embarking on a clinical-academic career in the UK. Postgrad Med J 2022;98(1155):4–9. https://doi.org/10.1136/postgradmedj-2020-139001

Anthony Codd and Philip White

Newcastle University

Academic practice in medical education encompasses three broad domains: teaching, research and leadership. We propose that through alignment with the traditional university-academic model, a hierarchy has been established in which prestige and perceived ‘value’ favour leadership over research and research over teaching. This creates a tacit career path which is neither derisible to all, nor is particularly helpful in the varied settings in which medical education occurs, and in the diverse professional groups who engage in medical educational activity. For example, one must often (explicitly or implicitly) acquire higher research qualifications or a research portfolio in order to move from an teaching position to a leadership position, even if these skills are peripheral to the subsequent job role.

In this ‘what is your point’ session, we would look to discuss and challenge this conceptualisation of academia in medical education, and suggest a novel model to help medical educators at all stages of their career take stock of where they currently are and where they aspire to be. By introducing a visual model that is simple to produce and read, we can create a common ‘language’ to communicate the richness and variety of individual careers in medical education, prompt reflection and map out career goals and identify the people who might help achieve them.

Keywords careers; development; leadership; research; teaching

Nicholas Shedd

University of Warwick

Background Clinical Judgement (CJ) is a key part of medical decision making.¹ It is regarded as one of the most important traits for a doctor to possess.² However, CJ is ill defined and poorly understood.³

Aims This review examined the components of CJ in trainee doctors and fully qualified doctors, with the purpose of gaining a better understanding of the processes which make up CJ and how they change with experience.

Methods Articles related to CJ were identified in the Medline and Embase databases, and underwent a systematic inclusion–exclusion criteria. These included studies then underwent thematic analysis.

Results Nine articles were included in the final study, yielding 27 descriptive themes split between trainee and fully qualified doctors. From these descriptive themes seven parent analytical themes were synthesised. Fully qualified doctors tended to possess a confident decision-making process, with mature information processing, and adaptable modes of cognition. Trainee doctors had difficulty organising information, were impacted by environmental mediation and possessed an iterative process of decision making.

Conclusion CJ is an under researched area despite its impact on clinical practice. This review identified some of the components of CJ in doctors at different stages of their career. A deeper understanding of these components could allow doctors to identify good CJ and enable them to make better decisions in the clinical environment.

Keywords clinical decision making; clinical judgement; clinical reasoning

References

1. Masic I. Medical decision making—an overview. Acta Inform Med Sept 2022;30(3): 230–235. https://doi.org/10.5455/aim.2022.30.230-235

2. Price PB, Lewis EG, Loughmiller GC, Nelson DE, Murray SL, Taylor CW Attributes of a good practicing physician. J Med Educ Mar. 1971;46(3): 229–237. https://doi.org/10.1097/00001888-197103000-00007

3. Tsang M, Martin L, Blissett S, Gauthier S, Ahmed Z, Muhammed D, Sibbald M What do clinicians mean by good clinical judgement: a qualitative study. International Medical Education 2023; 2(1): 1–10. https://doi.org/10.3390/ime2010001

Dilmini Karunaratne¹, Madawa Chandratilake² and Kosala Marambe³

¹School of Medicine, University of Dundee; ²Faculty of Medicine, University of Kelaniya, Sri Lanka; ³Faculty of Medicine, University of Peradeniya, Sri Lanka

Background The context specificity of clinical reasoning reflects that diverse contextual factors significantly influence doctors' reasoning.^1,2 This research investigated the impact of different clinical specialities on acquiring clinical reasoning skills in junior doctors to foster the advancement of these skills.

Methods A qualitative study employing a hermeneutic phenomenology³ methodology was conducted using semi- structured interviews (n = 18) and post-consultation discussions (n = 48). Immediate medical graduates at a main teaching hospital in Sri Lanka, working in the four main clinical specialties, were enrolled in the study. The data were analysed thematically to identify the overall patterns to explain the dataset.

Findings The application of knowledge and skills from multiple specialities enabled better clinical reasoning in contrast to the majority view that these are not transferable between specialities. Also, junior doctors often deviated from the standard approach to obtaining a clinical history, placing more emphasis on the comorbidities or the presenting complaint, based on the specialty-specific orientation. The former was associated with diagnosis orientation, a broader base of clinical reasoning, and more patient-centred care (e.g., General Medicine, Paediatrics, and Gynaecology) than the latter which was oriented towards management (e.g., surgery, Obstetrics).

Conclusion Working within a particular speciality encourages a narrow focus on speciality-specific diagnoses. Certain specialities promote a diagnostic orientation, which allows for a more comprehensive form of clinical reasoning and improved patient-centred care compared to specialities that prioritise management. Therefore, trainees should be encouraged to consider differential diagnoses beyond the confines of their specific speciality, particularly in specialities that are management-oriented.

Keywords clinical reasoning; decision making; hermeneutic phenomenology; junior doctors; qualitative research

References

1. Durning S, Artino AR, Pangaro L, van derVleuten CP, Schuwirth L. Context and clinical reasoning: understanding the perspective of the expert's voice. Med Educ 2011;45(9):927–938. https://doi.org/10.1111/j.1365-2923.2011.04053.x

2. Eva KW. What every teacher needs to know about clinical reasoning. Med Educ 2004;39(1):98–106. https://doi.org/10.1111/j.1365-2929.2004.01972.x

3. Kafle NP. Hermeneutic phenomenological research method simplified. Bodhi: An Interdisciplinary Journal 2011;5(1):181–200. https://doi.org/10.3126/bodhi.v5i1.8053

Alice Roberts, Jessica Polkey, Laura Black and Lucy McGowan

Glasgow Royal Infirmary

Aims Clinical placements for undergraduate medical students are required to cover a breadth of topics. This could lead to overload of tutorials instead of integrated teaching, which is shown to improve understanding (1). This ‘Theme of the Week’ project used mid-week tasks and Friday games based around a weekly theme to address difficult to reach undergraduate learning outcomes.

Methods Two groups of students (group 1 n = 33, group 2 n = 34) were given an investigator task at the start of the week. Group 2 additionally received a formative quiz. At the end of the week, the groups played a topic-related game (team-based quizzes, clinical describing games and clinical integrative puzzles (2)). Qualitative self-assessment feedback questionnaires collected data at the start and end of the week regarding perceived confidence in the topic.

Results Survey response numbers varied from 16 to 29 responses per questionnaire, per group. Perceived confidence in understanding improved through the week across all topics, for example from 25.5% (n = 51) to 71.0% (n = 38) in Swollen Limb. The games were also universally deemed to consolidate learning of each topi—93.5% (n = 31) of students agreed with respect to hypercalcaemia, 89.5% (n = 38) with swollen limb and 97.1% (n = 34) with anaemia.

Conclusions Our ‘Theme of the Week’-based learning tasks showed that alternative learning methods to tutorials are received positively in clinical placement and appear to improve understanding of targeted topics. This is particularly relevant with increasing student placement numbers and the need for flexible and integrated learning methods.

Keywords games; integrated; innovative; qualitative; undergraduate

References

1. Grant J. Principles of Curriculum Design. In: Swanwick T, Forrest K, O'Brien B, eds. Understanding medical education: evidence, theory, and practice. 3rd ed. Wiley Blackwell; 2019.

2. Ber R. The CIP (comprehensive integrative puzzle) assessment method. Med Teach 2003;25(2):171–176. https://doi.org/10.1080/0142159031000092571

Amir Mahmood and Christopher M. Smith

University of Warwick

Background Newly qualified doctors hold the responsibility of responding to the most serious of medical emergencies, a cardiac arrest. They may be the first medic on scene, despite being the most junior. This may be the first time they are performing CPR or seeing a cardiac arrest in real life.

Aims The aim of this study is to determine if final year medical students have any experience of doing CPR or feel confident responding to an in-hospital cardiac arrest as a newly qualified doctor.

Methods I conducted an online survey among final year medical students on the medical degree programme at Warwick Medical School. They were asked about their experience on placement to determine whether they had previously done CPR or other skills in a cardiac arrest situation.

Results The majority of students had limited experience, with 14% having done CPR and 41% having ever witnessed a cardiac arrest. Most would feel confident doing CPR and offering to help but less confident in other skills such as assisting ventilation and scribing. The majority felt more training was required, citing lack of confidence as their main barrier.

Conclusion Being a newly qualified doctor is a role that holds a massive responsibility with lives at stake. They have very limited experience during their training in managing the most seriously unwell patients. Medical students felt confident taking on some roles but wanted more experience and training. There is scope to research further across other medical schools and determine whether the general medical school curriculum needs change.

Keywords cardiac arrest; clinical skills; education; resuscitation

References

Baldi, E., Contri, E., Bailoni, A., Rendic, K., Turcan, V., Donchev, N., Nadareishvili, I., Petrica, A., Yerolemidou, I., Petrenko, A., Franke, J., Labbe, G., Jashari, R., Pérez Dalí, A., Borg, J., Hertenberger, N. and Böttiger, B.W. (2019) ‘Final-year medical students’ knowledge of cardiac arrest and CPR: we must do more!‘, Int J Cardiol, 296, pp. 76–80. https://doi.org/10.1016/j.ijcard.2019.07.016

Burridge, S., Shanmugalingam, T., Nawrozzadeh, F., Leedham-Green, K. and Sharif, A. (2020) ‘A qualitative analysis of junior doctors’ journeys to preparedness in acute care‘, BMC Med Educ, 20(1), pp. 12–8. https://doi.org/10.1186/s12909-020-1929-8

Hawkins, N., Younan, H.C., Fyfe, M., Parekh, R. and Mckeown, A. (2021) ‘Exploring why medical students still feel under-prepared for clinical practice: a qualitative analysis of an authentic on-call simulation‘, BMC Med Educ, 22(1). https://doi.org/10.1186/s12909-021-02605-y

Merry Patel and Chris Kowalski

Oxford Health NHS Foundation Trust

Children's safeguarding educators must use the intercollegiate document Safeguarding Children and Young People, as the guide to designing competencies and curriculum for Level 3 safeguarding training.¹ Such training is often delivered didactically, sharing government policies and laws while covering the safeguarding issues children face today. This gives little opportunity to share interprofessional expertise or develop skills in having difficult safeguarding conversations particularly with parents when addressing neglect. Staff can therefore lack confidence in this area—often delaying or even avoiding these conversations,² potentially leading to long-term consequences to achieving physical, social, emotional and educational potential as adults.³ These conversations matter.

How do we address this confidence gap? Developing ‘the art’ or skill for effective safeguarding conversations frequently relies on practitioner trial and error, often at the expense of parents. When relationships survive, trust can be fractured and fragile. Level 3 training is part of the solution to safeguarding conversations, but it needs supplementing with practical opportunities to practice, away from strong emotional parental responses.

Simulation-based education (SBE) is a pedagogical learning method that addresses this. SBE proactively trains practitioners in an experiential, reflective space to develop confidence and skills. Finding the words for difficult conversations and using compassionate, respectful curiosity can explore ways forward that parents can trust, engage with and potentially lead on.

SBE faculty can avoid the potential of using safeguarding simulation due to inexperience and anxieties regarding maintaining psychological safety. Research and debate can improve current educational practice—children and parents deserve better from us.

Keywords conflict; conversations; children; safeguarding; simulation

References

1. Royal College of Nursing. Safeguarding children and young people: roles and competencies for health care staff. 2019. Accessed 6th December 2022. Safeguarding Children and Young People: Roles and Competencies for Healthcare Staff|Royal College of Nursing (rcn.org.uk).

2. NSPCC. Neglect: learning from case reviews, NSPCC learning december 2022. Accessed 3rd January 2023. https://learning.nspcc.org.uk/research-resources/learning-from-case-reviews/neglect/

3. Department for Education (DfE). 2018, updated 2023. Accessed 15th December 2023.Working together to safeguard children - GOV.UK (www.gov.uk).

Mariam Elzayyat, Sarina Tong, Bavesh Jawahar, Yijun Wang, Yvonne Batson-Wright and Jia Liu

King's College London (KCL)

Introduction COVID-19 massively impacted healthcare delivery with telehealth consultations becoming a vital component.¹ This qualitative synthesis aims to explore factors affecting clinical communication on digital platforms (telephone, video and online).

Methods Initial literature search in eight databases yielded 21,949 records, refined to 68 following screening by title, abstract and full text. Preliminary synthesis identified four key themes.²

Results The four themes are as follows: (1) patients'/clinicians' varied perceptions of telehealth, (2) the psychological impact of shifting from in-person to digital consultations, (3) convenience and limitations of telehealth (e.g. the inability to perform clinical examinations or reducing the need to travel) and (4) concerns of digital divide.

Varied perceptions often led to some patients taking digital consultations less seriously than in-person. Psychologically, communication via digital platforms had the potential to either exacerbate or alleviate loneliness. Digital divide reflects the variations in technological literacy and means some groups found disproportionately challenging to navigate telehealth.

Educational Development Results informed the creation of educational material focusing on four aspects: legal/ethical considerations, online rapport building, e-mental health and tailoring practice to specific patient populations. Three case scenarios were developed, which aim to enable students' experiential learning³ through digital consultations with simulated patients.

Discussion Telehealth modalities are valuable complements to in-person healthcare. Triage may be essential to evaluate if suitable, dependent on patient preferences and disease severity. A hybrid model using telehealth exclusively for follow-ups may enhance satisfaction. A targeted approach to address barriers is beneficial, with particular emphasis on enhancing digital literacy.

Keywords clinical communication; curriculum development; systematic review; telehealth

References

1. Haileamlak A. The impact of COVID-19 on health and health systems. Ethiop J Health Sci 2021;31(6):1073–1074. https://doi.org/10.4314/ejhs.v31i6.1

2. Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol 2008;8(1):1–10. https://doi.org/10.1186/1471-2288-8-45, 45

3. Sims RR. Kolb's experiential learning theory: a framework for assessing person-job interaction. Acad Manage Rev 1983;8(3):501–508. https://doi.org/10.5465/amr.1983.4284610

Emily Mackie, Emily Pass, David Tan, Sarah Graham, Hugh Alberti and James Fisher

Newcastle University

Early clinical experience (ECE) is recognised as a valuable component of medical student teaching (1), although there is much diversity in what exposure students receive. The need to increase early exposure to general practice (GP) is clear since evidence has demonstrated an association between exposure at medical school and the likelihood of students opting for a career in the specialty (2).

There is existing research highlighting the benefits of pre-recorded consultations as a teaching tool for medical students (3). Our study aims to understand students' learning experiences when different forms of video are used for such sessions: pre-recorded footage from Virtual Primary Care (VPC), pre-recorded footage from local GPs and ‘live’ footage (video of an unselected patient consultation followed by a real-time debrief with the consulting GP).

Ethical approval has been obtained from Newcastle University's Research Management Group. Year 1 and 2 MBBS students will be invited to participate in a survey after each video session and latterly to focus groups, where their educational experiences will be explored. Year 1 students will have seen pre-recorded local and VPC footage, whereas Year 2 students will have seen pre-recorded local footage and ‘live’ footage. Focus groups will be audio recorded, and data will be thematically analysed from an interpretivist perspective. Staff involved in the sessions will also be invited to complete a questionnaire to explore their views on the different video resources.

Data collection and analysis is ongoing; results and their significance for medical education will be available for the ASME conference.

Keywords authentic; medical; undergraduate; video; virtual

References

1. Yardley S, Littlewood S, Margolis SA, Scherpbier A, Spencer J, Ypinazar V, Dornan T What has changed in the evidence for early experience? Update of a BEME systematic review. Med Teach 2010;32(9):740–6. https://doi.org/10.3109/0142159X.2010.496007

2. Alberti H, Randles HL, Harding A, McKinley RK. Exposure of undergraduates to authentic GP teaching and subsequent entry to GP training: a quantitative study of UK medical schools. British Journal of General Practice 2017; 67 (657): e248-e252. https://doi.org/10.3399/bjgp17X689881

3. Dow N, Wass V, Macleod D, Muirhead L, McKeown J. ‘GP live’—recorded general practice consultations as a learning tool for junior medical students faced with the COVID-19 pandemic restrictions. Educ Prim Care 2020;31(6):377–381. https://doi.org/10.1080/14739879.2020.1812440

Pedra Rabiee¹, Johann Malawana², George Miller³, Jacob Bloor⁴, Arian Arjomandi Rad⁵ and Robert Vardanyan³

¹The Healthcare Leadership Academy, Royal London Hospital; ²The Healthcare Leadership Academy, Medics Academy; ³The Healthcare Leadership Academy; ⁴The Healthcare Leadership Academy, Circle Health Group; ⁵Medical Sciences Division, University of Oxford

Background It is imperative that the next generation of healthcare professionals truly understands how to lead in order to enhance the care of the diverse populations they serve. The Healthcare Leadership Academy (The HLA) was formed to provide leadership development for students and early-career professionals.

At The HLA, we have explored the impact of utilising a messaging app created by Medics. Academy to provide effective leadership education worldwide for both our scholars and alumni.

Methods This is a mixed method study seeking to gain a deeper understanding of the app's impact among all 622 members. The app workspace seamlessly weaves together workshop schedules for our scholars, houses our mentorship program, facilitates international research masterclasses, hosts an HLA community-led book club, offers networking and job opportunities and supports the communications for our prestigious international healthcare leadership conference.

The study utilises qualitative interviews, post-teaching questionnaires, and quantitative information.

Results The impact of this initiative supports our community on a global level, providing a cohesive platform for our alumni and scholars to engage. This has resulted in over 150 individuals attending the international conference, 15 publications on healthcare leadership, and a book publication. Furthermore, within 2 years, over 300 participants actively utilise the application to engage, collaborate and learn from each other, showcasing how indispensable the tool is for disseminating leadership teaching and networking opportunities.

This app has helped The HLA overcome communication barriers and ensure a sustainable communication structure within its community of healthcare professionals and students.

Keywords communication; education; healthcare; leadership; technology

References

A. M West, Lyubovnikova J, Eckert R, Denis JL. Collective leadership for cultures of high quality health care. Journal of Organizational Effectiveness 2014 Sep 2;1(3):240–60. https://doi.org/10.1108/JOEPP-07-2014-0039

Dorgan S, Layton D, Bloom N, Homkes R, Sadun R, vanReenen J. Management in Healthcare: why good practice really matters [internet]. London; 2010.

Swanwick T, McKimm J. Faculty development for leadership and management. Faculty Development in the Health Professions: A Focus on Research and Practice 2014 Jan 1;53–78. https://doi.org/10.1007/978-94-007-7612-8_3

Jeremy Howick¹, Amber Bennett-Weston¹, Maya Dudko² and Kevin Eva³

¹The Stoneygate Centre For Empathic Healthcare, Leicester Medical School, University Of Leicester; ²Leicester Medical School, University of Leicester; ³University of British Columbia

Background Healthcare education, practice and research are generally considered to be highly dependent on practitioner empathy. Unfortunately, much confusion and controversy surround the concept,^1,2 precluding the clarity required to guide improvements in this domain. This study was, therefore, conducted to juxtapose and critically appraise the components of therapeutic empathy contained in the variable uses of the term.

Method Therapeutic empathy definitions were identified from two systematic reviews, an empathy definition database, and hand searches. Then, for each of the uncovered definitions, a SpiderCite search was conducted to identify papers that used it and the papers cited by those authors. Papers were randomly sampled in batches of 10 and screened for additional definitions. The included definitions were subjected to thematic analysis³ with sampling and analysis continuing, in parallel, until saturation was reached.

Results Twenty-six eligible definitions of therapeutic empathy were identified within 126 papers in the initial searches. The SpiderCite searches retrieved 3822 papers. After randomly sampling 90 papers, a further 13 definitions were identified and saturation was reached. Thematic analysis of the 39 definitions identified six components of therapeutic empathy: exploring, understanding, shared understanding, feeling, therapeutic action, and maintaining boundaries.

Conclusion We identified six interrelated components of therapeutic empathy. These findings deepen understanding by highlighting the full scope of the concept based on authors' use of the term. Future education, practice and research on therapeutic empathy can use the components identified in this study to more deliberately explicate what aspects are meant to be foregrounded in their particular activity.

Keywords communication; definition; empathy; healthcare

References

1. De Vignemont F, Singer T. The empathic brain: how, when and why? Trends Cogn Sci 2006;10(10):435–441. https://doi.org/10.1016/j.tics.2006.08.008

2. Decety J. Empathy in medicine: what it is, and how much we really need it. Am J Med 2020;133(5):561–566. https://doi.org/10.1016/j.amjmed.2019.12.012

3. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa

Samuel Chumbley

University of Bristol

In recent years, junior doctors have become increasingly involved with the delivery of undergraduate teaching in medical schools.¹ These near-peer teachers are well-equipped for this teaching role for a variety of reasons that draw on skills developed as medical students and junior doctors.¹ An example is good communication skills, which the General Medical Council (GMC) expects of its doctors,² and is undoubtedly essential for teachers. The range of communication skills expected of junior doctors spans from writing discharge letters to breaking bad news; however, when a group of 36 near-peer teachers were given the opportunity to seek development in their role, many expressed a desire to develop their skills in giving critical feedback.

Given the range of communication training given to medical students and the expected standard of communication skills in junior doctors, it is surprising that those working in these near-peer roles lack confidence in giving feedback. Their insights in this area were gleaned from a panel discussion in which we sought to explore and address their lack of confidence. As such, this talk will summarise some of the common barriers near-peer tutors face in providing critical feedback to medical students, and highlight some approaches they developed to overcome these obstacles. Given the prevalence of near-peer teaching in UK medical schools, this talk could have far-reaching implications on the experience of our medical students, who may be missing opportunities to receive valuable, honest feedback.

Keywords feedback; fellows; near-peer; solutions; students

References

1. Khapre M, Deol R, Sharma A, Badyal D. 2021. Near-peer tutor: a solution for quality medical education in faculty constraint setting. Cureus. 13(7): e16416. https://doi.org/10.7759/cureus.16416

2. General Medical Council. 2023. Domain 3: communication partnership and teamwork. Good Medical Practice. Published online at: www.gmc-uk.org. Accessed: 20th January 2024

Gill Price

University of East Anglia

Prizes are often offered for presentations at conferences. Presenters may aspire to a prize for their CV, and this could motivate them to spend extra effort on a higher quality presentation, a likely benefit for the audience.

What are prizes for and how awarded? Can this process ever be fair? Are most presenters motivated by prizes? My experience of organising post-graduate health-researcher student conferences raised these questions and informs the evidence.

A prize for ‘best poster’ sounds impressive, but what does ‘best’ mean - and who decides?

To give all presenters an equal chance, criteria must be developed and publicised in advance of submission. Audience voting systems seem a good option for a populist interpretation of ‘Best’. But did the voting attendees also hear all the other presentations? This system could be unfair to solo presenters or those tackling a non-popular topic who are contributing creatively and innovatively to thought and knowledge.

Alternatively, a judging panel could decide which is ‘best’. With wide-ranging topics, and to counter concerns about bias, they would need to have varied backgrounds. Each judge would need to attend each presentation in their judging-section. This could be onerous—both for the judges and for the organisers, in identifying and inviting them.

When all is ‘said and done’, a scoring system collects and totals scores, in time for the awards ceremony. Extra applause for a few! Did this motivate or improve the experience for the many?

Keywords conferences; equity; postgraduate; presentations; research

Annette Burgess, Akhil Bansal and Tyler Clark

University of Sydney

Background The Clinical Teacher Training (CTT) program was moved to ‘online-only’ delivery in response to the disruption of COVID-19. Delivered via synchronous and asynchronous sessions, 10 modules included the following: (1) feedback, (2) planning and delivering teaching sessions, (3) facilitating small group teaching, (4) key tips for teaching in the clinical setting, (5) teaching a skill, (6) teaching clinical handover, (7) team-based learning, (8) case-based learning, (9) journal club and (10) mentorship.¹ We investigated the efficacy of improvements made to the online program following the initial pilot. Evaluation was based on participation, participant perception and knowledge acquisition.

Methods Delivered across 4 weeks in 2022, the ‘online-only’ design included literature, frameworks, videos, discussion boards, ‘assignments’ and feedback. Zoom sessions provided active participation in interprofessional groups. Knowledge and skills acquisition were assessed using MCQs and scores provided by facilitators on participants' ability to teach and provide feedback. Quantitative and qualitative data were collected via questionnaire, and analysed using descriptive statistics.

Results A total of 122 clinicians completed the CTT program, from 13 Local Health Districts (LHDs), institutions and pharmacies. Disciplines included the following: Medicine (55%), Pharmacy (23%), Dentistry and Oral health (8%), Nursing (11%) and Speech pathology (2%). About 30% of participants responded to the survey. Participants found the program well-structured and interactive, with a variety of topics, delivered within appropriate timeframes. They appreciated the succinct literature with frameworks and multiple opportunities for practice and feedback. The majority of respondents commented on the flexibility and accessibility of ‘online only’ delivery. Assessment results demonstrated acquisition of a good level of knowledge and skills.

Keywords feedback; interprofessional; teacher training

Reference

1. Burgess A, Bansal A, Clarke A, Ayton T, vanDiggele C, Clark T, Matar E. Clinical teacher training for health professionals: from blended to online and (maybe) back again? Clin Teach 2021; 18(6):630–640. https://doi.org/10.1111/tct.13411. Epub 2021 Aug 22. PMID: 34423533.

Benjamin Davies

University of Cambridge

Background Within T&O, there is a reliance on consultants to train trainees in the operating theatre. This is expected in the day-to-day role of a ‘Day One’ consultant; however, there is little requirement for trainees to prove this ability to achieve completion of training.

Aim: The aim of this study is to understand the journey that specialty trainees in T&O go on to become trainers as Day 1 consultants in the operating theatre, to help guide changes in training.

Methods A survey and semi-structured interviews were used to collect qualitative data from five recent graduates of a T&O Higher Specialty Training (HST) Programme. Data underwent inductive thematic analysis.

Conclusions Experiences that trainees go through during training guide their educational practice as trainers. They recognise deficiencies in their training ability at their early stage and that their capacity to train is impacted by internal and external factors, the management of which improves as their confidence grows.

Opportunities to improve theatre management skills and an expectation that senior trainees have exposure to training junior colleagues throughout training might aid the transition of trainee to trainer.

Keywords mental capacity for training; operating theatre; surgical training; training the trainer; transition to trainer

Nandini Hayes, Maria Hayfron-Benjamin and Sarah Osborne

Queen Mary University of London

The COVID pandemic accelerated the development of innovative practice and catalysed a transformation in medical education.¹ During the 2 years of significant COVID disruption, medical schools adapted in different ways² and many of these changes can and should be integrated into new ways of working with medical students.

A national symposium was held in April 2021³ and confirmed that many medical schools were wrestling with the same issues and often independently coming to the same solutions in their preparation of students for a common end-point examination. It was clear that there was a desire from UK medical schools to work more collaboratively, to further explore this an ASME-sponsored national mixed-methods study was conducted in April 2023.

The aim was to explore areas of change and of best practices in medical education that have emerged in response to the pandemic. Questionnaire and/or interview data were gathered from 31 institutions.

References

1. Lucey CR, Johnston SC. The transformational effects of COVID-19 on medical education. Jama 2020;324(11):1033–1034. https://doi.org/10.1001/jama.2020.14136

2. Burbidge I. Understanding crisis-response measures. Published online 2020:11.

3. Hayes N, Hayfron-Benjamin M, Steele H. Transition to medical school in COVID times - Symposium report. Published online May 2021. Available on request.

Samuel Chumbley

University of Bristol

Clinical care within the National Health Service (NHS) is guided by evidence-based medicine.¹ This evidence considers both effectiveness and cost to ensure that resources are appropriately allocated to maximise positive outcomes. The stakeholders involved in this process draw these conclusions based on estimations of value. The same can be said for those concerned with the development of medical curricula.

However, in medical education, while the impact of teaching interventions is often discussed in the literature, cost remains relatively unexplored.^2,3 Without cost, the value of varying interventions cannot be estimated. This results in decisions being made on limited information, or, more commonly, inaction resulting from a lack of information.³

Some may resist cost-reporting through a fear of impaired generalisability, but transparent cost-reporting with clear breakdowns allows readers to insert or remove costs relevant to their institution. This has been demonstrated on a few occasions,³ but this does not reflect the vast uncosted pool of effectiveness data in medical education.

If we can equip medical curriculum designers with accurate, transparent cost data, conclusions on value can be estimated, granting more well-informed decisions and empowering decisions that can increase the value of medical education.^2,3 This talk will lightly explore medical education economics and heavily stress its relevance in medical education research.

Keywords cost; curricula-design; economics; education; value

References

1. National Institute for Health and Care Excellence. 2024. NICE guidance. NICE. Available at: www.nice.org.uk. Accessed: 21st January 2024.

2. Walsh K, Jaye P. 2013. Cost and value in medical education. Educ Prim Care 24:391–393. https://doi.org/10.1080/14739879.2013.11494206

3. Chumbley SD, Devaraj VS and Mattick KL. 2021. An approach to economic evaluation in undergraduate anatomy education. Anat Sci Educ 14(2). 174–181. https://doi.org/10.1002/ase.2008

Ishani Young, Hamza Latif and Claire Sharpe

University of Nottingham

Background Medical schools in the UK have set guidelines on what medical students are expected to achieve upon graduation. The NHS long-term workforce plan¹ details the need to reduce the length of training while maintaining set standards, to meet the growing demands of the population. Medical schools will need to adjust their curriculum, to ensure doctors acquire the necessary attributes to be considered trustworthy by patients.

Objective: That aim of this study is to identify the attributes that medical students and patients deem necessary for doctors to be considered trustworthy. This will help develop new curricula that ensures students are equipped with such characteristics.

Methods Volunteers were recruited using purposeful sampling. Interviews were carried out with 12 medical students and seven patients. Transcripts of the interviews were analysed using thematic analysis and Colaizzi's descriptive method.

Results Three main themes were identified. In the first theme, effective communication grouped attributes such as communication, listening, empathy, adaptability and reassurance. The last two attributes were however only identified by the patient group. Integrity was another theme identified. This included honesty, transparency and competence. Honesty was the only common attribute between both groups. The final theme, demeanour of the doctor, comprised confidence, calmness, friendliness, appearance and approachability. Only confidence and friendliness were mentioned by both medical students and patients.

Conclusion There were many attributes, not identified by students, which patients felt were essential to build trust. As patients are the recipients of care, incorporating patients' views in medical teaching will ensure that future doctors are equipped with the characteristics to inspire trust.

Keywords doctor; education; medical; patient; relationship; trust

Reference

1. England, N. NHS Long Term Workforce Plan. 2023. Available from: https://www.england.nhs.uk/wp-content/uploads/2023/06/nhs-long-term-workforce-plan-v1.2.pdf.

Humairah Zainal

Singapore General Hospital, Singapore

Background Notwithstanding the increasing prevalence of digital technologies in clinical practice, few studies have explored the reasons for the lag in the implementation of guidelines for digital health competency (DHC) training in medical schools. Using Singapore as a case study and by exploring the perspectives of doctors in organisational leadership positions, this paper identifies barriers to DHC implementation and proposes a common international framework to address these barriers.

Methods Individual semi-structured interviews were conducted with doctors in executive and organisational leadership roles. The participants were recruited using purposive sampling. The data were interpreted using inductive thematic analysis.

Results Thirty-three doctors participated in the study. They were either currently (n = 26) or formerly (n = 7) in organisational leadership. They highlighted six reasons for the lag in DHC integration: bureaucratic inertia, expectations of pursuing traditional career pathways, lack of protective mechanisms for experiential learning and experimentation, lack of clear policy guidelines for clinical practice, lack of integration between medical school education and clinical experience and lack of Information Technology integration within the healthcare industry.

Conclusions Some of these barriers have also been identified in other developed countries experiencing healthcare digitalization.^1,2 Thus, we propose Damschroder et al.'s (2009) Consolidated Framework for Implementation Research (CFIR) as a common global framework that would broaden the generalizability of recommendations in the existing literature.³ Applying relevant CFIR constructs to DHC curriculum integration highlights the importance of considering both structural and institutional barriers to DHC training and helps ensure consistency of implementation across time and contexts.

Keywords curriculum; digital competence; medical education; qualitative; technology

References

1. Petersson L, Larsson I, Nygren JM, Nilsen P, Neher M, Reed JE, Tyskbo D, Svedberg P Challenges to implementing artificial intelligence in healthcare: a qualitative interview study with healthcare leaders in Sweden. BMC Health Serv Res 2021;22:850. https://doi.org/10.1186/s12913-022-08215-8

2. Banerjee R, George P, Priebe C, Alper E. Medical student awareness of and interest in clinical informatics. JAMIA 2015;22:e42-e47. https://doi.org/10.1093/jamia/ocu046

3. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009;4(1):50. https://doi.org/10.1186/1748-5908-4-50

Anna Harvey Bluemel¹, Peter Yeates², Bryan Burford¹, Gillian Vance¹ and Sophie Park³

¹Newcastle University; ²Keele University; ³University College London

Background In a changing educational climate, clinical education research (ClinEdR) requires focus on key research priorities. Working with the national Incubator for ClinEdR, we aimed to update and expand on prior priority setting exercises for ClinEdR1 by including responses from UK-wide stakeholder groups in education and training: funders, policy makers, regulators, patients, researchers, educational providers and trainees.

Priorities fell into 13 themes: assessment; communication skills; Covid-specific, equality, diversity and inclusion; global health; holistic care; interprofessional working; learning; organisations; patient involvement; professional identity; use of big data; and workforce and careers.

Round 2 was completed by 200 people (10% patients/public). All items were considered to be more important than the scale mid-point. Patients/public had significantly different priorities to professionals.

Workshop participants concluded that further prioritisation should be decided case-by-case based on articulated necessity, clarity, methodological quality, patient/public involvement and likely impact of the intervention on training and patient care.

Conclusion The themes and underpinning principles can guide researchers, policy-makers and funders on future research directions that benefit healthcare educators, learners and patients.

Keywords delphi; multidisciplinary; priorities; research; stakeholders

Reference

Dennis A, Cleland J, Johnston P, Ker J, Lough M, Rees C. 2014. Exploring stakeholders' views of medical education research priorities: a national survey. Med Educ 48:1078–1091. https://doi.org/10.1111/medu.12522

Jennifer Hein and Pramodh Vallabhaneni

Swansea Bay University Health Board

Background Although most clinicians would like to contribute towards medical student education, there are often barriers to doing so in the clinical setting. This results in suboptimal teaching, negatively impacting clinical knowledge learned, the development of the attitudes and skills required to be a doctor, and students' enthusiasm for the speciality.

Aims This study aimed to explore the barriers behind delivering medical education to undergraduate medical students in a clinical setting, comparing primary and secondary care environments, to enable the development of better teaching opportunities.

Methods A survey surrounding the topic was sent to doctors involved in undergraduate medical student teaching in primary and secondary care environments. A total of 43 responses were received, with 28 (65%) and 15 (35%) being from primary and secondary care, respectively.

Results Clinicians described numerous barriers to delivering clinical medical education: time constraints and workload, clinical environment, motivation and interest of students, number of students, length of student placements, knowledge and experience in delivering medical education and lack of understanding of students' learning objectives. Detailed qualitative feedback was obtained surrounding each of these barriers and the methods clinicians have developed to overcome these barriers. This feedback, alongside related medical literature, was utilised to form ideas and suggestions to improve quality of teaching going forwards.

Conclusion This study has identified numerous barriers to delivering medical education to undergraduate medical students in the clinical setting and has explored ideas and suggestions for overcoming these barriers.

Keywords barriers; clinical; education; student; undergraduate

Janet Cooper and Kate Owen

University of Warwick

Background The NHS Long Term Workforce Plan¹ outlined plans to explore options for shortened medical degree programmes for existing healthcare professionals (HCPs). Many existing graduate entry medicine (GEM) programmes already admit students with prior degrees from a variety of registered healthcare disciplines but there has been little research into the experiences of these students. Differences in relation to the attainment of students with previous healthcare degrees have been identified with an Australian study² reporting that this group of students perform the best throughout medical school. However, more research into this group of students is required to inform future medical education and policy decisions.

Methods This was a mixed methods qualitative study. Participants were UK medical students studying a graduate entry medicine (GEM) programme who at the time of application to the course were a registered HCP. Data collection was via an online survey and semi-structured interviews.

References

1. NHS England. (2023). NHS Long Term Workforce Plan (Online). Available at (Accessed 25.01.24) https://www.england.nhs.uk/long-read/nhs-long-term-workforce-plan-2/#1-the-case-for-change

2. Aston-Mourney et al (2022). Prior degree and academic performance in medical school: evidence for prioritising health students and moving away from a bio-medical science-focused entry stream. BMC Med Educ 22 (1). https://doi.org/10.1186/s12909-022-03768-y

Nabeeha Toufiq, Anna Collini and Jane Valentine

King's College London

Background Medical students from diverse backgrounds play a crucial role in broadening the spectrum of healthcare. Having diverse students results in varying academic needs within the medical curriculum, particularly for medical students who come from widening participation backgrounds. For these students, their academic needs must be addressed to aim to eliminate any attainment gaps.¹ This pilot study aimed to identify any challenges, needs and support students faced throughout their time in medical school.

Methods A pilot survey was conducted via email to all students enrolled in the Extended Medical Degree Programme (EMDP) A101 at King's College London, spanning from first-year to final-year participants.² The A101 gateway programme is designed to widen participation in medical education, with specific contextualised entry requirements and eligibility criteria that automatically serve as inclusion criteria for this study.³ The pilot survey gathered 24 responses, and subsequent thematic analysis was conducted.

Results The four main themes were extracted from the survey—‘Creating an inclusive environment where students feel they belong’, ‘Support with study skills’ ‘Financial support’ and ‘Clear pathways for accessing academic, pastoral and financial support’. Responses commonly indicated a need for support with professional identity formation, promotion of well-being, and management of mental health concerns.

Conclusion The results of this pilot study provide a foundation for further research and for medical schools to continue to support medical students from widening participation backgrounds fostering an environment conducive to both academic achievement and personal growth.

Keywords medical students; student support; undergraduate; widening participation

References

1. O'Beirne C, Doody G, Agius S, Warren A, Krstic L. Experiences of widening participation students in undergraduate medical education in the United Kingdom: a qualitative systematic review protocol. JBI Evid Synth. 2020 Dec;18(12):2640–2646. https://doi.org/10.11124/JBIES-20-00064. PMID: 32813412.

2. King's College London, Extended medical degree programme [Internet]. Extended Medical Degree Programme - King's College London. 2020 [cited 2022Nov29]. Available from: https://www.kcl.ac.uk/study/undergraduate/courses/extended-medical-degree-programme-mbbs

3. Curtis S, Smith D. A comparison of undergraduate outcomes for students from gateway courses and standard entry medicine courses. BMC Med Educ 2020; 20(1):4. https://doi.org/10.1186/s12909-019-1918-y. PMID: 31900151; PMCID: PMC6942303.

Gemma Ashwell¹, Amy Russell¹, Andrea Williamson², Jennifer Hallam¹ and Lindsey Pope²

¹Faculty of Medicine and Health, University of Leeds; ²School of Health and Wellbeing, University of Glasgow

Background Extreme health inequities are experienced by inclusion health groups (including people experiencing homelessness, problem substance use, sex workers, gypsies and travellers and vulnerable migrants)¹; this is compounded by access barriers and health professional discrimination.² An inclusion health agenda has gained momentum over the past decade,³ but there is a lack of understanding about how the issues are addressed in undergraduate medical education.

Aims The aim of this study is to identify and analyse the existing literature about inclusion health content and pedagogy in undergraduate medical education.

Methods A search was undertaken across six bibliographic databases. Additional articles were found through citation and grey literature searching. A stepwise scoping review methodology was followed. Analysis includes quantitative frequency counts and thematic analysis using an inductive approach.

Results Eighty papers were included, a majority relating to education on substance use and homelessness, while literature concerning human trafficking, sex workers, gypsy and traveller communities was limited. Educational interventions commonly involved active community participation with inclusion health groups, helping students to breakdown preconceived biases. Positive role models, a supportive environment and structured reflection were key enablers for learning. Many interventions were optional, or student led, with no longitudinal integration across curricula. There were innovative examples of interprofessional learning and co-production with students or people with lived experience.

Conclusion Medical curricula need to advance to produce doctors equipped to meet the needs of socially excluded groups. We have sought to summarise themes from the literature that will be useful to medical educators in this endeavour.

Keywords education; inclusion; medical; review; undergraduate

References

1. Aldridge R, Story A, Hwang S, Nordentoft M, Luchenski SA, Hartwell G, Tweed EJ, Lewer D, Vittal Katikireddi S, Hayward AC Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. 2017. https://doi.org/10.1016/S0140-6736(17)31869-X

2. Public Health England. 2021. Inclusion health: applying all our health. GOV.UK. Accessed 20 May 2023; https://www.gov.uk/government/publications/inclusion-health-applying-all-our-health/inclusion-health-applying-all-our-health

3. Luchenski S, Maguire N, Aldridge R et al. What works in inclusion health: overview of effective interventions for marginalised and excluded populations. 2017; https://doi.org/10.1016/S0140-6736(17)31959-1

Justin Cox and Katherine Haber

Barts and The London School of Medicine and Dentistry

Background Failure is inevitable in medicine—key to developing competent and experienced doctors. Yet failure is also a traumatic source of stress and anxiety, contributing to the 40% of medical students that become ill from stress.^1,2

A main cause of anxiety is insufficient understanding around the consequences of failure, and poor transparency in failure policies.³ Furthermore, poor knowledge of remediation leaves students unequipped to improve.^1,3

This study aims to explore medical student understandings about the consequences of academic failure.

Methods In 2022, 30 clinical years medical students completed an online self-report questionnaire, evaluating understandings around the consequences of academic failure and what support would improve this.

Results Understanding was split evenly. Good understanding linked to shared experiences and knowing where to seek information. Uncertainty traversed responses.

The main education concerns were deregistration and retakes. Career consequences included worse career placements and specialties. Many cited no education or career consequences. Personal consequences included poor mental health, self-esteem, identity questioning, embarrassment and loss of essential summer rest.

Recommendations included transparency in assessment and failure policy, clearer information, shared experiences around failure, rejecting perfectionism and failure as taboo and improving prevention and remediation skills using individualised approaches.

Conclusion Uncertainty was commonplace. Transparency is needed in assessment policy, with clearer information for students, and a rejection of perfectionism and the taboo culture of failure.

Failure should be discussed openly with shared experiences. Individualised support should actively seek and coach students on avoiding failure and remediating successfully—academically and pastorally.

Keywords education; failure; medical; performance

References

1. Grant, A., Rix, A., Mattick, K., Jones, D., & Winter, P. (2013). Identifying good practice among medical schools in the support of students with mental health concerns.

2. Shepherd, L., Gauld, R., Cristancho, S. M., & Chahine, S. (2020). Journey into uncertainty: medical students' experiences and perceptions of failure. Med Educ, 54(9), 843–850. https://doi.org/10.1111/medu.14133

3. Yanes, A. F. (2017). The culture of perfection. Acad Med, 92(7), 900–901. https://doi.org/10.1097/ACM.0000000000001752

Pedro Elston

Queen Mary University of London

Medical education, especially 4–6 year undergraduate medical courses, have huge curricula, are heavily regulated and have recently been given a laser focus with the Medical Licensing Assessment (MLA) coming into effect in 2024/2025. In tandem, the COVID-19 pandemic has drastically altered the way we teach, with many universities in the offering more online and asynchronous material as part of their educational offering. Finally, there is the promise of a dramatic increase in medical students in the UK from 7500 to 15,000 by 2031^[1], with no clear route to it.

These three factors combined present a question and an opportunity. Why is there not yet widespread sharing of resources – both educational and administrative—among medical schools? Some barriers include the sale of curricula and materials, the practicalities as well as the issue of quality assurance and that of intellectual property. However, students are increasingly using digital resources, 3rd party question banks, and support services^[2], while lecturers masterfully reinvent the wheel on a yearly basis, speaking to half-filled lecture theatres. Many schools have made excellent strides in this area, but here lies the opportunity for medical educators to band together, truly share practice and make the next big step.

Keywords collegiality; medical education; medical schools; sharing; technology enhanced learning

References

1. Wilkinson E., 2023. NHS workforce plan aims to train thousands more doctors and open up apprenticeship schemes BMJ; 381:p1510. https://doi.org/10.1136/bmj.p1510

2. Wynter, L., Burgess, A., Kalman, E., Heron, J.E., Bleasel, J., 2019. Medical students: what educational resources are they using?. BMC Med Educ 19, 36. https://doi.org/10.1186/s12909-019-1462-9

Laura Shepherd, Lynsey Brown, Samuel Dearman and Matt Phillips

North Cumbria Integrated Care NHS Foundation Trust

Background Medical professionals rely on the workplace being a healthy learning environment in order to develop and progress. The learning environment describes a setting, inclusive of attitudes/behaviours, encapsulated in the wider learning culture.^1,2 The quality of the learning culture powerfully influences outcomes of trainees, highlighting the importance of positive learning culture in medical education.^2,3

Methods In response to feedback from foundation trainees, acknowledging the need for cultural improvement, we developed and introduced a new, innovative position within the medical education team; a specialised clinical teaching fellow post, focussed on processes that explore, describe and improve learning environment and culture.

Results The aim of this study is to demonstrate the breadth and impact of this novel role; a case study is shared; central is the exploration of concerns raised by foundation trainees. Detailed, in-depth interviews were conducted, enabling identification and understanding of the problems, essential to the development/implementation of solutions. Evaluation survey results from trainees are positive.

Learning points and take home messages Where specific methods of assessing and describing educational environments can sometimes feel conceptual, we offer a solution that organisations can incorporate operationally into teams and processes.

Keywords culture; education; learning; medical; postgraduate

References

1. Sarah, Sholl, Scheffler Grit, V. Monrouxe Lynn, and Rees Charlotte, 2019. ‘Understanding the healthcare workplace learning culture through safety and dignity narratives: a UK qualitative study of multiple stakeholders’ perspectives', BMJ Open, 9: e025615. https://doi.org/10.1136/bmjopen-2018-025615

2. Sellberg, Malin, Per J, Palmgren, and Riitta Möller. 2021. ‘-A cross-sectional study of clinical learning environments across four undergraduate programmes using the undergraduate clinical education environment measure’, BMC Med Educ, 21: 258. https://doi.org/10.1186/s12909-021-02687-8

3. Nordquist, Jonas, Jena Hall, Kelly Caverzagie, Linda Snell, Ming-Ka Chan, Brent Thoma, SaleemRazack, and Ingrid Philibert. 2019. ‘The clinical learning environment’, Med Teach, 41. 366–72. https://doi.org/10.1080/0142159X.2019.1566601

Zina Al Jubouri¹, Sally Curtis¹ and Ceri Nursaw²

¹University of Southampton; ²Medical Schools Council

Background The Medical Schools Council summer schools, funded by NHS England, target participants who are under- represented in medicine. Their aim is to increase participants' understanding of medical school and medicine as a career and the application process as well as increase confidence in progressing to higher education.¹ In 2022, a mix of four residential and online summer schools were delivered. This study aims to explore the experiences of the participants who attended to determine if the aims of the summer school were met.

Methods A qualitative study was undertaken using online semi-structured interviews. The interviews were transcribed and coded in accordance with Braun and Clarke's Six Step Data Analysis Process.² Research group meetings were held to assist with the analysis and extraction of themes.

Results Of the 115 participants contacted, 14 agreed to be interviewed, representing the 4 summer schools and the online and in-person delivery format. Overall, responses to the evaluation were positive with participants feeling supported and identifying areas of personal and skill development. The themes included organisation, application support, insight, interaction, personal development, enjoyment and wanting more. Advantages and disadvantages of both delivery methods were reported.

Discussion The findings showed the summer schools met their aims and many participants felt more certain about their ambition to apply for and study medicine. Participants reported enjoying most aspects of the summer schools including both the online and in person delivery format and stated that the good organisation was instrumental in facilitating the positive environment.

Keywords application; outreach; summer-school; support; transition

References

1. Medical Schools Council Summer Schools. Accessed 24 January 2024. https://www.medschools.ac.uk/our-work/selection/msc-summer-schools

2. Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qual Res Psychol, 3, 77–101. https://doi.org/10.1191/1478088706qp063oa

Sonia Bussey

Newcastle University

An overall lack of capacity of clinical academics in educational research is a well-recognised problem¹—one which the National Institute for Health and Care Research (NIHR) Incubator for Clinical Education Research (ClinEdR) was established to address.²

This project sought to increase capacity in the ClinEdR workforce through improving the retention, or re-engagement in research, of clinicians who have graduated from taught Masters programmes in clinical, medical or healthcare professions education.

Results The project examined the ClinEdR aspirations of current postgraduate students and the research career destinations of Masters Graduates to identify ways in which support—delivered through HEIs and the Incubator—may be best implemented to promote or facilitate their ongoing engagement with ClinEdR.

Discussion and Conclusions: Capitalising on their newly developed expertise, and encouraging and supporting graduates to maintain their research skills and interest, seems a potentially effective and cost-efficient way of increasing throughput of the ClinEdR careers pipeline. Increasing the conversion rate of Masters graduates to clinical academics, over a period of years, will prove a key foundation of the Incubator for ClinEdR's impact.

Keywords careers; education; masters; postgraduate; research

References

1. Quinn B, Ellis J, Vance G. Developing careers in clinical education research: UK experience. In: ADEE Palma Annual Meeting, 2022. https://adee.org/meetings/palma-2022

2. NIHR. Clinical education incubator. National Institute for Health and Care Research. Published 2021. Accessed January 15, 2023. https://www.nihr.ac.uk/documents/clinical-education-incubator/24887

Sally Curtis, Linda Turner, Chloe Langford, Josette Crispin, Kathy Kendall, Jacquie Kelly, Peta Coulson-Smith, Dahye Yoon and Oseahumen Momodu

University of Southampton

Introduction An awarding gap was reported in undergraduate medicine, University of Southampton, between Black students and White students; students from Index of Multiple Deprivation (IMD) Quintile 1 and 5 and students with mental health conditions and students with no disability. This study aimed to determine staff and student perceptions of the awarding gap alongside other possible contributory factors and suggest appropriate strategies and support interventions to help address these issues.

Methods Participatory action research ‘involves examining an issue systematically from the perspectives and experiences of the community members most affected by that issue’.¹ A staff group and student groups, split by relevant demographics, discussed potential reasons for the awarding gap. Anonymised outputs were presented back to all participants together, who were encouraged to address any misrepresentation or provide clarification.

Suggestions of measures to help minimise the awarding gap were then offered anonymously through interactive software.

Results The student groups negatively impacted by the awarding gap provided richer data than the unaffected student group and staff group, illustrating the wide and complex nature of disadvantage, especially in relation to ethnicity, social class, and intersectionality. Student experience of teaching and student relationships with staff and other students, identity and cultural and social capital were identified as areas for intervention.

Discussion The areas identified for intervention were reflected in the literature²; specific aspects included creation of safe spaces for student discussion, support for social networking, access to relatable role models and enhancing staff understanding of the challenges students face to enable more effective support.

Keywords awarding-gap; education; support; transition; undergraduate

References

1. Savin-Baden M, Howell Major C. Qualitative research: the essential guide to theory and practice. Oxon: Routledge. 2013: 248–254.

2. Jones S, et al. Causes of differences in student outcomes. London: HEFCE. 2015: 8–10.

Lopa Husain

University of Sheffield

Introduction Research suggests that Widening Participation (WP) learners may have fewer academic and emotional resources, social or financial capital compared to the more traditional higher education learner.¹ Within medical education, although the acquisition of knowledge and skills are important learning outcomes, there is a greater requirement to be able to analyse and evaluate knowledge.² It is not known whether WP learners have specific challenges to the process of progressing through Blooms taxonomy or whether they fall into the wider variability seen within learners as a whole.

This study explored possible scaffolding activities provided for a group of WP learners to develop the necessary academic skills for deeper learning and critique.

Methods Two focus groups and in-depth qualitative interviews were undertaken until saturation of themes was achieved. Participants were second year WP medical students who were struggling academically and had attended tailored study support sessions. Framework analysis was used to analyse the transcripts.

Results The learners reported being unfamiliar with appropriate resources, teaching styles and modes of assessment. Some reported feeling that their prior education was not on par with their peers and there was no support to learn how to apply knowledge. They valued the scaffolding techniques that helped make links between the taught knowledge, insight into exam technique and the opportunity to be exposed to different teaching styles within a safe learning environment.

Conclusion Appropriate scaffolding activities help WP learners face academic challenges and serves as a template for tailored academic support.

Keywords education; medical; qualitative; support; widening participation

References

1. Breeze M, Johnson K, Uytman C. What (and who) works in widening participation? Supporting direct entrant student transitions to higher education. Teaching in Higher Education. 2020; 25(1): 18–35. https://doi.org/10.1080/13562517.2018.1536042

2. Taylor DCB, Hamdy H. Adult learning theories: implications for learning and teaching in medical education: AMEE guide no. 83. Med Teach. 2013; 35(11): E1561–E1572. https://doi.org/10.3109/0142159X.2013.828153

Abbie Festa, Abbey Boyle and Ciara Dooner

Background There is a clear body of evidence for sex-based health inequalities,^1,2 the reasons for which are multifactorial. Medical students early on in their training do not feel confident performing a cardiovascular or respiratory examination on patients with breast tissue.

Methods Second year medical students attend clinical teaching for 5 days per module. These clinical days consist of learning a systems examination in the morning, with facilitated practice on a mannequin, followed by an afternoon examining real patients.

In this pilot study, the first cohort of 12 students only had mannequins without breast tissue available for practice, after which they responded to a self-assessment mixed-methods questionnaire regarding their confidence with these examinations on real patients with breast tissue.

Results The percentage of students not feeling confident performing cardiovascular and respiratory examinations on patients with breast tissue were 66.6% (8/12) and 75% (9/12), respectively. About 100% (12/12) students felt they would benefit from specific teaching on examining patients with breast tissue, with 83.3% (10/12) wanting to practice on a mannequin with breast tissue.

Conclusion At present, second year medical students do not feel confident performing cardiovascular and respiratory examinations on patients with breast tissue. The authors aim to improve confidence by providing mannequins with realistic breast tissue to be used in facilitated practice. This implementation will begin with the next cohort of medical students. The authors intend to follow up this cohort and ask participants to complete a further questionnaire.

Keywords education; equality; medical; undergraduate

References

1. Bugiardini R, Cenko E. Sex differences in myocardial infarction deaths. The Lancet 2020 Jul 11;396(10244):72–3. https://doi.org/10.1016/S0140-6736(20)31049-7

2. Kramer CE, Wilkins MS, Davies JM, Caird JK, Hallihan GM. Does the sex of a simulated patient affect CPR?. Resuscitation 2015 Jan 1;86:82–7. https://doi.org/10.1016/j.resuscitation.2014.10.016

Caitlin McCleary and Naomi Quinton

University of Leeds

Introduction Gender discrimination is prevalent within undergraduate medicine, affecting students' well-being, learning opportunities and career prospects.^1,2 This study examined medical students' experiences of gender discrimination on placement and their engagement with reporting measures. As research is limited regarding students' decision-making process, this study sought to identify barriers and motivators to reporting.

Methods Seven students from years 3 to 5 at the Leeds School of Medicine participated in individual semi-structured interviews. Braun and Clarke's reflexive thematic analysis was used to analyse the data.³

Results Female students in particular encounter inappropriate, sexualised comments and behaviours, offensive gender stereotypes and loss of learning opportunities. Students identify multiple barriers to reporting, including self- doubt and the perception that reporting is futile. They do not perceive discriminatory behaviour to be ‘bad enough’ to warrant reporting. They express uncertainty and misconceptions around reporting measures.

Students fear personal repercussions and future interactions with instigators. They are discouraged by poor bystander responses and previous negative reporting experiences. Students are motivated to report by positive bystander responses, previous positive reporting experiences, encouragement from support systems, and a sense of duty to patients.

Conclusions Although gender discrimination is experienced extensively among medical students on placement, they tend not to report their experiences. The Leeds School of Medicine should provide clear guidance on how students can access reporting tools, what the reporting process involves and what types of behaviour are expected to be reported. They should communicate directly with students regarding the outcome of their report and enable anonymised reporting if desired.

Keywords discrimination; education; gender; medical; reporting

References

1. Samuriwo R, Patel Y, Webb K, Bullock A. ‘Man up’: medical students' perceptions of gender and learning in clinical practice: a qualitative study. Med Educ 2020;54(2):150–61. https://doi.org/10.1111/medu.13959

2. Wear D, Aultman J. Sexual harassment in academic medicine: persistence, non-reporting, and institutional response. Med Educ Online 2005;10(1):4377. https://doi.org/10.3402/meo.v10i.4377

3. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa

Lauren Hardie-Bick

Brighton and Sussex Medical School

There has been a long history of attempts to embed health inequalities teaching and learning within undergraduate medical curricula. With rising inequality, ageing populations, increasing migration and climate change, these topics have never been more relevant.

This presentation will report on experiences of designing and delivering a module about health inequalities and inclusion healthcare at Brighton and Sussex Medical School (BSMS). The module runs in Year 1 and 2 of the undergraduate medical programme and Year 2 of the Physician Associate programme. The aims are to raise awareness and improve understanding of inequalities experienced by a range of people and communities, develop a sense of social sensitivity and responsibility to issues faced by disadvantaged people and communities and gain experience in discussing and working out personal and systemic approaches to address issues that may influence inequalities and inclusion in future healthcare interactions.

The module adopts a collaborative and integrated approach to developing content involving faculty with clinical, humanities, public health and social science backgrounds, as well as individuals from local Third sector organisations and students. I will reflect on some of the challenges associated with teaching such complex and politically charged topics, the lessons we have learned over the past 4 years and changes we have made and report on feedback from teaching faculty and students.

Medical educators need to work with key stakeholders to develop communities of practice and push for curriculum reform to create more inclusive curricula and improve health outcomes for marginalised groups.

Keywords inequality and inclusion healthcare; integration; medical education

Suhail Tarafdar¹, Noha Seoudi¹, Ruoyin Luo² and Kalman Winston³

¹College of Medicine and Dentistry, Ulster University; ²Ulster University; ³University of Cambridge

Background Dyslexia is a neurodevelopmental learning difficulty characterised by reading issues.¹ It is associated with differential attainment within undergraduate and postgraduate medical education.² In order to identify factors for this, and to provide effective support, there is a need to review the published literature concerning medical students and doctors with dyslexia. The aim of this systematic review was to understand the experiences of undergraduate medical students and postgraduate doctors with dyslexia, within current published literature.

Methods Boolean logic was applied to conduct a search strategy within scientific servers. Studies were included if they concerned either medical students or postgraduate medical doctors with dyslexia. A quality appraisal was undertaken and narrative synthesis employed to produce the final report.

Findings Thirty-one articles were included, with seven deemed high-risk of bias. Four overarching themes were identified, that were divided into subthemes. There are largely negative experiences reported in the literature, with stigma and poor awareness. Dyslexia impacts assessment performance, although reasonable adjustments are effective for written examinations. Strategies can reduce difficulties related to dyslexia, including task completion, peer support, organisational inclusivity and interactive educational methodologies. Moreover, dyslexia impacts the career trajectory of doctors.

Conclusion Training programmes should be inclusive, by raising awareness, peer support and provision of reasonable adjustments. A number of potential strategies have been identified to improve the educational experiences of students with dyslexia, but these should be flexibly used, according to individual needs. Further research is warranted on dyslexia within specialty training, particularly general practice.

Keywords dyslexia; inclusivity; neurodiversity; postgraduate; undergraduate

References

1. Rose J. Identifying and teaching children and young people with dyslexia and literacy difficulties. London; 2009

2. Murphy MJ, Dowell JS, Smith DT. Factors associated with declaration of disability in medical students and junior doctors, and the association of declared disability with academic performance: observational study using data from the UK medical education database, 2002-2018 (UKMED54). BMJ Open 2022;12(e059179):1–11. https://doi.org/10.1136/bmjopen-2021-059179

Daniel Mohammadian, Chloe Langford and Sally Curtis

University of Southampton

Background Reverse Mentoring is a potential method to disassemble the hierarchical nature of medicine, improve inclusivity in medical schools and help reduce the awarding gap.¹ A previous study² reported that reverse mentoring, delivered in a medical school, had an overall positive short-term impact on mentees, increasing their understanding of the challenges underrepresented students face and reducing the student deficit discourse.

This study aims to determine the long-term impact on mentees and determine possible improvements for future iterations of the scheme.

Methods This qualitative study with an interpretivist approach employed online semi-structured interviews of senior faculty and NHS trust staff who participated in the reverse mentoring scheme between 2020 and 2022. Interviews were audio recorded, transcribed and coded. Codes were verified by co-authors and used to create a coding framework. Iterative reflexive thematic analysis was undertaken to identify recurring and aligned aspects of the codes and to extract the data's main themes.

Results Fifteen participants were interviewed, key themes included the power of conversation, mentee–mentor relationship and understanding of role. The overall findings convey mixed to positive long-term impact on participants.

However, some mentioned negative outcomes relating to traditional medical hierarchy and power dynamics.

Discussion Most participants reported a positive long-term impact from being a mentee on their ongoing practice and personal development. Some participants reported the scheme's positive influence on the development of initiatives aimed at improving inclusivity in the NHS. Conversely, some participants reported little benefit, demonstrating this reverse mentoring scheme is not an initiative positively impacting all participants.

Keywords awarding; gap; inclusion; mentoring; reverse

References

1. Celia B, Charlotte G, Amir HS. Is the awarding gap at UK medical schools influenced by ethnicity and medical school attended? A retrospective cohort study. BMJ Open 2023;13(12):e075945. https://doi.org/10.1136/bmjopen-2023-075945

2. Curtis S, Mozley H, Langford C, Hartland J, Kelly J. Challenging the deficit discourse in medical schools through reverse mentoring-using discourse analysis to explore staff perceptions of under-represented medical students. BMJ Open Dec 24, 2021;11(12):e054890. https://doi.org/10.1136/bmjopen-2021-054890

Morgan Blake, Peta Coulson-Smith, Luca Di Gregorio, Kathleen Kendall, Ihuoma Osuji, Shmma Quraishe, Asha Raja, Roma Rajani, Anne Walter and Heather White

University of Southampton

Introduction In alignment with Medical Schools Council's guidance¹ and in response to student and staff feedback, the Faculty of Medicine at Southampton University have undertaken a series of student-staff collaborative activities to diversify and decolonise the curriculum.

Methods A survey of undergraduate medical students across all years and programmes was conducted, and 10 interviews with staff in educational leadership positions were held. The current curriculum was mapped and gaps identified, learning outcomes developed and a staff toolkit created. New clinical practice tutorials, delivered by foundation year doctors, were piloted with year 1 students in the three undergraduate programmes.

Findings The survey yielded a response rate of 9% (n = 127). Students considered the curriculum moderately inclusive but those from minoritised groups were least likely to feel this way. Overall, most students agreed it very important to diversify and decolonise the curriculum. Interviews showed staff to be supportive of diversifying and decolonising the curriculum too, but they were unclear about what decolonising means in practice. Staff were concerned about the lack of resources and time, and some were worried about an apparent contradiction of leading a decolonisation project from a position of white and other privileges. Evaluations of the tutorials were very positive.

Conclusion Both students and staff are supportive of efforts to diversify and decolonise the medical curriculum. Towards this end, the curriculum is being updated, staff development resources created, new teaching introduced and further research conducted. This project highlights the value and importance of student-staff collaborations in medical education.

Keywords collaboration; curricula; decolonising; diversifying; inclusion

Reference

1. Medical Schools Council Equality, Diversity & Inclusion Alliance. Active inclusion: challenging exclusions in medical education. Medical Schools Council; December 2021.

Nariell Morrison

Imperial College London

The underrepresentation of women and individuals from groups historically underrepresented in medicine (UiM) in leadership roles is a significant concern in healthcare and clinical education.¹ This disparity has been further highlighted by the growing awareness of equality, diversity, and inclusion (EDI) issues in medicine. As the medical student population evolves to more accurately reflect the diverse public it serves, there have been increasing calls from students for a more inclusive representation among faculty and leaders to foster a sense of belonging.² However, despite the apparent benefits and growing demand for diverse leadership, progress towards achieving such diversity remains slow.³

To address this challenge, one suggested approach is to create professional development opportunities, especially for those working in the field of EDI. As this year's recipient of the ASME Educator Development Award, I was awarded a place on the ASME ‘Developing Leaders in Healthcare Education 2024’ course to enhance my leadership skills. This presentation will outline my experiences of the course, focusing on the insights gained into effective team leadership, strategic vision setting, and managing educational change—essential skills for impactful leadership in EDI within clinical education.

Advancing the careers of emerging EDI leaders through professional development in leadership is crucial for equipping them with the necessary skills to become influential role models for their peers and students. Thus, participation in leadership courses such as the ASME ‘Developing Leaders in Healthcare Education 2024’ is an important step towards nurturing the next generation of EDI leaders in clinical education.

Keywords award; diversity; equity; inclusion; leadership

References

1. Samuel A, Soh MY, Durning SJ, Cervero RM, Chen HC. Parity representation in leadership positions in academic medicine: a decade of persistent under-representation of women and Asian faculty. BMJ Leader 2023;7(Suppl 2):e000804. https://doi.org/10.1136/leader-2023-000804

2. Morrison N, Machado M, Blackburn C. Bridging the gap: understanding the barriers and facilitators to performance for Black, Asian and minority ethnic medical students in the United Kingdom. Med Educ Oct 8, 2023. https://doi.org/10.1111/medu.15246

3. Soklaridis S, Lin E, Black G, Paton M, LeBlanc C, Besa R, MacLeod A, Silver I, Whitehead CR, Kuper A Moving beyond ‘think leadership, think white male’: the contents and contexts of equity, diversity and inclusion in physician leadership programmes. BMJ Lead Jun 2022;6(2):146–157. https://doi.org/10.1136/leader-2021-000542

Chloe Langford, Heather Mozley, Sally Curtis, Josette Crispin and Rebecca Bartlett

University of Southampton

Medical students from widening participation (WP) backgrounds can feel isolated and lack a sense of belonging in Higher Education and in medical school.¹ Prior research demonstrated how workshops facilitated by the University of Southampton staff and WP graduates helped to increase WP medical students' self-efficacy and sense of belonging, as well as providing opportunities to interact with relatable role models.² In this study, we expand on these findings by further exploring the impact of relatable role models and other peer relationships on participants' sense of belonging.

Focus groups with 15 workshop participants were facilitated and audio recorded. Transcripts were then iteratively coded and analysed using inductive thematic analysis. A secondary deductive analysis was undertaken using an analytical framework adapted from Williams et al.'s composite definition of Social Support.³

Eight key themes pertaining to the nature and benefits of the peer relationships were identified within two overarching Social Support categories of social relationships and supportive resources. An additional theme of intimate resources, denoting the authentic sharing of personal experiences and concerns with others, was an instrumental conduit linking both categories. Intimate resources and the themes within the Social Support categories build upon each other to enhance participants' sense of belonging.

The inclusive environment of the workshops supported the creation and strengthening of relationships between medical students and graduates from WP backgrounds. Participants found that the workshop resources and the facilitation of emotional support through accessible and reciprocal relationships enhanced their sense of belonging, giving them confidence to succeed in their clinical years.

Keywords sense of belonging; social support; widening participation

References

1. Bassett AM, Brosnan C, Southgate E, Lempp H. Transitional journeys into, and through medical education for first-in-family (FiF) students: a qualitative interview study. BMC Med Educ 2018;18(1):1–12. https://doi.org/10.1186/s12909-018-1217-z

2. Mozley H, D'Silva R, Curtis S. Enhancing self-efficacy through life skills workshops. Widening Participation and Lifelong Learning 2020;22(3):64–87. https://doi.org/10.5456/WPLL.22.3.64

3. Williams P, Barclay L, Schmied V. Defining social support in context: a necessary step in improving research, intervention, and practice. Qual Health Res 2004;14(7):942–60. https://doi.org/10.1177/1049732304266997

Alison Callwood, Jenny Harris and Maddy Coe

University of Surrey

Background Ensuring equitable access to healthcare education programmes and employment is a fundamental human right.¹ This is currently not the case for neurodivergent individuals who comprise 15%–20% of the population.²

Our aim was to better understand the accessibility needs of neurodivergent applicants when undertaking online interviews.

Methods A co-design approach³ was used to evaluate an existing asynchronous online Multiple Mini Interview (MMI) platform. A total of 100 neurodivergent volunteers took a three question, four-minute MMI on the platform which was assessed by independent interviewers. They completed a semi-structured evaluation questionnaire, suggesting accessibility optimisation features. An accessibility tool bar comprising these features was built into the platform and evaluated with 100 additional neurodivergent volunteers.

Data were analysed using descriptive statistics and conventional content analysis. Differential attainment was explored by comparing neurodivergent volunteers mean scores with a random sample of n = 50 neurotypical volunteers using Mann Whitney test.

Results Accessibility features included the following: colour and contrast, sub-titles, font choice, video settings and progress customisation, enabling applicants to optimise their set up before their interview.

About 92% of neurodivergent volunteers felt the platform made it easy to complete the interview; 93% found the instructions easy to follow; 70% thought the interview outcomes were fair, objective; and 70% were less anxious. Statistically significant differences were not found in mean interview scores (per question or total) between neurotypical and neurodivergent volunteers.

Conclusion These preliminary findings suggest that the co-designed interview platform was fair and highly acceptable to neurodivergent applicants. Neuroinclusive optimisations should be designed into online interviews to ensure equity.

Keywords ED&I; multiple mini interviews; selection

References

1. United Nations Sustainable Development Goals. 2012: https://sdgs.un.org/goals

2. https://mydisabilityjobs.com/statistics/neurodiversity-in-the-workplace/

3. Robert, G., Locock, L., Williams, O., Cornwell, J., Donetto, S., Goodrich, J. 2022. Co-producing and co-designing. Cambridge University Press, Cambridge. https://doi.org/10.1017/9781009237024

Cate Goldwater Breheny¹, Dominic Lee², Daniel Ly³, Holly Oliver⁴, Anbreen Bi⁵ and Stephanie Bull⁵

¹Imperial College School of Medicine; ²University of Dundee; ³University College London; ⁴University of Lincoln; ⁵Medical Education Innovation and Research Centre, Department of Primary Care and Public Health, School of Public Health, Imperial College London

Background Queer medical students feel unsupported at medical school, concealing their identities or avoiding reporting discrimination for fear of negative consequences.¹ Surveys in the United Kingdom (UK) show Queer students do not feel safe in their place of study.² This study explores Queer UK medical students' experiences across gender, sexual and romantic identities. This has not previously occurred in depth in the UK to our knowledge.

Methods Individual semi-structured interviews were conducted with 12 Queer medical students across three medical schools in England and Scotland. The project is led by students with a range of Queer identities. Interviews explored perceptions of how Queer identity affected their medical student experience. Thematic analysis was conducted.

Keywords equality, diversity and inclusivity (EDI), learning environments; identity; LGBTQ+; medical students

References

1. Butler K, Yak A, Veltman A. ‘Progress in medicine is slower to happen’: qualitative insights into how trans and gender nonconforming medical students navigate cisnormative medical cultures at Canadian training programs. Acad Med, 2019;94(11): 1757–65. https://doi.org/10.1097/acm.0000000000002933

2. British Medical Association (BMA) & Association of LGBTQ+ Doctors and Dentists (GLADD). Sexual orientation and gender identity in the medical profession. Published 2022. https://www.bma.org.uk/media/6340/bma-sogi-report-2-nov-2022.pdf

Kwaku Baryeh, Syeda Tasfia Tarannum, Lara Higginson and Christina Cotzias

Chelsea and Westminster Hospital NHS Foundation Trust

Background As part of our trust's commitment to supporting international medical graduates (IMGs), we have long looked for ways to improve their experiences. While historically this has been done on a local level, since the release of the national guidance ‘Welcoming and Valuing International Medical Graduates’,¹ it is clear that greater benefit can be gained from a collaborative approach. As such, our sector has established an IMG office to co-ordinate and deliver on-boarding, induction and orientation activities in line with national recommendations.

Methods The sector's IMG office was established in August 2023 with the first ‘soft launch’ induction programme running in November 2023. We have agreed a standardised start date with the week-long induction programme representing the first day of employment for IMGs recruited by any of the trusts within the sector with less than 12 months NHS experience. The programme's sessions cover a variety of topics including UK medical ethics and communication skills, to orientate the doctors before starting to work clinically.

Results To date, 32 doctors from three trusts have attended our induction programme. The induction programme represented the first day at work for 12/32 doctors. The feedback confirms that the course helps candidates feel welcomed and valued following the induction and they understood the NHS better as a result.

Conclusion An induction programme improves IMG confidence and their understanding of the NHS. By adopting a centralised collaborative approach, we avoid the need for educational replication, develop a broad robust faculty and increase the support network available to IMGs.

Keywords induction; international medical graduates; pastoral support; peer network

Reference

1. NHS England. Welcoming and valuing international medical graduates: a guide to induction for IMGs recruited to the NHS. 2022. https://www.nhsemployers.org/news/welcoming-and-valuing-international-medical-graduates.

Mytien Nguyen¹, Karina Pereira-Lima², Justin Bullock³, Amy Addams⁴, Christopher Moreland⁵ and Dowin Boatright⁶

¹Yale School of Medicine; ²University of Michigan Medical School; ³University of Washington; ⁴The Association of American Medical Colleges; ⁵Dell Medical School at the University of Texas at Austin; ⁶New York Medical College

Burnout poses significant challenges for medical student attrition,¹ particularly affecting underrepresented students.² While studies have identified higher burnout risks among disabled students,³ limited research explores the intersectionality of burnout risk among racial and ethnic underrepresented students with disabilities.

This cohort study analysed deidentified data from the Association of American Medical Colleges (AAMC) Year 2 Questionnaire (Y2Q) and included 27,009 students. Prevalence of disability by race, ethnicity, sex and age were assessed. Burnout risk was determined using the Oldenburg Burnout Inventory. Modified Poisson regression estimated burnout risk, adjusting for relevant factors.

Abou 13.66% of medical students had burnout risk, which increased with the number of disability types. Students reporting multiple disabilities at a 254% greater risk. Intersectional analysis revealed Asian and underrepresented minority (URiM) students with multiple disabilities faced the highest risk, more than threefold their non-disabled white peers.

The study emphasises the heightened burnout risk for Asian and URiM students with multiple disabilities, shedding light on the importance of an intersectionality lens in addressing the challenges for medical students with disabilities. These findings underscore the need for accommodations and support mechanisms to mitigate burnout and promote equity, especially for students facing intersecting forms of discrimination. The study has limitations including the inability to cluster results by medical school and examine burnout across other demographic groups.

These findings serve as a call to action and highlight the need to apply critical intersectional, antiracist and anti-ableist perspectives to addressing burnout among underrepresented students with disabilities and promoting equity in medical training.

Keywords burnout; disability; diversity; medical education; underrepresented

References

1. Nguyen M, Chaudhry SI, Desai MM, Chen C, Mason HRC, McDade WA, Fancher TL, Boatright D Association of sociodemographic characteristics with US medical student attrition. JAMA Intern Med 2022;182(9):917–924. https://doi.org/10.1001/jamainternmed.2022.2194

2. Teshome BG, Desai MM, Gross CP, Hill KA, Li F, Samuels EA, Wong AH, Xu Y, Boatright DH Marginalised identities, mistreatment, discrimination, and burnout among US medical students: cross sectional survey and retrospective cohort study. BMJ 2022;376:e065984. https://doi.org/10.1136/bmj-2021-065984

3. Meeks LM, Pereira-Lima K, Plegue M, Jain NR, Stergiopoulos E, Stauffer C, Sheets Z, Swenor BK, Taylor N, Addams AN, Moreland CJ Disability, program access, empathy and burnout in US medical students: a national study. Med Educ 2023;57(6):523–534. https://doi.org/10.1111/medu.14995

Chloe Labutte¹, Lauren Simmonds¹ and Alison Ledger²

¹University of Leeds; ²University of Queensland

Intercalation develops students' skills and motivation for a clinical academic career (1,2). However, in our experience, current students are questioning its value, following changes to the foundation programme application process and limited undergraduate medical education funding. Students from widening participation (WP) backgrounds are likely most affected by financial concerns, potentially limiting diversity within the future clinical academic workforce.

Our research aim was to explore WP students' experiences of intercalation, including perceived benefits, barriers prior to intercalation and demands during the intercalated year.

We recruited seven current or previous intercalating students who met University of Leeds WP criteria, via student mailing lists. These students were then invited to a semi-structured interview and to complete a mind map of intersections between their WP background and intercalation experience. Interviews were video recorded, transcribed and interpreted through applying and refining a coding framework.

Participants reported diverse experiences. Commonalities included the challenges of preparing for decreased financial support in subsequent academic years and approaching intercalation differently to non-WP peers (for example experiencing heightened pressure to excel due to financial costs). However, participants also reported feeling recognised and valued during their intercalated year, in ways they did not experience in their primary medical degree.

We not only recommend increased funding to support students to intercalate, but greater transparency about the financial implications of intercalation to allow students to make informed decisions. Our findings further demonstrate the importance of intercalation for maximising students' potential, and ensuring academic medicine is a career option available to all.

Keywords experiences; intercalation; widening participation

References

1. Finn G, Uphoff EP, Raine G et al. From the sticky floor to the glass ceiling and everything in between: a systematic review and qualitative study focusing on inequalities in clinical academic careers. URL: https://research.manchester.ac.uk/en/publications/from-the-sticky-floor-to-the-glass-ceiling-and-everything-in-betw-2. Published 2020. (Accessed January 20, 2024.).

2. Bracewell B. Igniting the fire and seeing through the smoke: enabling medical students to see themselves as future clinical academics [iBSc dissertation]. Leeds: University of Leeds; 2023.

Isobel Walker¹ and Emma Treharne²

¹Junior Association for the Study of Medical Education (JASME); ²Somerset Foundation Partnership

Background Planning JASME's 2022 conference involved promoting presenter diversity. An ‘experience bias’ exists within medical education—those with more confidence, institutional support and contacts have more opportunities to present and network. JASME represents many affected by procedural change in medical education but often with less prominent voices. Constraints early-career trainees¹ face mean there can be fewer opportunities to present at conferences and be involved in affecting policy. The conference challenged this standard: inviting those with no experience of publishing or presenting in medical education to submit an abstract for presentation under pre-set themes.

Evaluation Post conference, the value of the scheme was demonstrated objectively using a Likert scale, from 1 (not at all likely to participate) to 5 (extremely likely). Before the conference, the mean score was 3, rising to 4 during the conference. Delegates then assessed whether their likelihood to participate 6 months after the conference improved, with 1 being a ‘significant decline’ and 5 a ‘significant improvement’. The mean score was 4.

Qualitative evaluation revealed a supportive and inclusive environment, challenging imposter syndrome.

Implication This session aims to attract stakeholders involved in medical education promotion and engagement, or widening participation. By discussing this initiative, the aim is for stakeholders to understand the importance of ‘nothing about us without us’ within medical education and collaborate on developing ways to increase inclusive medical education within their own community. About 100% of respondents thought that the scheme should be run again, demonstrating how imperative it is that this topic is platformed.

Keywords accessibility; conference; education; inclusivity; innovative

Reference

1. Kircherr J, Biswas A. Expensive academic conferences give us old ideas and no new faces [Internet]. Guardian News and Media; 2017 [cited 2023 Jun 2]. Available from: https://www.theguardian.com/higher-education-network/2017/aug/30/expensive-academic-conferences-give-us-old-ideas-and-no- new-faces

Miriam Veenhuizen^1,2,3, Ayla Ahmed¹ and Andrew O'Malley¹

¹University of St Andrews; ²University of Keele; ³Foundation for Advancement of Medical Education and Research

Background Image generative artificial intelligence could be useful to medical educators, particularly in the disciplines of anatomy and dermatology. Medical textbooks have been noted to contain a paucity of images with subjects of a darker skin tone.¹ This study aimed to test if the same lack of diversity is also present in medical images generated by artificial intelligence.

Methods A prompt was given to two Artificial Intelligence image generation models (Dall-E and Midjourney) to generate images (n = 200) of people with psoriasis. Three researchers separately rated each image using the validated Massey-Martin skin tone rating scale.² The median skin tone rating was taken to represent each image. A goodness-of-fit test (Pearson's Chi-squared) was undertaken to compare the distribution of skin tones in the AI- generated images to an expected distribution of skin tones based on the American National Election Survey Time series 2012 study.³

Results Pearson's Chi-squared goodness-of-fit analysis showed a statistically significant difference existed between AI-generated skin tones and skin tones that might be encountered in society (p < 0.001). Educators who opt to use generative AI should be aware of its significant bias towards lighter toned skin. Further work should examine whether more sophisticated prompts can overcome this bias to create images which reflect the expected distribution of skin tones to be representative of the desired population. Other work should be undertaken to establish whether similar biases exist elsewhere in generative AI.

Keywords artificial intelligence; bias; diversity; medical images

References

1. Louie, P., & Wilkes, R. Representations of race and skin tone in medical textbook imagery. Soc Sci Med, 2018;202: 38–42. https://doi.org/10.1016/j.socscimed.2018.02.023

2. Massey, Douglas S., and Jennifer A. Martin. 2003. The NIS skin colour scale.

3. The American National Election Studies (ANES). ANES 2012 time series study. Inter-university Consortium for Political and Social Research, 2016. https://doi.org/10.3886/ICPSR35157.v1

Laura Knight and Ravi Parekh

Imperial College London

Significant efforts have been made to increase participation of underrepresented groups within healthcare professions.¹ Such efforts have produced mixed outcomes and many groups remain underrepresented,² suggesting there is still much to learn about widening participation in healthcare careers (WP). In particular, little is known about the barriers and facilitators to participants' engagement with WP programmes, and while access to suitable work experience is a known barrier to healthcare careers,³ there lacks an understanding of the value that it brings to students from WP backgrounds who are considering but have not yet committed to pursuing, healthcare careers. Here, we share the early findings from our realist evaluation of the Widening Access to Careers in Community Healthcare (WATCCH) program at Imperial College London.

WATCCH attendees are offered work experience placements, face-to-face workshops and mentoring. We have developed an understanding of which elements of WATCCH were working, for whom, in what circumstances, and how, by speaking with program participants, student mentors and staff. In this discussion of our findings, we highlight how WP efforts such as WATCCH can support students interested in healthcare careers to engage, and remain engaged, with the program. We also highlight how powerful WP programmes can be when they ‘get it right’. We consider the transferability of findings to broader WP efforts, and invite comment and discussion of our preliminary findings.

Keywords evaluation; qualitative; widening participation

References

1. Widening Participation in Medicine. British medical association. Updated 20 December 2023. Accessed 21 March 2024. https://www.bma.org.uk/advice-and-support/studying-medicine/becoming-a-doctor/widening-participation-in-medicine

2. Robinson D, Salvestrini V. The impact of interventions for widening access to higher education: a review of the evidence. Education Policy Institute Accessed 21 March 2023. https://epi.org.uk/wp-content/uploads/2020/03/Widening_participation-review_EPI-TASO_2020-1.pdf

3. Jackson D, Ward D, Agwu JC, Spruce, A. Preparing for selection success: socio-demographic differences in opportunities and obstacles. Med Educ 2022;56 (9): 922–935. https://doi.org/10.1111/medu.14811.

Maria Fisher and Helen Nolan

University of Warwick

Background Specific Learning Differences (SpLD's) encompass several neurocognitive conditions affecting how individuals learn and process information.¹ Despite medical school requirements to ensure inclusion, medical learners with SpLD's report real or perceived discrimination,^2,3 as educators may lack understanding of SpLD's and how to support learners.¹ Little is known regarding educators' perspectives on SpLD's, indicating further exploration.

Methods Fourteen medical educators from one graduate-entry medical school participated in this qualitative semi-structured interview study. Interviews explored educators' understanding of SpLD's and associated learner impacts, experiences of teaching learners with SpLD's and issues in delivering inclusive education.

Reflexive thematic analysis was used.

Keywords inclusion; medical education; medical learner; qualitative; specific learning difference

References

1. Murphy MJ, Dowell JS, Smith DT. Factors associated with declaration of disability in medical students and junior doctors, and the association of declared disability with academic performance: observational study using data from the UK medical education database, 2002-2018 (UKMED54). BMJ Open. 2022;12(4):e059179. Published 2022 Mar 31. https://doi.org/10.1136/bmjopen-2021-059179

2. Shaw SCK, Anderson JL. The experiences of medical students with dyslexia: an interpretive phenomenological study. Dyslexia 2018;24(3):220–233. https://doi.org/10.1002/dys.1587

3. Walker ER, Shaw SCK. Specific learning difficulties in healthcare education: the meaning in the nomenclature. Nurse Educ Pract 2018;32:97–98. https://doi.org/10.1016/j.nepr.2018.01.011

Jyotsna Needamangalam Balaji and Krishna Mohan Surapaneni

Panimalar Medical College Hospital & Research Institute, Chennai, India

Background There has been growing recognition of the importance of equity, diversity and inclusivity (EDI) in healthcare.¹ This includes understanding diverse patient backgrounds, health disparities and the need for culturally competent care.² Many medical schools are working to integrate EDI topics into their curricula. However, the depth and effectiveness of this integration vary widely. This study aims to assess and understand medical students' perspectives and expectations regarding Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual and other sexual orientations (LGBTQIA+) training.

Methods This qualitative approach included in-depth-personal interviews and Focus Group Discussions (FDG) with medical students from first to fourth years. A total of 36 students participated in the study. The interview assessed the knowledge, attitudes and confidence of medical students in understanding the needs of LGBTQIA and offering holistic care. Four 60-minute FGDs with nine participants in each further explored the current state of training, students' expectations and their willingness to EDI training. Content and thematic analysis were performed for all responses.

Results The responses were categorised into Foundational Understanding, Perceptual Insights, Clinical Assurance, Training in Curriculum, Unaddressed Needs, Personal Interests and Actionable Strategies. Students were not aware of terms like coming out/non-binary/queer/questioning/Zie&Hir. Their attitudes were positive. Majority felt that there was no formal training, and they were not confident about eliciting sexual history/performing clinical examinations on LGBTQIA+ patients. All students were willing to undergo EDI training in healthcare. However, students reported concerns over lack of time, real-time exposure to LGBTQIA+ patients, faculty support and authentic assessments.

Keywords diversity; equality; gender; inclusivity; medical education; medical students; undergraduate

References

1. Smith TK, Hudson Z. Enhancing curricula about diversity, equity, inclusion, and justice in undergraduate medical education. Pediatr Ann 2023;52(7):e249-e255. https://doi.org/10.3928/19382359-20230516-02

2. Kusurkar RA, Naidu T, Rashid MA. How should we do equity, diversity and inclusion work in health professions education? MedEdPublish (2016). 2023;13:31. https://doi.org/10.12688/mep.19673.1

Poppy Sullivan¹, Dalila Marra¹, Parmis Vafapour¹, Rida Kherati¹, Freya Goodman¹, Natalia Olszewska¹, Amrit Maraway¹, Evie Russell¹, Saher Ahmad¹ and Zainab Mashal Hussain Wasti²

¹Barts and the London Medical School; ²University College London

Background The Empowerment Project at Barts and The London addresses a critical void in medical education by employing a ‘Three Step Plan.’ This includes Active Bystander Training, the Elephant in the Room panel talk about NHS hot topics and the 70 kg Man lecture highlighting healthcare biases. The initiative empowers medical students to challenge discrimination, nurturing a proactive stance towards professional advancement.

Methods The ongoing qualitative research examines the impact of The Empowerment Project on third-year medical students. The programme is embedded to guarantee participants' completion of all steps, ensuring a comprehensive understanding of the interventions. Semi-structured interviews explore student experiences, considering ethical implications and potential distress. Quantitative data assess outcomes using Agentic Engagement Scale and the Academic Self-Efficacy Scale for Students (Zimmerman) scales. Questionnaires will consider changes in attitudes, collecting quantitative and qualitative data before and after sessions.

Results Prior findings indicate positive trends across interventions. Active Bystander Training demonstrates increased confidence using the taught principles. The 70 kg Man lecture exhibits early indications of enhanced critical thinking. The Elephant in The Room panel talk encourages open dialogues on socio-political issues within the NHS. Ethics proposals for further data collection will be submitted presently, so the project hopes to have more substantive qualitative and quantitative data by July to provide an understanding of medium and long-term impacts.

Conclusion This research will offer valuable insight into the efficacy of The Empowerment Project. The findings could inform medical education, underscoring the importance of critical reflection and providing skills to act against discrimination.

Keywords active bystanding; diversity; medical education

Alyssa Weissman

University of Buckingham

Background The medical profession is a diverse field requiring a broad range of skills, perspectives and experiences. Yet, medical education often overlooks the unique needs and contributions of neurodivergent students. This project leverages the lived expertise of the researcher and participants to identify ways to increase accessibility and foster inclusivity.

Methods Using a quantitative and qualitative survey targeting medical students and staff across medical schools in the UK, both x and neurotypical, participants shared their experiences and perspectives in various domains, including curriculum, teaching, assessment and support.

Results Preliminary findings from 68 responders to date indicate a significant disparity in the experiences of neurodivergent students compared to their neurotypical peers, particularly in communication and interactions with educators in teaching, learning,and assessment and access to support and reasonable adjustments. For example, 61.1% of neurodivergent individuals feel OSCEs do not accommodate for different communication styles, but most responders feel neurodiversity is underrepresented in the curriculum. Responses also revealed significant commonalities in the neurodivergent experience, including the impact of masking and lack of effective support.

Conclusion This study suggests that current practice may marginalise neurodivergent learners highlighting a critical need for systemic change in medical education. The lived experience in this research allows a dissection of the neurodiverse experience and highlights significant gaps in the provision of tailored support and reasonable adjustments. By embracing a neurodiversity-affirmative approach and leveraging the lived expertise of neurodivergent individuals, medical education can evolve to foster a more inclusive, empathetic and diverse healthcare workforce.

Keywords ADHD; autism; dyslexia; lived experience/expertise; neurodiversity

References

General Medical Council. Welcomed and valued: supporting disabled learners in medical education and training. GMC; 2020. Accessed September 12, 2023. https://www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/welcomed-and-valued/health-and-disability-in-medicine.

Shaw SCK, Anderson JL. The experiences of medical students with dyslexia: an interpretive phenomenological study. Dyslexia 2018;24(3):220–233. https://doi.org/10.1002/dys.1587.

Shaw SCK, Doherty M, Anderson JL. The experiences of autistic medical students: a phenomenological study. Med Educ 2023;57(10):971–979. https://doi.org/10.1111/medu.15119.

Neera Jain¹, Erene Stergiopoulos², Amy Addams³, Christopher Moreland⁴ and Lisa Meeks⁵

¹The University of Auckland; ²University of Toronto; ³Association of American Medical Colleges; ⁴Dell Medical School at the University of Texas; ⁵The University of Michigan Medical School

Purpose Despite widespread efforts to promote inclusion, students with disabilities face inequitable access to medical education. Existing research on systemic barriers and their impact on student performance often lacks first- person perspectives, particularly from students not relying on accommodations. This study addresses these gaps by analysing a national dataset of 674 open-text responses from the 2019 and 2020 Association of American Medical Colleges Year 2 Questionnaire, providing insights into the perceptions of medical students with disabilities regarding disability inclusion in US medical education.

Methods Using reflexive thematic analysis, we explored the experiences of students with disabilities in medical school.

Results Our inductive semantic approach to coding data led to the identification of key dimensions within the medical education system, including program structure, processes, people and culture. These dimensions played a crucial role in shaping students' perceptions of feasible changes to enhance educational access and the acceptability of pursuing such changes. In response, students actively navigated the system, employing administrative, social and internal mechanisms to manage their disabilities.

Discussion These findings emphasise the relational nature of disability production, revealing how key dimensions in medical school influence student experiences of disability inclusion and contribute depth to existing knowledge by exploring reasons behind students not pursuing accommodations. The study concludes by offering resources to assist medical schools in addressing systemic deficits and enhancing their disability inclusion practices.

Keywords accommodations; disability; experiences; medical students; well-being

References

Braun V, Clarke V. Thematic analysis: a practical guide. London: Sage; 2022, https://doi.org/10.1007/978-3-319-69909-7_3470-2.

Kafer A. Feminist, queer, crip. Bloomington, IN: Indiana University Press; 2013.

Neil Singh

Brighton and Sussex Medical School

As both doctors and patients have grown frustrated by the limitations of an overly reductionist, positivistic view of medicine, medical education has tried to adapt by emphasising the importance of communication skills, cultural competency and personal reflective practice. However, all three adaptations again reinforce the individual (rather than society) as the locus of disease and healing.

I argue that this is the wrong corrective for what really ails medicine most. In reality, the doctor–patient encounter is impoverished not due to poor communication but rather because doctors are not well trained in analysing the forces that influence health outcomes at levels above individual interactions. Drawing on the work of Metzl and Hansen (2014), I use the concept of ‘structural competency’ to summarise the critical structural analysis that is required to think through such problems—training in which is nearly entirely lacking in medical education.

Over the past 5 years, we have radically revised the undergraduate medical curriculum at Brighton and Sussex Medical School, in various ways that have all aimed towards developing structural competency in our graduates. I will also discuss some pilot projects we have led, delivering anti-racist training to health and social care workers at a postgraduate level across Sussex.

I will argue that structural competency is a helpful framing and should be a nationally-mandated component of all medical education, not only at undergraduate level but also at post-graduate level. I will close by discussing the challenges and opportunities of introducing such a pedagogical shift in medical education.

Keywords education; medical; postgraduate; sociology; undergraduate

Reference

Metzl, J. M., & Hansen, H. (2014). Structural competency: theorizing a new medical engagement with stigma and inequality. Soc Sci Med, 103, 126–133, https://doi.org/10.1016/j.socscimed.2013.06.032.

Cristina Costache¹, Megan Brown², William Laughey³, Silke Conen¹ and Gabrielle Finn¹

¹University of Manchester; ²University of Newcastle; ³York University

Background Doctors shape their professional values during medical school (1), that become the spine of their future medical practice. There is extensive evidence showing the sex difference in the pathophysiology of pain(3), and there is growing evidence of gender bias within medical practice (2).

This narrative review is looking at the gap between the shape that healthcare professionals take as they mould through training and the experience and need of patients on pain management, through the lens of gender bias.

Aims This is a narrative review looking at telling the story that pain has in society and medical education at present, from the lens of gender bias in pain diagnosis and management.

Sources The sources will include informal interviews, literature including grey literature, samples of social media posts and media resources that refer to pain and its biased approach in healthcare and health professions education.

Content Despite pain being one of the main experienced symptoms (3,4), this narrative review presents the discrepancy between the patient-centred care that doctors are expected to deliver and the societal bias involuntarily manifested through lack of research in the field and clinical practice.

Implications This narrative review shows a significant research gap in health professions education and will be followed by a scoping review of both social media, hospital guidelines and curricula.

Conflict of interest Two of the authors have chronic pain.

Keywords bias; education; medical; pain

References

1. Brown MEL, Coker O, Heybourne A, Finn GM. Exploring the hidden curriculum's impact on medical students: professionalism, identity formation and the need for transparency. Med Sci Educ 2020;30(3):1107–1121. Published 2020 Jul 24. https://doi.org/10.1007/s40670-020-01021-z

2. Samulowitz A, Gremyr I, Eriksson E, Hensing G. “Brave men” and “emotional women”: a theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain. Pain Res Manag 2018;2018:6358624. Published 2018 Feb 25. https://doi.org/10.1155/2018/6358624

3. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006;10(4):287–333. https://doi.org/10.1016/j.ejpain.2005.06.009

4. Petrie KJ, Faasse K, Crichton F, Grey A. How common are symptoms? Evidence from a New Zealand national telephone survey. BMJ Open 2014;4(6):e005374. Published 2014 Jun 12. https://doi.org/10.1136/bmjopen-2014-005374

Kehinde Akin-Akinyosoye¹, Jason Boland², Bethan Gulliver³, Charlie Williams³, Laura Mongan⁴ and Alison Graham⁵

¹Hull York Medical School, University of York; ²Hull York Medical School, University of Hull; ³Norwich Medical School, University of East Anglia; ⁴Birmingham Medical School, University of Birmingham; ⁵School of Medicine, Newcastle University

Widening participation (WP) programmes, such as Gateway programmes, attempt to alleviate disadvantages which may contribute to differential attainment. Yet, WP students report worse experiences while at medical school.¹ We explored how experiences in WP and non-WP students might vary between Gateway or standard programmes. Associations between WP and progression were investigated.

Year 2 and 3 students at Hull York- and University of East Anglia-medical schools (n = 98) completed a self-report survey containing 86 indicators across different dimensions (student experiences, demographic and socioeconomic characteristics).

Experts participated in consensus-based assessments to identify criteria for the definition of WP. Exploratory Structural Equation Modelling (ESEM) explored domains of student experiences. Correlation and logistic regression analyses tested for associations between underlying factors, entry pathway and progression.

Experts defined WP based on key characteristics: engagement with previous WP programme, receipt of free school meals, parental level of education, disability and being a care leaver. ESEM confirmed good fit for five factors measuring student experience within the survey: (1) academic self-efficacy, (2) work-life balance, (3) financial burden, (4) negative-emotional experiences and (5) positive-emotional experiences. Overall, student experiences were generally poorer in those with increased WP characteristics (r range = −0.21 to 0.23, p < 0.05), but most associations persisted only in non-Gateway groups. No associations with progression outcomes were identified.

Skills developed on the Gateway programmes might better equip students and improve their experience while at medical school. A tailored skills package inspired by the Gateway programme might benefit WP medical students without experience of a Gateway year.

Keywords academic self-efficacy; admission route; gateway entry; widening participation; work–life balance

References

1. Krstić C, Krstić L, Tulloch A, Agius S, Warren A, & Doody G. A. The experience of widening participation students in undergraduate medical education in the UK: a qualitative systematic review. Med Teach 2021;43(9):1044–1053. https://doi.org/10.1080/0142159X.2021.1908976

Bethan Gulliver and Barbara Jennings

UEA

Of the UK's 41 medical schools offering undergraduate MB BS courses, 18 offer an additional gateway year (GY) to students from widening participation (WP) backgrounds. Applicants are made contextual offers in recognition of their previous educational disadvantage. GY courses have been successful in increasing access to medicine from WP groups.¹ At UEA, 95% of GY students' progress to MB BS and MB BS completion rates are similarly high. However, for equity and sustainability, the authors suggest a rethink of our approach to widening access.

There are two problems with current GY provision. Firstly, students must fund an additional year and so face reduced potential working life earnings. Students from WP backgrounds are already experiencing economic disadvantage and are often reliant on holiday and term-time employment, contributing to differences in attainment and completion rates compared to their non-WP peers.²

Secondly, we question the need to provide additional curriculum content beyond that required in the standard medical degree. Educators have suggested that the biggest advantage students gain through foundation years is increased confidence.³ Can this only be achieved through teaching additional material, or could targeted support throughout a degree do the same or better?

As we reform and rationalise the MB BS curricula in the move to four-year courses, we propose a move away from the additional GY for WP students. We suggest that in future, WP students are made contextual offers and then provided with additional, longitudinal, tailored support throughout their MB BS course.

Keywords contextual offers; gateway year; widening participation

References

1. Haque E, Spencer A, Alldridge L. Developing a UK widening participation forum. Clin Teach 2021; 18: 482–484. https://doi.org/10.1111/tct.13357

2. Curtis, S. and Smith, D., 2020. A comparison of undergraduate outcomes for students from gateway courses and standard entry medicine courses. BMC Med Educ, 20, pp.1–14. https://doi.org/10.1186/s12909-019-1918-y

3. Hale, S., 2020. The class politics of foundation years. Journal of the Foundation Year Network, 3, pp.91–100.

Sarah Allsop¹, Stephen Jennings¹ and Annie Noble-Denny²

¹University of Bristol; ²Queen Mary University London

Background Bristol Medical School (BRMS) has a history of innovative teaching practice and high potential for the upscaling of education research capacity. However, prior to September 2022, there was no specific group/centre supporting medical education research.

Methods Our 2023 ASME Educator Development Award provided the platform to build a new community of practice (CoP)¹ to support excellence in medical education research at BRMS, the Bristol Medical Education Research Group (BMERG).

Keywords community of practice; medical education research; staff development

References

1. Wenger, E., McDermott, R., Snyder, W. 2002. Cultivating communities of practice. Boston, MA: Harvard Business School Press.

2. Bristol medical education research group (BMERG) website and blog. Available at: https://bmerg.blogs.bristol.ac.uk/

Sanat Kulkarni¹, Erin Lawson-Smith², Laura Mongan¹, Rachel Westacott¹ and Dawn Jackson¹

¹University of Birmingham; ²Sandwell and West Birmingham NHS Trust

Background The increasing incorporation of digital learning platforms has transformed pedagogical approaches in medical education. However, these tools are under-researched and under-theorised. In the 2022/2023 academic year, an asynchronous, personalised digital learning tool (Osmosis)¹ was provided to all medical students at the University of Birmingham. We are exploring students' experience of implementing the platform and the extent to which it has supported student motivation and inclusion.

Theory and Research Philosophy This will be examined through the lens of self-determination theory (SDT)² which places an emphasis on reforming the educational environment and student autonomy. This aligns with our overarching critical theoretical stance which places an emphasis on inclusion, and giving voice to students, as reflected in our rationale and methodology. We aim to investigate how the Osmosis platform nurtures and supports all learners, encompassing the needs of the individual.

Proposed Methods This qualitative study of second to final year medical students will utilise facilitated focus groups and interviews to explore student experiences of the Osmosis platform. Consistent with our inclusive ethos, students will be given different options of interview media, including written responses. Participants will be recruited using a range of media and offered an optional demographic survey to permit purposive sampling across a range of student groups, including those with self-reported disability. An estimated four focus groups and twenty interviews will be conducted using a topic guide designed around SDT principles. Data will be audio-recorded, transcribed and thematically analysed using the Framework Method³ with initial analysis completed by June 2024.

Keywords digital learning; osmosis; qualitative; self-determination theory; undergraduate

References

1. Osmosis. Elsevier. Accessed 13 September, 2023. https://www.osmosis.org/

2. Deci E, Ryan R. Intrinsic motivation and self-determination in human behaviour. 1985. https://doi.org/10.1007/978-1-4899-2271-7

3. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol 4. Sep 18 2013;13:117. https://doi.org/10.1186/1471-2288-13-117, 1

Joseph Mawhood, Emily Mackie, Kym Merritt, Judith Donkin and James Fisher

Newcastle University

Gaining experience of out of hours (OOH) clinical practice is an important part of medical student training, yet research suggests that its provision is not universal, with only 28% of medical schools providing OOH primary care experience (1). There is an absence of literature exploring OOH experiences for medical students in alternative settings, such as 111 call-centres.

Currently, final-year Newcastle MBBS students attend OOH sessions at an NHS 111 call-centre. As part of a local drive to enhance early clinical experience, we piloted 111 visits for second-year MBBS students, with 20 students attending visits in late 2023.

This study aims to understand how medical students engage with learning in a 111 call-centre, and to explore how this might differ between second and final-year students. Ethical approval has been obtained from Newcastle University.

Research questions were as follows: How does learning in an NHS 111 call centre influence students' perceptions of the 111 service? How does immersion in the remote assessment of acutely unwell patients influence students' views on the management of uncertainty and risk?

Participants will be invited to audio recorded focus groups to explore their experiences, with separate groups for second-year and final-year students. Data will be thematically analysed and explored through the lens of Cultural Historical Activity Theory (2), using Engestrom's Activity System (3) as a framework to understand the complex relationships that influence student learning to contrast these between year groups. Data collection and analysis is ongoing; results and their significance will be presented at the ASME ASM conference.

Keywords clinical; education; remote; uncertainty; undergraduate

References

1. Grove L, Boon V, Thompson T, Blythe A. Out of hours, out of sight? Uncovering the education potential of general practice urgent care for UK undergraduates. Educ Prim Care 2020;31(4):218–23. https://doi.org/10.1080/14739879.2020.1747364

2. Gladman T, Grainger R. Cultural historical activity and the complexity of health professions education. Med Educ 2022;56(11):1058–60. https://doi.org/10.1111/medu.14913

3. Engeström Y. Learning by expanding: an activity-theoretical approach to developmental research: Cambridge University Press; 2019.

Anna Harvey Bluemel, Bryan Burford, Gillian Vance, Megan Brown and Christopher Price

Newcastle University

Background There is increasing concern about the numbers of junior doctors taking post-Foundation career breaks in the UK.¹ This work aimed to understand factors influencing the decision to apply to specialty training or take a break for doctors who graduated in 2020.

Results A total of 320 people completed the survey; 114 (36%) had applied for specialty training; 95 intended to apply for training the following year; 154 respondents (48%) indicated their decision had been influenced by Covid-19.

While burnout varied, with 15% indicating high burnout, this was not associated with the decision to applying for specialty training. However, this decision was predicted by having taken time off due to work-related stress.

Those who had not taken time off were 2.4 times more likely to have applied for specialty training (odds ratio = 2.43, 95% CI 1.20 to 5.34).

Interviews found that reasons for not applying for specialty training included wanting to ‘step off the treadmill’ of training; perceptions of training pathways as inflexible, impacting well-being; and disillusionment with the community and vocation of healthcare, based in part on their experiences working through Covid-19.

Keywords careers; COVID-19; foundation; well-being; transition

References

1. Jewell P, Majeed A. The F3 year: what is it and what are its implications?. J R Soc Med 2018 Jul;111(7):237–9. https://doi.org/10.1177/0141076818772220

2. Braun V, Clarke V. Reflecting on reflexive thematic analysis, qualitative research in sport, Exercise and Health. 2019. 11:4, 589–597. https://doi.org/10.1080/2159676X.2019.1628806

Molly Dineen¹, Michelle D. Lazarus² and Georgina C. Stephens²

¹University of Bristol; ²Monash University

Uncertainty is innate to medical practice. Uncertainty Tolerance (UT) describes how individuals experience and respond to uncertainty, with lower UT associated with negative outcomes (1). Uncertainty is particularly prevalent during the transition from student to clinician (2), and it is pertinent that new doctors are prepared to manage this. This research explored doctors' experiences of uncertainty during their transition to internship (TTI) and considered how clinicians, educators and workplaces can impact this.

Engaging social constructionism, we conducted a cross-sectional qualitative study with 13 intern doctors who graduated from an Australian medical school. Participants completed a semi-structured interview within 5 months of commencing practice in 2021. Data were analysed using framework analysis with the integrative UT model as the preliminary framework (1).

The dominant sources of uncertainty participants described were the tasks, responsibilities and encounters they experienced for the first time in their new role. In response to uncertainty, participants predominantly described feeling stressed and asking senior colleagues for help. Key factors that moderated participants' responses to uncertainty included the presence of support, time availability and perceived risk.

The TTI is an uncertain time. Even with the requisite knowledge and skills, assuming the role of a doctor stimulated substantive uncertainty for participants. The findings highlight the importance of workforce planning to ensure interns have the time and support to address their uncertainty. Research should focus on techniques to manage uncertainty, given the reports of stress and reliance on asking for help. Educators should help students to get prior experience of internship.

Keywords internship; qualitative; transition; uncertainty

References

1. Hillen MA, Gutheil CM, Strout TD, Smets EMA and Han PKJ. Tolerance of uncertainty: conceptual analysis, integrative model, and implications for healthcare. Soc Sci Med 2017;180:62–75. https://doi.org/10.1016/j.socscimed.2017.03.024

2. Brennan N, Corrigan O, Allard J, Archer J, Barnes R, Bleakley A, Collett T, de Bere SR The transition from medical student to junior doctor: today's experiences of tomorrow's doctors. Med Educ 2010;44(5):449–58. https://doi.org/10.1111/j.1365-2923.2009.03604.x

Joe Gleeson

The Mid Yorkshire Teaching NHS Trust

Background NHS Trusts provide FY1s with 30 hours of core teaching per year. At my Trust, this consisted of weekly, hour-long teaching sessions, which were poorly reviewed.

The Solution - STR1DE I replaced the existing teaching with six teaching days across the year, developed and delivered by my team of FY3/FY4 Education Fellows. I called the new programme STR1DE – Simulation, Teaching, and Reflection for FY1 Development and Education.

Each STR1DE session ran four times with a quarter of FY1s attending each and involved half a day of teaching (including practical skills, small group teaching and reflective sessions) and half a day of simulation. STR1DE days were themed, for example on surgery, critical care or careers.

Results Feedback was excellent—100% of FY1s rated STR1DE 5/5 overall.

By analysing feedback, I identified the key drivers of STR1DE's success—including the near-peer approach, curriculum design, usage of simulation and the protected full-day approach.

Since 2021/2022, STR1DE has continued to be highly rated by FY1s, with newer teams of education fellows innovating and improving the teaching. We have also developed a similar programme for FY2s - STR2DE.

Implementing STR1DE required strong institutional support, as it involves withdrawing a quarter of FY1s from service provision 24 times per year. However, we feel that STR1DE is proving to have long-term benefits, has helped to establish the Trust as a centre of educational excellence (and gain teaching hospital status) and makes FY1s more likely to return to work in the Trust in future.

Keywords core teaching; foundation; near-peer; simulation; teaching fellows

Hamza A. Latif, Ishani Young and Claire C. Sharpe

University of Nottingham

Introduction Trust, a multifaceted and complex concept, holds significant importance in healthcare. Foundation Year 1 doctors (F1s) play a crucial role in healthcare teams and undertake many important responsibilities. With an increasing number of medical graduates, it is imperative to explore the characteristics these newly qualified doctors need to embody to be considered trustworthy. To understand ways to improve curriculum design, it was essential to obtain the perspectives of medical educators and students. A literature review illustrated an evident lack of research in this area.

Aims The aim of this study is to investigate the characteristics required for F1s to be considered trustworthy to aid future curriculum design.

Method One-to-one semi-structured Microsoft Teams interviews were conducted with 20 participants—8 medical educators and 12 medical students at the University of Nottingham. Interviews were recorded and transcribed. Inductive thematic analysis was performed to analyse the data.

Results Five main themes were identified: (1) honesty, (2) clinical competence, (3) communication, (4) kind demeanour and (5) professionalism.

Discussion Honesty was highlighted as transparency and sharing accurate information, recognising one's limits and accountability when considering F1s' potential lack of experience. Clinical competence involved foundational clinical knowledge and skills, asserting confidence and decision-making. Effective communication encompassed seamless information transfer, acknowledging patients and verbal and non-verbal aspects, all of which impacted patient satisfaction and teamwork. A kind demeanour, rooted in empathy and compassion, influenced trust, but different educator perspectives on empathy highlighted the need for balance.

Professionalism, marked by punctuality, appearance, confidentiality, teamwork and receptivity to feedback, impacted an F1’s trustworthiness.

Keywords doctor; educators; medical; students; trustworthiness

Abbie Festa, Hayley Boal and Joseph Thompson

Mid Yorkshire Teaching NHS Trust

Background Demonstrating exemplary antimicrobial stewardship is increasingly important given the risks of antibiotic resistance and poor patient outcomes as a result of inappropriate antibiotic prescriptions.¹ Reinforcing key principles of antimicrobial stewardship should be included in core teaching for newly qualified doctors and may be effectively delivered through gamification in an ‘escape room’.

Methods The 1-hour near-peer session was delivered to 52 Foundation Year 1 (FY1) Doctors (group size 8–12) over a 2-month period. It included an introduction to antimicrobial stewardship talk, followed by a ‘Microbiology Escape Room’ consisting of three clinical scenarios, including infective endocarditis, gentamicin prescribing and rationalising antibiotics. Participants completed tasks in order to ‘escape’, and the session concluded with a facilitated group discussion. Participants completed anonymised pre- and post-session questionnaires, collecting mixed-methods data.

Results Doctors self-assessed their confidence across all domains, with post-session outcomes shown below and pre-session confidence shown in brackets: (i) gentamicin dose calculation: 94% (pre-session: 65%), (ii) gentamicin level interpretation: 94% (69%), (iii) knowledge of criteria for IV to oral antibiotic switch 96% (8%) and (iv) locating common sources of bacterial infections 90% (19%).

Written recall of all four criteria for IV to oral antibiotic switch increased from 0% to 72% post-session. This will be further assessed at 8 weeks.

Feedback also demonstrated that the escape room helped consolidate knowledge, peer-learning, communication and was a fun way of learning.

Conclusion Gamifying microbiology teaching via an escape room improved FY1 confidence with their antimicrobial stewardship skills, and provided an innovative way of learning.

Keywords antimicrobial; gamification; near-peer; postgraduate; stewardship

References

1. Salam MA, Al-Amin MY, Salam MT, Pawar JS, Akhter N, Rabaan AA, Alqumber MA. Antimicrobial resistance: a growing serious threat for global public health. InHealthcare 2023 Jul 5 (Vol. 11, No. 13, p. 1946). MDPI, https://doi.org/10.3390/healthcare11131946.

Katherine Watson

Mid Yorkshire Hospitals Trust

Background Surgical teaching can induce anxiety for students, specifically regarding assessments and interactions with their surgical educator.¹ There is an emerging body of research suggesting that the use of gameplay in medical education improves learning through a change in learning environment improved attitudes and encourages positive behavioural changes.² Furthermore, the nature of an escape room has been suggested to improve teamwork and communication within a safe, time-pressured environment and this could be utilised in undergraduate surgical education.³

Method The surgical escape room pilot session was delivered to three separate groups of three third year medical students (nine in total) following two half-days of surgical teaching.

The escape room adapted crosswords, cryptic blend-words, clinical stems, connection games and riddles to cover multiple surgical themes, ranging from pancreatitis scoring and management to pre-operative checks. Students were asked to complete a questionnaire pre- and post-teaching that collected both qualitative and quantitative data, including questions on their anxiety surrounding surgical education.

Results Prior to teaching, 86% (12/14)of participants reported feeling apprehensive about surgical teaching with 45% (5/11) of those who had previously received surgical teaching stating that they had found the teaching intimidating.

About 100% (9/9) of participants felt that the escape room promoted teamworking and communication, while consolidating the knowledge gained from teaching. All participants found teaching enjoyable and denied feelings of intimidation or anxiety.

Conclusion Participants felt that the surgical escape room promoted their knowledge recall, teamworking and communication skills within a controlled, time-pressured environment without reporting feelings of anxiety or intimidation.

Keywords education; gamification; surgical; undergraduate

References

1. Sophia K. McKinley, Naomi M. Sell, Noelle Saillant, Taylor M. Coe, Trevin Lau, Cynthia M. Cooper, Alex B. Haynes, Emil Petrusa, Roy Phitayakorn. Enhancing the formal preclinical curriculum to improve medical student perception of surgery. J Surg Educ 2020;77(4):788–798. https://doi.org/10.1016/j.jsurg.2020.02.009

2. vanGaalen, A.E.J., Brouwer, J., Schönrock-Adema, J., Bouwkamp-Timmer T., Jaarsma A.D.C., Georgiadis J.R. Gamification of health professions education: a systematic review. Advancements in Health Science Education. 2021;26:683–711. https://doi.org/10.1007/s10459-020-10000-3

3. Guckian J, Eveson L, May H. The great escape? The rise of the escape room in medical education. Future Healthcare Journal 2020;7(2):112–115. https://doi.org/10.7861/fhj.2020-0032

Hannah Whelan and Joseph Thompson

Mid Yorkshire Teaching Trust

Background Medical students often have very limited exposure to ophthalmology during their medical degree. Clinicians often have reduced confidence and competence dealing with ophthalmology presentations due to their lack of exposure [1]. It is, therefore, essential to provide high-quality education in ophthalmology to medical students to benefit them in their post-graduate careers. Gamification could be effectively utilised in this teaching.

Methods 16 third year undergraduate medical students have completed the ‘Eye-conic Quest’ board game, with a further 36 planned to participate by May 2024. This was developed as a 1-hour activity to break up a full day of teaching. The board game takes the shape of a cross section of an eye. Three to four students each session roll dice to advance across the board. They are faced with numerous questions centred around the themes of anatomy, clinical knowledge and medicines management. Anonymised feedback is collated at the end of the day with QR codes on Google forms.

Results About 100% of students agreed that the board game improved their anatomy, clinical knowledge and principles of prescribing. About 100% agreed that the board game was fun and encouraged teamwork. Comments included ‘really useful to consolidate knowledge’ and ‘the board game was ingenious’.

Conclusion Eye-conic quest enhances consolidation of knowledge and adds entertainment to teaching. This maintains student engagement, breaking up a full day of content. This early exposure to teamwork allows students to prepare for team-based problem solving in clinical practice and may help alleviate clinician anxiety around ophthalmology at post-graduate level.

Keywords anatomy; clinical; medicine management; ophthalmology

Reference

1. Scantling-Birch, Y., Naveed, H., Tollemache, N., Gounder P., Rajak S. Is undergraduate ophthalmology teaching in the United Kingdom still fit for purpose?. Eye 2022; 36:343–345. https://doi.org/10.1038/s41433-021-01756-y

Katherine Watson

Mid Yorkshire Hospitals Trust

Background ‘Chunk and check’ is a recognised tool within healthcare to ensure that patients have understood new information during a consultation, to identify areas needing further explanation and as an opportunity for questions.¹ Alongside this, there is an emerging body of research suggesting that the use of gameplay in medical education improves learning and knowledge retention.²

Methods A pattern-recognition game that utilised ‘chunk-and-check’ method at regular intervals was created to complement traditional didactic surgical teaching sessions with three groups of three third-year medical students (nine in total). It comprised a grid of 16 squares, each containing one word. The words were grouped into 4 categories with 4 words in each category and then randomly placed within the 16-square grid. The categories, such as ‘red flag symptoms’ or ‘clinical signs’, were not known to the students. The students then had to recognise connections between the words within the grid and group the words accordingly. Participants completed pre- and post-teaching questionnaires collecting mixed quantitative and qualitative data.

Results Prior to teaching, 64% (9/14) of participants had never received surgical teaching and 21% (3/14) of participants had previously received teaching through educational games.

Following the teaching, 100% (9/9) of participants found teaching enjoyable and 100% (9/9) of participants felt that the game promoted teamwork and communication and was helpful as a knowledge checkpoint.

Conclusion Participants feel that incorporating gameplay into undergraduate surgical teaching as a ‘chunk-and-check’ method was an enjoyable addition to undergraduate surgical teaching that they felt promoted teamworking and communication.

Keywords education; gamification; surgical; undergraduate

References

1. Naughton, J., Booth, K., Elliott, P., Evans, M., Simões, M. and Wilson, S. Health literacy: the role of NHS library and knowledge services. Health Information Library Journal, 2021;38:150–154. https://doi.org/10.1111/hir.12371

2. vanGaalen, A.E.J., Brouwer, J., Schönrock-Adema, J., Bouwkamp-Timmer T., Jaarsma A.D.C., Georgiadis J.R. Gamification of health professions education: a systematic review. Advancements in Health Science Education 2021;26:683–711. https://doi.org/10.1007/s10459-020-10000-3

Ciara Dooner and Joseph Thompson

Mid Yorkshire Teaching Hospitals Trust

Background The GMC recognises that making referrals is an essential part of the daily workload of a junior doctor.¹ Previous data collection from UK junior doctors has highlighted that they feel underconfident when making referrals, struggled to know which speciality to refer to and frequently faced rejected referrals.²

Methods ‘Referrals Bingo’ is an interactive, hour-long session that was delivered to 44 final year medical students, over 5 days at a UK Teaching Hospital Trust. The ‘Referrals Bingo’ component involved discussion of cases which students had to determine the diagnosis and speciality to refer to, which were randomised onto students bingo cards. The simulated difficult referrals scenarios introduced common themes such as difficult colleagues and inappropriate rejections. Students received a randomised participant number and anonymously completed pre- and post-session questionnaires via QR code, collecting both quantitative and qualitative data.

Results About 63% (27/41) of students felt they had not received sufficient teaching on specialty referrals prior to this session. Following the session, an improvement was seen in both domains:

Knowledge of the appropriate specialty to refer to—56% (23/41) to 100% (42/42).

Self-reported confidence when dealing with rejected referrals—24% (10/41) to 93% (39/42) 90% of students felt more prepared to make referrals when graduating to a junior doctor.

Conclusion Newly qualified junior doctors commonly struggle when making referrals. Specific teaching on referrals has effectively improved final year medical student knowledge of appropriate specialties to refer to and improved confidence when dealing with rejected referrals.

Keywords communication; medical education; specialty referrals

References

1. General Medical Council. 2019. Accessed January 20, 2024. https://www.gmc-uk.org/-/media/documents/national-training-surveys-2019-initial-findings-report_pdf-79120296.pdf.

2. Thorley EV, Doshi A, Turner BR. Doctors improving referrals project: a referrals toolkit for junior doctors. BMJ Open Quality. 2023;12(2). https://doi.org/10.1136/bmjoq-2022-002066, e002066

Rachel Anderson and Harrison Mycroft

Mid Yorkshire Teaching NHS Trust

Background Despite the significance of sexual health in many fields of medicine, dedicated sexual health education is often lacking in medical school curricula.¹ When learning about sexual health, students often encounter a large volume of new clinical conditions and concepts. As there is an evolving wealth of evidence that gamification with online technology is an effective teaching method within medical education,² this could be implemented to deliver sexual health teaching.

Methods Eleven fourth year medical students attended a half-day pilot session of ‘SHUSH’, with 39 more students scheduled to attend by May 2024. The session consisted of interactive case studies to cover key sexual health content, including genital infections, skin conditions and HIV, followed by an online interactive escape room to consolidate learning. Students worked in teams to interact with an online interface, completing sexual health knowledge-based challenges. Anonymised pre- and post-session questionnaires were completed by students collecting quantitative and qualitative data.

Results Pre-session, 27% (3/11) students agreed to feeling confident managing genital skin conditions and common genital infections and 36% (4/11) to managing syphilis and HIV. Post-session, this increased to 100% across all domains. About 91% (10/11) students agreed that participating in the online escape room helped develop teamworking skills. About 100% agreed that the escape room was enjoyable and helped to consolidate knowledge.

Qualitative data supported these findings.

Conclusion The use of technology for gamification is an effective, innovative and enjoyable method for delivering sexual health teaching, which can also work holistically to develop students' team-working skills.

Keywords gamification; medical; sexual health; student

References

1. Beebe S, Payne N, Posid T, Diab D, Horning P, Scimeca A, Jenkins LC The lack of sexual health education in medical training leaves students and residents feeling unprepared. J Sex Med 2021;18(12):1998–2004. https://doi.org/10.1016/j.jsxm.2021.09.011

2. Krishnamurthy K, Selvaraj N, Gupta P, Cyriac B, Dhurairaj P, Abdullah A, Krishnapillai A, Lugova H, Haque M, Xie S, Ang ET Benefits of gamification in medical education. Clin Anat 2022;35(6):795–807. https://doi.org/10.1002/ca.23916

Joanna Gass

Warwick Medical School

Background Blended learning statistically improves academic performance to a greater extent in comparison to either didactic lectures or e-learning alone. Previous systematic reviews have highlighted advantages of gamification for promoting healthcare knowledge.

Method This mixed-methods exploratory study explored Phase 1 Warwick medical student perceptions concerning the utility of Social Media Telegram Near-Peer Teaching groups in ‘Blended Learning.’ In this study, a pre-intervention and post-intervention survey was completed by Phase 1 Warwick medical students participating in the 4-week intervention. Quantitative 5-point Likert scale data comparison between the pre-and post-surveys was conducted using the mode and median response point, with statistical significance determined using the Mann-Whitney-Wilcoxon. Quantitative paired binary knowledge test comparison was conducted with paired sample t-tests. Qualitative data were coded to identify themes and patterns to investigate the perceptions of the participants.

Results This study verified that SoMe Telegram NPT could successfully be incorporated into Warwick Medical School's ‘blended learning’ strategy. Wilcoxon signed ranks test established student perception of confidence of Block 1 material statistically increased post-study (Z = 76, p < 0.026). A paired samples t-test of participants' total binary knowledge test score increased significantly from pre-study (M = 10.05, SD = 2.519) to post-study (M = 12.29, SD = 2.411; t = −4.686, p < 0.001, d = −1.022). Qualitative data reaffirmed the benefits of NPT which helps to culminate a supportive community.

Conclusion This study has identified the utility of Telegram as a part of blended learning strategy, in improving Phase 1 Warwick medical student confidence and short-term memory retention.

Keywords education; medical; near-peer teaching; social media; telegram

Cindy Chew, Lindsey Pope and Patrick O'Dwyer

University of Glasgow

This project will attempt to address the theme of Uncertainty in Medicine through Drama. Reclaiming the traditions of the Medical Humanities—we will combine the Art and the Science of Medicine to explore this space together with medical students.

The pedagogical principles and theories of using Drama (‘The Art’) are well-articulated and recognised (1). Students will participate in small group discussions with and workshops led by experienced Artists from London, Campinas and Groningen. Students will receive an indicative reading list, watch some films and learn through the medium of drama and performance art. Juxtaposed with this will be small group discussions and workshops with Scientists—Doctors, Scientists and Patients—to flesh out the uncertainties inherent within Medicine and how to navigate that together with their patient partners.

Artistic themes of how to make choices in the moment respond with emotional intelligence; being alert to and collaborating with patients will be explored through role play, while scientific themes of clinical reasoning, realistic medicine, medical ethics, social justice through health inequality within the rapidly evolving UK medical healthcare scene will be discussed.

Faculty development—observation, immersion and workshops with our visiting experts—is incorporated to build sustainability, future collaboration and scholarship. Public engagement events are also planned.

Students' pre/post elective empathy score (MEET) will be evaluated. We will share our experience of this feasibility pilot to start a conversion and build a wider community of practice Humanities in Medical Education.

Keywords drama; evidence; expectation; uncertainty; undergraduate

Reference

1. deCarvalho Filho MA, Ledubino A, Frutuoso L, daSilva Wanderlei J, Jaarsma D, Helmich E, Strazzacappa M. Medical education empowered by theater (MEET). Acad Med 2020 Aug;95(8):1191–1200. https://doi.org/10.1097/ACM.0000000000003271. PMID: 32134785.

Aws Almukhtar¹, Kirsty Clarke¹, Lina Alim¹, Lina Alim¹, Amr Nimer¹ and Sadie Syed²

¹Imperial College London; ²Imperial College Healthcare NHS Trust

Background The increasing integration of innovative technologies, such as alternate reality devices, in surgical education underscores the need to examine their unique challenges.¹ Effective Cognitive Load (CL) management is particularly critical, with a growing body of literature advocating for basing instructional designs on Cognitive Load Theory to achieve intended learning outcomes.^2,3 This study examined the design and outcomes of adopting an innovative educational package, centred around Mixed Reality (MR), for final-year medical students' trauma teaching.

Method In addition to traditional teaching, three cohorts of final-year students (n = 32) had MR teaching composed of six clinical vignettes, all designed to be taught using MR headsets. Clinical knowledge scores during and after placement and anonymised supervisor feedback were used as outcome measures. NASA-TLX questionnaire was used to assess CL in Two cohorts (one had MR familiarisation to reduce extraneous CL). Analysis was performed using STATAv17.

Results In-placement clinical knowledge test scores and post-placement test scores were significantly higher for students who received MR teaching compared to those who did not (P = 0.0009; P = 0.0001). NASA-TLX scores during the sessions were consistently low (mean ± SD; 8.6 ± 3.32). Importantly, there is no significant difference between cohorts who had MR familiarisation sessions and those who did not.

Conclusion Introducing MR teaching package resulted in improvement across all outcomes (recall, analysis, application and retention). More importantly, the CL scores associated with the use of MR remained low, challenging the prevalent assumptions regarding purported cognitive challenges that digital native students might encounter when engaging with innovative technologies in an educational contexts.

Keywords cognitive load; mixed reality; surgical education; undergraduate

References

1. Shafarenko MS, Catapano J, Hofer SOP, Murphy BD. The role of augmented reality in the next phase of surgical education. Plast Reconstr Surg Glob Open 2022;10(11):e4656. https://doi.org/10.1097/GOX.0000000000004656

2. Sweller J. Cognitive load theory, learning difficulty, and instructional design. Learning and Instruction 1994;4(4):295–312. https://doi.org/10.1016/0959-4752(94)90003-5

3. Tokuno J, Carver TE, Fried GM. Measurement and management of cognitive load in surgical education: a narrative review. J Surg Educ 2023;80(2):208–15. https://doi.org/10.1016/j.jsurg.2022.10.001

Naireen Asim¹, Vafie Sherif¹, Adele Mazzoleni², Nadhira Samsudeen³ and Shazia Serala³

¹St George's, University of London; ²QMUL; ³UCL

Background There is an imperative need for sustainable healthcare education, highlighted by the General Medical Council (GMC) and a recent survey revealing a concerning 1.8% of medical students formally educated on sustainable health (1). Student MedAID London (SMAL) emerges as a pioneer in tackling this gap, employing an interdisciplinary and research-driven approach.

Methods SMAL's advocacy strategy involves collaborative partnerships with educators, healthcare professionals and institutions. The initiative integrates teaching interventions such as ‘Learn with Med-Aid’ and online seminars, fostering a culture of research and continuous improvement. The adaptability and scalability of the model are central, providing policymakers with an innovative framework for sustainable healthcare education.

Results Social media and seminar participation increased by 62% and 176% from formal establishment in 2021, respectively, with a broadened demographic from London medical students to young healthcare professionals across the UK, Ukraine and the USA. Notably, participants expressed a 50% increase in confidence in global health topics.

Conclusion The interdisciplinary nature of SMAL's advocacy model demonstrates the transformative potential of collaborative efforts. By incorporating research and innovation, the initiative not only addresses existing gaps but also provides an adaptable framework for the integration of sustainability principles into diverse medical curricula. The educational impact is further underscored by participants' expressed desire for more events on global health topics and increased engagement in discussions surrounding future careers in the healthcare sector.

Ultimately, SMAL is positioned as a trailblazer in equipping the next generation of healthcare professionals with the knowledge to address challenges of a sustainable future.

Keywords education; global health; interdiscipline; medicine; sustainability

Reference

1. Gupta D, Shantharam L, MacDonald BK. Sustainable healthcare in medical education: survey of the student perspectives at a UK medical school. BMC Med Educ 2022;22(1):689. https://doi.org/10.1186/s12909-022-03737-5

Emma Darbyshire and Abhilasha Jones

University of Central Lancashire

Background Integrating Interprofessional Education (IPE) into educational programmes is necessary to confront global healthcare challenges. Competence in interprofessional working is essential for health and social care professionals. Cultivating these competencies leads to improve patient outcomes.

IPE offers opportunity not only to create students who are better prepared for the healthcare workforce but also to facilitate increased efficiency, sharing of resources, improve capacity and tackle placement burdens and reduce staff workload.

Collaborative practice is the recognised approach to address the worldwide shortage of healthcare professionals.¹ This collaborative approach needs to be mirrored in university-wide culture.

Challenges Delivering effective IPE can be challenging due to coordination of multiple timetables, geographical spacing of students and availability of specialist space or facilitators. There is currently no university-wide strategy in place for developing and implementing IPE.

While several successful inter-school Interprofessional Education (IPE) events have been conducted and research shows benefits to students, there remains a significant disparity among courses in terms of the level of IPE exposure provided to students.

Keywords collaboration; education; inter-professional; IPE; multidisciplinary

Reference

1. World Health Organization. Framework for action on interprofessional education & collaborative practice. World Health Organisation; 2010. Accessed January 22, 2024. Framework for action on interprofessional education & collaborative practice (who.int).

Mandy Hampshire, Joshua Howard and David James

University of Nottingham

Introduction Artificial intelligence (AI) is being studied widely in medicine and in selection for training programmes. However, there are no publications studying the use of AI by undergraduate (UG) applicants for Medicine to improve their chance of selection.

We report a feasibility study of the use of AI by applicants to improve their performance online interviews.

Methods Three historic scenarios and associated questions from the University of Nottingham (UoN)database of Medicine course selection interviews were submitted to three AI platforms (two Open AI programmes, Chat GPT and Bing Chat Enterprise and a subscription AI programme, Chat GPT Plus) in a way that a potential applicant or accomplice could do during a virtual interview.

Results The speed of the AI response after a question was submitted varied between the three platforms. The fastest was Chat GPT (median response time was 14 sec (range 10–31 seconds). Overall, each response was comprehensive and aligned with the criteria UoN interviewers used to score applicants.

Conclusions We think the use of AI by an applicant for UoN UG Medicine to ‘enhance’ their performance would be difficult in practice. They would have to have an accomplice, disguise the fact that they were reading the AI script, make their responses sound natural and overcome the problem of a delay (at least 10 seconds) before they could answer a question. We think that candidates may perform better if they use AI in advance of interviews to generate answers that can be polished and practiced for a more confident delivery.

Keywords admissions; medical students; online interviews

References

Kok KY, Chen L, Idris FI, Mumin NH, Ghani H, Zulkipli IN, Lim MA Conducting multiple mini-interviews in the midst of COVID-19 pandemic. Med Educ Online 2021; 26:1891610. https://doi.org/10.1080/10872981.2021.1891610

Sedaghat S. Early applications of ChatGPT in medical practice, education and research. Clin Med 2023; 23:278–279. https://doi.org/10.7861/clinmed.2023-0078. https://www.medschools.ac.uk/media/2902/guidance-for-candidates-on-onlineinterviews-2022.pdf

Elisha De-Alker¹, Robert Bain², Jun Jie Lim³, Jack Wellington⁴, Wei Ying Chua¹, Ankit Gupta⁴, Chin Liu¹ and Jane Yi Jen Poh⁵

¹Hull York Medical School; ²Newcastle University; ³Sheffield University; ⁴University of Leeds; ⁵University of Sheffield

Background The Specialised Foundation Programme (SFP) is the first opportunity for medical graduates to establish their clinical academic career.¹ Most Specialised Units of Application utilise interviews for selection in a highly competitive application process. Access to preparatory resources is a barrier to potential applicants due to financial burdens, and a lack of resources available, particularly at the interview stage. Our near-peer virtual simulated interview scheme aimed to help the 2023 applicant cohort prepare for SFP interviews.

Methodologies ‘SFP Unlocked’ is a group founded by SFP doctors established to support SFP applicants. Simulated SFP interviews, organised in November 2023, were facilitated online by SFP doctors from 10 UK deaneries and designed to resemble the format of SFP interviews. Pre- and post-session feedback surveys were disseminated to attendees. Wilcoxon-rank test was used to assess statistical significance differences in quantitative data, with content analysis used to describe the qualitative data.

Results In total, 74 mock interviews were completed, with feedback 62 (84% response rate) attendees. Attendees' confidence when approaching the interview significantly increased over sessions (pre-session 2/5 [IQR: 2–3]; post-session 4/5 [IQR:4–4]; p < 0.001). Content analysis showed that attendees valued the realism of the interviews, the tailored feedback they were given and the confidence they were able to build through these interviews.

Suggestions for improvement mainly requested increasing session length.

Discussion The ‘SFP Unlocked’ interview series successfully provided a significant proportion of SFP applicants the opportunity to develop their interview skills. This provides a viable model for others to utilise in future application cycles.

Keywords applications; interviews; near-peer teaching; specialised foundation programme; undergraduate

Reference

1. Darbyshire D, Baker P, Agius S, McAleer S. Trainee and supervisor experience of the Academic Foundation Programme. Journal of the Royal College of Physicians of Edinburgh 2019;49(1):43–51. https://doi.org/10.4997/JRCPE.2019.111

Maria Keerig and Andy Cook

University of Leicester School of Medicine

Medicine with Foundation Year is part of an innovative Widening Participation program at Leicester Medical School which provides students from diverse backgrounds an opportunity to reach their goals in training as doctors. However, analysis of student performance data in Phase 1 MBChB suggests that the Foundation Year cohort are over-represented in exam resits. One approach taken to help maximise learning potential for progression was the introduction of learning to learn sessions for Foundation students.^1,2,3 These sessions are currently taught separately to core curriculum content.

This project involved the creation of a teaching session on Respiratory medicine integrating both evidence- based learning to learn skills and core curriculum content within the same session. The project sought to address the following question: Is the integration of learning to learn skills with curriculum content together in the same session, an effective and acceptable way of facilitating learning and promoting better learning skills for Foundation Year medical students at Leicester Medical School?

Qualitative evaluation with focus groups with students took place before and after the integrated teaching session. The pre-session focus group explored student's thoughts about the structure of teaching sessions and the facilitators and barriers to learning. The post-session focus group evaluated student's experience and perceptions of this integrated approach to learning.

The project helped to gain insights into student perspectives to help inform the design of future integrated teaching sessions which incorporate acceptable and effective evidence-based learning strategies into the substance of teaching sessions, in order to maximise students' future learning potential.

Keywords education; innovation; medical; participation; widening

References

1. Jossberger H, Brand-Gruwel S, van deWiel MW, Boshuizen HP. Exploring students' self-regulated learning in vocational education and training. Vocations and Learning 2020 Apr;13:131–58. https://doi.org/10.1007/s12186-019-09232-1

2. Sandars J, Cleary TJ. Self-regulation theory: applications to medical education: AMEE guide 58. Med Teach 2011 Nov 1;33(11):875–86. https://doi.org/10.3109/0142159X.2011.595434

3. Weinstein Y, Sumeracki M, Caviglioli O. Understanding how we learn: a visual guide. Routledge; 2018. https://doi.org/10.4324/9780203710463

Abbey Boyle, Noreen Akram, Abbie Festa and Joseph Thompson

Mid Yorkshire Teaching Hospitals Trust

Background ‘Neurophobia’ is a widely documented fear of neurology among medical students and can lead to limited engagement and understanding of neurological topics and subsequent lack of confidence assessing neurological presentations.^1,2

Gamification in medical education has been suggested to improve learning and retention of key concepts³; thus, this approach may be utilised to enhance neurology teaching.

Methods A neurological ‘Guess Who’ game was designed to encourage third year medical students to ask interrogative questions, utilising understanding of neurological concepts, to deduce the opposing team's conditions (e.g. migraine, meningitis). Two pilot sessions were conducted with a total of 13 students with 41 further students planned to attend before May 2024. Students completed pre- and post-session questionnaires.

Results Prior to the session, 54% (7/13) of students disagreed or strongly disagreed that they felt confident in neurology and 69% (9/13) agreed that they had previously found neurology teaching to be intimidating. About 85% (11/13) disagreed or strongly disagreed that their knowledge of neurology was comparable to other medical specialties such as cardiology or respiratory.

Post-session, 100% and 91% (10/11) of students agreed or strongly agreed that the teaching had made them more confident in neurology history taking and understanding of core neurological conditions respectively. About 100% of students agreed that the game helped recall of neurological presentations, and 91% (10/11) felt it encouraged application of history-taking skills.

Conclusion Neurology is perceived to be more challenging than other medical specialties. Utilisation of gamification effectively increased confidence and recall of neurological concepts within a neurological teaching day.

Keywords education; gamification; medical; neurophobia; undergraduate

References

1. Javaid MA, Chakraborty S, Cryan JF, Schellekens H, Toulouse A. Understanding neurophobia: reasons behind impaired understanding and learning of neuroanatomy in cross-disciplinary healthcare students. Anat Sci Educ 2018;11:81–93. https://doi.org/10.1002/ase.1711

2. Pakpoor J, Handel AE, Disanto G, Davenport RJ, Giovannoni G, Ramagopalan SV. National survey of UK medical students on the perception of neurology. BMC Med Educ 2014;14:225. https://doi.org/10.1186/1472-6920-14-225

3. Abdulmajed H, Park YS, Tekian A. Assessment of educational games for health professions: a systematic review of trends and outcomes. Med Teach. 2015;37(sup1). https://doi.org/10.3109/0142159X.2015.1006609

Henry Smith, Katie Craster and Katie Greatorex

University of Bristol

Acronyms and memory aids are frequently used in medical education.¹ These can be useful, though have their limitations.² The novel ‘QUALITIES’ acronym details a framework to close consultations, based on salient points from previous consultation models³. Students in a district general hospital were surveyed on confidence when closing consultations and elements to include when closing consultations. All 77 (42 third years, 35 fifth years) students on attachment at a district general hospital were invited to participate. A brief session was held, teaching students the QUALITIES framework. Students will be followed up at a 4- and 12-week interval to assess retention of the framework, any improvement in confidence and free text opportunity for qualitative feedback on the framework in their own practice.

While the results have not yet been received as we have not reached the follow-up times for all groups, a pilot study in 2022–23 showed a statistically significant improvement in confidence and qualitative data in open text answers showed popularity of the framework among the student body.

This study will hopefully add further evidence from the pilot that there is an opportunity to develop an acronym and framework to help students close consultations. There is significant promise of the QUALITIES framework to fulfil this role, and further work could investigate real-life application, barriers to its use and effects on patient experience. If a larger study supported its use, further research could be done to investigate its use in postgraduate education.

Keywords acronym; closing; communication; consultation; frameworks

References

1. Silverston, P., Shepard L., Thresher K., Boreham L., Scallan S., Tomson M., Mehay R. “Teaching exchange”. Educ Prim Care. 2013;24(3):206–218. Available at: https://doi.org/10.1080/14739879.2013.11494174

2. Lewis Jr, J.B., Mulligan, R. and Kraus, N. “The importance of medical mnemonics in medicine”. Pharos. 2018:pp. 30–35. Available at: https://www.alphaomegaalpha.org/wp-content/uploads/2021/03/2018-1-Lewis.pdf

3. Denness, C. “What are consultation models for?”. InnovAiT: Education and Inspiration for General Practice. 2023 6(9), pp. 592–599. Available at: https://doi.org/10.1177/1755738013475436

John Erskine, Megan Allman and Arwell Poacher

University Hospital of Wales

Our service evaluation aimed to compare ‘Traditional Medical Placement’ with a Clinical Teaching Fellow (CTF) led module. Both placements aimed to teach students Neurology and Neurosurgery.

Each placement was 3 weeks long. All students were from the same university. Forty students were allocated to a placement taught by a team of 3 CTFs in the University Hospital of Wales, and 10 students were allocated to a Traditional Placement led by consultants in other local hospitals in Wales. Placements occurred simultaneously. A total of 300 students were taught in the academic year, split into 3 terms. A total of 240 students were in a CTF-led module and 60 were in Traditional Placements.

Outcome measures were students' scores in a simulated integrated structured clinical exam (ISCE) and a 40- question single best answer (SBA) quiz. Comparison was made between CTF and Consultant groups for each term.

CTFs collected anonymous feedback on their module. CTFs evaluated each term's outcomes to determine teaching improvements for their module. Outcomes from different terms were compared.

Results found no significant differences between CTF-led and Consultant-led modules. There was significant improvement in SBA quiz scores for CTF-led students from terms 1 compared with 2 and 3. Anonymous feedback demonstrated a positive reception from students of CTF-led modules. CTF-led modules were likely to result in students considering a career in a Neurology.

The findings are important as it validates the increasing use of CTFs by Universities to deliver teaching modules as there was no difference found between traditional medical student placement and a CTF-led teaching module.

Keywords clinical teaching fellow; neurology; undergraduate medicine

Alice Roberts

University of Warwick

Background The prevalence of sexual violence is high, particularly among women and LGBTQ+ people. Over 1 in 4 adult women experience sexual violence in their lifetime.¹ The World Health Organization recommends that all healthcare professionals receive training in providing first-line support to survivors of sexual violence,² but very few doctors receive specialist training on how to communicate with survivors. Research into survivors' experiences shows dissatisfaction with healthcare encounters.³

Aim The aim of this study is to design and pilot test bespoke training for medical students, with the aim of increasing their awareness of sexual violence, and their confidence in supporting survivors of sexual violence.

Method A training course was designed, in consultation with experts from a rape crisis centre, and piloted on 12 medical students. Participants completed an online workbook, followed by an in-person interactive session delivered by a professional rape crisis trainer. The 1hr45 interactive session encouraged reflection on material from the workbook and included skills practice where students role-played patient survivors, clinicians and observers. A pre- and post-training questionnaire was used to evaluate the training against learning outcomes.

Results All respondents reported an increase in confidence in asking about sexual violence and responding to disclosures (from 3/10 to 8/10). Respondents' knowledge also significantly improved, particularly about services available for survivors.

Conclusion This pilot shows the potential for expert-delivered training to increase medical students' awareness of sexual violence and confidence in supporting patient survivors. The training will be trialled in the curriculum for all second-year medical students in June 2024, with further evaluation planned.

Keywords communication skills; gender-based violence; innovation; sexual violence; training

References

1. Office for National Statistics (ONS), released 23 March 2023, ONS website, article, Sexual offences prevalence and trends, England and Wales: year ending March 2022.

2. World Health Organization. (2013). Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines. World Health Organisation.

3. Caswell RJ, Ross JD, Lorimer K. Measuring experience and outcomes in patients reporting sexual violence who attend a healthcare setting: a systematic review. Sex Transm Infect 2019 Sep;95(6):419–427. https://doi.org/10.1136/sextrans-2018-053920

Naren Joshi and Anna Collini

Kings College London

Background Addressing the leadership crisis in the NHS, specifically among junior doctors, is imperative. With increasing patient numbers, staff burnout and funding shortages contributing to the current healthcare challenges,¹ there exists a crucial gap in effective leadership.² We conducted a narrative review exploring the integration of transformational leadership (TFL) into the medical curriculum as a strategic and sustainable solution. By doing so, we aim to combat the leadership deficit, promoting resilience, adaptability and purpose within the NHS, ultimately ensuring a more effective healthcare system.

Methods This review utilised PubMed for a targeted search on TFL. Employing Boolean operators and specific keywords, 41 studies were selected from 883 screened articles. Reviewing references led to the identification of other relevant literature and Mendeley facilitated additional study identification and efficient referencing.

Discussion The results of analysing multiple studies underscore the transformative impact of integrating TFL into medical education. The potential benefits include enhanced collaboration, improved patient outcomes, organisational effectiveness, fostering innovative behaviour and positively shaping healthcare culture. However, potential limitations may arise from resistance to change, resource constraints, and the need for comprehensive faculty training. Strategies such as targeted faculty development programmes, interdisciplinary collaboration and gradual phased implementation may help address resistance and resource constraints.

Conclusion Integrating TFL into medical education is not just an enhancement but a strategic imperative to ensure more resilient, innovative and patient-centred doctors capable of addressing the complex challenges of the NHS.

Keywords culture; education; leadership; medical; transformational

References

1. Khan, Z. (2023). The emerging challenges and strengths of the National Health Services: a physician perspective. Cureus, 15(5). https://doi.org/10.7759/cureus.38617

2. Omar, A., Shrestha, A., Fernandes, R., & Shah, A. (2020). Perceived barriers to medical leadership training and methods to mitigate them in the undergraduate medical curriculum: a mixed-methods study of final-year medical students at two medical schools. Future Healthc J, 7(3), e11–e16. https://doi.org/10.7861/fhj.2019-0075

Claudia Kate Au-Yeung, Cillian Kiely, Emily Unwin, Emily Unwin, Kate Owen, Imogen Davies and Catherine Bennett

Warwick Medical School

Background Teaching is a core professional activity. All doctors have a professional obligation to support education of medical trainees (GMC, 2020). There is limited incorporation of Medical Education modules into the core curriculum, although some schools offer student-selected components and student-led tutorials to promote positive teaching practices (GMC, 2009).

Methods As a peer-assisted learning student society, we proposed a three-level certificate curriculum to support medical students in developing teaching skills. Objectives covered educational principles, evidence-based teaching methodologies in delivering small and large group teachings, clinical skills, bedside examination teachings and creating accessible PowerPoint presentations. Sessions were delivered by university faculty members and hospital clinical education fellows, with promotion through year-group social media groups and voluntary participation. Online feedback was collected.

Results Over 50 students accessed the programme from 2020 to 2023. In 2023, 100% rated sessions as ‘extremely enjoyable’ or ‘enjoyable’. Positive feedback highlighted positive interactivity; incorporation of personal experiences, questions and polls into sessions; reflective opportunities; and organisation. Areas for improvement included offering pre-reading, a face-to-face format and incorporating small group discussions. All attendees derived at least one takeaway message per session and expressed motivation to apply acquired skills in student-led seminars.

Conclusion Our three-level structured curriculum successfully supports medical students in developing teaching skills across various settings and topics. Feedback indicates attainability within a peer-led society and can be adopted by other student institutions to enhance the teaching potential in future clinicians, contributing to good medical practice. We aim to evaluate the effectiveness of a face-to-face programme in the future.

Keywords feedback; medical education; peer-teaching

References

General Medical Council [GMC]. Developing teachers and trainers in undergraduate medical education. (2009). Available from: https://www.gmc-uk.org/—/media/documents/developing-teachers-and-;trainers-in-undergraduate-medical-education—guidance-0815_pdf-56440721.pdf (Accessed 20 Jan 2024).

General Medical Council [GMC]. The state of medical education and practice in the UK. (2020). Available from: https://www.gmc-uk.org/-/media/documents/somep-2020_pdf-84684244.pdf (Accessed 20 Jan 2024).

William Smith, Lesley Bowker, Amy Wai Yee Wong and Steven Gopaul

Norwich Medical School, University of East Anglia

Background Despite examiner training and station calibration, OSCEs are vulnerable to subjectivity.¹ This is partly explained by examiners being more stringent (‘hawk’) or lenient (‘dove’). As medical schools expand, OSCEs increasingly use several circuits in parallel. Low inter-rater reliability may impact results and occasionally require station removal. We evaluated examiner performance and identified risk factors for ‘hawk’ / ‘dove’ behaviour.

Methods Data were collected from 2022/2023 in one English medical school on examiner role/seniority, assessment frequency, and z-scores (standard deviations from the mean). Examiner status was decided by an expert-led committee where sufficient data existed, considering the direction and magnitude of their z-scores.² Descriptive statistics and t-tests were used in analysis.

Results Among 244 examiners from 25 OSCEs: 31 were classified ‘hawk’, 35 ‘dove’, 39 ‘owl’ (neither ‘hawk’ nor ‘dove’) and 139 ‘unable to assess’ due to insufficient data. Examiners who assessed more often were more likely to have their most recent z-score closer to zero (‘owls’). ‘Doves’ examined significantly less often than ‘hawks’ or ‘owls’ (p < 0.05). No trends were observed for junior doctors and hospital consultants; however, general practitioners were more likely to be ‘hawks’.

Conclusion This evaluation provides guidance on z-score interpretation and presents a novel evidence-informed strategy for quality assurance and classification of examiner reliability. Analysis suggests that regular examiners are more reliable. Intervention for less reliable examiners is only possible where sufficient data exists to confirm a trend. Therefore, utilising a smaller pool of regular examiners coupled with tailored feedback may improve inter-rater reliability over time.

Keywords examiner; medical; osces; reliability; undergraduate

References

1 Downing SM, Threats to the validity of clinical teaching assessments: what about rater error? Med Educ 2005;39(1): 353–355. https://doi.org/10.1111/j.1365-2929.2005.02138.x

2. Bartman I, Smee S, Roy M. A method for identifying extreme OSCE examiners. The Clin Teach 2013;10(1): 27–31. https://doi.org/10.1111/j.1743-498X.2012.00607.x

Katie Allan¹, Maya Alazzawi², Dede Ofili-Yebovi¹ and Roshni R. Patel²

¹Chelsea and Westminster NHS Foundation Trust; ²Imperial College London

Background Male medical students often report that they are ‘turned away’ from clinical learning opportunities in obstetrics and gynaecology (O&G),¹ potentially hindering their ability to fulfil mandatory assessments and acquire essential skills in comparison to their female peers.

Methods Fifth year medical students at Imperial College London completed a voluntary questionnaire after their 6-week O&G placement. This provided quantitative and qualitative responses and enabled gender-based comparisons.

Results Of the 69 respondents (48% male, 52% female), male students were more likely to be declined a range of learning opportunities: observing labour/delivery (70% versus 25% females), gynaecological examination (67% versus 31%), observing an outpatient consultation with a doctor/midwife (67% versus 19%) and taking a medical history (24% versus 11%). The most cited reason was patient discomfort with the presence of a male. About 52% of male students felt their personal learning opportunities were limited by their gender.

Female students acknowledged the higher likelihood of patient consent but were less likely to perceive a gender-based discrepancy in overall quality of learning experiences.

Students considered ways to approach this issue and felt that enhanced communication skills teaching and greater support from clinicians might help overcome the gap. However, many students were reluctant to challenge the status quo, as they would not want to compromise patient autonomy and dignity.

Conclusion Male medical students are more likely to be declined clinical learning opportunities in O&G compared to their female counterparts and perceive that they have a less satisfactory overall learning experience as a result.

Keywords consent; experience; gender; gynaecology; obstetrics

Reference

1. Chang JC, Odrobina MR, McIntyre-Seltman K. The effect of student gender on the obstetrics and gynecology clerkship experience. J Womens Health 2010;19(1):87–92. https://doi.org/10.1089/jwh.2009.1357

Katherine Gouveia, Ellie Ferguson, Anita Laidlaw, Amudha Poobalan, Colin Lumsden, Kim Walker and Kathrine Gibson Smith

University of Aberdeen

There has been significant investment, in Scotland, in getting students from widening access (WA) backgrounds into medicine. However, little is known about how best to assist these students over the course of their.

studies. It is crucial to support students from WA backgrounds to maintain retention, since previous research¹ has identified they may continue to face adversity. The purpose of this study is to understand what these needs are and develop a relevant support strategy.

Two workshops were conducted with MBChB staff engaged in course delivery and one with students from WA backgrounds from the same institution. In these sessions, participants collaboratively developed fictional WA characters and outlined the challenges faced by their characters. Participants then generated and critiqued potential intervention ideas and their implementation. To ensure intervention strategies were both evidence-based and theoretically informed, a systematic analysis of workshop data was undertaken grounded in a relevant intervention development framework (Behaviour Change Wheel)².

The workshops identified the support needs of students from WA backgrounds (developing awareness of social norms and culture, developing positive relationships with staff and, promoting a sense of belonging). Accordingly, three intervention strategies were developed: lectures to promote further awareness of professionalism in medicine, adaption of an existing staff tutor scheme to better support students from WA backgrounds and development of a WA peer support network.

Intervention strategies were developed with the aim of supporting students over the course of their studies. The study results could be transferable to other educational settings committed to WA.

Keywords medical students; progression; student support; widening participation

References

1. Sartania N, Alldridge L, Ray C. Barriers to access, transition and progression of widening participation students in UK medical schools: the students' perspective. MedEdPublish. 2021;10(1). https://doi.org/10.15694/mep.2021.000132.1

2. Michie S, Atkins L, West R. The behaviour change wheel: a guide to designing interventions. Silverback; 2014.

Rebecca O'Neill, Emma Smith and Phoebe Brobbey

University Hospitals of Coventry and Warwickshire

Introduction Junior doctors regularly provide the first assessment and management of trauma patients. However, medical students' exposure to and practical experience of managing acute trauma is limited.¹

Aim The aim to this study is to improve medical students' understanding and confidence in managing acute trauma in simulated scenarios.

Method Final year medical students in their musculoskeletal care block were offered the opportunity to participate in a pilot trauma sim. This included an introductory lecture on trauma, a practical session and two simulated trauma scenarios. The lecture included information on pre-hospital care, the trauma team and primary surveys. In addition, there was a video of a simulated real time run through of a trauma alert. The practical session comprised of using tourniquets and pelvic binders. The polytrauma scenarios took place in a simulation suite facilitated by faculty members. The scenario included receiving the trauma alert, allocating team roles and an AT-MIST handover from a paramedic. Students completed a pre- and post-simulation questionnaire to measure their understanding of trauma teams and confidence in assessing a trauma patient and open fractures.

Results The teaching was received positively by students, finding it useful and relevant. The questionnaires demonstrated that all students felt more confident in understanding the roles within a trauma team and managing open fractures.

Conclusion Adding a trauma simulation to final year medical student training would bridge the gap between medical students and carrying the trauma bleep as a junior doctor. The session provides the opportunity to learn and experience trauma management in a safe environment.

Keywords education; medical students; simulation; trauma

Reference

1. Mastoridis S, Shanmugarajah K, Kneebone R. Undergraduate education in trauma medicine: the students' verdict on current teaching. Med Teach 2011;33(7):585–587. https://doi.org/10.3109/0142159x.2011.576716

Adam Baker, Elizabeth Gay, Amy Adams, Emma Midgley, Mark Hughes and Calum Heslop

University of Nottingham

Community first responder (CFR) schemes have existed in the United Kingdom for 25 years, supporting the provision of lifesaving care and helping to bridge the gap between an emergency call and ambulance arrival. The University of Nottingham Co-Responders (UoNCR),¹ formerly a CFR scheme founded in 2014, is the UK's leading university scheme² for size and scope of practice. UoNCR developed a pilot response model with East Midlands Ambulance Service to enhance medical care, delivered by healthcare student volunteers, in a pre-hospital, minimally supervised environment and provides additional resources for 999 call responses. This publication provides proof of concept for student volunteer-led Co-Responder schemes, outlining key principles for initiation and development, to support the progression of pre-hospital care in the UK and enhance student education in the field.

UoNCR aims to supplement the clinical experience of healthcare students, with reported perceived benefits on clinical and communication skills, and provide exposure to pre-hospital emergency medicine, a field with limited student opportunities, while positively impacting the local community, with a real-term benefit for ambulance response times and initiation of life-saving treatment.³

Key requirements for success include developing a memorandum of understanding and stakeholder partnerships with local ambulance trust, university students' union and medical school, to provide financial and operational support. A robust continuing professional development programme maintains skill proficiency and clear procedural policies allow effective governance.

UoNCR sets the standard for University Co-Responder schemes, advancing student volunteer-provided pre-hospital emergency care, while enhancing educational opportunities, and is a replicable organisational model for other universities.

Keywords concept model; education; medical student; pre-hospital emergency medicine; volunteering

References

1. UoNCR Homepage. University of Nottingham Co-Responders. January 24, 2024. https://www.uonresponders.co.uk/

2. Phung V-H, Trueman I, Togher F, Orner R, Siriwardena AN. Community first responders and responder schemes in the United Kingdom: systematic scoping review. Scandinavian Journal of Trauma Resuscitation and Emergency Medicine. 2017;25(1). https://doi.org/10.1186/s13049-017-0403-z

3. Orsi A, Watson A, Nimali Wijegoonewardene, Vanessa Botan, Dylan Lloyd, Nic Dunbar, Zahid Asghar, A Niroshan Siriwardena Perceptions and experiences of medical student first responders: a mixed methods study. 2022;22(1). https://doi.org/10.1186/s12909-022-03791-z

Ellie Ferguson¹, Katherine Gouveia¹ and Samuel Watson²

¹University of Aberdeen; ²Liverpool University Hospitals NHS Foundation Trust

A new 20-person ‘apprenticeship’ course from Anglia Ruskin University is offering an ‘alternative’ route into medicine, and the only significant difference is that these 20 students will be paid to undertake their medical degree. About 80% of their time will be spent in university lectures or hospital placements, with the other 20% in a non-clinical work role.

Students undertaking this ‘apprenticeship’ will earn £14,000 of debt-free income in their first year; however, an equivalent student undertaking the course in Aberdeen who chooses to work over their 17-week summer at national living wage¹ would make about half this. Not only do traditional medical students make less money for equivalent work, but they also have the burden of paying tuition fees and taking on the associated student debt. An apprentice is defined as a person learning from a skilled employer,² but these students are not receiving any additional time on the wards compared to traditional medical students. The ‘apprentice’ aspect seems to be the fact that they are guaranteed a non-clinical job to work in parallel to their studies that does not conflict with scheduled lectures or exams, a luxury that many traditional medical students do not have.

These new apprentices will attend all the same teaching as the traditional students at Anglia Ruskin, sit the same examinations and leave with the same qualification.

How is this programme different from what is already offered? Is there a benefit to choosing this over traditional pathways?

Keywords apprenticeship; medical student; undergraduate; widening access

References

1. GOV.UK. National minimum wage and national living wage rates. GOV.UK. Published 2023. https://www.gov.uk/national-minimum-wage-rates

2. Cambridge Dictionary. Apprentice. @CambridgeWords. Published January 24, 2024. Accessed January 25, 2024. https://dictionary.cambridge.org/dictionary/english/apprentice#google_vignette

Georgina Stephens

Monash University

From patient presentation to prognosis, medical practice is inherently uncertain.¹ Rather than answering single best answer questions, medical students will instead enter a work environment characterised by shades of grey. Although learning to manage or ‘tolerate’ uncertainty is increasingly considered a graduate attribute, some educators believe that supporting learners' development of uncertainty tolerance (UT) is incompatible with teaching core content. Drawing on findings across longitudinal qualitative research^2,3 and the UT literature more broadly,¹ the author contends that there are practical ways for educators to support students' UT development, even in the early years of medical school.

Key strategies educators can engage include the following: (1) role modelling UT, (2) providing opportunities for students to practise managing uncertainty and (3) acknowledging healthcare uncertainty within learning outcomes and assessments. Practical examples aligned with these strategies will be described. For example, educators can role model UT by thinking aloud their own experiences of uncertainty and describing their approach to managing uncertainty. Early opportunities for managing uncertainty might include integrating unknown elements into case-based learning completed in teams, before later individually challenging students with uncertainties within simulation or placement settings. Finally, assessments should authentically reflect uncertainty that students are likely to experience in graduate practice, for example, communicating uncertainty to colleagues and patients in an objective structured clinical examination.

Although research suggests that medical students experience ‘a whole lot of uncertainty’,² educators should be reassured that they are well placed to prepare their students for the uncertain reality of medical practice.

Keywords ambiguity; early years; medical students; tolerance; uncertainty

References

1. Strout TD, Hillen M, Gutheil C, Anderson E, Hutchinson R, Ward H, Kay H, Mills GJ, Han PKJ Tolerance of uncertainty: a systematic review of health and healthcare-related outcomes. Patient Educ Couns 2018;101(9):1518–1537. https://doi.org/10.1016/j.pec.2018.03.030

2. Stephens GC, Sarkar M, Lazarus MD. ‘A whole lot of uncertainty’: a qualitative study exploring clinical medical students' experiences of uncertainty stimuli. Med Educ 2022;56(7):736–746. https://doi.org/10.1111/medu.14743

3. Stephens GC, Sarkar M, Lazarus MD. ‘I was uncertain, but I was acting on it’: a longitudinal qualitative study of medical students' responses to uncertainty. Med Educ 58(7):869–879. Published online November 14, 2023. https://doi.org/10.1111/medu.15269

Niamh Theresa McSwiney¹, Nicola Taylor² and Steve Jennings³

¹Bath Academy, Bristol Medical School; ²Wellbeing Lead, Bristol Medical School; ³TLHP Department, Bristol Medical School

Background The clinical teaching fellow (CTF) is a role often taken out of programme to develop skills in medical education. The non-academic components include providing pastoral support, administration and planning, co-ordinating social events, and mentorship. The nature of different responsibilities inevitably leads to role variation, not only within education departments but between hospital Academies (each hospital associated with Bristol Medical School is attached to a named Academy where the students attend clinical placement).

Uncertainty from CTFs and the wider faculty regarding the remit of the CTF role has been previously documented.¹ This has the potential for mismatch between Academy faculty, CTFs and students about what meets the threshold for seeking pastoral support from their CTF and the extent of this responsibility.

This project aims to understand what pastoral care means to CTFs at different academies, their experiences of providing it to medical students and what role, if any, they feel CTFs should have in providing pastoral care.

Methods Focus groups involve CTFs at all seven academy sites. The research team will generate codes, categories and themes based on reflexive thematic analysis.²

Results Pending. The Research Governance Team has validated ethical application for completeness.

Discussion Having first started the role of CTF in August 2023, providing pastoral support was not a responsibility I had experienced in my previous clinical practice. I want to discuss the extent of practice and responsibility of CTFs providing pastoral care, their experiences and feelings and consider support systems in place and the future of the role.

Keywords education; clinical teaching fellows; medical students; pastoral care; well-being

References

1. Baryeh K. The rise of the clinical teaching fellow: a personal view of the postgraduate experience. Br J Hosp Med 2022;83(10):1–6. https://doi.org/10.12968/hmed.2022.0339

2. Byrne D. A worked example of Braun and Clarke's approach to reflexive thematic analysis. Qual Quant 2022;56(3):1391–1412. https://doi.org/10.1007/s11135-021-01182-y

Oliver Sweeney, Lucy Easton and Jade Hazeldine

University of Leicester

With great focus on expanding cohort sizes for the healthcare workforce,¹ pressure is on to continue delivering high quality medical education for increasing numbers of students. Full-body cadaveric dissection forms an invaluable part of the Leicester Medical School curriculum among others, but as demand increases, facilitating classes divided into small groups with one facilitator per cadaver becomes increasingly challenging. It is important to maintain this ratio to maximise the potential of both the donors and students, while maintaining a safe environment. This project harnesses the increasingly evidenced concept of near-peer teaching^2,3 with the aim to enable second year medical students to facilitate first year students' dissection classes during their musculoskeletal module.

Of those that responded to feedback following a trial of near-peer facilitation in 2022/2023, 100% stated that they would be happy to have a near-peer tutor lead them again, with 76% enthusiastic to take up the opportunity of becoming a near-peer tutor themselves.

In 2023/2024, the programme is running a further pilot phase, selecting six student teachers keen to facilitate dissection classes, equipping them with some basic pedagogical knowledge and providing teaching aids for them to use with their small groups. The 6 student teachers will cover at least 10 groups of around 7 students weekly, reducing the workload of dissection classes by more than 20%. Across five sessions, they will engage with over 182 different learners, mostly on two occasions to ensure the balance of variety and rapport to maximise their impact on learning.

Keywords dissection; education; medical; peer; teaching

References

1. NHS workforce plan aims to train thousands more doctors and open up apprenticeship schemes - ProQuest. Accessed December 31, 2023. https://www.proquest.com/openview/ccec5da7201bad8769660b9134d2448f/1?pq-origsite=gscholar&cbl=2043523

2. Evans DJR, Cuffe T. Near-peer teaching in anatomy: an approach for deeper learning. Anat Sci Educ 2009;2(5):227–233. https://doi.org/10.1002/ase.110

3. Hall S, Harrison CH, Stephens J, Andrade MG, Seaby EG, Parton W, McElligott S, Myers MA, Elmansouri A, Ahn M, Parrott R, Smith CF, Border S The benefits of being a near-peer teacher. Clin Teach 2018;15(5):403–407. https://doi.org/10.1111/tct.12784

Suleiman Ayoub and Alice Cranston

Buckinghamshire Healthcare Trust

Mentorship is a valuable but often overlooked resource for medical students nationwide. While the benefits of clinical supervisors are well-documented,¹ the potential of peer mentors is frequently underestimated. Many challenges faced by medical students, such as administrative hurdles, exam success and securing a foundation year role, are best addressed by recent healthcare graduates in similar positions.

Early exposure to mentorship skills is crucial for budding medical professionals. A disengaged mentor can adversely affect young doctors, while an engaged mentor contributes to holistic professional development.

Recognising this, we introduced the ‘Medimentors’ program in 2021 at Buckinghamshire Healthcare Trust. This initiative connects medical students with foundation year 1 or 2 doctors, offering practical insights into various challenges. Emphasising student-centric meetings and addressing the hidden curriculum, the programme focuses on informal guidance rather than formal teachings. An induction presentation prepares mentors, emphasising the significance of mentorship and outlining techniques like the mentoring contract² and key components of a positive mentorship relationship.^3.

In its second year, this programme demonstrated success, attracting 25 student participants and engaging over 50 foundation year doctors. Quantitative data from our initiative indicate that these adjustments led to increased student-mentor interactions, ultimately amplifying the programme's overall impact. From a qualitative perspective, the feedback received was overwhelmingly positive, underscoring the programme's value for both students and doctors.

Keywords education; foundation year; hidden curriculum; mentor; near-pear education

References

1. Snowdon DA, Leggat SG, Taylor NF. Does clinical supervision of healthcare professionals improve effectiveness of care and patient experience? A systematic review. BMC Health Serv Res. 2017;17(1). https://doi.org/10.1186/s12913-017-2739-5

2. The Mentoring “Contract” and Why It Matters. Talent thinking. Published November 30, 2020. https://talentandpotential.com/articles/2020/11/30/the-mentoring-contract-and-why-it-matters/

3. Eller LS, Lev EL, Feurer A. Key components of an effective mentoring relationship: a qualitative study. Nurse Educ Today 2014;34(5):815–820. https://doi.org/10.1016/j.nedt.2013.07.020

Hannah Gillespie¹, Bryan Burford¹, Nicola Brennan² and Gill Vance¹

¹Newcastle University; ²University of Plymouth

Background Speciality training in the UK is competitive at the point of entry,⁽¹⁾ but despite this, not all doctors appointed to these positions complete the training. The latest GMC workforce report has shown a sharp increase in the proportion of doctors intending to leave and taking steps to do so.⁽²⁾ This led us to ask: what is known about why doctors leave speciality training programmes?

Methods We conducted a scoping review, following Arksey and O′Malley's five-step framework. ⁽³⁾ First, our research question was defined. Second, we searched MEDLINE, EMBASE, Scopus, Web of Science for relevant articles, published between 2014 and 2024. Third, we screened 4122 titles of which 272 were selected for further review. We then extracted relevant data into a data charting proforma and iteratively developed an interpretative framework.

Results Twenty-eight studies explored why doctors leave training posts in 12 countries. Most (43%) papers were from the USA, with only five articles including experiences of UK trainees. The majority (71%) of studies investigated attrition from surgery or surgical sub-specialities; other specialities were relatively underrepresented. Across specialities, contextual factors (such as bullying, personal support and work-life balance) weighed heavily on trainees decision to leave.

Discussion To date, our understanding of attrition is influenced heavily by surgical specialities. Less is known about other specialities and the experiences of trainees in the UK. Further work to help quantify the rate of attrition and identify driving factors is of clear importance to health and care services.

Keywords attrition; postgraduate; retention; speciality training

References

1. Health Education England. (2023) Competition ratios for 2023.

2. General Medical Council. (2022) The state of medical education and practice in the UK: the workforce report 2022.

3. Arksey & O'Malley (2005) Scoping studies: towards a methodological framework, International Journal of Social Research Methodology, 8:1, 19–32. https://doi.org/10.1080/1364557032000119616

Ciaran Carr

Royal College of Physicians of Ireland

Irish medical trainees experience geographical rotations, relocating every 3 to 6 months to gain experience.¹ They often request placements close to their homes but cannot always be accommodated.² Additionally, less than full-time training (LTFTT) is becoming popular, though places are limited¹. This study investigated trainees' experiences of LTFTT.

Through explanatory, sequential mixed-methods, RCPI trainees completed a questionnaire on their experiences of LTFTT. Post-completion, participants were invited to contribute to a focus group. Qualitative data were analysed thematically.

The survey was completed by 287 trainees. While 5% (n = 15) were participating in a LTFTT arrangement, 68% (n = 194) indicated they would apply for LTFTT if available. Focus group participants (N = 12) discussed the schedule and frequency of rotations impeding imbedding in their hospital environment. They added that their training suffered, perceiving supervisors, colleagues and management as less likely to invest time in them given their imminent rotation or ‘part-time’ schedule. Flexibility enabled balancing training and personal commitments, with reduced schedules being attractive.

The working and learning preferences of trainees have changed. There is an appetite for flexible training, but there are significant barriers. Facilitating trainee preferences will have a positive effect, predicting staff retention, improved patient outcomes and continuity of care.³ Where possible, trainees should be accommodated to train to their preferred schedule.

Keywords geographical rotations; Ireland; less than full-time training; postgraduate

References

1. Health Service Executive. Guide to HSE national supernumerary flexible training scheme. 2022; 1.

2. Kumwenda B, Cleland JA, Prescott GJ, Walker KA, Johnston PW. Geographical mobility of UK trainee doctors, from family home to first job: a national cohort study. BMC Med Educ 2018; 18(1): 1–10. https://doi.org/10.1186/s12909-018-1414-9

3. Clark TR, Freedman SB, Croft AJ, Dalton HE, Luscombe GM, Brown AM, Tiller DJ, Frommer MS. Medical graduates becoming rural doctors: rural background versus extended rural placement. Medical Journal of Australia 2013; 199(11):779–82. https://doi.org/10.5694/mja13.10036

Laura Emery

University of Sheffield

Background Reflection is a key aspect of postgraduate UK General Practice (GP). In training, reflection is used to evidence achievement of curriculum competencies, a requirement for progression to membership of the Royal College of General Practice.¹ Post qualification, reflection forms an integral part of the appraisal process.²

International medical graduates (IMGs) are at a disadvantage compared to their UK-based counterparts, the majority having no previous experience of reflection before entering UK GP training.³ The aim of this study was to gain insight into IMG experiences of reflection so that educational interventions can be developed to support IMGs in developing this important skill.

Methods Qualitative analysis of verbatim data (open questions) from a national survey of IMGs in UK training was used to develop a topic guide for semi-structured interview. Interviews continued to data saturation in a purposive maximum variety sample of participants.

Results A total of 485 IMGs completed the survey, and 11 participants were recruited to interview. Positive aspects of reflection were that it provided an effective approach for learning, opportunities for self-assessment and professional development and was a means of developing self-awareness. Negative aspects were that it was time-consuming, that it often felt forced (due to being mandated) and that reflections in online environments are not confidential, creating a fear of medico-legal consequences.

There are a plethora of educational interventions across the UK which aim to support IMGs in adapting to the NHS as well as CPD/mandatory assessments. These currently do not meet IMGs concerns and specific needs.

Keywords international graduates; postgraduate; primary care; qualitative; reflection

References

1. RCGP. Workplace based assessments-learning log. Accessed 09/05/2023, 2023. https://www.rcgp.org.uk/mrcgp-exams/wpba/assessments/learning-log

2. GMC. Guidance on supporting information for appraisal and revalidation. Accessed 11/01/2024, 2024. https://www.gmc-uk.org/registration-and-licensing/managing-your-registration/revalidation/guidance-on-supporting-information-for-appraisal-and-revalidation/your-supporting-information---compliments-and-complaints

3. Emery L, Jackson B, Oliver P, Mitchell C. International graduates' experiences of reflection in postgraduate training: a cross-sectional survey. BJGP Open. 2022;6(2). https://doi.org/10.3399/bjgpo.2021.0224

Alexander Rutherford and Elizabeth Mallon

Great Western Hospital, Swindon, UK

Background The transition to the medical registrar role is known to be one of the most challenging within clinical medicine with increasing exposure to high-acuity patients and leadership, organisational and communication challenges.^[1] Despite research clarifying these challenges, little exists in the literature of the optimal methods of preparing doctors for this step-up. Here we present a novel course of multiple patient encounter simulation training for medical registrars.

Approach A multiple patient encounter simulation was set up in a district general hospital in the UK. Scenarios incorporated two high-acuity patients managed synchronously, interruptions from junior members of the team and hospital colleagues and important practical skills to perform. Eight internal medicine trainees (IMTs) took part, with qualitative feedback collected anonymously. A multiple patient encounter format was chosen to replicate real-world situations, increase scenario complexity and incorporate human factors training.^[2,3]

Evaluation Trainee feedback demonstrated that intended learning outcomes (ILOs) focused on high-acuity patient management, and medical registrar-specific human factors training were well-achieved. Trainees unanimously fed back that the simulation accurately replicated the on-call experience. Themes from the feedback illustrated that the multiple patient encounter simulation appropriately challenged and pushed the comfort boundaries of trainees. Future areas for development include incorporating challenging communication scenarios.

Implications This novel approach to medical registrar training highlights significant benefits and successful targeting of appropriate ILOs from multiple patient encounter simulation. Our work demonstrates that multiple patient encounter simulation could be incorporated as part of an IMT curriculum designed towards developing trainees for the registrar role.

Keywords multiple-patient; postgraduate; registrar; simulation; teaching

References

1. Negundi, A. Ming, C. Woodward, F. Lasoye, T. Birns, J. Supporting the transition to becoming a medical registrar. Future Healthcare Journal 2021:8(1);e160–163. https://doi.org/10.7861/fhj.2020-0177

2. Brown, C.W. Multiple patient encounter simulations in emergency medicine. BMJ Simulation & Technology Enhanced Learning 2016;2(4):129–130. https://doi.org/10.1136/bmjstel-2016-000145

3. Kobayashi, L. Shapiro, M.J. Gutman, D.C. Jay, G. Multiple encounter simulation for high-acuity multipatient environment training. Educational Advances. 2007;14(12), 1141. https://doi.org/10.1111/j.1553-2712.2007.tb02334.x

Zain Mohammed¹, Mohammed Sarwar Shah¹, Imtanaan Abbas¹, Shehzar Shah¹, Nabeel Hussain¹, Saira Chowdry², Shyam Balasubramanian² and Kate Owen¹

¹Univeristy of Warwick; ²University Hospitals Coventry and Warwickshire

Background This study evaluates the impact of pharmacist peer-led teaching on final-year medical students' performance in Prescribing Safety Assessments (PSA) and the factors influencing prescribing training.

Methods In a prospective crossover study, 74 students were randomly allocated to two groups (Stream A: 36, Stream B: 38) and assessed using a 50-mark PSA at baseline, midpoint and endpoint. Stream A received a 5-week teaching intervention post-baseline, and Stream B after the midpoint assessment. The primary outcome assessed was the impact on PSA performance. Secondary outcomes were derived from qualitative analysis of semi-structured interviews (n = 10), focusing on student perceptions of the intervention.

Results Repeated measures ANOVA demonstrated no significant performance difference between Streams A and B at baseline. Stream A showed a significant improvement at the midpoint following intervention (mean = 75%, 95% CI: 71.8–78.8) compared to Stream B (mean = 65.6%, 95% CI: 62.2–69.1). Both groups exhibited improvement at endpoint compared to baseline, with an overall average improvement of 16% (p = <0.001).

Qualitative findings highlighted the positive impact of a pharmacist peer-led teaching experience, enriched by group learning dynamics and case-based learning. Participants reported a positive outlook towards future interprofessional relations and increased confidence in prescribing. Improved PSA domains included patient safety, planning management and calculation skills.

Conclusion The pharmacist peer-led teaching intervention improved final-year medical students' prescribing skills. This innovative approach fostered a supportive learning environment, enhancing assessment performance and prescribing confidence. It offers potential as an effective tool in medical education in preparing students for the PSA and future prescribing responsibilities.

Keywords graduate-entry; peer-led; pharmacist; prescribing; PSA

Richard Bodington, Paul Crampton, David Hepburn and Matthew Morgan

Hull-York Medical School

An increasing proportion of our elderly population suffer from, and are burdened by, problematic polypharmacy. It is vital that physicians have ability in medicines optimization, which includes the activities of medication review and deprescribing, as a key intervention to address this issue. Unfortunately, the teaching of these complex skills at undergraduate level is often neglected, and interventions to improve ability in postgraduate doctors have yielded mixed and often disappointing results.^(1,2)

It seems that embedding these skills at undergraduate level has a fair prospect of successfully improving medicines optimization ability in clinical practice. However, a literature review of the outcomes of these educational interventions at undergraduate level has not been performed. Furthermore, the studies of these interventions in postgraduates have failed to elucidate the factors associated with educational effectiveness because they have not unpacked ‘what works, for whom, in what contexts’. Realist methodology is well-placed to unpack the ‘black-box’ of these complex educational interventions ⁽³⁾.

Here, we present a 3-year project, begun in October 2023, to fill this knowledge gap in the educational literature. The project will consist of a realist review followed by realist interviews and then a medical student workshop and realist focus group, to glean, refine and consolidate a programme theory explanatory of generative causation in these educational interventions. We will describe our approach and anticipated research deliverables and look forward to discussion.

Keywords deprescribing; evaluation; medicines optimisation; realist; undergraduate

References

1. Barnett, N., et al. (2021). “Medication review, polypharmacy and deprescribing: results of a pilot scoping exercise in undergraduate and postgraduate education.” Pharmacy Education 21(1): 126–132. https://doi.org/10.46542/pe.2021.211.126132

2. Reeve J, Maden M, Hill R, Turk A, Mahtani K, Wong G, Lasserson D, Krska J, Mangin D, Byng R, Wallace E, Ranson E Deprescribing medicines in older people living with multimorbidity and polypharmacy: the TAILOR evidence synthesis. Health Technol Assess 2022;26(32):1. https://doi.org/10.3310/AAFO2475

3. Tilley, N. and R. Pawson (2000). Realistic evaluation: an overview. Founding conference of the Danish Evaluation Society.

Anthony Codd

Newcastle University

UK medical students spend, on average, 7% of their course in General Practice (GP).¹ Current conceptualisations position undergraduate GP teaching and learning as a primarily sociocultural construct² that highlight the importance of the learning environment in the overall clinical experience, but leave the consideration of material components secondary, or absent. The emergence of sociomaterial theory in medical education³ provides an attractive theoretical lens through which to study GP learning environments, placing humans and materials as equals.

The aim of this project was to take a holistic, sociomaterial view of both the human and material actors present in the GP surgery as experienced by undergraduate students and to explore and map the mediators of learning in this environment.

A total of 120 hours of ethnographic observation was undertaken in two GP surgeries in North East England that deliver longitudinal third year undergraduate medical placements. Both clinical, patient-facing learning experiences and practice-based classroom learning were observed, with data analysis informed by sociomaterial theories and institutional ethnography.

Findings discussed include learning in physical and digital clinical environments, the creation of ‘artefacts’ by students, the use of electronic devices in learning, the strong mediating power of the curriculum, the semiotics of undergraduate clinical learning and the use of ‘people as things’.

This discussion provides an exploration of undergraduate learning in the general practice environment from a novel perspective and a useful illustration of the key concepts and utility of the sociomaterial lens.

Keywords ethnography; general practice; learning environment; primary care; undergraduate

References

1. Cottrell, E., Alberti, H., Rosenthal, J., Pope, L. and Thompson, T. Revealing the reality of undergraduate GP teaching in UK medical curricula: a cross-sectional questionnaire study. British Journal of General Practice. 2020; 70(698), pp. e644-e650. https://doi.org/10.3399/bjgp20X712325

2. Park, S., Khan, N.F., Hampshire, M., Knox, R., Malpass, A., Thomas, J., Anagnostelis, B., Newman, M., Bower, P., Rosenthal, J., Murray, E., Iliffe, S., Heneghan, C., Band, A. and Georgieva, Z. A BEME systematic review of UK undergraduate medical education in the general practice setting: BEME guide no. 32. Med Teach 2015; 37(7), pp. 611–630. https://doi.org/10.3109/0142159X.2015.1032918

3. Fenwick, T. and Nimmo, G.R. Making visible what matters: sociomaterial approaches for research and practice in healthcare education. Researching Medical Education. 2015;pp. 67–80. https://doi.org/10.1002/9781118838983.ch7

Nicola Franc and Hugh Alberti

Newcastle University

Background Medical school curricula have seen an expansion of teaching in the community. A rural primary care setting may afford a student exposure to a variety of patients and opportunities to improve their clinical skills and work as part of a small team.¹ GP recruitment is an issue particularly for rural areas, and there is some evidence that exposure to rural settings may positively influence students career intentions.²

Methods An Interpretative Phenomenological Approach was utilised to explore students' lived experiences of their rural primary care placements. Semi-structured interviews were conducted with five final year medical students.

Results Interview transcripts were analysed, and themes were identified, interpreted and developed to generate multiple Personal Experiential Themes and Group Experiential Themes. This led to the development of four higher level Group Experiential Themes: adjusting to rural living, relationship with GP supervisor and team, autonomy and developing as a doctor.

Students' experiences of rural primary care placements are influenced by their adjustment to their new environment. Once a student's basic needs are met on this foundation, other factors important in learning can begin to develop including a sense of belonging for a student. A student's relationship with their GP supervisor and team is important and may influence their autonomy. A rural placement may offer opportunities for students to integrate into a small team, feel valued and have an ‘almost doctor’ role consulting with a diverse range of patients, learning by doing and preparing them to be independent practitioners.

Keywords education; medical; primary care; rural; undergraduate

References

1. Deaville JA, Wynn-Jones J, Hays RB, Coventry P, McKinley R, Randall-Smith J Perceptions of UK medical students on rural clinical placements. Rural Remote Health 2009;9(2):1165. https://doi.org/10.22605/RRH1165

2. Ray RA, Young L, Lindsay D. Shaping medical student's understanding of and approach to rural practice through the undergraduate years: a longitudinal study. BMC Med Educ 2018;18(1):147–147. https://doi.org/10.1186/s12909-018-1229-8

Katie Scott, Victoria Collin, Arti Maini and Viral Thakerar

Imperial College London

Health coaching can motivate patients to change health behaviours and improve health outcomes.¹ Training medical students in health coaching may influence GP tutors' approaches to coaching in primary care.^{2, 3}

However, research is limited exploring tutors' experiences of this and the impact upon their own learning and practice. This research explores GP tutors' experiences supervising second year medical students at Imperial College London holding health coaching conversations in General Practice.

Two focus groups (with two to three GP tutors in each group) and one interview were conducted, to accommodate tutor availability. Discussion focused on tutors' experiences supervising students' health coaching. Transcribed data were analysed using inductive thematic analysis.

GP tutors reported positive impacts on their own patient care through: applying coaching skills learned from students, gaining insight into their patients' health perspectives, better relationships between patients and the practice and increasing motivation of other healthcare professionals to practice health coaching.

Tutors felt rewarded by contributing to students' development of personalised care and pride showcasing the role of general practice in personalised care. Enablers included the following: student enthusiasm, tutor peer and faculty support, tutors recognising the value of primary care settings and their own skills. Challenges included the following: variability in student engagement, difficulties recruiting patients and tutors not directly observing coaching conversations.

This study builds on previous research,^{2, 3} suggesting that student coaching skills training during GP placements is feasible and well-received by tutors, with benefits for tutors, practices and patients. Coaching training and support for GP tutors is recommended, alongside consideration of how best to engage patients.

Keywords coaching; primary care; undergraduate

References

1. Kivelä K, Elo S, Kyngäs H, Kääriäinen M. The effects of health coaching on adult patients with chronic diseases: a systematic review. Patient Educ Couns 2014; 97(2): 147–157. https://doi.org/10.1016/j.pec.2014.07.026

2. Leedham-Green K, Wylie A, Ageridou A, Knight A, Smyrnakis E Brief intervention for obesity in primary care: how does student learning translate to the clinical context? MedEdPublish. 2019; 8(16). https://doi.org/10.15694/mep.2019.000016.1

3. Maini A, Fyfe M, Kumar S. Medical students as health coaches: adding value for patients and students. BMC Med Educ 2020; 20(1),182. https://doi.org/10.1186/s12909-020-02096

Catherine Kennedy and Zoe McElhinney

University of Dundee

In August 2021, the Scottish Government launched ‘Women's Health Plan: A plan for 2021–2024’, which recognised that women experience different health needs to men and that these are often not provided for in terms of appropriate health care or equality of outcomes. The plan focuses on six initial priority areas: access to support and services for menopause, endometriosis, menstrual health, abortion and contraception and postnatal contraception and to reduce inequalities women's health outcomes, particularly in relation to cardiac disease.

As GPs in the UK are the first point of contact for patients and act as gatekeepers to specialist services, an understanding of women's health needs and appropriate management of these needs is vital within primary care. However, there is a dearth of research exploring the preparedness of GPs and GP trainees to address women's health needs; that has been carried out has identified a lack of preparedness of primary care physicians in assessing women's risk of cardiovascular disease and how a lack of knowledge and awareness led to diagnostic delays for endometriosis Netherlands. This study explored GPs and GP trainees' perceptions of the priority health needs for women and of their preparedness to meet them.

This study utilised a qualitative research design to conduct interviews with GPs and GP trainees in NHS Tayside. The research was conducted in early 2023 and utilised a thematic narrative approach to data analysis. The findings have been developed as composite narratives to explore the commonalities of experience.

Keywords GP training; qualitative; women's health

References

Scottish Government. Women's health plan: a plan for 2021–2024. Available from https://www.gov.scot/publications/womens-health-plan/ March 2022.

Isakadze N, Mehta PK, Law K, Dolan M, Lundberg GP. Addressing the gap in physician preparedness to assess cardiovascular risk in women: a comprehensive approach to cardiovascular risk assessment in women. Curr Treat Options Cardiovasc Med. 2019;21(9):1–1. https://doi.org/10.1007/s11936-019-0753-0

Van Der Zanden M, Teunissen DA, Van Der Woord IW, Braat DD, Nelen WL, Nap AW. Barriers and facilitators to the timely diagnosis of endometriosis in primary care in the Netherlands. Fam Pract 2020;37(1):131–6. https://doi.org/10.1093/fampra/cmz041

Clare Polack¹ and Lindsey Cherry²

¹University of Southampton/Mulberry Surgery; ²University of Southampton

Background Partly due to the GP workforce crisis, Primary Care Networks (PCNs) receive funding to employ Allied Health Professionals (AHPs) as First Contact Practitioners (FCPs) through the additional roles reimbursement scheme (ARRS).¹ Guidance on the training and supervision required to implement the scheme is lacks detail.²

Methods We present a personal case study of a GP and a podiatrist. We are both health educators and have reflected on, and discussed, the topic at length. We attended training,³ kept abreast of the politics and literature and talked to others through local and national networks so feel in a position to ‘make a point’ and lead a discussion.

Results We think an FCP podiatrist should be more than just a podiatrist practising their speciality in a primary care setting. To achieve this, the AHP must be open to learning new ways of consulting, embrace holistic care and contribute to the aim of the whole primary care team. Being a novice learner can be destabilising, particularly for a senior AHP. Both the GP and AHP need to acknowledge the tensions and embrace the uncertainty.

Adopting a positive, enquiring, collaborative and supportive approach made the process enjoyable for both parties. Role boundaries are contentious, particularly given the current narrative about replacement of doctors with AHPs but should take into account the individual.

Conclusion With nurturing, trust and supervision AHPs can add to the primary care workforce, take work from GPs (not replace them), contribute to the practice, improve patient care and increase job satisfaction.

Keywords first contact practitioner; interdisciplinary learning; primary care; supervision

References

1. NHS England. General practice. Expanding our workforce. [Online] Available from https://www.england.nhs.uk/gp/expanding-our-workforce/25.01.24

2. The Kings Fund. (2022). Integrating additional roles into primary care networks. [Online] Available from Integrating additional roles into primary care networks|The King's Fund (kingsfund.org.uk) 25.01.24.

3. NHS Health Education England. (2021) First contact practitioners and advanced practitioners in primary care: (Podiatry) a roadmap to practice. [Online] Available from First Contact Practitioners - Roadmaps to Practice|Health Education England (hee.nhs.uk) 25.01.24.

James McMillan

University of Dundee

Lifelong learning is accepted in medical education as an important concept. A cursory search for the term ‘lifelong learning’ in the medical/medical education literature will avail you of thousands of items. It is a concept which underpins our professional standards, and students who graduate are expected to explain and demonstrate its importance and their commitment to it.¹

So what is it?

More importantly, perhaps, how are we assessing it, and does it matter in modern medical education?

Research carried out as part of a master's project² suggests that students' understandings of lifelong learning if left unchallenged are constrained by a cultural narrative espoused by medical practice. Although this may appear a benign issue, this situation arguably deprives students of exposure to a rich and multifaceted concept and a valuable opportunity for exploration of their capacity to learn and develop.

Drawing on recent writing,³ this presentation will put forward the position that a more deliberate application of the concept of lifelong learning in medical education could be a valuable tool not only in developing the resilience and skillset of the future healthcare workforce but also in meeting the needs of future patient populations where, perhaps, the current healthcare system is failing.

Keywords curriculum design; lifelong learning; medical; personal development; undergraduate

References

1. General Medical Council. Outcomes for graduates. Published online 2018. Accessed January 10, 2024. https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/outcomes-for-graduates/outcomes-for-graduates

2. McMillan JCD, Jones L. A qualitative study exploring how students' conceptualisations of lifelong learning develop in an undergraduate medical training programme. Practice 2022;4(3):212–225. https://doi.org/10.1080/25783858.2022.2133624

3. McMillan JCD. Is it time to reconsider our understanding of lifelong learning in medical training. JoSSSR. 2022;1(1). https://doi.org/10.20933/30000100

Sriraj Aiyer

University of Oxford

‘Problems in diagnosis have … been heavily dominated by physicians with little input from the cognitive sciences. What is missing … is foundational work aimed at understanding how clinicians in actual situations take a complex, tangled stream of phenomena … to create an understanding of them as a problem’. (Wears, 2014).

Medical decision making, as much as being about technical and anatomical knowledge, is also a psychological process. There is growing awareness about the role of cognitive biases in medical decision making (Saposnik et al, 2016). One hypothesis is that by increasing teaching on cognitive biases, such as overconfidence, confirmation bias and availability/representativeness bias, their incidence and their downstream effect on medical errors would decrease. However, educational interventions may have a limited effect on longer-term outcomes (Sherbino et al, 2014). An alternative then might be aids during the decisional process. These can include ‘checklists, mnemonics, ground rules, computerised decision support or exhortations’ (Wears, 2014). However, interventions are deficient in two areas. Firstly, designing interventions adds to an ever-growing set of aids available to medical professionals, with little guidance/consensus on which to use. Secondly, interventions present solutions before understanding the problems. There is anecdotal evidence that biases negatively affect medical decisions, but it is a challenge to establish an empirical link between biases and outcomes without characterising them as cognitive processes first.

This session aims to spark discussion about directions for research into the psychology of medical decision making, especially where there is a lack of empirical understanding, and how psychology can aid medical education.

Keywords biases; cognition; decisions; education; non-technical

References

Wears, R. L. (2014). Diagnosing diagnosis. Ann Emerg Med, 64(6), 586–587. https://doi.org/10.1016/j.annemergmed.2014.08.009

Saposnik, G., Redelmeier, D., Ruff, C. C., & Tobler, P. N. (2016). Cognitive biases associated with medical decisions: a systematic review. BMC Med Inform Decis Mak, 16(1), 1–14. https://doi.org/10.1186/s12911-016-0377-1

Sherbino, J., Kulasegaram, K., Howey, E., & Norman, G. (2014). Ineffectiveness of cognitive forcing strategies to reduce biases in diagnostic reasoning: a controlled trial. Canadian Journal of Emergency Medicine, 16(1), 34–40. https://doi.org/10.2310/8000.2013.130860

Jun Jie Lim, Shareen Nisha Jauhar Ali, Amir Burney, Dyfrig Hughes, Emily Newbould and Chris Roberts

School of Medicine and Population Health, The University of Sheffield

The sequential objective structured clinical exam (sOSCE) plays a pivotal role in balancing the robustness and affordability of assessing the clinical skills of medical students while providing a more comprehensive assessment of those candidates whose performances are considered borderline.¹ Previous research has primarily focused on the psychometric properties of the sOSCE.² Hence, there is a noticeable lack of an in-depth qualitative analysis of the thoughts and opinions of students and examiners.³ This study aims to address this gap by employing Bandura's self-efficacy theory and Weiner's attribution theory within an interpretivist paradigm to investigate the perceptions of students and examiners about the sOSCE.

A total of 20 semi-structured interviews were conducted (12 phase 2b MBChB students, 8 examiners), with a median interview duration of 38 minutes. Data were transcribed verbatim, and framework analysis was undertaken with qualitative research software NVivo.

Students and examiners reported unfamiliarity with the sequential format and felt that confirmation OSCE is a resit, which contributed to low self-efficacy. However, students preferred the sequential OSCE format, which alleviated their anxiety about passing the first time around; examiners think that sequential offered students a ‘second chance’ to reflect and improve.

Students primarily attributed their dissatisfaction with their OSCE performance to external, uncontrollable factors such as the artificial exam nature, stressful, time-pressured environment, subjectivity in terms of patient variation in script interpretation, willingness to volunteer information and in examination stations, patients' gender and number of signs patients had. Examiner factors were attributed, such as examiner bias, attentiveness and prompts given.

Keywords assessments; interview; OSCE; qualitative; undergraduate

References

1. Pell G, Fuller R, Homer M, Roberts T. Advancing the objective structured clinical examination: sequential testing in theory and practice. Med Educ 2013;47(6):569–77. https://doi.org/10.1111/medu.12136

2. Smee SM, Dauphinee WD, Blackmore DE, Rothman AI, Reznick RK, Des Marchais J. A sequenced OSCE for licensure: administrative issues, results and myths. Adv Health Sci Educ Theory Pract 2003;8(3):223–36. https://doi.org/10.1023/A:1026047729543

3. Duncumb M, Cleland J. Student perceptions of a sequential objective structured clinical examination. J R Coll Physicians Edinb 2019;49(3):245–9. https://doi.org/10.4997/jrcpe.2019.315

Valerie Rae¹, Samantha Smith², Samantha Hopkins¹ and Vicky Tallentire¹

¹NHS Lothian, Medical Education Directorate; ²Scottish Centre for Simulation and Clinical Human Factors

Introduction ‘Chaotic, difficult to untangle and antithetical to belonging’ is a common description of the medical student experience of clinical learning environments. Belonging is vital for learning and well-being.¹ Co-creation is a learning relationship in which students are actively involved.² It is known to promote belonging within higher education environments.³ A paucity of literature exists about how co-creation is experienced by students in clinical learning environments.³ Hence, this project aimed to explore medical students' experience of co-creation, in the hope of enhancing belonging in the clinical workplace.

Methods Following ethical approval, medical students were invited to become co-creators of a team-based learning bulletin resource. Students subsequently participated in semi-structured interviews about how they experienced co-creation. The interview transcripts were analysed using interpretative phenomenological analysis (IPA) to enable an in-depth exploration and integration of individual lived experiences.

Results Nine medical students participated. Three group themes were identified: identity maturation; learning community; and workplace integration. The support found within the co-created learning community, as well as the maturation of their identities, empowered participants to integrate differently within the workplace. Findings were situated within the developmental concept of self-authorship and contributed to a new understanding of how co-creation promoted social integration, via bonds and bridges.

Discussion Co-creation enabled students to contribute in meaningful ways, and belong as themselves in the clinical learning environment. The relational power of co-creation can be harnessed to help future doctors unlock their fullest potential, via promotion of social integration and self-authorship.

Keywords co-creation; belonging; identity; integration; medical education

References

1. Neufeld A, Mossière A, Malin G. Basic psychological needs, more than mindfulness and resilience, relate to medical student stress: a case for shifting the focus of wellness curricula. Med Teach 2020;42(12):1401–1412. https://doi.org/10.1080/0142159X.2020.1813876

2. Bovill C, Jarvis J, Smith K. Co-creating learning and teaching: towards relational pedagogy in higher education. Critical Publishing; 2020

3. Könings KD, Mordang S, Smeenk F, Stassen L, Ramani S. Learner involvement in the co-creation of teaching and learning: AMEE guide no. 138. Med Teach 2021;43(8):924–936. https://doi.org/10.1080/0142159X.2020.1838464

Helen Anne Nolan

University of Warwick

As a pilot exercise, trained student quality reviewers (SQRs) participated fully in quality review visit of clinical learning settings. Subsequent feedback confirmed value of rich, novel learning arising from the experience. ASME award was sought to expand training resources and evaluate student experience.

ASME funding was utilised to employ a student co-creator to (a) participate as an SQR and (b) co-create a training package for future students, informed by their experiences of the process.

Together, we identified five key areas to explore within training. These areas were iteratively developed, informed by previous SQR feedback, review of relevant literature,¹ quality policy,² curricular guidance³ and regular discussion.

Technology-enhanced learning was adopted in creating interactive, online resources for ‘flipped classroom’ learning addressing key content, for example, quality assurance and student leadership. Online training contains objective setting tasks, reflections, and quizzes. This is followed by face-to-face session, enabling relationship development with staff and critical discussion of case scenarios prior to quality review event. Learning content is sequenced to explore core themes of relevance to all medical students, followed by specific content for those undertaking SQR role. Video testimony from previous SQRs is shared on student-facing webpages, illuminating the role for future participants. Debrief and evaluation of SQR experience are undertaken post-visit.

Project strengths include benefits afforded by co-creation, which harnessed student perspective and prior experiences in creating learning resources. Selected content is available to all learners in an accessible format. The next steps will include incentivising wider student participation to enhance representativeness of SQRs, enabling learning gains for all groups.

Keywords co-creation; education quality; leadership; quality assurance; student engagement

References

1. Crampton P, Mehdizadeh L, Page M, Knight L, Griffin A. Realist evaluation of UK medical education quality assurance. BMJ Open 2019;9(12):e033614. https://doi.org/10.1136/bmjopen-2019-033614

2. General Medical Council. Promoting excellence—standards for medical education and training. General medical council. 13 November, 2022. Updated 15 July 2015. Accessed 13 November, 2022. https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/promoting-excellence.

3. Faculty of Medical Management and Leadership. Medical leadership and management—an indicative undergraduate curriculum. 2018. October 2018. Accessed 18 November 2020. https://www.fmlm.ac.uk/sites/default/files/content/news/attachments/Medical%20leadership%20and%20management%20-%20an%20indicative%20undergraduate%20curriculum.pdf

Anna Harvey Bluemel and Megan Brown

Newcastle University

What is degrowth? Degrowth is a political and economic theory¹ with roots in 19th-century anti-industrial movements. It acknowledges the finite physical resources of the planet and suggests that to increase the health of humans we must scale back economic growth. Degrowth focuses on shrinking economies—using fewer resources and measuring ‘success’ by other metrics. We argue that the concept of degrowth has significant potential to revolutionise our approach to and the content of health professions education (HPE). We argue for teaching those in healthcare about the degrowth movement and encouraging them to consider a degrowth approach to educational and clinical practice.

Why must we embrace degrowth principles in health professions education?

Climate impact Degrowth aims to reduce pressure on natural resources and man-made climate change. The climate crisis is a health crisis.² Degrowth represents a critical framework for teaching healthcare professionals about strategies for addressing the root causes of the climate crisis, including consumerism, overproduction and lack of circularity in the economy.

Health outcomes Degrowth principles include redistribution of resources, aiming to reduce poverty and improve health.³ With increasing focus on the social determinants of health and health justice in HPE, a degrowth framework provides a mechanism for critical discussion of the root causes of health inequities.

Well-being of workforce HPE research includes research into the health and well-being of the healthcare workforce. Degrowth frameworks offer innovative policy ideas for the protection of the well-being of employees, including the reduction of the working week and introduction of a basic income.

Keywords philosophy; sustainability; well-being

References

1. Degrowth: what's behind this economic theory and why it matters today. World Economic Forum. Accessed January 18, 2024. https://www.weforum.org/agenda/2022/06/what-is-degrowth-economics-climate-change/.

2. Climate change. World Health Organization. Accessed January 18, 2024. https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health.

3. Cosme I, Santos R, O'Neill DW. Assessing the degrowth discourse: a review and analysis of academic degrowth policy proposals. J Clean Prod 2017;149:321–334. https://doi.org/10.1016/j.jclepro.2017.02.016

Alison Pearson¹, Roma Forbes², Karen Mattick¹ and Christy Noble²

¹University of Exeter; ²University of Queensland

This presentation will share insights gained from the delivery of the 2023 ASME Developing Medical Education Scholarship Award. This project was jointly awarded to two early career researchers (located at the University of Exeter and The University of Queensland), each supported by an experienced mentor.

Developing health professions education (HPE) researchers is a shared goal worldwide. While components of thriving research environments have been articulated (1), including the importance of research community support (2), the journey of developing these environments has been less well-documented. We aimed to explore how a novel international collaborative approach for establishing research groups in Health Professions Education (HPE) could support Early Career Researchers (ECR) within their first five postdoctoral years. To better understand the development of new research groups in HPE, we documented and reflected on the establishment of research groups at our respective universities, while also sharing this learning for mutual benefit.

The project has also included the creation of joint inter-continental researcher workshops and networking opportunities, as a way of supporting the critical early stages of research group formation as well as providing an extended international community for ECRs in both locations. Insights gained from working together and analysing our approaches to establishing HPE research groups in two different universities and countries will be shared. We will reflect on the challenges and benefits of two contrasting approaches to research group development and share top tips for others seeking to establish and develop HPE research groups in the future.

Keywords early career researchers; researcher development; research environment; research group; support

References

1. Ajjawi R, Crampton PE, Rees CE. What really matters for successful research environments? A realist synthesis. Med Educ 2018 Sep;52(9):936–50. https://doi.org/10.1111/medu.13643

2. McAlpine L, Pyhältö K, Castelló M. Building a more robust conception of early career researcher experience: what might we be overlooking? Studies in Continuing Education 2018 May 4;40(2):149–65. https://doi.org/10.1080/0158037X.2017.1408582

Camillo Coccia¹, Megan Brown² and Mario Veen³

¹Mayo University Hospital; ²University of Newcastle; ³HU lectoraat Communicatie in Digitale Transitie

Identity is a topic that has been thoroughly researched and explored in medical education ¹ It is an idea that is often employed to describe certain learning points that fall outside of the domain of the necessary scientific knowledge needed to become a medical practitioner ^2.However, the current methods at our disposal in researching Identity can lead us to contradictions which hinder our progress in understanding what identity is. This article formulates an argument using the work done by existentialist philosophers to elucidate how these contradictions are not a sign that there are strict restrictions to what can be known but rather that certain contradictions are latent within the concept of Identity itself. Using existentialist modes of thinking can help us establish different philosophical frameworks for understanding research into Identity and its daughter concepts, allowing us to approach more concrete models for grounding the results of research.

Keywords identity; philosophy; research; theory

References

1. Sarraf-Yazdi S, Teo YN, How AEH, Teo YH, Goh S, Kow CS, Lam WY, Wong RSM, Ghazali HZB, Lauw SK, Tan JRM. A scoping review of professional identity formation in undergraduate medical education. J Gen Intern Med 2021;36(11):3511–3521. https://doi.org/10.1007/s11606-021-07024-9

2. Veen M, de laCroix A. How to grow a professional identity: philosophical gardening in the field of medical education. Perspect Med Educ 2023;12(1):12–19. https://doi.org/10.5334/pme.367

Philip White¹, Hugh Alberti¹, Gill Rowlands², Eugene Tang², Dominique Gagnon³ and Eve Dube⁴

¹Academic Clinical Fellow in General Practice, Newcastle University; ²Newcastle University; ³Department of Biohazard, Quebec National Institute of Public Health, Quebec, Canada; ⁴Laval University, Quebec, Canada

Background Personal recommendations by a physician can reduce vaccine hesitancy (VH) and subsequently improve vaccine uptake (1), yet this is often done poorly and can be improved by training early-career training (2). We carried out a systematic narrative review of interventions that included medical students in western countries with the aim to synthesise what is being taught, to identify which elements are effective and why and to review the quality of evidence available.

Method This review used a mixed methods systematic narrative review with convergent integrated approach, guided by the JBI methodological framework. Studies were assessed for quality against MERSQI and Cote & Turgeon frameworks, with data extracted to examine content and framing.

Results A total of 32 studies were identified with 29 unique interventions. Most interventions analysed in this review improved knowledge, skill and attitudes yet unintentionally reinforced a deficit-based approach (assuming a decision to refuse vaccines is made because of lack of the ‘correct’ information) to addressing VH rather than focusing on other evidence-based approaches. This approach has been shown to be ineffective and potentially backfire (3).

Conclusions Effective interventions utilised hands-on interactive methods emulating real practice, supported by didactic methods, to develop knowledge, skills and attitudes around addressing VH. Study designs should incorporate short and long-term follow-up with objective assessments of skills, validated questionnaires and patient impact where possible. Most interventions effectively taught ineffective methods around a deficit model approach, so should consider framing content and approach around evidence-based approaches such as motivational interviewing.

Keywords medical education; review; teaching intervention; vaccine hesitancy

References

1. Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger J. Vaccine hesitancy: an overview. Hum Vaccin Immunother 2013;9(8):1763–73. https://doi.org/10.4161/hv.24657

2. Kerneis S, Jacquet C, Bannay A, May T, Launay O, Verger P, et al. Vaccine education of medical students: a nationwide cross-sectional survey. Am J Prev Med 2017;53(3):e97-e104. https://doi.org/10.1016/j.amepre.2017.01.014

3. Hornsey MJ, Harris EA, Fielding KS. The psychological roots of anti-vaccination attitudes: a 24-nation investigation. Health Psychol 2018;37(4):307–15. https://doi.org/10.1037/hea0000586

Amber Bennett-Weston, Simon Gay and Elizabeth Anderson

University of Leicester

Background Guided by the Spectrum of Involvement, healthcare educators continue to strive towards involving patients as ‘equal partners’ in curriculum development, delivery and evaluation. However, there is little pedagogic evidence to endorse such partnerships. Moreover, we do not know what these partnerships mean for all stakeholders and how they can be achieved in practice. This study explores key stakeholders' understandings and experiences of partnerships for patients in healthcare education.

Methods A qualitative case study design was adopted, underpinned by a social constructivist philosophical stance. Semi-structured interviews were conducted with patients (n = 10) and educators (n = 10) from across a Medical School and a Healthcare School. Five focus groups were held with penultimate year students (n = 20) from across the two Schools. Data were analysed using reflexive thematic analysis.

Results Three themes were generated: (1) equal partnerships are neither feasible nor desirable, (2) partnership is about being and feeling valued and (3) valuing patients as partners. Most patients did not desire the highest levels of involvement, where they would be ‘equal partners’ in education. All stakeholders agreed that partnership need not be synonymous with equality. Instead, they contended that true partnerships were about valuing patients for their contributions at any level of involvement.

Conclusion Participants challenged the Spectrum of Involvement and its hierarchical set of steps towards involving patients as ‘equal partners’ in healthcare education. Critical application of the Spectrum of Involvement in future research and education is encouraged. We propose a model for achieving valued patient partnerships in educational practice.

Keywords health professions education; patient involvement; undergraduate

Helen Anne Nolan and Louise Dunford

University of Warwick

Introduction Trauma, which arises from events experienced as physically or emotionally harmful, that may have lasting adverse effects on well-being,¹ has traditionally been conceptualised as impacting only mental health.

Substantial evidence demonstrates widespread trauma prevalence and significant additional impacts on physical health.²

Trauma-informed approaches promote systematic integration of trauma-related evidence in healthcare and are increasingly advocated in healthcare policy to promote recovery.³ Literature review suggests that UK medical education does not currently address trauma-informed care. Exploration of educators' practice is required.

Methods University-based UK medical educators were recruited to participate in qualitative semi-structured interviews exploring familiarity with trauma and trauma-informed approaches, current practice, benefits and drawbacks. Data were analysed using reflexive thematic analysis.

Keywords equality, diversity and inclusion; trauma-informed approaches; trauma-informed medical education; undergraduate medical education; well-being

References

1. Office for Health Improvement & Disparities. Working definition of trauma-informed practice. Gov.UK. 27 August 2023, 2023. Accessed 14 March 2023, 2023. https://www.gov.uk/government/publications/working-definition-of-trauma-informed-practice/working-definition-of-trauma-informed-practice.

2. Bellis MA, Hughes K, Leckenby N, Hardcastle KA, Perkins C, Lowey H. Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England: a national survey. J Public Health 2014;37(3):445–454. https://doi.org/10.1093/pubmed/fdu065

3. NHS. The NHS long term plan. 2019. 7 January 2019. Accessed 31 October 2021. https://www.longtermplan.nhs.uk/

Shalini Gupta¹, Stella Howden², Mandy Mofat¹, Lindsey Pope³ and Cate Kennedy¹

¹University of Dundee; ²Herriot-Watt University; ³University of Glasgow Medical School

Background Gender bias is an enduring issue in the medical profession with lasting impact on students' professional development and career trajectories. This paper presents an ethnographic exploration of the experiences of female medical students and doctors in the clinical learning environment (CLE), aiming to disrupt the cycle of gender inequity in the clinical workplace.¹

Methods Our research field involved two teaching wards in a Scottish hospital, where 120 h of non-participant observations were conducted. Additionally, 36 medical students, foundation doctors, postgraduate trainees, consultant supervisors and other health care professionals were interviewed through purposive and convenience sampling. Data was thematically analysed using Bourdieu's theory of social power reproduction.²

Results Combining the observational and interview data, five themes were generated, which suggested gender-related differentials in social and cultural capital. Experiences of discriminatory behaviour and stereotypical thought processes adversely impacted the habitus. In contrast, the valuable influence of gendered role-models in building confidence and self-efficacy signified a positive transformation of habitus. Considerable internalisation of the gendered processes in the CLE appeared to be linked to the transient nature of clinical placements.

Conclusions This research reveals that despite constituting the majority demographic of medical school, female students struggle to gain social and cultural capital. Based on our theoretically informed investigation, we advocate for role-models given their positive impact on students' and doctors' habitus and extended clinical placements that provide opportunities for female students and doctors to secure social and cultural capital through integrating better in health care teams and building meaningful interprofessional relationships.

Keywords clinical learning; ethnography; gender; medical students; role-models

References

1. Brewer J. Ethnography. McGraw-Hill Education (UK); 2000.

2. Bourdieu, P. (1977). Outline of a theory of practice, transl. R. Nice

Catherine Kellett, Shaikha Al Zaabi, Nusrat Khan, Riad Bayoumi, Paddy Kilian, Hani Benamer, Sam Ho and Adrian Stanley

Mohammed Bin Rashid University

Background Simulation allows students to develop skills in a safe environment. This study investigated whether simulation assessment correlates with workplace-based assessments and summative exam outcome in senior medical students.

Methods Forty-two final year (Year 6) medical students undertook four ward simulation exercises¹ during the academic year. Each exercise was progressively more complex, covering a variety of educational domains.² For each simulation, students were assessed by two faculty assessors using Entrustable Professional Activities (EPAs) and a 5-point Likert Global Rating Score (GRS). Assessment in Years 5 and 6 involves workplace-based assessment, summative theory and clinical exams. Pearson's R was used in the analysis.

Results A total of 35 students undertook 4 simulations exercises, and 7 undertook 3 simulations. Each student was assessed by a mean 10.2 different assessors (range 5–12). A total of 7428 simulation EPA assessments were performed (average 17.4 per assessor-student encounter). There was a significant correlation between Simulation EPA and Simulation GRS (Pearson's = 0.835, p = 0.000). Student mean Simulation EPA score significantly correlated with Year 5 OSCE (Pearson's = 0.378, p = 0.014) and cumulative GPA (Pearson's = 0.318, p = 0.04) but not with the theory exams. The Simulation GRS revealed no significant correlation. There was significant correlation between workplace-based assessments and simulation EPAs (Pearson's = 0.43, p = 0.004).

Conclusion Formative ward simulation exercise performance significantly correlates to workplace-based assessment, summative Year 5 OSCE performance and cumulative GPA but not other, mostly theory, summative exams. These results may have an impact on future use of simulation in undergraduate medical education and programmatic assessment. Students with low scores in simulation lead to faculty review and support.³

Keywords assessment; epas; reflection; simulation exercise; undergraduate

References

1. Till, H., Ker, J., Myford, C., Stirling K., Mires G. Constructing and evaluating a validity argument for the final-year ward simulation exercise. Adv in Health Sci Educ 20, 1263–1289 (2015). https://doi.org/10.1007/s10459-015-9601-5

2. Jean S. Ker, Anne Hesketh, Fiona Anderson & David A. Johnston (2006) Can a ward simulation exercise achieve the realism that reflects the complexity of everyday practice junior doctors encounter?, Med Teach, 28:4, 330–334. https://doi.org/10.1080/01421590600627623

3. Claudia Behrens, Diana H. J. M. Dolmans, Jimmie Leppink, Gerard J. Gormley & Erik W. Driessen (2018) Ward round simulation in final year medical students: does it promote students learning?, Med Teach, 40:2, 199–204. https://doi.org/10.1080/0142159X.2017.1397616

Maria Miles¹, Sam Chumbley¹, Rachel Scott¹, Clodagh Beattie¹ and Anive Grewal²

¹University of Bristol; ²Portsmouth Hospitals NHS Trust

Background On-call simulation has been shown to improve the confidence of prospective junior doctors in undertaking on- call shifts.^1,2 Despite this, on-call simulation is not routinely available at UK medical schools. Barriers to widespread implementation may include the unknown effectiveness in large cohorts, or unknown cost of this approach.³ We aimed to address these gaps in the literature.

Methods An on-call simulation programme, ‘Bleep 101’, was developed and implemented at eight sites. A total of 197 students took part in simulation sessions and completed feedback, including Likert scale data of preparedness to complete an on-call. A further 20 participants undertook paired pre- and post-session forms to evaluate the impact of the session on specific on-call skills. The costs of implementation were reported, enabling a cost-outcome description to be completed.

Results Post-session feedback demonstrated a significant increase in preparedness to complete an on-call shift (pre 4/10, post 7/10, p < 0.01) with outcomes consistent across multiple sites. The paired feedback cohort also demonstrated increased confidence in using a bleep, prioritisation, gathering information and handing over. The cost-report demonstrated that on-call simulation could cost institutions £1.99/student/year or £99.48/student/year excluding costs saved by volunteers and donations. Cost-outcome calculations indicate a maximal increase in preparedness for on-call of two Likert scale points/GBP/student.

Discussion This study indicates on-call simulation is a low-cost, effective intervention for undergraduate medical students with replicable results across multiple sites. We therefore recommend that on-call simulation should be available to all medical students as part of the national curriculum.

Keywords cost-outcome; multicentre; on-call; simulation; undergraduate

References

1. Kiosoglous. Does ‘on call’ simulation training have a place in medical education programs? Clinical Practice 2023;20(1):12–8.

2. Misquita L, Millar L, Bartholomew B. Simulated on-call: time well spent. Clin Teach 2020 Dec;17(6):629–37, https://doi.org/10.1111/tct.13148.

3. Hawkins N, Younan HC, Fyfe M, Parekh R, McKeown A. Exploring why medical students still feel underprepared for clinical practice: a qualitative analysis of an authentic on-call simulation. BMC Med Educ 2021 Dec;21:1–1, 1, https://doi.org/10.1186/s12909-021-02605-y.

Amynta Arshad¹, Haneesh Johal², Harshin Balakrishnan³, Nevil Philip², Sahrish Khan², Swetha Palanichamy², Yun Sin², Punith Kempegowda⁴ and SIMBA and CoMICs Team⁴

¹University of Birmingham; ²Queen Elizabeth Hospital Birmingham; ³School of Medicine, Far Eastern Federal University, Vladivostok, Russia; ⁴Institute of Applied Health Research, University of Birmingham

Introduction Simulation via instant Messaging – Birmingham Advance (SIMBA) is a simulation-based learning approach using WhatsApp that is effective in increasing healthcare professionals' knowledge and confidence in managing medical cases.^1,2 Currently, there are limited formal simulation-based teaching opportunities for locally employed doctors. This study aimed to determine whether SIMBA could improve the confidence of junior doctors in managing acute medical scenarios.

Methods 8 SIMBA sessions across 4 months included participants currently working as junior doctors. Each session involved a WhatsApp-based simulation of real-life acute clinical cases followed by a debrief session with a specialist. Pre- and Post-session surveys assessed Junior Doctors confidence in managing clinical cases using a Likert scale. Quantitative analysis was performed using the Wilcoxon signed rank test.

Results 41 participants responded to both pre- and post-surveys. Participants' self-reported confidence of simulated cases significantly increased from 45.8 to 86.2% (p < 0.0001). Self-reported improvements in ACGME Core Competencies were seen in most participants (patient care: 70.7%; n = 29/41, knowledge on patient management: 82.9%%; n = 34/41 and practice-based learning 68.3%; n = 28/41). Overall, 90.2% agreed they would attend future SIMBA sessions and 97.6% found the content impactful at a personal learning level.

Conclusions SIMBA is an efficient simulation-based learning tool in improving junior doctors' confidence in the approach to and management of acute medical scenarios. Incorporation of SIMBA into locally employed doctors' teaching could aid ongoing learning and improve confidence in patient care and knowledge.

Keywords education; employed; locally; medical; simulation

References

1. Melson, E., Davitadze, M., Aftab, M., Ng C.Y., Ooi E., Blaggan P., Chen W., Hanania T., Thomas L., Zhou D., Chandan J.S., Senthil L., Arlt W., Sankar S., Ayuk J., Karamat M.A., Kempegowda P. Simulation via instant messaging-Birmingham advance (SIMBA) model helped improve clinicians' confidence to manage cases in diabetes and endocrinology. BMC Med Educ 20, 274 (2020). https://doi.org/10.1186/s12909-020-02190-6

2. Dengyi Zhou, Meri Davitadze, Emma Ooi, Cai Ying Ng, Isabel Allison, Lucretia Thomas, Thia Hanania, Parisha Blaggan, Nia Evans, Wentin Chen, Eka Melson, Kristien Boelaert, Niki Karavitaki, Punith Kempegowda, on behalf of SIMBA and CoMICs team, Sustained clinical knowledge improvements from simulation experiences with simulation via instant messaging—Birmingham advance, Postgrad Med J, Volume 99, Issue 1167, January 2023, Pages 25–31, https://doi.org/10.1093/postmj/qgac008

Merry Patel and Chris Kowalski

Oxford Health NHS Foundation Trust

Children's safeguarding educators must use the intercollegiate document Safeguarding Children and Young People, to design competencies and curriculum for Level 3 safeguarding training.¹ Such training is often delivered didactically with few opportunities to share interprofessional expertise or develop skills in having difficult conversations with parents when addressing neglect. Staff can therefore lack confidence in this area - often delaying or even avoiding these conversations.²

Delayed responses to neglect can lead to significant harm and impact developmental milestones in babies and young children, with long-term consequences to achieving physical, social, emotional and educational potential as adults.³

‘Strengthening Practice Around Early Neglect’ is a simulation course designed to equip staff to intervene in a manner responsive to both the child and parents. Simulation creates an immersive, realistic and reflective learning experience, allowing practitioners to identify barriers to timely safeguarding decision-making.

Community complex health and health visiting teams attended a full day's course. Five scenarios supported professionals to consider the complexities of working in this area, identifying ways to improve their own confidence and competence for this work.

Quantitative data (n = 37) recorded the highest effect changes in increased knowledge for implementing neglect tools and documentation, and increased confidence communicating with parents. Debrief discussions identified potential for over-empathy and blurring of boundaries when experiencing parental resistance.

Going forward, there is an imperative for educators to incorporate experiential methods into safeguarding training, enabling clinicians to be better equipped to deal with the real-world complexities of working with neglect and indeed all child safeguarding issues.

Keywords children; interprofessional; postgraduate; safeguarding; simulation

References

1. Royal College of Nursing. Safeguarding children and young people: roles and competencies for health care staff - United Kingdom, 2019. Accessed 6th December 2022. Safeguarding Children and Young People: Roles and Competencies for Healthcare Staff|Royal College of Nursing (rcn.org.uk).

2. NSPCC. Neglect: learning from case reviews, NSPCC learning December 2022 Accessed 3rd January 2023. https://learning.nspcc.org.uk/research-resources/learning-from-case-reviews/neglect/

3. Department for Education (DfE). (2023) Accessed 15th December, 2023. Working together to safeguard children: a guide to multi-agency working to help, protect and promote the welfare of children.

Mary Claxton¹, Matilda Boa¹ and Katherine Stenlake²

¹University of Bristol; ²Musgrove Park Hospital (Somerset Foundation Trust & University of Bristol)

Background Simulation of patient death is uncommon in undergraduate medical training, due to the perception of potential emotional harm.¹ Consequently, it is difficult to combat newly qualified doctors' anxiety relating to cardiac arrests and death, often felt despite life support training.² We demonstrate that unsuccessful cardiopulmonary resuscitation (CPR) simulations within a controlled environment, with appropriate debriefing and signposting to support, is a beneficial educational tool with potential to improve well-being and reduce burnout risk.³

Methods Within a simulated on-call programme, 19 final year medical students appropriately recognised and managed anaphylaxis which subsequently deteriorated into cardiac arrest. Following initiation of a crash call, a consultant anaesthetist and medical registrar attended to simulate a realistic response. Team discussion involving the treatment escalation plan ultimately resulted in cessation of CPR. A post-scenario qualitative questionnaire evaluated the students' psychological well-being and confidence.

Results Mean confidence in recognising and managing cardiac arrests pre-simulation was 3.92/10, increasing to 7.92/10 afterwards; all (n = 13) respondents found it beneficial in addition to Immediate Life Support. All students felt ‘very well supported’ throughout and agreed it was a useful experience prior to commencing foundation training. A common theme from qualitative analysis was improved awareness of junior doctors' roles during cardiac arrests, contributing to improved confidence and preparedness for future practice.

Key Messages Medical students found participating in simulated unsuccessful CPR within a psychologically safe environment beneficial in preparing them for foundation training and managing the associated emotional stress.

Keywords death; medical student; multidisciplinary team work; psychologically safe environment; simulated cardiac arrest

References

1. Bruppacher HR, Chen RP, Lachapelle K. First, do no harm: using simulated patient death to enhance learning? Med Educ 2011;45(3):317–318. https://doi.org/10.1111/j.1365-2923.2010.03923.x

2. Scott G, Mulgrew E, Smith T. Cardiopulmonary resuscitation: attitudes and perceptions of junior doctors. Hosp Med. 2003;64(7):425–428. https://doi.org/10.12968/hosp.2003.64.7.2311

3. Yardley S. Death is not the only harm: psychological fidelity in simulation. Med Educ 2011;45(10):1062–1062. https://doi.org/10.1111/j.1365-2923.2011.04029.x

Jonathan Guckian¹, Sarah Edwards², Eliot Rees³ and Bryan Burford⁴

¹University of Leeds; ²Nottingham University Hospitals NHS Trust; ³Keele University; ⁴Newcastle University

Social Media (SoMe) as a learning tool is often criticised as superficial. Its limitless output has been blamed for shorter attention spans and shirking in-depth reflection.¹ The literature is itself superficial, dominated by innumerable single-centre, educator-focused evaluations of initiatives lacking rigour or meaning.² There is lack of consensus on the meaning of ‘quality’ in SoMe undergraduate medical education or relevant theory-guided exploration.

We conducted a mixed-methods study of UK medical students using a fully theory-informed inductive study design. The research question was: ‘How do medical students conceptualise quality of learning on social media?’. A sequential approach was used, involving a SoMe-distributed questionnaire, querying SoMe learning behaviours mapped to Bloom's Taxonomy. Responses informed recruitment for semi-structured interviews.

Interview data were analysed using framework analysis. Ethical approval was granted by Newcastle University.

Questionnaire responses were gathered from 118 medical students across 25 UK medical schools. Content analysis revealed numerous rapidly evolving, often high-level SoMe learning activities, mapped to factual, conceptual, procedural and metacognitive fields of Bloom's Taxonomy. Three themes were the product of subsequent interview framework analysis: cognitive hacking, professional identity reflection and safety, control and capital.

Numerous practice points and ‘quality indicators’ for educators engaging with SoMe were generated. ‘Cognitive hacking’ is a novel connectivism-driven model for high-level collaborative learning on SoMe. Learners use SoMe to model professional behaviours and critique educational norms. Quality SoMe learning may be conceptualised as a socially connected process, built upon constantly evolving networks but inexorably influenced by fluctuating hierarchy within learner-centric communities of practice.

Keywords connectivism; quality; social media; theory; undergraduate

References

1. Delgaty L, Fisher J, Thomson R. The ‘dark side’ of technology in medical education. MedEdPublish. 2017;6:81. https://doi.org/10.15694/mep.2017.000081

2. Guckian J, Utukuri M, Asif A, Burton O., Adeyoju J., Oumeziane A., Chu T., Rees E.L. Social media in undergraduate medical education: a systematic review. Med Educ 2021;55(11):1227–1241. https://doi.org/10.1111/medu.14567

Josie Cheetham

Aneurin Bevan University Health Board, NHS Wales

Dyscalculia within postgraduate medical education (PGME) is an unresearched area, reflective of a wider paucity of adult dyscalculia learning studies.

This contrasts with growing awareness of the importance of supporting greater equality, diversity and inclusivity within PGME, reflecting aspirations that the medical community better emulates patient population diversity (1).

Therefore, this scoping study, using an interpretivist, constructivist qualitative methodology, aimed to explore PGME educators' attitudes, understanding and perceived challenges of supporting trainee doctors with dyscalculia. Using purposive sampling and semi-structured interviews, the stories of 10 Wales-based PGME educators were discovered. Through reflexive thematic analysis, multiple themes emerged including a lack of educator and wider societal knowledge, understanding and experiences of learners with dyscalculia, educator–trainee relationship importance, the varied challenges for clinical educators, the influence of clinical contexts on learning and the impact of delayed identification. The inextricable interplay between participants' roles as educators and doctors affected their approach—and their perception of postgraduate training as being learning deeply embedded in social interactions within clinical environments. The strongly student-centred approach to supporting trainee learning was underpinned by generally positive attitudes towards doctors with dyscalculia, sometimes tempered by uncertainty over potential patient safety risks, reasonable adjustments and coping strategies appropriateness. Perceiving themselves as learners, educators saw educator-learner relationships as a major learning route given the lack of dyscalculia training available, with experience leading to confidence.

Overall, participants perceived a need for greater awareness, understanding and knowledge across the medical education community requiring research and pre-emptive, proactive training and evidence-based guidance.

Keywords dyscalculia; educator; medical; postgraduate; trainee

Reference

1. General Medial Council. Welcomed and valued: supporting disabled learners in medical education and training. Available from: https://www.gmc-uk.org/-/media/documents/welcomed-and-valued-2021-english_pdf-86053468.pdf. Accessed 9th October 2023.

Helen West and Dominic Johnson

University of Liverpool

Background A trauma-informed approach to learning involves understanding the effects of psychological trauma, and creating an educational context that promotes well-being and prevents further harm. This approach would improve student engagement, learning, progression, health and well-being.

The principles for trauma-informed practice are as follows: safety; trustworthiness and transparency; support and connection; collaboration and mutuality; empowerment, voice and choice; and social justice.^1,2 These are relevant to medical education.³ This study considered a trauma-informed approach to medical education in participatory workshops.

Methods Medical Educators participated in interactive workshops. Following informed consent and a brief introduction, participants chose principles to discuss in smaller groups, answering the prompts ‘what are we already doing?’ and ‘what else could we do?’ Qualitative data were analysed using reflexive thematic analysis. The study was approved by the University of Liverpool Research Ethics Committee (ref: UoLREC12813).

Results Participants represented six medical schools, with a wide variety of roles, and experience in medical education ranging from 3 months to 20 years. Initial themes from the wide-ranging discussions include the following: sensitive or challenging content, individuality and diversity, connections and supportive systems, involving students in decision-making and the role of educators.

Conclusions Most participants had not previously heard of a trauma-informed approach or had not considered it in medical education. Feedback indicated that they valued the opportunity to reflect, learn from colleagues and share ideas. Our results indicate that trauma-informed principles have valuable applications in the context of UK undergraduate medical education.

Keywords medical education; trauma-informed; undergraduate; well-being

References

1. Substance Abuse and Mental Health Services Administration. samhsa's concept of trauma and guidance for a trauma-informed approach. HHS publication no. (SMA)14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014:1–27.

2. Carello, J. Creating spaces for trauma-informed care in higher education: session 1 - creating a common language. Conference presentation; 10-11/02/2021, East Tennessee State University, United States

3. Brown, T., Berman, S., McDaniel, K., Radford, C., Mehta, P., Potter, J., & Hirsh, D. A. Trauma-informed medical education (TIME): advancing curricular content and educational context. Acad Med 2021, 96(5), 661–667. https://doi.org/10.1097/ACM.0000000000003587

Ellen Nelson-Rowe¹, Ky-Leigh Ang², Jack Wellington³, Moksh Sharma⁴, Julia Ka-wai Turner⁵, Amirah Latief⁵, Yousif Aldabbagh⁴ and Nidhruv Ravikumar⁴

¹University Hospitals of Derby and Burton Trust; ²Oxford University Hospitals NHS Foundation Trust; ³Bradford Teaching Hospitals NHS Foundation Trust; ⁴Nottingham University Hospitals NHS Trust; ⁵Sherwood Forest Hospitals NHS Foundation Trust

Background Free online teaching programmes have continued post-COVID as popular models to supplement education nationally.¹ This approach was used to tackle a demand to support final year medical students applying for the specialised foundation programme (SFP).

Methods Webinars were delivered via Medall over 5 months in conjunction with the application timeline and recordings open-access sequentially. Live attendees filled post-session questionnaires containing eight Likert-scale and two free-text questions. The live attendance was compared to on-demand views. Data were analysed using Wilcoxon signed rank test on SPSS and Microsoft Excel.

Results A total of 222 students attended live across nine sessions, with 43% providing feedback. The mean student-rated understanding of webinar topics rose by 1.85 points (P < 0.001) following attendance, and 71.88% of students rated content to be very helpful on a 5-point Likert scale. Qualitative responses cited worked examples, use of personal anecdotes and Q&A time to be particularly helpful. Overall, on-demand views increased on average by 314.5% when compared to our live views.

Discussion The proximity in training of SFP doctors (FY1) to students fostered a near-peer approach to tailor sessions effectively.² Due to platform limitations, we were unable to collect feedback after on-demand views. Some possible explanations for predominant asynchronous engagement include the following: flexibility, batch reviewing and playback efficiency.¹ However, qualitative feedback promotes benefits of live interaction. Going forward, a blended approach could accommodate for both preferences, perhaps by way of providing a separate Q&A opportunity for asynchronous learners.³

Keywords engagement; feedback; near-peer; online; teaching

References

1. Mao S, Guo L, Li P, Shen K, Jiang M, Liu Y. New era of medical education: asynchronous and synchronous online teaching during and after COVID-19. Adv Physiol Educ 2023;47(2):272–281. https://doi.org/10.1152/advan.00144.2021

2. Gottlieb Z, Epstein S, Richards J. Near-peer teaching programme for medical students. Clin Teach. 2017;14: 164–169. doi.https://doi.org/10.1111/tct.12540

3. Saxena R, Carnewale K. Exploring the synergy of synchronous and asynchronous learning approaches in medical education. IJRDO- Journal of Educational Research 2023;9(8), 6–11. https://doi.org/10.53555/er.v9i8.586

Vanessa Rodwell¹, Afaa Altar¹, Nora Alali², Sanika Khopkar¹, Rohan Saga¹, Ansam Khan², Abdal Al-Ubeidi¹, Nethmin Seneviratne¹ and Terese Bird¹

¹University of Leicester; ²University Hospitals of Leicester

Introduction The escalating potential of Artificial Intelligence (AI) in medical education necessitates systematic exploration of its integration into teaching modules.¹ This study, conducted in collaboration across University of Leicester departments, serves as a precursor to identify viable strategies and potential benefits of incorporating AI, with a focus on enhancing student learning experiences.

Methods Initial trials within teaching modules are executed, involving the Medical school, Museum Studies and Education departments. Short medical courses will be created in Endocrinology and Rheumatology, topics which may miss focus in Phase2 Medicine, and will be vetted by Medicine teachers. AI platforms include ChatGPT and Top Hat.² Research employs a mixed-methods approach, combining quantitative data from student performance. Outputs inform the creation of a guide for staff and students, utilising AI platforms for revision and to fill in learning gaps.

Results Preliminary findings indicate student and staff awareness of positives and negatives of AI platforms, and ability to mitigate against problems. Both quantitative and qualitative data will be analysed to identify promising areas for further exploration.

Discussion and Conclusion As time and resource constraints are felt by both staff and students, increasing judicious use of AI into course design should benefit all stakeholders. The discussion integrates the findings, exploring the potential implications for future implementations of AI in medical education while collaboration across departments enriches the depth of the analysis, addressing concerns and potential pitfalls while identifying strategies to optimise AI integration, necessary for both staff and students in the AI age.

Keywords technology enhanced learning

References

1. Shoja MM, Van de Ridder JMM, Rajput V, Shoja MM, Van de Ridder JMM, Rajput V. The emerging role of generative artificial intelligence in medical education, research, and practice. Cureus 2023;15(6). doi: https://doi.org/10.7759/CUREUS.40883, e40883

2. Top Hat. http://tophat.com

Oliver Sweeney, Lucy Easton and Steven Jacques

University of Leicester

With the expanding curriculum and ever-growing cohort sizes, intricate dissection during scheduled sessions becomes more challenging each year.^1,2 Anatomy at the University of Leicester already boasts a wealth of Technology Enhanced Learning (TEL) resources; however, it will never be exhaustive.

The layered approach allows students to orientate themselves with ease while recreating the dissection room in their chosen learning environment. The six models are freely available to students and can be viewed by an unlimited number at once without degrading with time or use. Student and faculty feedback has been positive while highlighting the versatility of the approach for application to structures other than musculature.

Creating resources using this approach not only enhances learning by complementing the dissection room experience but also maximises the potential of donors, facilities and staff.

Keywords anatomy; education; medical; musculoskeletal; photogrammetry

References

1. NHS workforce plan aims to train thousands more doctors and open up apprenticeship schemes - ProQuest. Accessed December 31, 2023. https://www.proquest.com/openview/ccec5da7201bad8769660b9134d2448f/1?pq-origsite=gscholar&cbl=2043523

2. Rising pressure: the NHS workforce challenge. Health Foundation. Accessed December 31, 2023. https://reader.health.org.uk/rising-pressure-nhs-workforce-challenge

3. Bucchi A, Luengo J, Fuentes R, Arellano-Villalón M, Lorenzo C. Recommendations for improving photo quality in close range photogrammetry, exemplified in hand bones of chimpanzees and gorillas. Int J Morphol 2020;38(2):348–355. https://doi.org/10.4067/S0717-95022020000200348

Agalya Ramanathan, Viral Thakerar, Gautham Benoy, Aisha Yahaya, Rebecca Wright, Aaliya Mohammed, Callum Parr, Hamish Clark, Ravi Parekh and Arti Maini

Imperial College London

Background Students report feeling underprepared for their first clinical placement, including encountering diverse patients' perspectives.

Immersive (360°) videos may help support placement preparedness in nursing students through increasing familiarity with premises and staff roles.¹ They may also elicit emotional responses to consultations through increasing empathy and motivation for learning.^2,3 This project explores using immersive videos in facilitating medical student preparedness for clinical placements.

Methods We are developing immersive videos with input from students and people with lived experience of health conditions. The first explored clinical environments through a guided GP practice tour and staff interviews, and others will explore diverse patient perspectives through simulated consultations.

Videos were accessible in conventional (2D) or immersive formats. The first video was shown in 2D format to all first-year students. Students were invited to also view the immersive format and participate in evaluative focus groups. Further videos are in production and will be evaluated similarly.

Keywords medical; immersive; preparedness; undergraduate; videos

References

1. Donnelly F, McLiesh P, Bessell S, Walsh A. Preparing students for clinical placement using 360-video. Clin Simul Nurs 2023; 77 34–41. https://doi.org/10.1016/j.ecns.2023.02.002.

2. Pan X, Slater M, Beacco A, Navarro X, Bellido Rivas AI, Swapp D, Hale J, Forbes PAG, Denvir C, de C. Hamilton AF, Delacroix S (2016) The responses of medical general practitioners to unreasonable patient demand for antibiotics - a study of medical ethics using immersive virtual reality. PLoS ONE 11(2): e0146837. https://doi.org/10.1371/journal.pone.0146837

3. Jacobs C, Maidwell-Smith A. Learning from 360-degree film in healthcare simulation: a mixed methods pilot. J vis Commun Med 2022;45(4):223–233. https://doi.org/10.1080/17453054.2022.2097059

Sushil Rodrigues Ranjan

University of Dundee

I attended the AI UK 2024 event, funded by my Education Development Award, at The Alan Turing Institute. This experience included workshops, talks and networking opportunities with AI experts, focusing on the integration of large language models (LLMs) in education, which is central to my ongoing Master of Research (MRes) project.

Looking forward, LLMs are expected to diversify within medical education, applying varied methodologies for various tasks.

My research explores the potential of an LLM-powered desktop application to assist medical educators. This tool critiques and suggests enhancements for PowerPoint slides, focusing on content and design. It adjusts slides based on feedback approved by educators.

Developed using Python, the application extracts and processes textual and design elements from slides to formulate optimised prompts for GPT-4, which then suggests content and design improvements, including updated reading materials and actionable modifications. Following educator approval, it generates a revised PowerPoint file.

Initial tests indicate the application performs effectively, especially with text-dense slides, providing feedback and modifications under 2 minutes. While no factual errors have been noted, about 12% of feedback were too generic, lacking detailed actionable suggestions.

Keywords AI; artificial; education; intelligence; medical

References

1. Abd-alrazaq A, AlSaad R, Alhuwail D, Ahmed A., Healy P.M., Latifi S., Aziz S., Damseh R., Alabed Alrazak S., Sheikh J. Large language models in medical education: opportunities, challenges, and future directions. JMIR Medical Education 2023;9. https://doi.org/10.2196/48291

2. Safranek CW, Sidamon-Eristoff AE, Gilson A, Chartash D. The role of large language models in medical education: applications and implications. JMIR Medical Education. 2023;9. https://doi.org/10.2196/50945

3. Benítez TM, Xu Y, Boudreau JD, Kow AWC, Bello F, van Phuoc L, Wang X, Sun X, Leung GKK, Lan Y, Wang Y, Cheng D, Tham YC, Wong TY, Chung KC Harnessing the potential of large language models in medical education: promise and pitfalls. J am Med Inform Assoc 2024;31(3):776–783. https://doi.org/10.1093/jamia/ocad252

Pranesh Balasubramaniam and Narciss Okhravi

Moorfields Eye Hospital

Social media has become a popular platform for sharing educational content. Nano-learning is increasingly used to deliver quick, digestible information to healthcare professionals and patients in under 2 minutes.¹

The author employed a whiteboard application on a tablet and created learning modules in ophthalmology. The narrations with annotations were then screen-recorded and uploaded on YouTube as bite-sized chunks of information that play for under a minute called ‘Shorts’.² These videos garnered more views and interaction from the audience than the author's lengthier lectures. The videos were then shared with the medical students, who used them to complement the classroom lectures. From the post-classroom feedback questionnaire, 95% of the medical students felt that the nano-learning modules complimented their ophthalmology curriculum and posed an effective review tool.

What is the point? With the increased consumption of short content on social media platforms such as Instagram or TikTok, medical educators should be aware of the attention economy and create videos in under a minute. The longer content can be linked to these ‘reel type’ videos for expanded learning.

This promotes a connectivism-based e-learning experience for early learners, where multiple short videos can help consolidate the underlying theories and practice points in medicine.³ Short-interval videos can be created for case-based learning, mnemonics, high-yielding factoids and comparisons. They can be helpful pre- and post-reading material for the learners.

Keywords microlearning; social media; TEL; YouTube

References

1. Khlaif ZN, Salha S. Using tiktok in education: a form of micro-learning or nano-learning? Interdisciplinary Journal of Virtual Learning in Medical Sciences. 2021;12(3). https://doi.org/10.30476/ijvlms.2021.90211.1087

2. Pranesh Balasubramaniam - YouTube. www.youtube.com. Accessed January 24, 2024. https://www.youtube.com/@pranesh/shorts

3. Goldie JGS. Connectivism: a knowledge learning theory for the digital age? Med Teach 2016;38(10):1064–1069. https://doi.org/10.3109/0142159x.2016.1173661

Miriam Leach

University College London

Social media has been co-opted in a big way by medical educators. Often described as the town square, educators from all walks of life and geographical locations can come together and discuss issues as wide ranging as professionalism to everyday clinical practice. It is a site of significant social negotiation and construction of shared meaning. This means that the text evidence of these conversations are a rich source of data for understanding the contemporary culture of education. Would not it be great to use this data? Dive right in and analyse the what and how. But hang on?! What about consent? What about the ethics of using this data?

Have those creating tweets or insta posts (or tiktoks[!]) thought about this kind of use of their data? Is this really secondary data? Perhaps not, one might argue that this data sits in a strange limbo of kind of primary kind of secondary data and maybe we need to think twice about how we approach the use of this data.

Keywords ethics; qualitative; research; SoME

Reference

AoIR, T. A. o. I. R. (2019): Internet research: Ethical guidelines 3.0. https://aoir.org/ethics/.

Jake Oughton and Christopher Mannion

University of Leeds

The formation of a professional identity (PI) is a fundamental outcome of medical education, considered equal in importance to the attainment of competence in clinical skills and knowledge.^1,2 PI formation is accepted to be a complex, lifelong process. However, while the transition from medical student to junior doctor is a uniquely formative period, there is limited research concerning PI formation in newly-qualified UK Foundation Doctors.

This study used interpretive phenomenological analysis and semi-structured interviews to elicit the experiences and perspectives of six purposively sampled doctors during their first FY1 rotation.

Keywords doctor; education; identity; qualitative; transition

References

1. Jarvis-Selinger S, Pratt DD, Regehr G. Competency is not enough: integrating identity formation into the medical education discourse. Acad Med 2012 Sep 1;87(9):1185–90. https://doi.org/10.1097/ACM.0b013e3182604968

2. Wilson I, Cowin LS, Johnson M, Young H. Professional identity in medical students: pedagogical challenges to medical education. Teach Learn Med 2013 Oct 1;25(4):369–73. https://doi.org/10.1080/10401334.2013.827968

Josette Crispin, Sally Curtis and Chris Downey

University of Southampton

Introduction It is well-known that supportive relationships are vital for a good educational experience. Social networks of support provide valuable insights when exploring the dynamic nature of relationships in undergraduate medical students.¹ This study aimed to explore whether the social support networks of medical students' from widening participation backgrounds differ from standard-entry students pre-transition to clinical placement.

Methods Social network theory² was used to explore the relationships of Year 3 medical students on the standard entry (SE) and widening participation (WP) programmes at the University of Southampton, ahead of transition to full-time placement. Data on their social support networks including the impact and frequency of support were collected via an online questionnaire.

Results There were 54 survey responses from 215 students (45 BM5 students and 9 BM6 students). Initial analysis indicates preplacement student networks consist primarily of family, medical students and other friends. WP students did not identify as many supporters as those on the SE programme; however, they more frequently identified university staff whom they turn to for support. Very few SE students' networks included university tutors.

Discussion This is the first study to compare WP and SE medical students' social networks. The findings reflect the diversity of networks reported elsewhere in the literature¹ but also important differences between student groups, which can inform preplacement support. We will consider how our analysis provides insight for the preparation and teaching of students before periods of clinical placement and how best to support all students during placement.

Keywords placement; social networks of support; students; transition; widening participation

References

1. Atherley, A.E., Nimmon, L., Teunissen, P.W., Dolmans, D., Hegazi, I. and Hu, W., 2021. Students' social networks are diverse, dynamic and deliberate when transitioning to clinical training. Med Educ, 55(3), pp.376–386. https://doi.org/10.1111/medu.14382

2. Loury, G.C., 1987. Why should we care about group inequality?. Soc Philos Policy, 5(1), pp.249–271. https://doi.org/10.1017/S0265052500001345

Rosemary Arnott and Steven Agius

University of Nottingham

Background The Covid 19 pandemic first wave in 2020 resulted in 6 months of medical school closure¹ with the second wave of 2021 bringing further uncertainty. Medical educators in 2020 predicted that students would not feel prepared for the transition,² and yet, this was not reflected in the yearly UK National Student Survey.³ This study sought to provide insight into these phenomena by interviewing UK medical school graduates from 2020 and 2021 and explore their perceptions of preparedness for clinical practice.

Methods Twelve semi-structured interviews with UK medical student graduates were undertaken with analysis of data underpinned by Gadamer's hermeneutic phenomenology. Reflexivity and member-checking were used to increase the trustworthiness and credibility of the data.

Results Covid 19 created fear and uncertainty, yet all participants saw personal growth through this challenge and that those developed skills were transferrable to the clinical environment. Interim Foundation Year 1 (FiY1) was excellent preparation for clinical practice due to the good level of supervision, appropriate level of independence and positive learning environment created. Preparedness for practice means to have the metacognitive ability of knowing your own limits, competence in performing daily ward tasks and a positive learning attitude. The post-graduate training environment was perceived as poor.

Future recommendations Undergraduate: Increased emphasis on developing metacognitive ability and managing uncertain environments. Developing extended assistantships which mirror the student's future clinical role. Postgraduate: Valuing the role of supervision by encouraging supervisors to develop ‘expert’ status. Creating psychologically safe and civil environments to encourage learning.

Keywords Covid 19; doctor; preparedness; postgraduate; transition

References

1. Menon, A., Klein E.J., Kollars K., Kleinhenz A.L.W. (2020) ‘Medical students are not essential workers: examining institutional responsibility during the COVID-19 pandemic’, Acad Med, 95(8), pp. 1149–1151. https://doi.org/10.1097/ACM.0000000000003478.

2. Byung, C. et al. (2020) ‘The impact of the COVID-19 pandemic on final year medical students in the United Kingdom: a national survey’, BMC Med Educ, 20, p. 206. https://doi.org/10.1016/j.jacc.2020.06.027

3. https://reports.gmc-uk.org/analytics/saw.dll?Dashboard&PortalPath=%2Fshared%2FNTS_LTD%2F_portal%2FNTS&Page=F1%20preparedness&P1=dashboard&Action=Navigate&ViewState=ca0psit0hidanklk98kbe41c2q&P16=NavRuleDefault&NavFromViewID=d%3Adashboard~p%3Asa83s2lirsn15bnb accessed 20/1/23@12:45.

Nicola Jones¹, Zilley Khan², Jeremy Webb¹, Mark Lillicrap¹ and Charlotte Tulinius¹

¹School of Clinical Medicine, University of Cambridge; ²Royal Papworth Hospital

Background The National Health Service (NHS) is experiencing unparalleled pressure, and the effects are being felt by the patients in need of care and the doctors who treat them. Unmanageable workloads, dissatisfaction with the workplace and high rates of burnout, are causing more doctors than ever to leave.¹ This is resulting in a ‘vicious cycle’ that compromises the well-being of doctors and threatens the patient safety. Urgent action is needed to break this cycle.

Research from the GMC suggests that interventions to increase workplace satisfaction may result in a ‘virtuous cycle’ that improves doctors' experiences, and ultimately patient safety.² One proposed intervention is to develop clinical learning environments (CLE) that provide more protected training time. This might be achieved through appointment of Clinical Teaching Fellows (CTF)³ who have dedicated time to teach.

The aim of this study is to evaluate the impact of CTF on the experience of medical students in a variety of clinical learning environments.

Methods We will adopt an interpretivist paradigm and a phenomenological stance. The study will utilise a mixed methods explanatory sequential design, comprising an initial quantitative survey and follow up qualitative interviews.

Results will be reported using the Mixed Methods Article Reporting Standards.

Results It is hoped that this study will increase understanding of the impact of CTF on medical students' experiences of the (CLE) and provide insights into whether CTF serve as a positive intervention to turn vicious into virtuous cycles for the workforce in the NHS.

Keywords clinical learning environment; clinical teaching fellows; medical students; mixed-methods; workplace satisfaction

References

1. Palmer W, & Rolewicz L. (2022). “The long goodbye? Exploring rates of staff leaving the NHS and social care.” Nuffield Trust Explainer.

2. GMC. (2023). The state of medical education and practice in the UK: workplace experiences 2023.

3. Pippard, B., & Anyiam, O. (2016). The many roles of a clinical teaching fellow. BMJ, i5677. https://doi.org/10.1136/bmj.i5677

Mary Mathew¹ and Krishna Mohan Surapaneni²

¹Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India; ²Panimalar Medical College Hospital & Research Institute, Chennai, India

Purpose Narrative Medicine is a novel healthcare approach that focuses on integrating patients' personal stories and experiences into clinical practice to enhance empathy and understanding in patient care. This study aimed to assess medical and nursing students' knowledge, attitudes and practices regarding Narrative Medicine, thereby understanding the extent of its integration into their education. This approach is vital in fostering more empathetic and patient-centred training in education system.

Methods Participants completed a 40-item online survey, covering knowledge (17 items), attitudes (11 items), and practices (12 items), with later two rated on a five-point Likert scale. Informed consent was obtained, anonymity ensured, and data analysed using SPSS, with significance at p < 0.05.

Results Only 35% of students were familiar with Narrative Medicine, though most recognised its patient- centeredness (57%) and agreed doctors should encourage patient storytelling (76%). About 80% felt healthcare students should learn Narrative Medicine, citing benefits in patient attention and doctor-patient relationships. Concerns included increased workload (50%) and uncertainty about its impact (32.8%). Few practised reflective listening (21%) or engaged in related research (15.3%). Only 20.4% explored emotional aspects through Narrative Medicine, with 62% reporting its infrequent inclusion in their curriculum.

Conclusion The study reveals limited familiarity but positive attitudes towards Narrative Medicine among Indian medical and nursing students. Findings suggest a need for its comprehensive integration into healthcare education to enhance empathy. Addressing workload concerns and clarifying its impact are vital for effective implementation and improved patient care. These insights are crucial for advancing empathy in healthcare education.

Keywords empathy; health professions; humanities; narrative medicine; undergraduate education

References

Milota MM, vanThiel GJMW, vanDelden JJM. Narrative medicine as a medical education tool: a systematic review. Med Teach 2019;41(7):802–810. https://doi.org/10.1080/0142159X.2019.1584274

Charon R. The patient-physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust. Jama 2001;286(15):1897–1902. https://doi.org/10.1001/jama.286.15.1897

Fioretti C, Mazzocco K, Riva S, Oliveri S, Masiero M, Pravettoni G. Research studies on patients' illness experience using the narrative medicine approach: a systematic review. BMJ Open 2016;6(7):e011220. https://doi.org/10.1136/bmjopen-2016-011220

Abigail Proctor, Kathleen Thompson, Alex Lister and Bethan Roberts

Bradford Teaching Hospitals NHS Foundation Trust

The undergraduate medical education team implemented a new teaching programme with final year medical students, looking to improve their preparedness and confidence regarding FY1 on calls. This teaching programme was a Simulated On call (SOC) session and was started in response to students reporting that they felt unprepared for oncalls with a lack of teaching on prioritisation.

The simulated on call session involved two final year medical students working together to complete a simulated oncall shift within a 2-hour session. The simulation ran for 60–90 minutes with the remaining time for feedback and debrief. The students carried a bleep, were given a handover of jobs at the beginning of their shift and had to complete these tasks while receiving other tasks via the bleep. The simulation ended with the students handing their remaining jobs back over at the end.

We collected data from 113 students that took part in the SOC sessions. A pre-course questionnaire was used to ask the students to rate their confidence for being on call on a scale 0–10, with 0 being ‘unconfident’ and 10 being ‘confident’. There were 111 respondents to this pre-course questionnaire and 88% of students felt unconfident. At the end of the simulation session, students were then given a post-course questionnaire and again asked to rate their confidence. There were 113 respondents to this questionnaire and only 16.5% of students felt unconfident, showing a large improvement in students confidence levels after completing just one session of SOC.

Keywords confidence; foundation; on call; simulation; undergraduate

Harrison Mycroft and Rachel Anderson

Mid Yorkshire Teaching Trust

Background The GMC expects that newly qualified doctors can safely and appropriately prescribe medicines and understand causes and consequences of prescribing errors.¹ However, prescribing and understanding of pharmacology is often something that students struggle with throughout medical school.²

Methods Inspired by the increasing successes of gamification in medical education, an interactive medicines management course was designed and piloted. Thirteen second year medical students attended the 2-hour course, comprising of a flipped classroom approach to peer teaching, whereby students taught each other about specific medicines they had researched prior to the session. This was followed by a bespoke team-based quiz game to test acquired knowledge, with students working together to answer questions on different classes of medications. Participants completed anonymised post-session questionnaires collecting qualitative and quantitative data.

Results All participants expressed a preference for pharmacology sessions to be delivered by clinical fellows compared to senior clinicians, lecturers or pharmacists. About 100% agreed that the course improved their knowledge of medicines management. Around 92% (12/13) of participants found it useful to learn about medicines management from peers, and 85% (11/13) found the quiz helped to consolidate learning. Approximately 69% (9/13) of participants found that the course allowed them to develop their team-working skills. Participants expressed how fun the quiz was and recognised its educational value within the qualitative feedback.

Conclusion This pilot has demonstrated that an interactive, gamified medicines management course for second year medical students was not only effective in improving pharmacology knowledge but also aided development of team-working skills and was enjoyable.

Keywords fellow; flipped; gamification; pharmacology; prescribing

References

1. General Medical Council: Outcomes for Graduates. June, 2018. Updated November, 2020. Accessed January 10th, 2024. https://www.gmc-uk.org/-/media/documents/outcomes-for-graduates-2020_pdf-84622587.pdf

2. Rothwell C, Nazar M, Chaytor A, Portlock J, Husband A, Nazar H Teaching safe prescribing to medical students: perspectives in the UK. Adv Med Educ Pract 2015:279. https://doi.org/10.2147/AMEP.S56179

Giles Roberts and Peter Yeates

Keele University

Introduction The importance of perceived teacher credibility and its association with improved educational outcomes is well established within education literature; however, an understanding of how students make these judgements has not previously been described.¹ This grounded theory study explores what influences undergraduate medical student perception of credibility and generates a theory on how this information is used to construct credibility judgements about their teachers.

Method Sixteen semi-structured interviews were conducted with undergraduate medical students in their final or penultimate year of study across two UK medical schools; data were analysed using initial open coding, axial coding and memo-writing as part of iterative process using constant comparison and theoretical sampling.

Results For the majority of teachers, their credibility is assumed on the basis of attributes which the student associates with knowledge, technical teaching skills, and trust. Students only begin to actively think about their teacher's credibility if they have reason to question any of these features. This can occur following a single significant interaction or a series of smaller events at which point the student weighs up their own experiences of the teacher to determine their credibility. Credibility is viewed as a dynamic spectrum with actions that improve credibility being context-specific but actions that damage credibility doing so across all contexts. Rarely, a threshold can be passed that makes credibility unrecoverable.

Discussion A novel theory is presented which echo's observations of other authors and offers a more complete framework to explain them, summarising this complex multi-faceted interaction between student and teacher.

Keywords credibility; grounded theory; judgement; teacher; undergraduate

Reference

1. Finn AN, Schrodt P, Witt PL, Elledge N, Jernberg KA, Larson LM. A meta-analytical review of teacher credibility and its associations with teacher behaviours and student outcomes. Communication Education 2009;58(4): 516–537. https://doi.org/10.1080/03634520903131154

Russell D'Souza¹, Mary Mathew², Dr Princy Palatty³, Dr J. A. Jayalal⁴ and Krishna Mohan Surapaneni⁵

¹Global Network for Medical Health Professions and Bioethics Education; ²Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India; ³Amrita Institute Of Medical Sciences, Kochi, India; ⁴Commonwealth Medical Association; ⁵Panimalar Medical College Hospital & Research Institute, Chennai, India

Purpose Traditional lectures have shown limitations in effectively teaching bioethics in medical education. This study evaluates the effectiveness of integrating creative and interactive elements such as the use of participatory theatre, particularly street plays, as an innovative approach to impart the principles of the Universal Declaration of Bioethics and Human Rights (UDBHR).

Methods In a two-stage process, medical students volunteered to learn and depict the principle of Non-Discrimination and Stigmatisation through street theatre. Following their performances, they were categorised into observers, focal group discussion participants and those engaging in qualitative reflection. Data were collected through validated questionnaires and analysed using Gibb's cycle for a comprehensive qualitative assessment.

Results The effectiveness of street plays in teaching bioethical principles was recognised by 94% of the student participants. Moreover, 79% rated the overall usefulness of participatory theatre in educating on ethical principles as either excellent or very good. Key theatrical elements like portrayal accuracy, relevance, impact and group dynamics were highly rated for their effectiveness in the learning process.

Conclusions Participatory theatre, specifically street plays, is demonstrated as a potent educational tool for teaching bioethics to medical undergraduates. It not only facilitates active learning but also challenges students to reassess and evolve their attitudes and behaviours towards complex ethical issues. This method effectively immerses students in diverse scenarios, enhancing their understanding and engagement with bioethics. The approach presents a dynamic and impactful alternative to traditional bioethics education, making it a valuable addition to medical curricula.

Keywords bioethics education; communication; humanities; medical students; participatory theatre

References

Wilson J. Visualisation through participatory/interactive theatre for the health sciences. Adv Exp Med Biol 2023;1421:191–203. https://doi.org/10.1007/978-3-031-N30379-1_9

Leung J, Som A, McMorrow L, Zickuhr L, Wolbers J, Bain K, Flood J, Baker EA Rethinking the difficult patient: formative qualitative study using participatory theatre to improve physician-patient communication in rheumatology. JMIR Form Res 2023;7:e40573, https://doi.org/10.2196/40573.

Singh S, Kalra J, Das S, Barua P, Singh N, Dhaliwal U. Transformational learning for health professionals through a theatre of the oppressed workshop. Med Humanit 2020;46(4):411–416. https://doi.org/10.1136/medhum-2019-011718

Catherine Carr, Helen Box, Nicola Cosgrove and Jamie Fanning

University of Liverpool

Method Student evaluations have been instrumental to the design and development of each pathway with student views and experiences sought at regular intervals, leading to the continuing evolvement of the pathways and overall programme.

Results Pre-evaluation data suggest that this group of learners often feel alone, lack confidence, feel they are behind their peer group and worry about reintegration into a new cohort. Post-evaluation data show that students developed their own communities of practice; learner confidence is increased and makes returning to studies smoother and helps with integration to a new cohort. Engagement appears to be a key indicator for how students' progress.

Keywords clinical skills; education; medical; supportive; undergraduate

Reference

GMC welcomed and valued: supporting disabled learners in medical education and training 2019. Accessed November 6th, 2023. https://www.gmc-uk.org/—/media/documents/welcomed-and-valued-2021-english_pdf-86053468.pdf.

Hugh Alberti¹, Simon Thornton², Joe Rosenthal³ and Jo Protheroe⁴

¹Newcastle University; ²Bristol University; ³UCL; ⁴Keele University

Primary care placement capacity for undergraduate medical students and postgraduate doctors in training (DiTs), not to mention other health care professional students, is at a crisis point. The majority of undergraduate medical student providers¹ state that they currently have difficulty in recruiting practices to host students even without further increases proposed: The NHS Workforce Plan recommends a doubling of medical student numbers and a significant increase in DiTs in primary care.(2).

We see no other radical solution, enabling a potential doubling of students and trainees in primary care, than making it mandatory. This could take a variety of forms, and we acknowledge upfront that this not ideal solution, but if the alternative is that our future workforce does not get sufficient clinical placement experience, then it must be worth exploring. There will be concerns that the high quality generally of primary care placements may be difficult to maintain, and this should be addressed with continued quality monitoring, teacher training and support for practices. Space is an issue in many practices, and we would strongly encourage the relevant bodies to review funding possibilities for practices. Adding more potential pressure to an already pressured and over-stretched workforce is a concern although it is noted that there is an association between teaching/training practices and quality of care indicators (3).

The necessity of finding a radical solution has never been more critical for the future of general practice education and indeed the NHS.

Keywords capacity; placement; primary care

References

1. Cottrell E, Alberti H, Rosenthal J, Pope L, Thompson T. Revealing the reality of undergraduate GP teaching in UK medical curricula: a cross-sectional questionnaire study. British Journal of General Practice 2020 Sep 1;70(698):e644–50. https://doi.org/10.3399/bjgp20X712325

2. NHS England. NHS long term workforce plan, 2023.

3. Eliot L. Rees, Simon P. Gay & Robert K. McKinley (2016) The epidemiology of teaching and training general practices in England, Educ Prim Care, 27:6, 462–470. https://doi.org/10.1080/14739879.2016.1208542

Amber Bennett-Weston¹, Leila Keshtkar¹, Chris Sanders², Max Jones², Cara Lewis³, Josie Solomon¹, Keith Nockels⁴ and Jeremy Howick¹

¹The Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester; ²Leicester Medical School, University of Leicester; ³Hong Lab, Geisel School of Medicine, Dartmouth College; ⁴University of Leicester

Background Medical student well-being is below that of their peers.¹ Several reviews have explored the effectiveness of interventions to enhance medical student well-being but have focused on a single intervention, a single facet of well-being, or on a single country.^2,3 There is no up-to-date synthesis of the totality of evidence in this field. We conducted an overview of systematic reviews that explore the effectiveness of interventions to enhance medical student well-being.

Methods Five databases were searched for systematic reviews of interventions to enhance medical student well-being. The Assessing the Methodological Quality of Systematic Reviews V.2 (AMSTAR-2) tool was used to appraise the quality of included reviews. A narrative synthesis was conducted and the evidence of effectiveness for each intervention rated.

Results A total of 13 reviews (with 94 independent studies and 17,616 students) were included. The reviews covered individual- and curriculum-level interventions. Most interventions were not supported by sufficient evidence to establish effectiveness. However, there was some evidence of a benefit of mindfulness for reducing stress and anxiety, of mental health programmes for reducing anxiety and depression and of pass/fail grading systems for reducing stress. Eleven reviews were rated as having ‘critically low’ quality, two reviews were rated as having ‘low’ quality.

Conclusions Individual- and curriculum-level interventions can improve medical student well-being. These conclusions should be tempered by the low quality of evidence. Further, high-quality research is required to explore additional effective interventions to enhance medical student well-being and the most efficient ways to implement and to combine these for maximum benefit.

Keywords medical education; medical student; mental health; overview of reviews; well-being

References

1. Medisauskaite A, Silkens ME, Rich A. A national longitudinal cohort study of factors contributing to UK medical students' mental ill-health symptoms. Gen Psychiatr 2023;36(2). https://doi.org/10.1136/gpsych-2022-101004

2. Wasson LT, Cusmano A, Meli L, Louh I, Falzon L, Hampsey M, Young G, Shaffer J, Davidson KW Association between learning environment interventions and medical student well-being: a systematic review. Jama 2016;316(21):2237–52. https://doi.org/10.1001/jama.2016.17573

3. Yogeswaran V, El Morr C. Effectiveness of online mindfulness interventions on medical students' mental health: a systematic review. BMC Public Health 2021;21(1):1–12. https://doi.org/10.1186/s12889-021-12341-z